2025-11-12T09:46:56-06:00 2024-12-31 990 2024-01-01 464420358 Claiborne Medical Center CLAI 8653745329 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 JOSEPH C DOLAN EVP/CFO 8653746872 2025-11-12 1 2024 2025-03-06 01:10:19Z Covenant Health Claiborne James D VanderSteeg 244 Ft Sanders W Blvd Knoxville TN 37922 37143056 0 X https://www.covenanthealth.com/claiborne 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. 20 19 464 25 64410 26350 20900 507543 36431950 36307195 19681 21258 123674 203233 36596205 37039229 5574 2075 0 0 19861606 21056045 0 0 0 17580775 17056310 37447955 38114430 -851750 -1075201 14194553 18461414 3809750 9151812 10384803 9309602 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 35942722 2075 36273063 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 health care is a much-needed service, and more than 23.1 percent of the population is below the poverty line. Claiborne became part of Covenant Health in 2014. Claiborne is also one of the largest employers in Claiborne County, with over 300 employees. Located near the state lines of Kentucky and Virginia, Claiborne serves citizens in Bell County, KY; Lee County, VA; and Claiborne and surrounding counties in East Tennessee.SERVICEClaiborne maintains an ambulance service, which enhances area residents' ability to access health care. Claiborne EMS is the primary 911 service for Claiborne County, and a helicopter pad located next to the hospital makes air medical transport services available when needed. 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 independently without assistance. Claiborne Health and Rehabilitation Center is currently rated a 4-star facility by the Centers for Medicare and Medicaid Services (CMS). In 2024 the Center was recognized by both Newsweek and U.S. News and World Report as a "Best Nursing Home."In 2024, the hospital provided care for 35,744 patients. Of these, 34,680 were outpatients and 1,064 were inpatients with an average length-of-stay of 3.49 days.PUTTING PATIENTS FIRSTCurrently licensed for 85 beds, the hospital is best known for its surgical services, cardiac rehabilitation, lymphedema program, nursing home, and emergency medical services. Claiborne is certified by The Joint Commission as an Acute Stroke-Ready hospital and is a member of Covenant Health's stroke hospital network, providing rapid diagnosis and treatment of stroke. Claiborne has two full-time general surgeons and one part-time orthopedic surgeon to provide excellent surgical care for patients.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 received both a new CT scanner and new MRI equipment in 2024.Claiborne was recognized in the spring and fall of 2024 with an "A" grade from The Leapfrog Group for patient safety and quality. The hospital was also recognized with the American Heart Association's Get With the Guidelines-Rural Stroke Bronze quality achievement award. The medical center also was recognized by Becker's Healthcare Review in 2024 for Top Hospitals in Nurse Communication, Doctor Communication, and Cleanliness. Recently Claiborne received three Zero Harm awards from the Tennessee Hospital Association for outstanding achievements in patient safety. The awards celebrate hospitals that reached zero healthcare-associated infections in certain areas over the calendar year.IMPROVING THE COMMUNITY'S QUALITY OF LIFE THROUGH BETTER HEALTH Claiborne completed a Community Health Needs Assessment in 2023 and identified four areas as health priorities in the community. As part of the Claiborne Health Council, Claiborne is working to develop projects to improve mental health, substance abuse disorders, diabetes, and obesity in Claiborne County. Teams have been developed for each focus area, and hospital staff are working on the obesity and diabetes teams. In 2024 these teams partnered with other members of the Claiborne County Health Council to provide community health education. One of the hospital's managers served on a community drug coalition led by Live Free, a local nonprofit that provides alcohol and drug addiction and mental health counseling.Claiborne EMS participated in several community events in 2024, including safety days at Midway and Forge Ridge Elementary Schools, training with the North Claiborne County Fire Department, and providing hands-only CPR education at several local events. Hospital staff also provided stroke education and emergency poison control education at the Claiborne County Fair in August 2024.Claiborne partnered with local high schools and colleges to provide expanded opportunities for students interested in pursuing healthcare careers. The hospital partnered with Cumberland Gap High School to encourage healthcare careers by offering hospital tours, job shadowing, and career day presentations. Claiborne also serves as a rotation site for nursing students from Walters State Community College and Lincoln Memorial University, as well as medical students from the LMU DeBusk College of Osteopathic Medicine who are doing rural hospital rotations.Claiborne also focuses