2019-11-14T07:14:57-06:00 2018-12-31 990 2018-01-01 464420358 Claiborne Medical Center CLAI 8653743140 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 JOHN T GEPPI EVP/CFO 8653746872 2019-10-03 168.85.177.4 2019-11-14 08:14:40 ES P 9FAA1952C08CFF6F9E2CB5A334C8BD7C4DA173D5 9FAA1952C08CFF6F9E2CB5A334C8BD7C4DA173D5 2018 2020-03-31 21:24:44Z James D VanderSteeg 100 Ft Sanders W Blvd Knoxville TN 37922 27849194 0 X www.claibornemedicalcenter.com X 2013 TN Claiborne Medical Center is an 85-bed full service, acute care hospital located in Tazewell, TN. It also operates the Claiborne Health and Rehabilitation Center which is licensed for 100 beds. It is a member of the Covenant Health system. 18 16 449 30 106196 73200 136223 279390 27713193 27166081 2810 2379 207151 301718 28059377 27749568 8850 3000 0 0 14953842 16009411 0 0 0 16511425 15966697 31474117 31979108 -3414740 -4229540 13015689 13653885 3777391 3685850 9238298 9968035 X Claiborne 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 30524389 3000 27142187 Claiborne Medical Center ("Claiborne") opened in 1959 and serves the Tri-State area. It is located near the Cumberland Gap, in a rural area where healthcare is a much-needed service and more than 25 percent of the population is below the poverty line. Claiborne became part of the Covenant Health system in 2014.SERVICEClaiborne Medical Center is the only Covenant Health hospital with an ambulance service, which enhances area residents' ability to access health care. The hospital also operates Claiborne Health and Rehabilitation Center, a long-term care facility offering both short-term rehabilitation and residential care for those who can no longer live without assistance.In 2018, Claiborne provided care for 42,144 patients. Of these, 40,831 were outpatients and 1,313 were inpatients with an average length-of-stay of 3.36 days. PUTTING PATIENTS FIRSTThe hospital is best known for its surgical services, cardiac rehabilitation, a lymphedema program, and its nursing home and emergency medical services. The hospital is also a member of Covenant Health's stroke hospital network, which links Covenant Health's member hospitals in providing access to rapid diagnosis and treatment of stroke. Two full-time general surgeons are on staff, in addition to specialists who provide care on a on a part-time basis. Three surgical suites at Claiborne are equipped with integrated high-definition cameras and monitors to enhance the ability of the operating room team to view the surgical site. Laparoscopic surgery is also available. Claiborne offers imaging services that include a full-service clinical laboratory, digital mammography, high-definition MRI scans, CT services, echocardiography, and nuclear medicine. The imaging department is accredited by the American College of Radiology in five areas: CT scan, mammography, MRI, nuclear medicine, and ultrasound. Claiborne Health and Rehabilitation Center has been named a "Best Nursing Home and "Best Short Stay Rehabilitation" by U.S. News and World Report. Registered nurses, LPNs, and certified nursing assistants are on duty 24 hours a day. The Center provides physical, speech, and occupational therapy by licensed therapists, mental health services, podiatry, vision, dental and audiology services, and group activities. IMPROVING THE COMMUNITY'S QUALITY OF LIFE THROUGH BETTER HEALTHClaiborne joined with other community partners in 2018 to provide workshops about cancer, adverse childhood experiences, and falls prevention for seniors. The medical center has participated in a program to encourage more outdoor exercise in the community with a hiking program; provided on-site flu vaccinations for local business, industry, and community organizations; and partnered with the governor's health initiative to provide information to the community about breast cancer awareness. COVENANT HEALTH SYSTEMClaiborne 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 10,000 employees, affiliated physicians and volunteers, Covenant Health is the Knoxville area's largest employer and has been named by Forbes as a Best Employer four years in a row. 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.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.Claiborne, 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. 