2023-11-13T16:21:41-06:00 2022-12-31 990 2022-01-01 621373691 Fort Loudoun Medical Center FORT 8653743140 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 Joseph C Dolan EVP/CFO 8655315421 2023-11-08 Joseph Dolan 999009999 1 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z James D VanderSteeg 244 Ft Sanders W Blvd Knoxville TN 37922 45783471 0 X www.covenanthealth.com/fort-loudoun/ X 1988 TN Fort Loudoun Medical Center is a 50-bed full service, acute care hospital located in Loudon County, Tennessee. It is a member of the Covenant Health system. 23 22 329 52 0 0 445055 912511 40723513 44620604 22403 8709 220228 235504 41411199 45777328 1000 2620 0 0 15425404 15311062 0 0 0 22430194 25195051 37856598 40508733 3554601 5268595 20853136 20744558 5398907 4213943 15454229 16530615 X Fort Loudoun Medical Center provides quality healthcare, in alignment with Covenant Health's mission to serve the community by improving the quality of life through better health, regardless of a patient's ability to pay. 0 0 38973364 2620 44625404 Fort Loudoun Medical Center has been located in Lenoir City, Tennessee, since 2004, after serving the area from a previous location in Loudon County for many years. SERVICEFort Loudoun Medical Center ("Fort Loudoun")is known for quality and safety, and has earned accolades for top performance on core measures for inpatient care. The medical center is in the top 10 percent of hospitals nationwide in the prevention of hospital-acquired infections. The medical center is certified by The Joint Commission as an Advanced Primary Stroke Center. As part of Covenant Health's stroke hospital network, Fort Loudoun provides rapid diagnosis and treatment of stroke. In 2022 the hospital saw 62,898 patients. Of these, 60,741 were outpatients and 2,157 were inpatients with an average length-of-stay of 4.87 days. PUTTING PATIENTS FIRSTFort Loudoun Medical Center Descriptive Highlights - 87,000-square-foot facility, with an adjacent two-story medical office building - 50 beds with bedside charting technology - State-of-the-art imaging: X-Ray, CT, MRI, nuclear medicine and Low-Dose CT Lung Cancer screening. The hospital's Picture Archiving and Communications System (PACS) allows for digital capture, storage and transmission of medical images - Emergency department with 12 private suites, open 24/7, 365 days a year - Surgical suites for endoscopy and gastrointestinal procedures; ear, nose and throat; gynecology; ophthalmology; orthopedic; podiatry; pulmonology, and general non-invasive procedures - Women's Imaging Department offers mammography, ultrasound and bone density testing - Central registration area - Spacious private and semi-private rooms - Helipad for emergency transportation - Physicians representing various medical specialties provide a growing community with increased access to convenient, local care.IMPROVING THE COMMUNITY'S QUALITY OF LIFE THROUGH BETTER HEALTHBecause of COVID-19, many of Fort Loudoun's community-focused health events were paused. Previously, hospital staff, including the chief administrative officer and chief nursing officer, provided stroke education to the community through tours and luncheons offered at the hospital as well as external presentations to churches, schools, neighborhoods, fire departments, EMS, and local organizations. Fort Loudoun collaborated with local schools to provide tobacco education to students, offering health-related information to students who are caught using tobacco products on school property.Friday Fitness, a local hiking program through Covenant Health, provided quarterly community hikes throughout the year. Fort Loudoun looks forward to resuming these community events.COVENANT HEALTH Fort Loudoun is a member of Covenant Health. Covenant Health is a comprehensive, community-owned health system dedicated to improving the health of the people it serves. Established in 1996 by the consolidation of Fort Sanders Health System, Knoxville, Tennessee, and MMC HealthCare System in Oak Ridge, Covenant Health is governed by a voluntary board of directors comprised of community leaders and medical professionals. With more than 11,000 employees, affiliated physicians and volunteers, Covenant Health is the Knoxville area's largest employer and has been named a Best Employer by Forbes. Covenant Health includes nine acute care hospitals in East Tennessee: Methodist Medical Center of Oak Ridge, Fort Sanders Regional Medical Center and Parkwest Medical Center in Knoxville, Fort Loudoun Medical Center in Lenoir City, LeConte Medical Center in Sevierville, Morristown-Hamblen Healthcare System in Morristown, Roane Medical Center in Harriman, Claiborne Medical Center in Tazewell and Cumberland Medical Center in Crossville. It also includes Peninsula, a division of Parkwest Medical Center, a behavioral health hospital in Blount County, Tennessee. The health system also includes Covenant Medical Group, which includes more than 200 physicians and advanced practice clinicians in office locations throughout East Tennessee.Affiliated organizations include Thompson Cancer Survival Center, Thompson Oncology Group, Fortress Corporation and Subsidiaries, Covenant HomeCare, and Fort Sanders Perinatal Center. Philanthropic organizations include Fort Sanders Foundation and the Thompson Cancer Survival Center Foundation in Knoxville, Methodist Medical Center Foundation in Oak Ridge, Dr. Robert F. Thomas Foundation in Sevierville, and Morristown-Hamblen Hospital Foundation in Morristown. Funds raised by the foundations provide services, equipment and other resources for excellence in patient care.Fort Loudoun, as a member of the Covenant Health System, benefits from the collaboration among all affiliated organizations to promote quality improvement, patient safety and efficient delivery of care for the communities served. 