on community education, with hospital staff visiting and presenting information to senior adults on a variety of topics, including breast cancer awareness. A senior health fair was held in May 2024, with Claiborne staff providing screenings and stroke education at the event. Hospital staff participated in community resource fairs and back-to-school events at Clairfield Elementary School and the Tazewell Municipal Park. In October 2024, the hospital partnered with the Claiborne County Health Department and hosted a breast cancer survivor's luncheon, providing education and support to local breast cancer survivors and those currently battling the disease. The hospital continues to work with the Claiborne Family Justice Center, and a hospital employee serves on the Justice Center's Coordinated Community Response (CCR) team. Claiborne also hosted Healthcare and Emergency Services Day for the Leadership Claiborne community leadership program.Hospital staff worked with the Claiborne County Healthcare Foundation to raise funds, including coordinating the 24th annual Golf for Great Healthcare tournament. Funds from the tournament were used to purchase furniture for the hospital's outpatient lobby and emergency department.Claiborne staff also participated in child-related activities, including having a hospital manager participate in the Pre-K Advisory Council for the Claiborne school system. Both the Chief Administrative Officer and the manager were members of the Wilderness Road Kiwanis, with the manager participating in reading events at Springdale and Midway elementary schools. 35942722 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 1 0 0 1 141 0 1 464 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 20 19 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Andrew McCreary 8653745329 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 Mitchell Dickson MD Director 0.00 1.00 X 0 0 0 Stephanie Flood Director 0.00 1.00 X 0 964 0 James Gibson Director 0.00 1.00 X 0 0 0 Edgar Gray Director 0.00 1.00 X 0 844 0 Leslye Hartsell Director 0.00 1.00 X 0 1124 0 Donald Hickman Director 0.00 1.00 X 0 675 0 Timothy Matthews Director 0.00 1.00 X 0 657 0 Janice McKinley Director 0.00 1.00 X 0 0 0 Cletus McMahon MD Director 0.00 1.00 X 0 0 0 Dave Miller Director 0.00 1.00 X 0 0 0 Bill Myers Director 0.00 1.00 X 0 0 0 Alvin Nance Director 0.00 1.00 X 0 648 0 Linda Ogle Director 0.00 1.00 X 0 0 0 King Purnell Director/Chair 0.00 1.00 X X 0 935 0 Jorge Sanabria Director 0.00 1.00 X 0 807 0 William Seale Director 0.00 1.00 X 0 1060 0 Cosby Stone Director 0.00 1.00 X 0 1113 0 Joe Sutter Director 0.00 1.00 X 0 881 0 James Tramontana MD Director 0.00 1.00 X 0 1086 0 James D VanderSteeg President & CEO 0.00 50.00 X X 0 2880556 362274 Joseph C Dolan EVP/CFO 0.00 50.00 X 0 861693 105608 Patricia J Ketterman Fmr Pres & CAO (through Aug 2024) 50.00 0.00 X 0 342437 24561 Jacqueline H Hounshell Fmr VP - Fin Svcs (through Aug 2024) 15.00 35.00 X 0 222480 42550 Gordon E Lintz President & CAO 15.00 35.00 X 0 564436 26089 Amy E Herndon VP - Financial Services 15.00 35.00 X 0 198501 28623 Anthony W Rowe Pharmacist 50.00 0.00 X 151865 0 35173 Vicki L Cornelius VP - Chief Nursing Officer 50.00 0.00 X 127106 0 24465 Robert B Davis Physical Therapist 50.00 0.00 X 107389 0 22211 William C Martin Clinical Nurse 50.00 0.00 X 104415 0 33169 Jodi L Whitaker Fmr VP - CNO 0.00 50.00 X 0 195709 38562 490775 5276606 743285 4 1 1 0 Resource Anesthesia PC 12752 Kingston Pike Suite E 201 Knoxville TN 37934 Anesthesia Services 686564 MedHost of TN Inc 2739 Momentum Place Chicago IL 60689 IT Services 562081 Preferred Surgical Associates 1610 Tazewell Rd Ste 301 Tazewell TN 37879 Surgical Services 244800 Johnson & Galyon Inc 1130 Atlantic Ave Knoxville TN 37917 Construction Services 229630 Linen King 1521 W 36th Place Tulsa OK 74170 Laundry Services 164971 8 4321 474222 29000 507543 Net Patient Revenue 622110 25571119 25571119 Nursing Home Revenue 623000 8225465 8225465 Ambulance Services 621910 2461203 2461203 Laboratory 621500 34132 34132 Rental - Exempt Affiliates 531120 15276 15276 36307195 19758 19758 194343 103827 90516 90516 30278 60238 1500 0 1500 1500 1500 Cafeteria 722514 57911 57911 Miscellaneous 900099 40890 40890 Gift Shop 459420 13916 13916 112717 37039229 36273063 64410 194213 2075 2075 16882369 16063408 818961 232988 217564 15424 2787403 2598090 189313 1153285 1076936 76349 2562465 2437335 125130 3208705 3084761 123944 8175 5920 2255 119480 115330 4150 728355 634215 94140 21554 21524 30 2139 2139 1462278 1462278 25589 25589 UBI Tax 2000 2000 Medical Supplies 3432016 3432016 Bad Debt 2605049 2605049 Minor Equipment 1553686 902878 650808 1324819 1281204 43615 38114430 35942722 2171708 0 1043381 2010697 2990271 4277850 235409 231227 413387 535343 18155769 11056968 5262843 7098801 4002840 4002840 246422 304656 14194553 18461414 3219214 3045716 590536 6106096 3809750 9151812 X 10384803 9309602 10384803 9309602 14194553 18461414 -1075201 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 766827 705129 61698 17252154 10351839 6900315 136788 136788 7098801 Due to Affiliates, Net 5598477 Due to Third Party Payors 382451 Long-Term Deferred Compensation 25911 Operating and Finance Leases 99257 6106096 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, 2024 and 2023. As such, no interest or penalties were recognized in the consolidated financial statements related to unrecognized tax benefits. At December 31, 2024 and 2023, tax returns for 2021 through 2024 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, 2024 and 2023. 