2024-04-24T11:52:46-05:00 2023-06-30 990 2022-07-01 205485346 Abingdon Physician Partners ABIN 4233023467 311 Princeton Road Suite 1 Johnson City TN 376012080 John Jeter VP, CEO 2762582861 2024-04-24 John Jeter 999009999 1 P03077501 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z John Jeter 16000 Johnston Memorial Drive Abingdon VA 24211 14207933 0 X www.balladhealth.org X 2006 VA Our mission: Honor those we serve by delivering the best possible care 4 0 111 0 0 0 33036 9534 13280444 14198185 15592 127 6796 87 13335868 14207933 0 0 0 0 8928361 8940821 0 0 0 4541567 5266490 13469928 14207311 -134060 622 2959735 3137910 2426743 2254170 532992 883740 Honor those we serve by delivering the best possible care.Ballad Health is dedicated to improving the health of the 29-county Appalachian Highlands region. 0 0 12704277 14198272 Abingdon Physician Partners (APP) was created to augment Johnston Memorial Hospital's exempt purpose of responding to the healthcare needs of individuals and communities in its service area. To promote the general health and welfare of the communities served, the corporation has more than 10 primary care, general surgery, orthopedic, gynecology, and oncology clinics.Multiple APP clinics also serve as outpatient teaching locations for family medicine and internal medicine residency programs. 12704277 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 111 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 VA X Shane Hilton 4233023467 303 Med Tech Parkway Suite 300 Johnson City TN 37604 Alan Levine BH PresCEO Director, Chair 1.00 64.00 X X 0 3557360 247091 Marvin Eichorn BH EVPCAO Director 1.00 64.00 X X 0 3107146 45520 Eric Deaton BH EVPCOO Director 1.00 64.00 X X 0 1268808 106688 Tim Belisle BH EVPGen Cnsl Director, Secretary End July 2022 1.00 64.00 X X 0 827127 56231 Andrew Wampler BH Gen Cnsl Director, Secretary End April 2023 1.00 49.00 X X 0 207386 40760 Julie Bennett CLOGovnc Offcr Director, Secretary Beg April 2023 1.00 64.00 X X 0 0 0 Edward Pryor AVP/CFO JMH/APP 0.50 44.50 X 0 205628 19997 John Jeter VP/CEO JMH/BRMC/APP 0.50 44.50 X 0 432429 40617 Lynn Krutak BH EVP/CFO 1.00 64.00 X 0 1209478 109728 William Cummins MD Physician 40.00 0.00 X 553982 0 44217 Matthew Dorn MD Physician 40.00 0.00 X 459613 0 43120 Timothy Davis MD Physician 40.00 0.00 X 460744 0 43130 Amy Hitchcock MD Physician 40.00 0.00 X 403869 0 11324 Kenneth More MD Physician 40.00 0.00 X 421118 0 26735 Carl Kilgore BH SVP Retail Former Officer 0.00 55.00 X 0 812534 94803 Adrienne Griffin MD Frmr HComp Physician 40.00 0.00 X 292744 0 33087 2592070 11627896 963048 20 1 1 0 0 9534 9534 Hospital Support 621110 7471632 7471632 Patient Revenue 621110 6493684 6493684 Medical Education Training 621110 202712 202712 Performance Bonuses 621110 30157 30157 14198185 127 127 Misc 900099 87 87 87 14207933 14198272 0 127 X 7476395 7476395 245355 245355 806417 806417 412654 412654 2250084 1965412 284672 229 229 47104 40642 6462 685221 677463 7758 39797 39797 277090 276890 200 177818 177818 Support Services 1197482 1197482 Medical Supplies 461570 461570 Maintenance 68675 68675 Physician Recruitment 24158 24158 37262 30802 6460 14207311 12704277 1503034 0 174275 115550 1491393 1549349 35354 27210 39187 27143 3859851 2932479 1184898 927372 34628 34628 0 456658 2959735 3137910 1645519 2039994 781224 214176 2426743 2254170 X 532992 883740 532992 883740 2959735 3137910 X 622 350126 X 0 1 X 1 1 1 X X 1 Johnston Memorial Hospital 540544705 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Part I, Line 12g, Column (vi) Abingdon Physician Partners provides physician services to Johnston Memorial Hospital, it's sole member. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 295340 170048 125292 243021 241452 1569 3321490 2520979 800511 927372 Due from Affiliates 456658 456658 Operating Lease Obligation ST 12347 Operating Lease Obligation LT 14796 Professional Liabilities Reserve 177818 Due to Payor Stimulus Reserve 9215 214176 X Part X, Line 2: Abingdon Physician Partners 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, 2023 and 2022. Tax returns for 2020 through 2022 are subject to examination by the Internal Revenue Service." 