38973364 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 50 0 1 329 1 0 0 0 0 0 0 0 0 0 0 0 0 X 23 22 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Amy DeLong 8653743140 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 Gerald Boyd Director 0.00 1.00 X 0 0 0 Willard Campbell MD Director 0.00 1.00 X 0 0 0 Michael Casey MD Director 0.00 1.00 X 0 0 0 Ronni Chandler Director 0.00 1.00 X 0 0 0 Mitchell Dickson MD Director 0.00 1.00 X 0 268 0 Stephanie Flood Director 0.00 1.00 X 0 849 0 James Gibson Director 0.00 1.00 X 0 74 0 Edgar Gray Director 0.00 1.00 X 0 1432 0 Leslye Hartsell Director 0.00 1.00 X 0 889 0 Donald Hickman Director 0.00 1.00 X 0 1538 0 Timothy Matthews Director 0.00 1.00 X 0 906 0 Janice McKinley Director 0.00 1.00 X 0 1097 0 Dave Miller Director 0.00 1.00 X 0 1208 0 Bill Myers Director 0.00 1.00 X 0 0 0 Alvin Nance Director 0.00 1.00 X 0 0 0 Linda Ogle Director 0.00 1.00 X 0 0 0 King Purnell Director/Chair 0.00 1.00 X X 0 1050 0 Jorge Sanabria Director 0.00 1.00 X 0 1485 0 William Seale Director 0.00 1.00 X 0 1251 0 Cosby Stone Director 0.00 1.00 X 0 1408 0 Joe Sutter Director 0.00 1.00 X 0 979 0 James Tramontana MD Director 0.00 1.00 X 0 1208 0 James D VanderSteeg President & CEO 0.00 50.00 X X 0 2346646 316057 John T Geppi EVP/CFO 0.00 50.00 X 0 1099851 33916 Jeffrey L Feike Fmr Pres & CAO (through Apr 2022) 50.00 0.00 X 0 306366 22185 Connie B Martin President & CAO 50.00 0.00 X 0 244887 38175 M Scott Hamilton VP - Financial Services 10.00 40.00 X 0 247377 41607 Suzanne Miller VP - Chief Nursing Officer 50.00 0.00 X 168636 0 16490 Ashley N Touton Clinical Nurse 50.00 0.00 X 142700 0 16594 Brenda L Smith Clinical Nurse 50.00 0.00 X 130878 0 27326 Matthew A Messer Pharmacist 50.00 0.00 X 119108 0 39195 Julie A Roberts Team Leader - Ultrasound 50.00 0.00 X 118401 0 25855 Steven M Mccullar Jr Administrative Supervisor 50.00 0.00 X 121947 0 27698 801670 4260769 605098 10 0 1 0 The MCR Group LLC PO Box 51325 Knoxville TN 37950 Consulting Fees - Managed Care 780121 Linen King LLC 1521 W 36th Pl Tulsa OK 74107 Linen Services 368121 Medic Regional Blood Center 1601 Ailor Avenue Knoxville TN 37921 Blood Processing 207204 Quest Diagnostics PO Box 912512 Pasadena CA 911102512 Diagnostic Services 154961 Mayo Collaborative Services LLC PO Box 4100 Rochester MN 559034100 Lab Services 131721 7 912511 912511 Net Patient Revenue 622110 44620604 44620604 44620604 14852 14852 6143 -6143 -6143 -6143 Cafeteria 722514 117158 117158 Gift Shop 459420 113166 113166 Student Sponsorships 812900 4800 4800 380 380 235504 45777328 44625404 0 239413 X 2620 2620 185126 185126 12585303 11999527 585776 387788 375038 12750 1240244 1186556 53688 912601 869105 43496 4583827 4522835 60992 905 905 7314715 7259465 55250 83297 79422 3875 332244 221912 110332 1140859 866098 274761 5536 5041 495 2389 2389 1939455 1939455 46986 7638 39348 Medical Supplies 4773292 4773292 Bad Debt 3348752 3348752 Minor Equipment 1170803 1120360 50443 Food and Dietary 229267 229160 107 222724 164699 58025 40508733 38973364 1535369 0 1800 1800 -240048 -172196 4529943 4940438 324235 324923 116832 106507 48231256 33131449 15177630 15099807 942744 443279 20853136 20744558 4194563 2938237 1204344 1275706 5398907 4213943 X 15454229 16530615 15454229 16530615 20853136 20744558 X 5268595 -4192209 X 0 1 X 1 1 1 X 2335985 2335985 17586046 10941348 6644698 49526 36193 13333 28166955 22153908 6013047 92744 92744 15099807 Due to Affiliates, Net 209505 Long-Term Deferred Compensation 188478 Long-Term Reserve for Workers Comp 50000 Operating and Finance Leases 150765 Third Party Settlements 676958 1275706 X Part X, Line 2: Excerpt from the consolidated audited financial statements of Covenant Health (Covenant), parent company to Fort Loudoun Medical Center: Covenant and certain of its subsidiaries or controlled entities are exempt from income taxes pursuant to Section 501(c)(3) of the Internal Revenue Code. Accordingly, no provision for income taxes on qualifying activities has been made for these entities in the accompanying consolidated financial statements. However, certain entities and operations are subject to income taxes. Covenant had no unrecognized tax benefits at December 31, 2022 and 2021. As such, no interest or penalties were recognized in the consolidated financial statements related to unrecognized tax benefits. At December 31, 2022 and 2021, tax returns for 2019 through 2022 are subject to examination by the Internal Revenue Service. Covenant has no uncertain tax positions that would require financial statement recognition or disclosure under GAAP at December 31, 2022 and 2021. 1 1 X 1 X 1 X 1 1 1 0 1 1 1740364 1740364 0.04680 5239252 4727637 511615 0.01380 7951 15071 0 0.00000 6987567 4742708 2251979 0.06060 23674 23674 0.00060 87 87 0.00000 2782046 2782046 0.07490 10480 10480 0.00030 2816287 2816287 0.07580 9803854 4742708 5068266 0.13640 6304 6304 0.00020 745 745 0.00000 35 35 0.00000 7084 7084 0.00020 1 3348752 399477 8493566 7724928 768638 X 1 1 1 1 Fort Loudoun Medical Center 550 Fort Loudoun Medical Center Drive Lenoir City TN 37772 www.covenanthealth.com/fort-loudoun 00000084 X X X Fort Loudoun Medical Center 1 0 0 1 X X X X X X X X 20 1 0 1 1 X See Part V, Page 8 X 1 20 1 See Part V, Page 8 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X 1 X https://www.covenanthealth.com/patients-visitors/financial-assistance/ X https://www.covenanthealth.com/patients-visitors/financial-assistance/ X https://www.covenanthealth.com/patients-visitors/financial-assistance/ X X X X X X 1 X 0 X X X 1 X 0 0 Fort Loudoun Medical Center Part V, Section B, Line 5: Fort Loudoun Medical Center ("Fort Loudoun") conducted