1 1 X 1 X 1 X 1 1 1 0 1 1 1712678 1712678 0.04820 9367758 6009397 3358361 0.09460 19471 8991 10480 0.00030 11099907 6018388 5081519 0.14310 76 76 0.00000 681949 681949 0.01920 2110 2110 0.00010 684135 684135 0.01930 11784042 6018388 5765654 0.16240 20 20 0.00000 3697 3697 0.00010 421 421 0.00000 1112 1112 0.00000 170 170 0.00000 5420 5420 0.00010 1 2605049 484539 4983192 4381299 601893 X 1 1 1 1 Claiborne Medical Center 1850 Old Knoxville Rd Tazewell TN 37879 www.covenanthealth.com/claiborne 00000014 X X X Claiborne Medical Center 1 0 0 1 X X X X X X X X 23 1 0 1 1 X See Part V, Page 8 X 1 23 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 Claiborne Medical Center Part V, Section B, Line 5: Claiborne Medical Center ("Claiborne") conducted its fourth Community Health Needs Assessment ("CHNA") in 2023. A Steering Committee was formed to guide the assessment process and included the Claiborne County Health Department, Claiborne Medical Center, the Claiborne County Health Council, Claiborne Board of Education, Servolution Clinic, Live Free Claiborne, and the Tennessee Extension Service. 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 Claiborne County household survey and to host four focus groups of community leaders, each participant represented a part of the overall Claiborne County public health system. The household survey collected information from 340 Claiborne 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 Claiborne County Family Justice Center and Stand in the Gap Coalition. Claiborne Medical Center Part V, Section B, Line 6b: Focus groups were beneficial in discussing and identifying community needs in Claiborne County. Organizations and individuals participating in the focus groups include:- Claiborne Medical Center - County Mayor - Buchanan Place Health & Rehabilitation - Cherokee Health System - Claiborne Emergency Medical Services - Family Justice Center- Claiborne County Schools - Claiborne Board of Education- Claiborne Coordinated School Health - UT Extension Service- Claiborne County Health Council - Chamber of Commerce- Claiborne County Health Department - Harrogate Senior Center- Live Free Program - Stand in the Gap Coalition- Claiborne Health & Rehabilitation Center - Servolution Clinic - Walters State Community College Claiborne Medical Center Part V, Section B, Line 11: For 2023, the Steering Committee elected to use the same secondary health indicators that were used in the 2020 assessment. The indicators were updated to include the most current data points available. Additionally, COVID-19 statistics were included that did not exist in 2020. Updated demographics, leading causes of death, community survey results, focus group analysis and secondary data for dozens of health indicators was used by the Data Team to determine the most significant health priorities for the 2023 health assessment cycle. The Data Team used a methodology to determine whether the 2020 CHNA significant issues should be continuted, modified or replaced. New issues that may have emerged since the 2020 CHNA also were discussed for potential inclusion. Largely due to COVID-19, the Data Team consensus was to continue the four health priorities of the 2020 CHNA. Data team members felt each priority area of the 2020 assessment had worsened. Communities were faced with increased uncertainty and stress, many community resources were paused and healthcare organizations were pushed to the breaking point. Overall, the demand for health and human resources far outweighed the supply. The 2023 most significant health priorties for Claiborne County are Substance Abuse Disorders, Mental Health Access, Diabetes and Obesity. Claiborne adopted the 2024-2026 Implementation Plan and is focusing its resources on the following:1. Substance Abuse DisorderPeninsula Drug Treatment Program: - Claiborne can now refer patients to the Peninsula Medication Assistance Treatment program's Center for Outpatient Services for Substance Abuse. This program offers specialized medications and intensive therapy to treat substance abuse disorders. Community Drug Coalitions: - Claiborne will continue to support our multi-disciplinary coalitions to address substance abuse issues in Claiborne County. These coalitions include Stand in the Gap, the Claiborne Community Coalition, and the Claiborne County Opioid Board.Opioid Light Program: - Claiborne's Emergency Department is participating in a Covenant Health system-wide initiative to curb the use of hospital-prescribed opioids. Physicians are prescribing non-opioid drugs when indicated for pain management, both during treatment and upon discharge from the hospital. - Claiborne works in conjunction with other community resources, including the McNabb Center and the Claiborne County Opioid Board to address opioid issues. 