30524389 1 1 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 1 1 1 0 0 0 1 108 0 1 449 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 18 16 0 0 1 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 1237 0 Willard Campbell MD Director 0.00 1.00 X 0 0 0 Michael Casey MD Director 0.00 1.00 X 0 1572 0 Ronni Chandler Director 0.00 1.00 X 0 0 0 Mitchell Dickson MD Director 0.00 1.00 X 0 1612 0 James Fitzsimmons Director/Chair 0.00 1.00 X X 0 1081 0 James Gibson Director 0.00 1.00 X 0 1081 0 Eddie Mannis Former Director (through March 2018) 0.00 1.00 X 0 0 0 Timothy Matthews Director 0.00 1.00 X 0 1438 0 Larry Mauldin Director 0.00 1.00 X 0 1429 0 Joseph Metcalf MD Director 0.00 1.00 X 0 14046 0 Linda Ogle Director 0.00 1.00 X 0 0 0 Roger Osborne Director 0.00 1.00 X 0 0 0 Cosby Stone Director 0.00 1.00 X 0 0 0 Carl Storms Director 0.00 1.00 X 0 1563 0 Richard Swanson Director 0.00 1.00 X 0 0 0 David C Verble Director 0.00 1.00 X 0 0 0 Amber Wisner Director 0.00 1.00 X 0 1438 0 James D VanderSteeg President & CEO 0.00 50.00 X X 0 1578890 192255 John T Geppi EVP/CFO 0.00 50.00 X 0 951309 27744 Anthony L Spezia CEO - Emeritus 0.00 40.00 X 0 606147 15119 Patricia J Ketterman President & CAO 50.00 0.00 X 0 201156 21874 Erik J Hockman VP - Financial Services 50.00 0.00 X 115322 0 25003 Kathy P Kelley Pharmacist 40.00 0.00 X 136857 0 26090 Anthony W Rowe Pharmacist 40.00 0.00 X 130308 0 25230 Jodi L Whitaker VP - Chief Nursing Officer 50.00 0.00 X 108113 0 22208 Robert B Davis Physical Therapist 40.00 0.00 X 103955 0 19694 594555 3363999 375217 5 0 1 0 Hospital Medicine Associates Inc PO Box 634850 Cincinnati OH 45263 Physician Services 697500 Resource Anesthesia PC 12752 Kingston Pike Suite E 201 Knoxville TN 37934 Anesthesia Services 336441 Angelica Textile Services Inc PO Box 532268 Atlanta GA 30353 Linen Services 192220 Medic Regional Blood Center 1601 Ailor Avenue Knoxville TN 37921 Blood Processing 138986 Quest Diagnostics PO Box 912512 Pasadena CA 91110 Lab Services 138096 21 237653 41737 279390 Net Patient Revenue 622110 19125691 19125691 Nursing Home 623000 5730892 5730892 Ambulance Services 621910 2222285 2222285 Meaningful Use 900099 50874 50874 Laboratory 621511 23894 23894 12445 12445 27166081 2379 2379 224765 99626 125139 125139 82302 42837 Food Services 722514 101610 101610 Miscellaneous 900099 53247 53247 Gift Shop 453220 18377 18377 3345 3345 176579 27749568 27142187 106196 221795 3000 3000 140325 140325 13021237 12669384 351853 144840 139581 5259 1785724 1691245 94479 917285 864973 52312 1546188 1491147 55041 24260 24260 2895728 2792841 102887 21937 21937 86801 40229 46572 609189 554316 54873 24151 24144 7 12013 6921 5092 1162613 1162613 59276 59276 Unrelated Business Inco 8000 8000 Medical Supplies 3773113 3773113 Bad Debt 3237651 3237651 Minor equipment 1364838 935170 429668 1140939 1078785 62154 31979108 30524389 1454719 0 741510 1124168 2160308 2353215 518166 551546 253562 341193 9079731 4496167 4580315 4583564 4727828 4611830 34000 88369 13015689 13653885 3557973 3401656 219418 284194 3777391 3685850 X 9238298 9968035 9238298 9968035 13015689 13653885 X -4229540 -2064 4961341 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 766827 256237 510590 8250718 4239930 4010788 62186 62186 4583564 Due to Affiliates, Net 28828 Due to Third Party Payors 238382 Long-term Deferred Compensation 16984 284194 X Part X, Line 2: Excerpt from the consolidated audited financial statements of Covenant Health (Covenant), parent company to Claiborne 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, 2018. As such, no interest or penalties were recognized in the consolidated financial statements related to unrecognized tax benefits. At December 31, 2018, tax returns for 2015 through 2018 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, 2018. 1 1 X 1 X 1 X 1 1 1 0 1 1 3708176 50874 3657302 0.12720 4803976 3266736 1537240 0.05350 41758 79458 0 0.00000 8553910 3397068 5194542 0.18070 598797 598797 0.02080 10411 10411 0.00040 609208 609208 0.02120 9163118 3397068 5803750 0.20190 15 15 0.00000 520 520 0.00000 6034 6034 0.00020 72 72 0.00000 6641 6641 0.00020 1 3237651 728472 4806377 5120951 -314574 X 1 1 1 1 Claiborne Medical Center 1850 Old Knoxville Rd Tazewell TN 37879 www.claibornemedicalcenter.com 00000014 X X X Claiborne Medical Center 1 0 0 1 X X X X X X X X 17 1 0 1 1 X See Part V, Page 8 X 1 17 1 See Part V, Page 8 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X 1 X https://www.claibornemedicalcenter.com/financial-assistance/ X https://www.claibornemedicalcenter.com/financial-assistance/ X https://www.claibornemedicalcenter.com/financial-assistance/ X X X X X X 1 X 0 X X X 1 X 0 0 Claiborne Medical Center Part V, Section B, Line 5: Claiborne