its third Community Health Needs Assessment ("CHNA") in 2020. A Steering Committee was formed to guide the assessment process and included the Loudon County Health Department, Loudon County United Way, Fort Loudoun Medical Center, Loudon County Health Council, and the Prevention Alliance of Loudon County. Each of these community organizations serve the broader community and, in particular, the low-income, uninsured, and chronically ill. The Steering Committee worked with the University of Tennessee-Knoxville Social Work Office of Research and Public Service ("UT-SWORPS") to devise a Loudon County household survey and to host three focus groups of community leaders, each of which represented a part of the overall Loudon County public health system. The household survey collected information from 353 Loudon County residents. Participation in the survey was diverse and reflected the demographic profile of the county for the attributes of educational level, income, ethnicity and age. The primary research was analyzed and combined with county demographics, mortality, and secondary data for more than 60 health indicators. A Data Team was formed to begin the analysis of the data and determine the most significant findings from the assessment. The Data Team included members of the Steering Committee as well as representatives from the Tennessee Department of Public Health, Office on Aging, Prevention Alliance of Loudon County, and several community leaders. Fort Loudoun Medical Center Part V, Section B, Line 6b: Though Fort Loudoun's CHNA was issued as a stand-alone report, many non-hospital organizations assisted with the report. Research partners provided expertise on survey design, focus group facilitation, data collection, data sources, and analysis. UT-SWORPS was an integral participant, as well as the Loudon County Health Department and the Loudon County Health Council.Additionally, focus groups were beneficial in discussing and identifying community needs in Loudon County. Organizations and individuals participating in the focus groups include:- Align 9 - Boys and Girls Club - Cherokee Health System - Edward Jones Financial- Good Samaritan Center - Community Hispanic advocate - Community Volunteer - Senior Advocate - District Attorney's Office- Loudon Co. Coordinated School Health - Loudon Co. Health Department- Loudon Co. Health Council - Loudon Co. Government - Loudon Co. United Way - News Herald - Prevention Alliance of Loudon Co. - Tate and Lyle - Tellico Recreation Center - UT Extension Service - Veterans Affairs - Victim Advocate YWCA Fort Loudoun Medical Center Part V, Section B, Line 11: At the conclusion of the 2020 assessment process, the Data Team identified a list of 7 health priorities. The primary findings from the assessment were chronic disease management, mental health, substance abuse, COVID-19, tobacco, homelessness and non-English speaking residents. The top four most significant issues in rank order as determined by the Data Team were: 1. Substance Abuse Disorder 2. Chronic Disease Management 3. Mental Health 4. Tobacco Fort Loudoun updated its 2020 Implementation Plan based on the identified needs and plans to address all of the identified issues in the following ways:1. Mental HealthBehavioral Health Services Expansion - Psychiatric consult service is now being provided for patients in the Emergency Department and for inpatients at Fort Loudoun via tele-video through Peninsula Behavioral Health, a department of Parkwest Medical Center. - Fort Loudoun, with funding support from the Covenant Health Office of Philanthropy, implemented an Emergency Department Diversion Program in 2021. A team of medical and behavioral specialists will conduct a behavioral assessment and treatment plan to propose measures to meet the identified needs. An outreach specialist will follow up with patients to oversee the implementation plan. 2. Chronic Disease ManagementPulmonary Outreach Programs - Fort Loudoun is offering a grant-funded pulmonary rehab program that addresses Chronic Obstructive Pulmonary Disease and Post-COVID Syndrome. Information is given to medical providers for community members who would benefit from the program.Community Stroke Education - Fort Loudoun will continue to promote and implement a community-wide stroke education program in Loudon County to improve and ensure awareness of stroke, stroke symptoms and the need for rapid treatment.3. Substance AbusePeninsula Drug Treatment Program - Fort Loudoun can now refer their patients to Peninsula Medication Assistance Treatment program's Center for Outpatient Services for Substance Abuse. This program offers specialized medications and intensive therapy to treat substance abuse disorders. Opioid Lite Program - Fort Loudoun's Emergency Department is participating in a Covenant Health system-wide initiative to curb the use of hospital prescribed opioids (tobacco products were identified as well). Physicians are prescribing non-opioid drugs when indicated for pain management, both during treatment and upon discharge from the hospital. - Fort Loudoun will work in conjunction with other community resources, including Helen Ross McNabb, Loudon County Health Department and the Prevention Alliance of Loudon County to address opioid-related issues. 4. Tobacco CessationVaping Impact Program - Fort Loudoun, in partnership with the Prevention Alliance of Loudon County, is co-developing education and prevention videos and other content for use in Loudon County Schools to reduce the incidence of vaping among students. Fort Loudoun Medical Center Part V, Section B, Line 16j: All other ways in which the hospital widely publicizes the FAP are discussed in detail in Part VI, Line 3. Part V, Line 7a, CHNA website https://www.covenanthealth.com/fort-loudoun/chna/ Part V, Line 10a, Implementation Strategy Website https://www.covenanthealth.com/fort-loudoun/chna/ Part V, Line 20d, Presumptive Eligibility Determinations The hospital follows the eligibility procedures as detailed within the FAP and does not make presumptive eligibility determinations. 