Ballad Health

“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.”

“Ballad Health has a conflict of interest policy for all members of the Board of Directors, the Executive Chair/President, Executive Vice Presidents, Senior Vice Presidents, and Vice Presidents, and applies to all Ballad Health organizations. All persons covered by this policy are required to complete a conflict of interest disclosure form on an annual basis. Should a conflict arise, it is the responsibility of the conflicted individual to update his or her disclosure immediately. All meetings of the board or board committees have a standing agenda item first on the agenda titled "Conflicts of Interest". If a member of the board or board committee has a conflict of interest involving any issue on the board agenda, he or she must declare the conflict of interest during the period allotted for disclosure. If any issue arises during a meeting in which the board member has a conflict of interest, he or she must immediately declare the conflict. While each member of the board or board committee is responsible for disclosing conflicts of interest, it is also the responsibility of any board member aware of a conflict which has not been disclosed to ensure the board is made aware. The presiding officer of a board or board committee meeting may ask a conflicted member to excuse themselves from the meeting during the discussion related to the issue with which the conflict of interest applies. Under no circumstances shall a member vote on a matter that gives rise to a potential conflict.”

“Part VI, 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. Part VI, Line 15b Compensation Process for Officers & Key Employees: The executive committee reviewed and approved compensation for all Ballad Health executives at the vice-president level and above during FY21 using the same methodology used to determine the CEO's compensation. In addition, Ballad Health offers an incentive plan to executives based on targeted achievement metrics approved by the Ballad Health Board of Directors which include Quality of Care, Access to Care, Cost Management, etc.”

“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.”

“IMPROVING THE COMMUNITY'S HEALTH STATUS: ACCOUNTABLE CARE COMMUNITY ACHIEVEMENTS - To help address the broader needs of the community at large, Ballad Health has convened the nation's largest accountable care community (ACC), spanning two states with more than 300 participating organizations in 21 counties throughout the Appalachian Highlands. Through five months of regional focus groups and stakeholder meetings, the ACC selected four priority areas to influence through its work: substance abuse, tobacco use, overweight and obesity, childhood trauma and resiliency. The ACC leadership council has agreed that the most impactful way to address the four priority areas is by focusing on interventions that benefit children and families. To reflect this commitment toward youth, the group chose the name STRONG (Striving Toward Resilience and Opportunity for the Next Generation) Accountable Care Community and is organizing activities into four categories: STRONG Starts (conception through kindergarten), STRONG Youth (kindergarten through 12 years old), STRONG Teens (13 to 18 years old) and STRONG Families (adults and caregivers). In May, Ballad Health announced it would invest $2 million in 21 regional, community-based organizations to support strategies aimed at improving children's health outcomes in the region, including providing social support services and navigation for women suffering from addiction, preventing food insecurity, parenting and resiliency training and keeping youth from dropping out of school. The work these community organizations are doing will help ensure that children and families reach their full potential. Ballad Health and the region's STRONG Accountable Care Community unveiled a new partnership and coordinated care network with Unite Us that will enhance community members' health and well-being. The partnership, announced in June, will join Ballad Health with the Unite Tennessee and Unite Virginia networks. These networks connect people with unmet health and social service needs, such as housing, food, transportation and employment. Within Ballad Health, specially trained staff now conduct health related social needs screenings for gaps in care, such as food and housing insecurity, transportation challenges or other obstacles. The Unite Us technology helps staff connect families with community organizations committed to resolving those issues. The network, however, is not dependent on Ballad Health. Participating organizations also now use the system to refer clients to each other even if the people they're referring aren't Ballad Health patients. CREATION OF NEW BALLAD HEALTH BEHAVIORAL SERVICES DIVISION - To achieve success in a value-based healthcare environment and to achieve the goals for improved access to behavioral services for the region, Ballad Health created the Behavioral Health Services Division. CREATION OF THE BALLAD HEALTH INNOVATION CENTER - Ballad Health created The Innovation Center to serve as a hub for development of partnerships and collaborations that can bring to market life-saving initiatives and other technologies and services that can improve the human condition. COMMUNITY RESOURCES - Ballad Health parish nurses work with individual congregations to help people in religious communities improve their health, prevent illness and injury and ease suffering associated with any health crisis. The parish nurse acts as counselor, educator and healthcare provider by identifying needs of the congregation, coordinating health screenings, providing educational programs, supplying health literature and referring congregants to supportive health services where appropriate. Also, the parish nurse maintains an active visitation program to parishioners who are homebound, hospitalized or in nursing homes. Currently, there are dozens of churches in Northeast Tennessee and Southwest Virginia that are serviced by the Ballad Health parish nurse program. Ballad Health's Nurse Connect is a toll-free line”