1 1 0 0 0 0 0 0 0 Alan Levine BH PresCEO Director, Chair 0 1351717 0 2162808 0 42835 0 218859 0 28232 0 3804451 0 0 Marvin Eichorn BH EVPCAO Director 0 752788 0 598921 0 1755437 0 17400 0 28120 0 3152666 0 0 Eric Deaton BH EVPCOO Director 0 720293 0 530155 0 18360 0 84013 0 22675 0 1375496 0 0 Lynn Krutak BH EVP/CFO 0 682629 0 520077 0 6772 0 82332 0 27396 0 1319206 0 0 Carl Kilgore BH SVP Retail Former Officer 0 473763 0 319356 0 19415 0 65761 0 29042 0 907337 0 0 Tim Belisle BH EVPGen Cnsl Director, Secretary End July 2022 0 277977 0 310583 0 238567 0 29779 0 26452 0 883358 0 0 William Cummins MD Physician 320603 0 216106 0 17273 0 25725 0 18492 0 598199 0 0 0 Timothy Davis MD Physician 428523 0 6034 0 26187 0 18812 0 24318 0 503874 0 0 0 Matthew Dorn MD Physician 348791 0 79329 0 31493 0 18024 0 25096 0 502733 0 0 0 John Jeter VP/CEO JMH/BRMC/APP 0 340640 0 83783 0 8006 0 17859 0 22758 0 473046 0 0 Kenneth More MD Physician 413834 0 6510 0 774 0 5815 0 20920 0 447853 0 0 0 Amy Hitchcock MD Physician 364657 0 10250 0 28962 0 1840 0 9484 0 415193 0 0 0 Adrienne Griffin MD Frmr HComp Physician 255550 0 8250 0 28944 0 17654 0 15433 0 325831 0 0 0 Andrew Wampler BH Gen Cnsl Director, Secretary End April 2023 0 202835 0 1250 0 3301 0 30762 0 9998 0 248146 0 0 Edward Pryor AVP/CFO JMH/APP 0 111108 0 35080 0 59440 0 0 0 19997 0 225625 0 0 Part I, Lines 4a-b 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 $201,459 Eric Deaton $ 66,613 Lynn Krutak $ 64,932 Carl Kilgore $ 47,841 Tim Belisle $ 22,233 Andrew Wampler $ 18,111 The following executives received a change-of-control payment. The payments were reported as taxable income with appropriate tax withheld and remitted to the IRS. Tim Belisle $179,601 Edward Pryor $ 42,500 Form 990, Part V, line 1a For CY22 Ballad Health (BH), the parent organization of Abingdon Physician Partners (APP) and our sole member Johnston Memorial Hospital, filed Form 1096 on a consolidated basis for all subsidiaries that were required to file Forms 1099-MISC/NEC. APP reimburses BH for all expenses related to vendor payments and the expenses are recorded on APP's books. Form 990, Part VI, Section A, line 3 The corporation contracted with Blue Ridge Medical Management Corporation, a for-profit corporation, to perform management duties such as accounting, payroll, budgeting, financial operations, and management responsibilities. Form 990, Part VI, Section A, line 6 The corporation is organized as a Virginia non-stock, nonprofit organization with Johnston Memorial Hospital, a Section 501(c)(3) organization, as the sole member. Form 990, Part VI, Section A, line 7a There is a single class of member, Johnston Memorial Hospital. Form 990, Part VI, Section A, line 7b 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. Form 990, Part VI, Section B, line 11b 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 CEO and is provided in electronic form to all members of the Board of Directors prior to filing 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 President & 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 the 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 IX, line 11g Environmental Services: Program service expenses 19,146. Management and general expenses 0. Fundraising expenses 0. Total expenses 19,146. Laundry Services: Program service expenses 4,493. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,493. Collection Services: Program service expenses 0. Management and general expenses 284,672. Fundraising expenses 0. Total expenses 284,672. Credentialing Fees: Program service expenses 47,298. Management and general expenses 0. Fundraising expenses 0. Total expenses 47,298. Contract Labor: Program service expenses 1,770,690. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,770,690. Other: Program service expenses 123,785. Management and general expenses 0. Fundraising expenses 0. Total expenses 123,785. Form 990, Part XI, line 9: Intercompany Debt Forgiveness 350,126. Ballad Health 303 Med Tech Parkway Suite 300 Johnson City TN 37604 611771290 Supporting Organization TN 501C3 12b N/A 0 Ballad Health Center for Early Learning 400 N State of Franklin Road Johnson City TN 37604 923891827 Child Day Care Services TN 501C3 Line_10_Organization BALLAD HEALTH 0 Ballad Health Foundation 1019 West Oakland Ave Suite 2 Johnson City TN 37604 581594191 Fundraiser TN 501C3 Line_7_Organization_ BALLAD HEALTH 0 Dickenson Community Hospital 312 Hospital Drive Clintwood VA 24228 770599553 Hospital VA 501C3 Line_3_Hospital_Coop WHS 0 East TN Healthcare Holdidngs Inc 203 Gray Commons Circle Ste 110 Gray TN 37615 815475903 Opioid Treatment TN 501C3 Line_3_Hospital_Coop MSHA 0 Johnston Memorial Hospital 16000 Johnston Memorial Drive Abingdon VA 24211 540544705 Hospital VA 501C3 Line_3_Hospital_Coop MSHA 0 Mountain States Health Alliance 303 Med Tech Parkway Suite 300 Johnson City TN 37604 620476282 Hospital System TN 501C3 Line_3_Hospital_Coop BALLAD HEALTH 0 MSHA Auxiliary 400 N State of Franklin Road Johnson City TN 37604 581418345 Supporting Organization TN 501C3 12a MSHA 0 Smyth County Community Hospital 245 Medical Park Drive Marion VA 24354 540794913 Hospital VA 501C3 Line_3_Hospital_Coop MSHA 0 Takoma Regional Hospital Inc DBA GCH 1420 Tusculum Boulevard Greeneville TN 37745 510603966 Hospital TN 501C3 Line_3_Hospital_Coop WHS 0 Wellmont Cardiology Services 303 Med Tech Parkway Ste 220B Johnson City TN 37604 263557623 Medical Services TN 501C3 Line_10_Organization WHS 0 Wellmont Hawkins Co Memorial Hosp Inc 851 Locust Street Rogersville TN 37857 621816368 Hospital TN 501C3 Line_3_Hospital_Coop WHS 0 Wellmont Health System 303 Med Tech Parkway Suite 300 Johnson City TN 37604 621636465 Hospital System TN 501C3 Line_3_Hospital_Coop BALLAD HEALTH 0 Wellmont Imaging Services Inc 400 N State of Franklin Road Johnson City TN 37604 861103148 Healthcare TN 501C3 12a WHS 0 Wellmont Madison House 2000 Greenway Street Kingsport TN 37660 621308216 Assisted Living TN 501C3 Line_10_Organization WHS 0 Wellmont Medical Associates Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 270898372 Medical Services TN 501C3 Line_7_Organization_ WHS 0 Wellmont Wexford House 2421 N John B Dennis Hwy Kingsport TN 37660 581859039 Nursing Home TN 501C3 Line_10_Organization WHS 0 East TN Ambulatory Surgery Center 701 Med Tech Parkway Suite 100 Johnson City TN 37604 621787537 Medical Services TN N/A 0 0 Emmaus Community Healthcare PLLC 6419 Bristol Hwy Piney Flats TN 37686 200577483 Medical Services TN N/A 0 0 Medical Specialists of JC LLC 2528 Wesley Street Suite 2 Johnson City TN 37601 272199037 Medical Services TN N/A 0 0 Quality Improvement Ptrs LLC 2528 Wesley Street Suite 2 Johnson City TN 37601 861932106 Healthcare TN N/A 0 0 Ballad Health Development Corporation 400 N State of Franklin Road Johnson City TN 37604 883118592 Investments TN N/A C 0 Ballad Ventures LLC 400 N State of Franklin Road Johnson City TN 37604 844214681 Investments TN N/A C 0 Blue Ridge Medical Management Corp 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621490616 Medical Services TN N/A C 0 Community Home Care Inc 1490 Park Avenue NW Suite B Norton VA 24273 541453810 Durable Medical Equipment VA N/A C 0 Mediserve Medical Equipment 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621212286 Durable Medical Equipment TN N/A C 0 Mountain States Physician Grp 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621700412 Medical Services TN N/A C 0 Mountain States Properties 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621845895 Property Management TN N/A C 0 Nolichuckey Mgmt Svcs Inc 1420 Tusculum Boulevard Greeneville TN 37745 621776681 Medical Services TN N/A C 0 Wellmont Health Services Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621254373 Medical Services TN N/A C 0 Wellmont Insurance Co SPC LTD PO Box 30600 Grand Cayman CJ KY1-1203 981195624 Insurance CJ N/A C 0 Wellmont Physician Services Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621567353 Medical Services TN N/A C 0 Wellmont Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 621320035 Medical Services TN N/A C 0 Wilson Pharmacy Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 620329587 Pharmacy TN N/A C 0 WPS Providers Inc 303 Med Tech Parkway Ste 220B Johnson City TN 37604 205564642 Medical Services TN N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 1