3 1 - Ft Loudoun Cardiopulmonary Rehab Ctr 423 Medical Park Drive Suite 500 Lenoir City TN 37772 Cardiac Rehab Therapy Center 2 - Ft Loudoun Therapy Center 423 Medical Park Drive Suite 300 Lenoir City TN 37772 Physical Rehabilitation & Therapy Center 3 - Fort Loudoun Therapy Center 1127 Grove Street Loudon TN 37774 Physical Rehabilitation & Therapy Center Part I, Line 3c: In addition to the Federal Poverty Guidelines ("FPG"), Fort Loudoun utilizes an asset test as a factor in determining eligibility for free or discounted care. Ten percent (10%) of the patient/guarantor's net assets will be added to income for determination of total annual income. The guidelines for determining assets include, but are not limited to, primary dwelling (and attached land), automobiles, liquid assets, investments, farm land, business property, rental property, farm and/or business equipment including livestock and crops. All real property will be considered at fair market value. The values of both real and personal property will be reduced by any existing liabilities incurred by the applicant in obtaining the assets (net assets) with the exception of primary dwelling. The primary dwelling net asset will be the amount of equity above $100,000. Actual or potential liability to the patient, hospital or the guarantor by common law, contract, statute or otherwise, shall be considered an asset and must be listed on the Hospital Financial Assistance application. Part I, Line 6a: Covenant Health, the parent company of Fort Loudoun and other affiliated acute care hospitals, prepares an annual Report to the Community on behalf of the entire system. Part I, Line 7: Amounts on Lines 7a-7c and certain program costs included on Line 7g are from the hospital's cost accounting system, which addresses all patient segments. Other community benefit expenses are at cost from the general ledger. Part I, Line 7g: Subsidized health services includes the difference between the cost of services and the payments received for those services. The organization has included $2,782,046 in physician sponsorship fees in total subsidized health services. All subsidized health services included on line 7g are for services that would otherwise be unavailable in the community or be below the community's needs. Part I, Ln 7 Col(f): The Bad Debt expense included on Form 990, Part IX, Line 24a, but subtracted for purposes of calculating the percentage in this column is $3,348,752. Part II, Community Building Activities: Fort Loudoun cares for the whole person and recognizes that improved social and economic conditions may lead to the improved health and well-being of the community. The hospital's community building activities and those of its parent organization, Covenant Health, address many of the root causes of health problems, such as poverty and homelessness, and help find solutions to alleviate the symptoms.An allocation of the Parent's community building expenditures has been made to each member hospital in proportion to the financial contribution of each to the health system. Covenant Health is not a hospital and does not file Schedule H with its Form 990. Contributions in 2022 were made to organizations meeting the community's needs by providing: - The basic needs of life including temporary shelter, food and clothing (Ladies of Charity, City Shepherds, Safe Families for Children East TN and Second Harvest Food Bank) - Youth mentoring, development and after-school programs (Emerald Youth Foundation, Boys and Girls Club, Knox Education Foundation, First Tee of Greater Knoxville and Great Smoky Mountain Council) - Business recruitment and marketing initiatives that boost economic development (Knoxville Technology Council, Knoxville Zoological Garden and Pellissippi State Foundation) - Leadership development programs and workshops (Knoxville Area Urban League and Leadership Knoxville) - Assistance and special programs for at risk older adults, people with physical and mental challenges, and abused and neglected children (Senior Citizens Home Assist and Sertoma Center) - Improve access to health services (East TN Children's Hospital, Helen Ross McNabb Center, Interfaith Health Clinic, Knoxville Academy of Medicine, and Region II Emergency Medical Services) - Programs supporting patients and their families (Air Force Association, Alzheimer's Tennessee, American Cancer Society, American Heart Association, Angel Wings Memory Gowns, East TN Kidney Foundation, East TN Veteran Memorial Association, Juvenile Diabetes Research Foundation and Leukemia & Lymphoma Society, Wreaths Across America) Part III, Line 2: Bad debt expense on Part III, Line 2 is the amount recorded in the organization's financial statements. Discounts and payments on patient accounts are netted against bad debt. The allowance for bad debt is determined based on management's assessment of factors including the age of the accounts, historical collections data, and industry standards. Part III, Line 3: At regular intervals, the Vice President of Revenue Cycle analyzes all self-pay accounts receivables to identify patients who may have been eligible for charity care during a particular period or year. Because this analysis does not yield a final determination of eligibility due to various factors including but not limited to charity applications still in process, failure of eligible patients to submit their charity application, and