2023-11-14T06:39:02-06:00 2022-12-31 990 2022-01-01 680673354 Roane County Medical Center ROAN 8653743140 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 JOSEPH C DOLAN EVP/CFO 8653746872 2023-11-08 JOSEPH DOLAN 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Roane Medical Center James D VanderSteeg 244 Ft Sanders W Blvd Knoxville TN 37922 49088432 0 X www.covenanthealth.com/roane/ X 2008 TN Roane County Medical Center is a 54-bed full service, acute care hospital located in Harriman, TN. It is a member of the Covenant Health system. 23 22 343 56 21274 18247 3740979 871313 44599543 47813076 15661 5862 225292 264796 48581475 48955047 1750 1650 0 0 16163982 16880756 0 0 0 26136113 30521235 42301845 47403641 6279630 1551406 54535174 52766609 4807430 4491812 49727744 48274797 X Roane County 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 45585355 1650 47845342 Roane County Medical Center, doing business as Roane Medical Center ("Roane"), located in Harriman, Tennessee, has been serving the community since 2008 and previously served the community as a county hospital. A new state-of-the-art hospital was built and opened in February 2013.SERVICERoane Medical Center is a 54-bed hospital offering quality medical, surgical and critical care, emergency services, rehabilitation support, diagnostic imaging and health education. Roane's dedicated staff provides specialized care in cardiac and pulmonary rehabilitation, women's services, inpatient/outpatient rehabilitation and sleep services.In 2022 the hospital saw 59,836 patients. Of these, 56,852 were outpatients and 2,984 were inpatients with an average length-of-stay of 4.17 days. PUTTING PATIENTS FIRSTRoane is certified by The Joint Commission as an Advanced Primary Stroke Center and is a member of Covenant Health's stroke hospital network, providing rapid diagnosis and treatment of stroke. The hospital is also accredited in magnetic resonance imaging by the American College of Radiology. Roane's cardiac diagnostics and interventional services provide comprehensive heart care to patients in the surrounding community. These services meet evidence-based standards recommended by organizations such as the American Heart Association, American College of Cardiology, Society of Nuclear Medicine and Molecular Imaging, and the American Society of Echocardiography. Roane's emergency room has 15 suites with dedicated rooms for cardiac, major treatment and orthopedic emergencies. It is staffed 24 hours a day by healthcare professionals with advanced training in adult and pediatric emergencies. A helicopter pad makes air medical transport services available when needed. IMPROVING THE COMMUNITY'S QUALITY OF LIFE THROUGH BETTER HEALTHAs an active organizational participant in community outreach programs, Roane partners with Mid-East Senior Services and UT Extension Services to expand access for seniors to participate in a congregate feeding program, which regularly offers meals at the hospital for senior adults. Roane has had an active Patient/Family Partnership Council since 2017. The group meets regularly to identify any service concerns that might benefit from a hospital/community collaboration. Current members include a surgery RN, a chaplain (and former Information Technology professional), the Director of Health Services/NCM/Therapy at Michael Dunn Center, a cardiac rehab RN, a chaplain and retired director of the Michael Dunn Center, a chaplain and minister at Kingston United Methodist Church, a nuclear medicine technician, and the hospital's patient experience manager, who is also an RN. The group's latest project is a focus group for patient experience in the Emergency Department. Roane currently has 28 community volunteer chaplains who are on-call for pastoral needs for patients, families or employees. The group meets monthly and recently heard a presentation from the ED manager regarding how chaplains can meet the specific needs of patients, families and staff in the Emergency Department. About half the volunteer chaplains currently pastor churches, while the other half are retired and/or lay leaders in their congregations. Covenant Health Roane 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.Roane, 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.IMPACT OF COVID-19In 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. 