“EXPANDED ACCESS TO RURAL COMMUNITIES - In addition to opening new hospitals in rural communities, Ballad Health has focused on expansion of access to other healthcare services. Ballad Health opened a new urgent care center in Banner Elk, North Carolina. This center provides convenient access to residents who previously were required to travel excessive distances for care. This clinic also serves as a convenient resource for students, faculty, and staff of a nearby college. CREATED SINGLE COORDINATED REGIONAL TRAUMA SYSTEM - One of the most significant ways Ballad Health has been able to comply with the provisions of the Certificate of Public Advantage and Cooperative Agreement, which required avoidance of duplication of services where appropriate, was the consolidation of the two Level I trauma centers operating in the region and the subsequent creation of a coordinated regional trauma system. In approving this move in advance, the State of Tennessee relied upon the evidence published in multiple respected studies which found higher volume trauma centers lead to improved outcomes. The move toward a single coordinated trauma system followed the guidance of the American College of Surgeons (ACS), which verifies trauma centers. The Tennessee Department of Health, after conducting a rigorous review of the trauma program at Johnson City Medical Center, issued its Level I Trauma Center Reverification Site Visit Report. The report found the hospital "has demonstrated an outstanding commitment to care for the injured patient." Further, the survey resulted in zero deficiencies, a first for trauma care in the region. CONSOLIDATED REGIONAL PERINATAL CENTER - Tennessee law requires a regionalized system of care for high-risk newborns. The result of this law is a policy in Tennessee that recognizes five regional perinatal centers. Niswonger Children's Hospital at Johnson City Medical Center is the designated center for regional perinatal care for the Appalachian Highlands. Prior to the merger, perinatal care in the Appalachian Highlands did not meet the goals of the state, with two NICUs that were not coordinated and shared volumes. Ballad Health immediately took steps to correct this after the merger, leading to a more sustainable and coordinated system of care for neonates, while also reducing the costs associated with maintaining two lower-volume units. After this consolidation, Ballad Health partnered with ETSU's Quillen College of Medicine, which provides ongoing expert neonatology coverage for the hospital, ensuring Ballad Health has neonatology provider coverage 24 hours per day. With more than 25 pediatric specialists to provide support for the Perinatal Center, this is the first time every newborn in the region has access to such highly specialized care. EXPANDED ACCESS TO PEDIATRIC SPECIALTIES - With financial support from Ballad Health and the State of Tennessee, the ETSU Quillen College of Medicine was able to successfully recruit pediatric surgeons to support the Niswonger Children's Hospital. Our partners at ETSU's Quillen College of Medicine also provide 24/7 neonatology coverage for the NICU. Ballad Health now proudly meets the highest standards for regional perinatal care, something that was not thought possible prior to the merger creating Ballad Health. PARTNERSHIP WITH ETSU TO CREATE FELLOWSHIP PROGRAM IN ADDICTION MEDICINE - Ballad Health and East Tennessee State University formed a partnership to create a new fellowship program in addiction medicine. As part of its commitment to expand education and training in the region, Ballad Health will fund any unreimbursed costs of the fellowship program which, over a 10-year period, could cost more than $2.5 million. ESTABLISHMENT OF CENTER FOR RURAL HEALTH RESEARCH - Tennessee Governor Bill Lee announced the creation of a new Center for Rural Health Research that will be housed at the College of Public Health at East Tennessee State University. In addition to state funding, B”