Medical Center ("CMC") was guided in the assessment process by representatives of several community organizations whose expertise and relationships helped the hospital access the general population as well as the most vulnerable residents of Claiborne County. Assessment partners were recruited from the broader public health system including staff from the local health department, United Way director, local school system, court system, public safety, senior programs, and social service organizations that serve the needs of the community's most vulnerable and at-risk population. The assessment process began with a half-day community health forum using an assessment tool "Forces of Change" by the Center for Disease Control. Twenty-eight participants representing a diverse make up of stakeholders gave input into the significant issues facing Claiborne. The Data Team members represented the health department, Servolution, the Claiborne Health Council, East Tennessee Human Resource Agency, DeRoyal Industries, and Citizens Bank. These community leaders analyzed and distilled volumes of data into a short list of the most significant health issues affecting Claiborne County.Part V, Section B, Line 4:It was determined per audit that while the Community Health Needs Assessment ("CHNA") was prepared as of December 31, 2016, it was completed on May 8, 2017 with board approval. Claiborne Medical Center Part V, Section B, Line 6b: -Claiborne County Health Department -Stand in the Gap Coalition-Lincoln Memorial University -Chamber of Commerce-Claiborne County Children's Center -Servolution Health Clinic-Smoky Mountain Home Health -Tennessee Dept. Human Services-Amedisys Home Health Care -Claiborne County Office on Aging-Claiborne County Senior Center -Claiborne County Sheriff's Office-Claiborne County Economic Development -Cumberland Trail State Park-Claiborne County Schools -Walters State Community College-Tazewell Police Department -DeRoyal Industries-Lincoln Museum -Claiborne County Health Council-Family Resource Center -East Tennessee Human Resource Agency Claiborne Medical Center Part V, Section B, Line 11: CMC has adopted an implementation strategy to meet the community health needs identified and is focusing its resources on the following:Primary Care AccessPartnership with Lincoln Memorial University DeBusk College of Osteopathic Medicine:CMC provides its facility and other Covenant Health hospitals for clinical rotation and training of LMU-DCOM medical students. CMC and Covenant Health will seek to retain these physicians and place them in areas of need in East Tennessee. In 2018, DCOM medical students and PA students did rotations at CMC. CMC was also represented at the LMU-DCOM Hospital Day where Covenant representatives spoke with 1st and 2nd year LMU-DCOM students about the clinical rotations available at their respective hospitals. One LMU-DCOM graduate and one current DCOM instructor are employed at CMC as hospitalists through Team Health, and another graduate is employed at Claiborne Medical Associates located in the medical office building adjacent to Claiborne. CMC is a sponsor of the LMU-DCOM annual golf tournament, the proceeds of which provide scholarships for LMU-DCOM medical students. Community Health Fairs: CMC sponsors and participates in community health fairs to provide low or no cost access to screenings (bone density, blood pressure, blood sugar, cholesterol, and other lab tests) for a variety of audiences, including senior citizens and the local labor force. The hospital participated in two health fairs in 2018, did a presentation on fall prevention for the Tazewell Senior Citizens, and provided a cancer support workshop for the community on February 8th. Partnership with Servolution Health Services: Continue partnership with Servolution Health Services (a free health clinic) to provide free mammography screenings for people who are uninsured or under-insured. The CMC Marketing Manager is a member of the Servolution Health Services Advisory Board, and CMC has provided sponsorships for Servolution fundraising events. Both the hospital and Servolution are members of the Claiborne County Health Council and the Claiborne Senior Citizens Interagency Council. The CEO of Servolution is also a member of the Claiborne Medical Center Patient and Family Partnership Council, which partners with the hospital to suggest improvements and provide input on hospital services. Community Flu Shot Program: CMC will continue its community flu shot program, providing