45585355 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 1 1 0 0 1 51 0 1 343 1 1 1 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 Jason B Pilant President & CAO 50.00 0.00 X 0 343669 40944 Rick A Carringer Fmr VP - Fin Svcs (through Mar 2022) 0.00 50.00 X 0 280698 29083 Catherine M Bunch VP - Financial Services 20.00 30.00 X 0 151800 5535 Brenda F Gray VP - Chief Nursing Officer 50.00 0.00 X 183868 0 7274 Matthew P Magee Manager Rehab Services 50.00 0.00 X 117611 0 36090 Ayn M Brockman Clinical Nurse - IV CCU 50.00 0.00 X 105517 0 25197 Laura K Jennings Rish Clinical Nurse 50.00 0.00 X 102179 0 5592 Elissa G Jolly Fmr RMC Pres/CAO; Curr LMC Pres/CAO 0.00 50.00 X 0 230362 17415 Carolyn S Shipley Fmr RMC VP-CNO; Curr LMC VP-CNO 0.00 50.00 X 0 180550 26554 509175 4649218 543657 4 1 1 0 Canon Medical Systems USA Inc 2441 Michelle Drive Tustin CA 92780 Maintenance & Support 915120 SRS Telemedicine PO Box 198813 Nashville TN 37219 Physician Fees 521030 Linen King LLC 1521 W 36th Pl Tulsa OK 74107 Linen Service 338280 Johnson & Galyon Inc PO Box 3070 Knoxville TN 37927 Construction Services 210515 Your Home Team Care LLC 300 N Winston Rd Ste 403 Knoxville TN 37919 Patient Sitters 194296 9 3794 867519 871313 Net Patient Revenue 622110 47784240 47784240 Rental Income - Exempt Affiliates 531120 28836 28836 47813076 5862 5862 154227 133385 20842 20842 21274 -432 Cafeteria 722514 144545 144545 Gift Shop 459420 54268 54268 Sleep Clinic 621400 32266 32266 12875 12875 243954 48955047 47845342 21274 217118 X 1650 1650 191142 191142 13522269 12967569 554700 441750 425896 15854 1757221 1668408 88813 968374 920295 48079 4943780 4805829 137951 5767 5767 9091754 9011081 80673 49664 47240 2424 326591 208412 118179 1886872 1518940 367932 5823 5726 97 11949 9603 2346 3119736 3053796 65940 49829 48596 1233 Medical Supplies 4881894 4881894 Bad Debt 4170577 4170577 Minor Equipment 1283103 1237292 45811 Food and Dietary 307972 305840 2132 385924 296711 89213 47403641 45585355 1818286 0 1550 1550 5670 1749 4007790 4763044 387692 309041 161611 234101 79088492 32027476 48518431 47061016 1452430 396108 54535174 52766609 4354125 3570244 453305 921568 4807430 4491812 X 49727744 48274797 49727744 48274797 54535174 52766609 X 1551406 -3004353 X 0 1 X 1 1 1 X 4092049 4092049 46337342 11578148 34759194 49725 6289 43436 28609376 20443039 8166337 47061016 Deferred Revenue 20126 Due to Affiliates, Net 188316 Due to Third Party Payors 399539 Long-Term Deferred Compensation 42043 Long-Term Reserve for Workers Comp 100000 Operating and Finance Leases 163326 Other Liabilities 8218 921568 X Part X, Line 2: Excerpt from the consolidated audited financial statements of Covenant Health (Covenant), parent company to Roane County 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 3297799 3297799 0.07630 9679723 8103349 1576374 0.03650 4155 10390 0 0.00000 12981677 8113739 4874173 0.11280 43952 43952 0.00100 93 93 0.00000 1840272 1840272 0.04260 11633 11633 0.00030 1895950 1895950 0.04390 14877627 8113739 6770123 0.15670 3949 3949 0.00010 799 799 0.00000 37 37 0.00000 4785 4785 0.00010 1 4170577 1116307 8834357 7550259 1284098 X 1 1 1 1 Roane County Medical Center 8045 Roane Medical Center Dr Harriman TN 37748 www.covenanthealth.com/roane 00000098 X X X Roane Medical Center 1 0 0 1 X X X X X X X X 22 1 0 1 1 X See Part V, Page 8 X 1 22 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 Roane Medical Center Part V, Section B, Line 5: Roane County Medical Center d/b/a Roane Medical Center ("Roane") conducted its fourth Community Health Needs Assessment ("CHNA") in 2022. A Steering Committee was formed to guide the assessment process and included the Roane County Health Department, Roane Alliance, Roane Medical Center, Roane County Health Council, UT Extension, Free Medical Clinic, Ridgeview Behavioral Health, and the Roane County Anti-Drug Coalition. 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 Roane County household survey and to host two focus groups of community leaders, each of which represented a part of the overall Roane County public health system. The household survey collected information from nearly 300 Roane 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, UT Extension Office, and several community leaders. Roane Medical Center Part V, Section B, Line 6b: Though Roane'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 Roane County Health Department and the Tennessee Department of Public Health (Nashville, TN).Additionally, focus groups were beneficial in discussing and identifying community needs in Roane County. Organizations and individuals participating in the focus groups include:- Local pastor - Roane County Health Department- Leadership Roane County - Mid-East Office on Aging- Roane Alliance - Roane County Mayor's office- Free Medical Clinic - Local nurses and physicians- Kingston Rotary Club - Roane County Anti-Drug