“IMPROVING HEALTHCARE QUALITY: QUALITY METRICS - Ballad Health continues to make headway in its aim of being a zero-harm, top-decile health system by improving the quality of care delivered to patients by reducing hospital-acquired infection rates and improving other key indicators related to quality care. The State of Tennessee established a scoring system in the COPA to measure key indicators related to quality care and compares those scores to a baseline figure established prior to the merger. In 2021, seven of our quality measures performed among the top decile in the country, the most in the health system's history. Those metrics included in-hospital fall with hip fracture rate, post-operative sepsis rate and perioperative hemorrhage or hematoma rate, among others. These quality metrics were achieved during a time when COVID-19 had a terrible impact on hospital operations, while associated infections and complications have deteriorated nationally. FOCUS ON QUALITY - Ballad Health launched a series of initiatives, including the work of the Clinical Council, implementation of systemwide tiered safety huddles and bold and ambitious initiatives like "30 in 90" reducing infections by 30% over 90 days that target hospital-acquired infections like Clostridioides difficile (C. diff), Catheter-associated Urinary Tract Infections (CAUTI), surgical site infections and others. Not only did Ballad Health achieve its goal of reducing the number of C. diff cases by 30% within 90 days, the reduction in C. diff cases has continued as Ballad Health has now reduced C. diff cases by 70% since the program's inception. As part of Ballad Health's systemwide initiative to improve safety and reduce harm, Ballad Health has continued its tiered-safety huddle program throughout the pandemic, which continues to grow in popularity among frontline caregivers. Any issues identified during those huddles are elevated to hospital leadership. If hospital leadership cannot resolve the issue, the issue is further elevated to the market level and then to the corporate level. Using this approach, Ballad Health can improve outcomes and enhance safety by rapidly deploying resources to support and solve safety issues as they arise. PARTICIPATION IN THE MEDICAID TRANSFORMATION PROJECT - Ballad Health and a group of the nation's leading health systems joined forces to identify ways to better care for some of the nation's most vulnerable populations. The project is a national effort to transform healthcare and address social determinants of health for the nearly 75 million Americans who rely on Medicaid. The work focused on four keys areas of opportunity: behavioral health, child and maternal health, substance use disorder and avoidable emergency department visits. PARTICIPATION IN THE HIGH-VALUE CARE COLLABORATIVE - Ballad Health was chosen for a national initiative, The High-Value Care Collaborative, a partnership of the American Hospital Association, the American Board of Internal Medicine Foundation's Choosing Wisely campaign, and the Costs of Care organization. The High-Value Care Collaborative brings together participants to improve efficiency, decrease cost and improve quality in healthcare. During the past year, Ballad Health and other participants in the program adopted strategies to reduce unnecessary cost and deliver evidence-based care that has been demonstrated to reduce the burden on patients. INVESTMENTS: COMMON ELECTRONIC HEALTH RECORD - Ballad Health continued building on prior progress around a common electronic medical record. An implementation plan was developed to include infrastructure enhancements to support the expansion. This investment of over $200 million will allow patient information to be shared immediately at the point of service regardless of where a patient enters the Ballad Health system, providing clinical staff with information to better manage patients in the emergency room, clinics, acute and post-acute settings. In the midst of,”

“OTHER NOTABLE EVENTS AND AWARDS: *Recognized by Forbes Magazine as being a top employer for diversity and inclusion ranked 29th in the entire nation and fifth among employers in the "Healthcare and Social" industry. *Earned the College of Healthcare Information Management Executives (CHIME) Digital Health Most Wired recognition. *Smyth County Community Hospital earned CMS 5 Star rating for patient experience. *Ballad Health provided support to build the Miracle League Field at Brickyard Park in Kingsport, TN that provides opportunities for children and adults with both mental and physical disabilities to play baseball on a safe, smooth, cushioned field. It is the only field of its kind in Northeast Tennessee. *Received its Accreditation/Department of Distinction from the International Association for Healthcare Security & Safety (IAHSS). *Partnered with East Tennessee State University (ETSU) to launch Strong BRAIN Institute to study adverse childhood experiences. The Strong BRAIN (Building Resilience through Adverse Childhood Events -Informed Networking) Institute facilitates the development and dissemination of evidence-based practices that prevent, reduce or mitigate the negative effects of Adverse Childhood Events (ACEs) on health and health disparities. The Institute will also work to inform the citizenry and workforce in the Appalachian Highlands on the importance of being trauma informed. Established through a five-year gift from Ballad Health to ETSU, the Strong BRAIN Institute will be guided by an advisory board comprised of ETSU experts, Ballad Health experts and community members. *Recognized by Harvard University and UnitedHealthcare as one of four healthcare organizations leading the way towards a 3D model for value-based care. *Partnered with Mayo Clinic, in response to the COVID-19 Pandemic to conduct research into convalescent plasma as an experimental treatment.”

“COVID - 19: Program service expenses 1,206,210. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,206,210. Consulting: Program service expenses 0. Management and general expenses 1,340,301. Fundraising expenses 0. Total expenses 1,340,301. Contract Labor: Program service expenses 1,762,877. Management and general expenses 472,118. Fundraising expenses 0. Total expenses 2,234,995. Mars Julia Davis Collection Center: Program service expenses 2,027,507. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,027,507. COPA Compliance: Program service expenses 0. Management and general expenses 789,172. Fundraising expenses 0. Total expenses 789,172. Other: Program service expenses 3,652,303. Management and general expenses 7,210,495. Fundraising expenses 0. Total expenses 10,862,798.”

“Change in Fair Value of interest Rate Swap 4,145,652. Elimination of Intercompany Rec/Pay 135,859,436. Other Acquisition -4,797,264. Temp. Restricted Grants 14,890.”