on-site flu vaccinations for local business, industry, and community organizations. During 2018, CMC provided 450 flu shots for local businesses and industries in Claiborne County. Obesity"Get on the Trails" Patch Program: Beginning in 2017, CMC initiated a program with the Cumberland Gap National Historical Park to encourage residents to exercise by walking the local trails. Each participant agrees to walk 25 miles during a two-month period, record their trails and distances and upon completion of the program will receive an embroidered patch. Each subsequent year will have a new patch to be earned. CMC promoted this program to its employees and to the broader community. The 2018 Pioneer Patch program was held in Fall 2018 (September-December), with participants walking/hiking 26 miles on trails in the Cumberland Gap National Historical Park or other nearby walking trails. Partnership with the Claiborne County Health Council:CMC will continue its partnership with the Claiborne County Health Council to promote school and community walking trails and healthy activities for families such as the annual "Race for School Health" 5k race, and the development of raised garden beds at all the elementary and middle schools in Claiborne County. The Claiborne County Health Council is also participating in the "Change Claiborne" community health initiative through the Governor's office, with CMC setting up an information table at Change Claiborne's Breast Cancer Awareness Walk/Run on October 16. Health Hiking Events with Missy Kane: CMC initiated a hiking program in a collaborative effort with Servolution Clinic. Local hikes were promoted to patients of the clinic and Covenant Health's health promotion coordinator, Missy Kane held a Hiking 101 workshop for the community at CMC. TransportationPartner with Claiborne County Office on Aging on SMiles (Senior Smiles) Program: As part of the Claiborne Senior Citizen Advisory Council, CMC is a partner in the establishment of SMiles (Senior Smiles), a senior citizen transportation program. CMC will continue its partnership and assist with advertising and fundraising efforts to support the program. Most of the transportation trips are for healthcare needs. As part of the Claiborne Senior Citizen Interagency Council, CMC provides input and support into the SMiles program. Recruit Specialty Physicians: Recruit specialists to see patients locally at the Claiborne Medical Center Outpatient Specialty Clinic, reducing the need for residents to drive long distances for medical care. In 2018 the clinic leased space to the following specialists: OB/GYN, vascular surgery, urology, gastroenterology, pulmonary, and podiatry. Increase Physician Connectivity: Continue program to develop effective referral system between local primary care physicians and physician extenders (physician assistants and nurse practioners) with specialists who see patients at the Claiborne Medical Center Outpatient Specialty Clinic, so that patients with transportation difficulties can see specialists locally. Claiborne has a part-time physician relations staff member who visits primary care physicians, PA's, and nurse practioners in Claiborne, Union, Hancock, and Grainger counties in Tennessee, and in Bell County, KY and Lee County, VA. The staff member creates calendars listing the specialists' office days and the cardiology schedule on a monthly basis, and provides information on new physicians and hospital services. CMC also conducts quarterly physician office manager meeting to network with the office managers, answer questions, and provide information.Opioid AbuseEducation:CMC partnered with the Claiborne County Health Council to host a community health symposium to educate the public on opioid use/abuse in Claiborne County. The symposium included a speaker from the state of Tennessee who spoke about Adverse Childhood Experiences (ACE), and how issues such as parental drug use affects their children. As a member of the Claiborne Health Council, CMC also partners with Appalachian Promise, a local non-profit that assists those with drug issues to get treatment and support. Sponsor Prescription Drug Take-Back Events: Partner with the Claiborne County Health Department to sponsor drug take-back events in Claiborne County and CMC sponsored health fairs and events. CMC continues to work with the Sheriff's Department to schedule additional events in 2019. Dental CareCMC chooses not to develop strategies and tactics around the priority of dental care as that is not within the hospital's ability to address, either by resources or expertise. However, the hospital will support the efforts of the Servolution free clinic, which provides free dental services to residents without insurance. Claiborne 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 www.claibornemedicalcenter.com/community-health-needs-assessment/ Part V, Line 10a, Implementation Strategy Website www.claibornemedicalcenter.com/community-health-needs-assessment/ 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. 