Coalition- Ridgeview Behavioral Health - Senior Advocate- Roane County Chamber of Commerce - Roane County Schools- UT Extension Office - Roane County Sheriff's office- Roane County Health Council Roane Medical Center Part V, Section B, Line 11: At the conclusion of the 2022 assessment process, the Data Team identified a top ten list of health priorities and further refined this list into the top 4 most significant health issues. The top four identified community needs (in order of priority) are: Substance Abuse Disorder, Mental Health Access, Health Education for Chronic Diseases, and Improving Access to Healthcare Providers - Primary Care, Behavioral Health and Dentist.Roane updated its 2022 Implementation Plan based on the identified needs and plans to address all of the identified issues in the following ways:1. Substance Abuse DisorderRoane County Anti-Drug Coalition - Roane will continue to actively participate in the Anti-Drug Coalition and its outreach activities. Roane prints marketing materials, provides health education and provides items for care packages with the goal of reducing youth substance use and educating and raising awareness of alcohol, tobacco, and other drug issues in Roane County.Opioid Light Protocol - Roane will continue to build upon the successes of its Emergency Department use of Opioid Light. Emergency Department physicians, when possible, are using non-opioid pain medications during treatment and at discharge.In-patient Pain Management Initiative - Roane is teaching in-patients how to better manage pain with alternatives like repositioning, ice packs, and pain scales (1-10).2. Mental Health AccessTelehealth Options for Psychiatric Access - Roane is using telehealth options for patients with mental health needs. Services began in the Emergency Department("ED")and have been expanded to inpatients. ED physicians are being trained to use certain medications which allows the opportunity to begin treatment sooner for psychosis patients while they are waiting for facility placement. - Ridgeview Behavioral Health Services is a tax-exempt community mental health center based in Oak Ridge, Tennessee, which is expanding its services into Roane County. Roane contracts for use of its mobile crisis unit to assist in treating and caring for mental health patients within the community.3. Health Education for Chronic DiseaseDiabetes Education - Roane recently hired new dietician staff members to focus on patient nutrition and education, including community health fairs.Education in Local Schools - Roane is focused on a school education program, including a presentation on the dangers of smoking and vaping.Stroke Education - Roane will regularly provide community education programs on Stroke Signs and Symptoms to emphasize the importance of getting someone to the hospital for better outcomes. Additionally, the Unit Practice Council of Nurses will expand community education outreach to include stroke, organ donation, and advance directives.Senior Nutrition Program - Roane offers a nutrition program for seniors age 60 or older, including cafe style dining at the hospital cafeteria to encourage healthy lifestyles. In partnership with Mid-East Community Action Agency, the hospital also sponsors a local Meals on Wheels program to deliver meals to homebound seniors in Roane County. Though COVID-19 impacted these programs, the hospital is committed to continued support in the future.Continuing Health Education upon Discharge - Roane utilizes a patient portal allowing patients access to educational videos on various chronic diseases. Patients are provided videos for a new diagnosis and given access in the hospital room. The hospital recently expanded such services to include access via a patient's phone or computer. 4. Improving Access to HealthcareRound about Roane - Roane was a founding member of the design and implementation of Round about Roane, a community transportation program for seniors. Due to COVID-19, the program is currently suspended; however Roane is actively seeking volunteers in hopes of starting the program again. Free Medical Clinic of Oak Ridge - Roane is a partner with the Free Medical Clinic in Roane County. The hospital provides lab and imaging services to the Clinic's patients at no charge and has recently expanded to include procedures. The Pharmacy Advocate Program previously conducted by Roane is now provided within the Free Medical Clinic. The Pharmacy Advocate helps both discharging hospital patients and primary care clinic patients who have little or no insurance find programs to assist in maintenance medicines for chronic