applications still under consideration, further analysis of the accounts comprising the self-pay accounts receivable is conducted. The accounts for which a patient was contacted to apply for charity care include an identifier; these charity-identified accounts are then categorized according to status. A ratio of the dollar amounts of those accounts whose charity application is in process or has been approved divided by the total self-pay accounts receivable is computed. This ratio is applied to the bad debt expense total to determine the estimated amount of the bad debt expense attributable to patients eligible for charity care according to the hospital's policy. Part III, Line 4: Note B to the 2022 Audited Consolidated Financial Statements of the Covenant Health system, of which Fort Loudoun is a member, states: Patient accounts receivable are reported net of an estimated allowance for contractual adjustments and an allowance for implicit price concessions. Covenant's policy does not require collateral or other security for patient accounts receivable and Covenant routinely accepts assignment of, or is otherwise entitled to receive, patient benefits payable under health insurance programs, plans or policies. Part III, Line 8: Costing Methodology: Fort Loudoun used a combination of sources in calculating Medicare allowable costs on Part III, Line 6 including its cost accounting system, general ledger accounting system, and facility-specific analyses and calculations. Part III, Line 9b: Fort Loudoun utilizes a look-back method to determine amounts generally billed ("AGB") to establish the maximum amount that will be charged to individuals eligible under the financial assistance policy ("FAP") for emergency or other medically necessary care. Self-pay patients automatically receive a 66% discount on charges based on the facility's calculated AGB. Federal poverty guidelines are utilized in the determination of charity care eligibility. Patients who are unable to pay and have exhausted all sources of payment assistance may qualify for charity care. A sliding scale is used for extending charity care utilizing the income levels reported under the federal poverty guidelines. Patients/guarantors with income that falls below 200% of the federal poverty guidelines receive 100% charity care. Patients/guarantors with income of 201-300% of the federal poverty guidelines receive 90% charity care. For catastrophic illness, exceptions to income and asset limitations may be made on a case-by-case basis. The amount considered for charity will be based upon the evaluation of the patient's/guarantor's ability to pay.Fort Loudoun makes reasonable efforts to determine a patient's eligibility under the facility FAP. All collection activity will be halted if a charity application is received and will remain on hold until a determination is made by Fort Loudoun and communicated in writing to the responsible party. If the charity application is approved, all collection activities taken will be reversed and any amounts paid above the amount required will be refunded. Patients/guarantors who qualify for partial financial assistance are responsible for paying any balance remaining after the charity adjustment and third party payments. Fort Loudoun will not engage in extraordinary collection actions ("ECA") before it makes reasonable efforts to determine whether an individual who has an unpaid bill is eligible for financial assistance. Reasonable efforts to determine whether the individual who has an unpaid bill is eligible for financial assistance include notification to the individual of the financial assistance policy, contacting individuals who have submitted incomplete financial assistance applications regarding how to complete the application and allowing a reasonable time period to do so, and reviewing completed applications for financial assistance eligibility. Fort Loudoun does not sell any accounts receivable accounts to outside firms. All accounts remain property of and under the policies set by Fort Loudoun. Fort Loudoun will not defer or deny medically necessary care because of nonpayment for previously provided care whether it was covered or not covered under the charity program. Part VI, Line 2: While the CHNA is a formal means by which the health system assesses the needs of the community, there are many informal networks that give the Covenant Health hospitals a sense of community issues and needs. Fort Loudoun obtains additional community information through the service of its employees with the local health council, United Way of Loudon County, Chamber of Commerce, and Rotary Clubs. Covenant Health, the parent organization, maintains community benefit professionals working year-round to ensure that all hospitals are assessing and addressing the needs of the communities served. Part VI, Line 3: The FAP states that patients who are unable to pay or have exhausted all sources of payment assistance may be considered for charity care. Signage about the policy is posted in highly visible areas of the hospital, such as lobbies and registration areas. Information about the FAP is posted in patient booklets provided to patients during the registration process and communicated via patient billing statements. In addition, the FAP and application are available on the facility website. Fort Loudoun employs full time financial counselors to assist patients in applying for TennCare and screening for eligibility for financial assistance. Office hours and the phone number for the counselors are included on the signage. Wall signs informing patients about available financial assistance state the following: Covenant Health is committed to providing quality health services in a caring environment. It is the expressed philosophy of Covenant Health and its member hospitals that no one should be denied necessary medical care because of the inability to pay. In conjunction with this philosophy, counselors at Fort Loudoun Medical Center are available to assist you with your financial needs. If you are an uninsured person with no public or private source of payment for medical services Fort Loudoun Medical Center will provide, at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling 865-271-6219 or 865-271-6223, Monday through Friday between the hours of 8:30 a.m.