2 1 - Claiborne Health & Rehabilitation Ctr 1850 Old Knoxville Road Tazewell TN 37879 Skilled Nursing Facility 2 - Claiborne EMS LLC 1809 Old Knoxville Road Tazewell TN 37879 Ambulance Service Part I, Line 3c: In addition to the FPG (federal poverty guidelines), CMC 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). Part I, Line 6a: Covenant Health, the parent company of CMC 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 total includes $598,797 in physician sponsorship fees. 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 $3,237,651. Part II, Community Building Activities: CMC 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 2018 were made to organizations meeting the community's needs by providing: - The basic needs of life including temporary shelter, food and clothing (Catholic Charities and Ladies of Charity) - Youth mentoring, development and after-school programs (Emerald Youth Foundation, Boys and Girls Club, The Change Center, Young Life, Williams Creek Youth Foundation and the Dollywood Foundation) - Business recruitment and marketing initiatives that boost economic development (East Tennessee Economic Development Agency and Knoxville Urban League) - Leadership development programs and workshops (Leadership Knoxville and Junior Achievement) - Assistance and special programs for at risk older adults, people with physical and mental challenges, and abused and neglected children (Senior Citizens Home Assist, Sertoma Center, Inc., East TN Technology Access Center, and Variety-The Children's Charity of Eastern Tennessee) - Improve access to health services (Interfaith Health Clinic, St. Mary's Legacy Clinic, and Knoxville Academy of Medicine) - Programs supporting patients and their families (Alzheimer's Tennessee, Cancer Support Community, Inc. and Random Acts of Flowers) 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 expense. 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: The amount reported on Line 3 was estimated by multiplying self-pay bad debt by the percentage of the population living below the poverty level on a county-by-county basis. It is our belief that the amount of bad debt on Line 3 should be included as community benefit. As a tax-exempt hospital, we must provide necessary services regardless of the patient's ability to pay for the service provided. As a not-for-profit hospital, patient care is provided to all, regardless of ability to pay for that care. Making quality patient care available to all in our community, regardless of economic means, qualifies bad debts as a community benefit. Part III, Line 4: Note B to the 2018 Audited Consolidated Financial Statements of the Covenant Health system, of which Claiborne Medical Center 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: Medicare Shortfall: CMC believes that all of the $314,574 shortfall reported in Line 7 should be considered as community benefit. The IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in our community. This year, Medicare patients accounted for 32% of total patient days (1,222 out of 3,826 total). The hospital provides care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries.Costing Methodology: CMC 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: CMC 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 71% 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.CMC 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 CMC 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. CMC 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. CMC does not sell any accounts receivable accounts to outside firms. All accounts remain property of and under the policies set by CMC. CMC 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. CMC obtains additional community information through the service of its employees with the local Claiborne County Health Council and, also, through its relationship with the professors and staff of Lincoln Memorial University and the Debusk College of Osteopathic