medical conditions.Expansion of Telehealth Services - In an effort to expand access to health services in the community, Roane offers telehealth services for nephrology and neurology, allowing medical providers outside of the community to treat patients in Roane County. Partnering with Covenant Health, the critical care department also utilizes telehealth for patient monitoring of ICU patients. Upon discharge, patients are also provided with information on access to follow-up health services via telehealth. Working with Local Partners - Roane will continue regular meetings with organizations such as Roane Health Council, Patient Family Partnership Council, and the Roane County Sheriff's Department to collaborate to improve access to healthcare in Roane County. Examples of Roane's efforts with these organizations include a community baby shower where local mothers receive free diapers; food drives in partnership with Hands of Mercy, the local food pantry; and wellness checks with seniors who may not be able to otherwise receive medical care. Roane 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/roane/chna/ Part V, Line 10a, Implementation Strategy Website https://www.covenanthealth.com/roane/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 - RMC Patricia Neal Outpatient Center 8035 Medical Center Drive Ste 120 Harriman TN 37748 Rehabilitation Therapy Center 2 - RMC Sleep Center 8045 Roane Medical Center Drive Harriman TN 37748 Sleep Diagnostic Center 3 - RMC Cardiopulmonary Rehab 8035 Roane Medical Center Dr Ste 110 Harriman TN 37748 Cardiopulmonary Rehab. Center Part I, Line 3c: In addition to the Federal Poverty Guidelines ("FPG"), Roane 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 third party 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 Roane 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 for those services. The organization has included $1,840,272 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 $4,170,577. Part II, Community Building Activities: Roane 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 Roane 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: Roane 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: Roane 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 64% 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.Roane 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 Roane 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. Roane 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. Roane does not sell any accounts receivable accounts to outside firms. All accounts remain property of and under the policies set by Roane. Roane 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. Roane obtains additional community information through the service of its employees with the Roane County Chamber of Commerce, Roane County Health Council, local Rotary Clubs, and Roane ElderWatch, and by partnering with the local justice system to combat prescription drug abuse. 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. Roane 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 Roane 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 Roane Medical Center will provide, at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling 865-316-2303, Monday through Friday between the hours of 8:00 a.m.-4:30 p.m. Additional information regarding financial assistance is also available on our website at www.roanemedical.com.Signage at the registration areas state the following:It is Roane 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 RoaneMedical.com. A financial counselor is available to assist you with these matters by calling 865-316-2303, Monday through Friday between the hours of 8 a.m.-4:30 p.m. Part VI, Line 4: Roane County is the primary market area for Roane. It is the only hospital in the county, which is in close proximity to the metropolitan Knoxville area. Although Roane serves patients from multiple counties, 75% of its inpatients and 70% of its outpatient encounters come from Roane County.The following statistics are taken from the 2022 County Ranking Data from the Robert Wood Johnson Foundation. The population is 53,841, indicating very little change since the 2019 assessment. The population of Roane County is 50.9% female and Caucasian (92.3%). The median household income is $59,000. The percentage of county residents over the age of 65 is 23.9%, and 18.5% of the population are under the age of 18. Nearly 13% of the adult population are uninsured as are 4% of children. The unemployment rate is 6.6% for 2022. The dominant labor force is from the manufacturing sector (20.3%).In support of the significant findings from the 2022 CHNA, the following data points support the conclusions of the 2022 assessment:Substance Abuse Disorder - With a county population of 53,036, there are 15,819 patients receiving opioids for pain. - There were 1,423 opioid prescriptions written for every 1,000 adults in Roane County. - Eighty-eight percent of the survey respondents identified substance abuse as the number one health problem in Roane County.Health Education for Chronic Diseases - The leading causes of death in Roane County over the past decade include, in rank order, heart disease and cancer (tied for #1), accidents and adverse effects, COVID-19, respiratory disease, stroke, Alzheimer's disease, diabetes, kidney disease and flu and pneumonia. Most all of these are to a large degree preventable. - Access to community health education programming is lacking in Roane County.Mental Health Services - The Mental health provider ratio in Roane County is one provider per 2,210 residents. The State of Tennessee overall ratio is one provider per 700 residents. - Community leaders, when ranking the top health priorities, had substance abuse and mental health tied for first place.Improving Access to Healthcare - Transportation continues to be a barrier for many people trying to access health services. Existing services are focused on the senior population. - There is a lack of mental health providers in the county. - Many residents are under-insured, most having health insurance with high deductibles. Part VI, Line 5: Roane, 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 Roane's board. The board is comprised of independent community leaders with diverse educational and professional backgrounds. The board provides governance and oversight of Roane. Roane 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: Roane, 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.Roane's 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, 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 X 1 1 1 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 Jason B Pilant President & CAO 0 217828 0 74128 0 51713 0 11600 0 29344 0 384613 0 0 Rick A Carringer Fmr VP - Fin Svcs (through Mar 2022) 0 212745 0 38950 0 29003 0 18432 0 10651 0 309781 0 0 Elissa G Jolly Fmr RMC Pres/CAO; Curr LMC Pres/CAO 0 48903 0 85952 0 95507 0 11600 0 5815 0 247777 0 0 Carolyn S Shipley Fmr RMC VP-CNO; Curr LMC VP-CNO 0 86866 0 28505 0 65179 0 6509 0 20045 0 207104 0 0 Brenda F Gray VP - Chief Nursing Officer 135453 0 27973 0 20442 0 6396 0 878 0 191142 0 0 0 Catherine M Bunch VP - Financial Services 0 135899 0 10000 0 5901 0 0 0 5535 0 157335 0 0 Matthew P Magee Manager Rehab Services 111183 0 1720 0 4708 0 6974 0 29116 0 153701 0 0 0 Part I, Line 1a Tax gross-up payments related to deferred compensation and reimbursement of fees for personal services for legal and financial planning are provided to certain executives and managers. Amounts are included in taxable compensation. Part I, Line 3 Covenant Health, the parent company of Roane County 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, Lines 4a-b Carolyn Shipley, Former VP Chief Nursing Officer, received a severance payment of $55,384 during 2022. The amount is included in taxable compensation. Her termination date was August 22, 2022. 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 VI, Section A, line 6 Covenant Health is the sole member of Roane County Medical Center. Form 990, Part VI, Section A, line 7a Covenant Health's board of directors also serves as the board of directors for Roane County Medical Center. Form 990, Part VI, Section A, line 7b Governance decisions of Roane County 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 Roane County 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 Roane County Medical Center's CEO is included in response to Part VI, Section B, line 15b. Part VI, Section B, Line 15b: Base salary and annual bonus opportunities for Jason Pilant, 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 Roane County 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 Sponsorship Fees: Program service expenses 1,863,524. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,863,524. Intercompany Purchased Services: Program service expenses 1,576,926. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,576,926. Other fees for Services: Program service expenses 5,570,631. Management and general expenses 80,673. Fundraising expenses 0. Total expenses 5,651,304. Form 990, Part XI, line 9: Transfers of Capital -3,004,353. 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