-5:00 p.m. Additional information regarding financial assistance is also available on our website at FtLoudoun.com. Signage at the registration areas state the following:It is Fort Loudoun Medical Center's philosophy that no one shall be denied medically necessary services based on an inability to pay. Financial assistance applications for medically necessary services are available during the registration process, through a financial counselor, or on our website at FtLoudoun.com. A financial counselor is available to assist you with these matters by calling 865-271-6219 or 865-271-6223, Monday through Friday between the hours of 8:30 a.m.-5 p.m. Part VI, Line 4: Loudon County, Tennessee, is the primary market for Fort Loudoun. Loudon is a rural community within close proximity to the metropolitan Knoxville area. Fort Loudoun is the only hospital in the county. According to internal hospital data for 2022, over 73% of inpatient and 69% of outpatient encounters were Loudon County residents. The following statistics are taken from the 2022 County Health Rankings data, Robert Wood Johnson Foundation. The population of Loudon County is 54,910. Persons over the age of 65 account for 27.6% of the population. The racial makeup of the population is 86.8% white persons, non-Hispanic, 9.6% Hispanic, and less than three percent of other races. Loudon is one of several counties in East Tennessee that is experiencing a significant increase in the Hispanic population. In 2022, 16% of the adults were uninsured as were 7% of the children. The median income of Loudon County is $70,300 per household. Unemployment is at 6.4%, and the manufacturing sector accounts for 22.7% of the labor market. According to the 2022 County Health Rankings Report of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, Loudon County residents have the following health indicators that are above the national benchmarks: Loudon - TN - National Adult Smoking: 21% - 21% - 16% Adult Obesity: 37% - 37% - 32% Teen Birthrate: 29 - 27 - 19 of every 1,000 teenage girls Poor or Fair Health: 21% - 20% - 17% Physical Inactivity: 30% - 29% - 26% Drug Overdose Deaths: 35 - 34 - 23 per 100,000 population Part VI, Line 5: Fort Loudoun, in conjunction with its parent company, Covenant Health, uses any available surplus of receipts over disbursements to expand and modernize the facility and to support the education of healthcare professionals, both of which serve to improve patient care and serve the unmet needs of the community.Covenant Health's Board of Directors serves as Fort Loudoun's board. The board is comprised of independent community leaders with diverse educational and professional backgrounds. The board provides governance and oversight of Fort Loudoun.Fort Loudoun maintains an open medical staff, with privileges available to all qualified physicians. Additionally, the hospital operates an active and accessible emergency department that accepts all patients regardless of ability to pay. Part VI, Line 6: Fort Loudoun, as a member of the Covenant Health system, benefits from the collaboration among all affiliated organizations to promote quality improvement, patient safety and efficient delivery of care for the communities served.As a system, Covenant assures that business processes are in place at each facility to measure and report quality; to increase the role of compliance; and to integrate risk management, utilization review, peer review, mandatory reporting and quality improvement into one cohesive function. In this way, the system is able to use analytic tools to help identify any systemic inability to satisfy the various requirements on the part of the facilities.Fort Loudoun patients benefit from the availability of and ease of access to Covenant Health affiliated entities for services not provided by the hospital itself. Transfer or referral to such services is expedited and coordinated to help create a seamless continuum of care. A full range of community mental health and psychiatric hospital services are available within the system that help support the hospital's emergency room as well as provide an accessible and efficient pathway for those patients who require such services post discharge. Other specialized services such as inpatient rehabilitation, cardiac care, cancer treatment, home health and hospice services are provided by affiliated entities. The Covenant Health system also enhances the patient's access to care through the provision of outpatient services in a variety of settings located throughout the service area. These include a diabetes center, wound care center, bariatric surgery center, pulmonary rehabilitation programs and ambulatory infusion centers.Fort Sanders Foundation seeks out community financial support for Fort Loudoun and other Covenant Health hospitals. Funds are used for indigent patient care, medical equipment, outreach programs, services and staff.Through this combination of resources and the collective development, implementation and monitoring of clinical protocols and other improvement initiatives, the affiliated entities of Covenant Health are able to deliver higher quality care in a more efficient manner than could