Medicine. Part VI, Line 3: CMC informs patients and other persons who may be billed for patient care about its FAP by posting a sign in the main registration area and including information about the FAP in patient booklets placed in all inpatient rooms. In addition, the FAP and application are available via the facility website and notice of the availability of financial assistance is communicated via patient billing statements. The following sign is posted at the main registration area:Financial Assistance: 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, staffs of Claiborne 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, Claiborne Medical Center, in compliance with Tennessee Code Annotated, Title 47, Chapter 18 and Title 68, will provide at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling 423-526-2193, Monday through Friday between the hours of 8:00 a.m. and 4:30 p.m.CMC employs full time financial counselors who meet with each uninsured patient. In addition, Claiborne Medical Center assists them with completion of a TennCare application and ensures the application is directed to the appropriate Department of Human Services.The FAP states that patients who are unable to pay and have exhausted all sources of payment assistance may be screened for potential charity care eligibility. According to the policy, the financial counselors initiate screening of the patient and/or guarantor by obtaining income and other financial information to determine eligibility for charity care or discounted services. Part VI, Line 4: Claiborne County, Tennessee is the primary market for Claiborne Medical Center. Claiborne is a rural community located approximately 50 miles from the metropolitan Knoxville area. Claiborne is the only hospital in the county. In 2018, Claiborne County residents accounted for 41% of the inpatient and 39% of the outpatient activity at Claiborne.The following statistics are taken from the 2018 County Health Ranking report of the Robert Wood Johnson Foundation. The population of Claiborne County is 31,757 with non-white residents making up 4.6%. The percentage of the population 65 and older is 19.2%. Youth under 18 years of age make up 19.3% of the population and 33% of these live in poverty, 32% in single parent homes. The largest employers are manufacturers of furniture, healthcare supplies and manufactured homes. Unemployment was 6.3% in 2018.According to the 2018 County Health Rankings Report of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, Claiborne County residents have the following health indicators that are above national benchmarks: Claiborne - TN - NationalAdult Smoking 23% - 22% - 14% Adult Obesity 27% - 32% - 26%Children in poverty 33% - 23% - 12% Low birth weight babies 10% - 9% - 6% Physical Inactivity 33% - 30% - 20% Drug Overdose Deaths 45 - 22 - 10 per 100,000 population Part VI, Line 5: CMC, 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 CMC's board. The board is comprised of independent community leaders with diverse educational and professional backgrounds. The board sets policies and provides oversight of CMC.CMC 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: CMC, 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.CMC 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.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 1023861 0 420000 0 135029 0 169408 0 22847 0 1771145 0 0 John T Geppi EVP/CFO 0 605182 0 251100 0 95027 0 10800 0 16944 0 979053 0 0 Anthony L Spezia CEO - Emeritus 0 49155 0 0 0 556992 0 10800 0 4319 0 621266 0 0 Patricia J Ketterman President & CAO 0 165990 0 23400 0 11766 0 7083 0 14791 0 223030 0 0 Kathy P Kelley Pharmacist 128054 0 0 0 8803 0 4119 0 21971 0 162947 0 0 0 Anthony W Rowe Pharmacist 123309 0 0 0 6999 0 3981 0 21249 0 155538 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 Claiborne 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 $158,608 are reported as deferred compensation on Schedule J, Part II, Column C. Contributions along with 2018 earnings of $19,018 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). Anthony L. Spezia retired as President and CEO in 2016 after serving Covenant Health for twenty years. Mr. Spezia was named CEO-Emeritus and continued serving the organization through early 2018 as a consultant. During 2018, Mr. Spezia received distributions from two NQDC plans resulting from contributions and associated earnings on contributions. Amounts vested in 2018 total $476,126 and are included in other reportable