2. Mental HealthBehavioral Health Services Expansion: - Psychiatric consult services are now being provided for patients in the Emergency Department and for inpatients at Claiborne via tele-video through Peninsula Behavioral Health. - Claiborne's patients can be referred to Cherokee Health Systems which is located 4.4 miles away from the hospital, or to the McNabb Center Mobile Health Clinic, which serves Claiborne County. - Covenant Health is using Foundation funding to offer supportive psychiatric social services to patients in the system's hospital Emergency Departments. This project began in the second quarter of 2021.3. DiabetesFree Community Education Classes/Workshops: - Claiborne will provide at least two "Lunch and Learn" community education programs yearly on diabetes and other healthy living topics. - Claiborne provides chronic disease education (e.g., diabetes) in conjunction with the Claiborne County Health Council and its partners. This includes programs such as "Take Charge of Your Diabetes and "Reversing Diabetes."Sponsor and Participate in Community Health Fairs: - Claiborne will sponsor and participate in community health fairs to provide low- or no-cost access to screenings (including blood sugar screenings) for a variety of audiences, including senior citizens and the local labor force.4. ObesityCovenant Kids Run: - Each year, as part of the Covenant Health Knoxville Marathon, children in kindergarten through 8th grades participate in the Covenant Kids Run. Participants work on completing 26.2 miles of activity with the final mile taking place on race day of the marathon. The intent of the program is to get youth to engage in physical activity and develop healthy habits. Claiborne and Covenant Health's marketing department will coordinate with the Claiborne County Schools to encourage participation.Promote Healthy Activities: - Continue partnership with the Claiborne Health Council and its members to promote healthy activities for students and families such as the Annual Race for School Health, Walk Across Tennessee and other activities. - Claiborne will sponsor a Spring community walking program in partnership with the Claiborne County Health Council and Change Claiborne. 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 https://www.covenanthealth.com/claiborne/chna/ Part V, Line 10a, Implementation Strategy Website https://www.covenanthealth.com/claiborne/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. 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 Federal Poverty Guidelines ("FPG"), Claiborne 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 Claiborne 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 $681,949 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 $2,605,049. Part II, Community Building Activities: Claiborne 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 access to care, tobacco use, and conditions such as diabetes and obesity, and help develop collaborative responses with other community organizations.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 2024 were made to organizations meeting the community's needs by providing: - The basic needs of life, including temporary shelter, food, clothing, and safety (Ladies of Charity, Seymour Volunteer Fire Department, YWCA Knoxville, Salvation Army, Clinch River Habitat for Humanity) - Youth mentoring, development and after-school programs (Emerald Youth Foundation, Boys and Girls Club, First Tee of Greater Knoxville, Great Smoky Mountain Council) - Business recruitment, education marketing and community initiatives that boost economic development and quality of life (Knoxville Technology Council, Pellissippi State Foundation, Tennessee Wesleyan University, University of Tennessee College of Nursing) - Leadership development programs and workshops (Knoxville Area Urban League, Leadership Knoxville) - Assistance and special programs for at-risk older adults, children and adults with physical or developmental challenges, and children who have experienced abuse, neglect or trauma (Knoxville-Knox County Community Action Committee, Senior Citizens Home Assistance Services, Sertoma Center, Friends of Tennessee's Babies with Special Needs, New Hope Children's Advocacy Center, Street Hope Tennessee, Variety Children's Charity of East Tennessee) - Improve access to health services (East TN Children's Hospital, McNabb Center, Metropolitan Drug Commission, Interfaith Health Center, Knoxville Academy of Medicine, Region II Emergency Medical Services, Renew Clinic) - Programs supporting patients and families (Alzheimer's Tennessee, American Heart Association, Angel Wings Memory Gowns, Cancer Support Community East Tennessee, East TN Veterans Memorial Association, Honor Air Knoxville, Knox County Imagination Library, Random Acts of