be achieved working independently. X 1 1 0 1 0 0 0 0 0 0 0 James D VanderSteeg President & CEO 0 1425507 0 742500 0 178639 0 284975 0 31082 0 2662703 0 0 John T Geppi EVP/CFO 0 679719 0 309084 0 111048 0 11600 0 22316 0 1133767 0 0 Jeffrey L Feike Fmr Pres & CAO (through Apr 2022) 0 89596 0 71369 0 145401 0 11600 0 10585 0 328551 0 0 M Scott Hamilton VP - Financial Services 0 191681 0 39975 0 15721 0 9440 0 32167 0 288984 0 0 Connie B Martin President & CAO 0 169207 0 31775 0 43905 0 15849 0 22326 0 283062 0 0 Suzanne Miller VP - Chief Nursing Officer 122254 0 26362 0 20020 0 6019 0 10471 0 185126 0 0 0 Ashley N Touton Clinical Nurse 139250 0 3440 0 10 0 7225 0 9369 0 159294 0 0 0 Matthew A Messer Pharmacist 112907 0 1220 0 4981 0 7287 0 31908 0 158303 0 0 0 Brenda L Smith Clinical Nurse 127541 0 3190 0 147 0 5915 0 21411 0 158204 0 0 0 Part I, Line 1a Tax gross-up payments related to deferred compensation are provided to certain executives and managers. Amounts are included in taxable compensation. Part I, Line 3 Covenant Health, the parent company of Fort Loudoun Medical Center, used the following methods in establishing the compensation of President/CEO, James D. VanderSteeg: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board or compensation committee. Additional detail is provided in response to Form 990, Part VI, Section B, Lines 15a and 15b within Schedule O. Part I, Line 4b Covenant Health maintains a nonqualified deferred compensation ("NQDC") plan intended to support retention of President and CEO, James D. VanderSteeg. Employer contributions of $273,375 are reported as deferred compensation on Schedule J, Part II, Column C. Contributions along with 2022 earnings of $70,560 are subject to a substantial risk of forfeiture. Amounts are combined with other compensation and considered for reasonableness. Compensation procedures are discussed in detail in Schedule O (Form 990, Part VI, Section B, Line 15a). Form 990, Part III, Line 4a IMPACT OF COVID-19 In March 2020, the outbreak of the coronavirus disease 2019 ("COVID-19") was declared a public health emergency by the Department of Health and Human Services and declared a national pandemic by the World Health Organization. The COVID-19 pandemic had a major impact on the operations of all hospitals and affiliates included within the Covenant Health System. Three years later, although the overall number of hospital admissions due to the virus is significantly lower than the prior two years, COVID-19 continues to be a long-term problem. The stresses on the System which began in 2020 continue to have long-term and far-reaching implications, creating new challenges for every hospital in the System. The rapid rise in costs for supplies and equipment, unprecedented staffing shortages, and lower patient volumes continue to result in financial stress. Elective surgeries and diagnostic procedures have not yet returned to pre-COVID levels. Government subsidies in 2020 and 2021 helped offset the financial losses caused by significant declines in volumes due to cancelled and postponed procedures. In 2021 and 2022, Federal and state grants continued to be used to subsidize the rising costs of retaining staff and providing quality care. These federal and state grants were helpful but the financial pressures of rising costs across the System are ongoing. Early results from our focus groups for the Community Health Needs Assessments indicate that community problems such as substance abuse, mental illness, asthma and other respiratory diseases, and access to health care have gotten worse since COVID-19, thus stressing the health care System even more than usual. Covenant Health has put in place a number of changes to address these challenges. We are aggressively pursuing cost reductions in supplies across our hospitals and with our vendors. Covenant has increased nurse pay and implemented retention bonuses and other incentives to help reduce staff fatigue and turnover. A number of innovations, including a growing use of Tele-health capabilities, have assured that we continue to reach and serve patients in the community. Patient care continues to be our top priority despite the economic pressures. Form 990, Part VI, Section A, line 6 Covenant Health is the sole member of Fort Loudoun Medical Center. Form 990, Part VI, Section A, line 7a Covenant Health's board of directors also serves as the board of directors for Fort Loudoun Medical Center. Form 990, Part VI, Section A, line 7b Governance decisions of Fort Loudoun Medical Center are subject to approval of the sole member, Covenant Health. Form 990, Part VI, Section B, line 11b The Covenant Health board of directors has delegated to its Finance Committee the full power and authority of the board to receive, review, approve, authorize the filing of, address and resolve audit or review issues, and otherwise take all action required or appropriate relative to IRS Forms 990 and other applicable tax filings. Prior to filing Form 990, management reviews with the committee the returns, discusses any material variations in the Form 990 as compared to those to be filed by the organization's affiliates, and answers any questions. At the conclusion of review and discussion, the Finance Committee approves the Form 990. Form 990, Part VI, Section B, line 12c Board members, officers, and employees are required to adhere to rules and policies regarding conflicts of interest. Covenant Health distributes a board-approved Code of Conduct to all employees. The Code covers among other subjects, conflicts of interest, and requires disclosure and resolution of employee conflicts of interest. Additionally, officers, employed physicians, and highly compensated employees are required to complete and