compensation on Schedule J, Part II, Column B(iii). Form 990, Part VI, Section A, line 4 In 2018, the Covenant Health system-wide bylaws were amended to provide that new directors who have not previously served on the board will be elected to an initial one-year term instead of three years (the previous standard). Amendments also grant authority to the compensation committee to negotiate and approve the CEO's compensation. The bylaws were also amended to authorize the board to establish special board committees which may be terminated by resolution of the board. The chairman of the board may establish special board committees to advise executive leadership, other board committees or the full board. Committees may be composed of elected or ex-officio board members. Also in 2018, Covenant Health adopted system-wide medical staff bylaws. The bylaws created two new committees: System Quality Committee and System Credentials and Clinical Standard Committee. The System Quality Committee consists of licensed physician voting board members, other appointed voting board members, Covenant Health's CEO, and the chiefs of staff of Covenant Health system hospitals. The committee shall review quality of patient care, perform other duties assigned in the system-wide medical staff documents, receive and review proposed amendments to the medical staff documents and make recommendations to the board, initiate quality-related investigations, and act as a Quality Improvement Committee as defined under Tennessee law. The System Credentials and Clinical Standard Committee consists of licensed physician voting board members and other appointed board members. Covenant Health's VP of Hospital Operations, Chief Medical Officer, and Chief Nursing Officer shall also serve as non-voting members of the committee. The committee shall develop and implement system-wide clinical standards, perform other duties as outlined in the medical staff documents, make determinations regarding routine credentialing matters and medial staff appointments/terminations, and act as a Quality Improvement Committee as defined under Tennessee law. Other 2018 amendments to the governing documents were not considered significant. Form 990, Part VI, Section A, line 6 Covenant Health is the sole member of Claiborne Medical Center. Form 990, Part VI, Section A, line 7a Covenant Health's board of directors also serve as the board of directors for Claiborne Medical Center. Form 990, Part VI, Section A, line 7b Governance decisions of Claiborne 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, the parent company of the organization, distributes a board-approved Code of Conduct to all employees. The Code covers among other subjects, conflicts of interest. Additionally, managers are required to complete and sign a bi-annual management certification that addresses conflicts of interest. 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 key employees. These records are available to be queried prior to engaging in business transactions. The Chief Compliance Officer initially reviews all 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 Overall compensation policies for Claiborne Medical Center, Covenant Health (Parent Company), and affiliates are set by the Compensation Committee of the board of directors ("the Committee"), which is comprised of independent members of the board. The Committee is guided in its decision-making process by an independent, nationally-recognized executive compensation consultant experienced in advising nonprofit hospital boards. The Covenant Health CEO is compensated by Covenant Health, and a detailed description of the compensation process is included on Covenant Health's 990. The process for Claiborne 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 Patricia Ketterman, President and Chief Administrative Officer, are set by the Covenant Health CEO in consultation with the Senior Vice President-Human Resources, subject to approval of the Compensation Committee of the Covenant Health board of directors ("the Committee"), 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 approved by 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 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 0-35% 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 intially 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 Claiborne 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 XI, line 9: Transfer of Capital 4,961,341. 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