sign an annual conflict of interest disclosure statement. Board members' conflicts of interests are addressed in the corporate bylaws, and board members are required to complete and sign a conflict of interest questionnaire on an annual basis. The Integrity-Compliance Office maintains records that contain conflict of interest information obtained from board members, officers, and employees. These records are available to be queried prior to engaging in business transactions. The Chief Compliance Officer reviews conflict of interest data. Based on this information, the officer determines what conflicts of interest exist at that point in time. Between times when surveys are collected, board members are expected to disclose any new conflicts that have arisen that affect pending board decisions. Officers and other employees are expected to report conflicts to the Chief Compliance Officer as they arise. Depending on the nature of the conflict and the circumstances surrounding the conflict and transaction, the Chief Compliance Officer, senior leadership, or the board of directors may review the conflict of interest. When appropriate, these parties may also consult legal counsel. Restrictions imposed on persons with a conflict of interest are determined on a case by case basis. For Covenant Health employees, the Chief Compliance Officer in conjunction with Covenant Health Executive Leadership determines how to appropriately manage the conflict. In any conflict involving a board member, such member is expected to recuse himself or herself from voting on matters related to the conflict. Form 990, Part VI, Section B, line 15 Form 990, Part VI, Section B, Line 15a: Overall compensation policies for Fort Loudoun Medical Center, Covenant Health (Parent Company), and affiliates are set by the Covenant Health Chief Executive Officer (CEO) in consultation with appropriate Executive Vice Presidents and the Senior Vice President-Human Resources, after review by and discussion with the executive compensation consultant ("the Consultant") to ensure that total compensation for each executive is reasonable and within a fair market value range. The Covenant Health CEO is compensated by Covenant Health, and a detailed description of the compensation process is included on Covenant Health's Form 990. The process for Fort Loudoun Medical Center's CEO is included in response to Part VI, Section B, line 15b. Form 990, Part VI, Section B, Line 15b: Base salary and annual bonus opportunities for Connie Martin, President and Chief Administrative Officer, are set by the Covenant Health CEO in consultation with appropriate Executive Vice Presidents and the Senior Vice President-Human Resources, after review by and discussion with the executive compensation consultant ("the Consultant") to ensure that total compensation is reasonable and within a fair market value range. Salary ranges are based upon the recommendations of the Consultant made after comparison with similar jobs in similar size health systems across the nation. Bonuses are recommended by the CEO and reviewed with the Committee conditioned upon receipt of a written opinion from the Consultant that total compensation for the executive is reasonable and consistent with fair market value. Base salary is initially targeted at the 25th percentile and may vary according to market conditions, performance, tenure, experience, special skills or qualifications, recruitment and retention challenges, and other relevant factors. Annual bonuses are designed to award 0-35% of base salary based upon system performance and accomplishment of certain targets established by the CEO. Base salaries and annual bonus opportunities for other officers and key employees are based on targets established by historical compensation consultant data and the Covenant Health Compensation department. Salary ranges are based upon comparison with similar jobs in similar size health systems across the nation. Base salaries and bonuses are approved by Executive Leadership predicated upon performance, and are reasonable and consistent with fair market value. Base salaries are initially targeted at midpoint and may vary according to market conditions, performance, tenure, experience, special skills or qualifications, recruitment and retention challenges, and other relevant factors. Annual bonuses are designed to award 0 - 20% of base salary based upon system performance and accomplishment of certain targets established by Executive Leadership. Form 990, Part VI, Section C, line 19 Fort Loudoun Medical Center files a joint annual report containing financial information with the Tennessee Department of Health. Per its tax exempt bond provisions, Covenant Health, the parent company of the organization, is required to file quarterly and annual consolidated and obligated group financial statements and other documentation with various bond insurers and other agencies, including the Electronic Municipal Market Access (EMMA) service of the Municipal Securities Rulemaking Board (MSRB). Any member of such a repository has access to these financial statements. The organization's governing documents and conflict of interest policy are not made publicly available. Form 990, Part IX, line 11g Intercompany Purchased Services: Program service expenses 1,637,534. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,637,534. Other Purchased Services: Program service expenses 3,139,885. Management and general expenses 55,250. Fundraising expenses 0. Total expenses 3,195,135. Sponsorship Fees: Program service expenses 2,482,046. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,482,046. Form 990, Part XI, line 9: Transfers of Capital -4,192,209. 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