Flowers, Spark, Survivor Fitness) 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. Claiborne uses the most recent data available from the U.S. Department of Agriculture Economic Research Service. Part III, Line 4: Note B to the 2024 Audited Consolidated Financial Statements of the Covenant Health system, of which Claiborne 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 receives payments for services rendered from federal and state agencies, managed care health plans, commercial insurance companies, employers and patients. Covenant recognizes that revenues and receivables from government agencies are significant to operations, but does not believe there are significant credit risks associated with these government agencies. Covenant does not believe there are any other significant concentrations of revenues from any particular payer that would subject Covenant to any significant credit risks in the collection of accounts receivable. 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: Claiborne 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: Claiborne 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 of Claiborne automatically receive a 72% 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.Claiborne 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 Claiborne 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. Claiborne 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 FAP, 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.Claiborne does not sell any accounts receivable accounts to outside firms. All accounts remain property of and under the policies set by Claiborne. Claiborne 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. Claiborne 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: 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. Claiborne 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 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 will provide, at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling 423-526-2327, Monday through Friday between the hours of 8 a.m.-3:30 p.m. Additional information regarding financial assistance is also available on our website at covenanthealth.com/claiborne/. Signage at the registration areas state the following:It is Claiborne 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 covenanthealth.com/claiborne/. A financial counselor is available to assist you with these matters by calling 423-526-2327, Monday through Friday between the hours of 8 a.m.-3:30 p.m. Part VI, Line 4: Claiborne County, Tennessee, is the primary market for Claiborne Medical Center. Claiborne County is a rural community located approximately 50 miles from the metropolitan Knoxville area. Claiborne is the only hospital in the county. In 2024, Claiborne County residents accounted for 59.72% of the inpatient and 59.72% of the outpatient activity at Claiborne Medical Center.The following statistics are taken from the 2024 Health Rankings of the Robert Wood Johnson Foundation. The population of Claiborne County is 32,431 with nonwhite residents making up 5.5%. The percentage of the population 65 and older is 20.5%. Youth under 18 years of age make up 19.0% of the population and 26% of these live in poverty, 22% in single parent homes. The largest employers are manufacturers of furniture, healthcare supplies and manufactured homes. Unemployment was 3.8% in 2024.Claiborne County residents have the following health indicators that are above national benchmarks: Claiborne TN National Adult Smoking: 25% - 20% - 15% Adult Obesity: 37% - 36% - 34% Children in poverty: 26% - 18% - 16% Dental Providers: 3,600:1 - 1,780:1 - 1,360:1 Physical Inactivity: 32% - 27% - 23% Part VI, Line 5: Claiborne, 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 voluntary Board of Directors serves as Claiborne's board. The board is comprised of independent community leaders with diverse educational and professional backgrounds. The board provides governance and oversight of Claiborne.Claiborne 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: 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.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.Claiborne 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. 1 1 1 0 0 0 0 0 0 0 James D VanderSteeg President & CEO 0 1578849 0 1078259 0 223448 0 335103 0 27171 0 3242830 0 0 Joseph C Dolan EVP/CFO 0 697828 0 138667 0 25198 0 72802 0 32806 0 967301 0 0 Gordon E Lintz President & CAO 0 387063 0 110000 0 67373 0 13200 0 12889 0 590525 0 0 Patricia J Ketterman Fmr Pres & CAO (through Aug 2024) 0 121127 0 50000 0 171310 0 10587 0 13974 0 366998 0 0 Jacqueline H Hounshell Fmr VP - Fin Svcs (through Aug 2024) 0 153925 0 29000 0 39555 0 9057 0 33493 0 265030 0 0 Jodi L Whitaker Fmr VP - CNO 0 145568 0 24000 0 26141 0 7118 0 31444 0 234271 0 0 Amy E Herndon VP - Financial Services 0 136570 0 25000 0 36931 0 6127 0 22496 0 227124 0 0 Anthony W Rowe Pharmacist 140871 0 0 0 10994 0 4631 0 30542 0 187038 0 0 0 Vicki L Cornelius VP - Chief Nursing Officer 110429 0 16000 0 677 0 3335 0 21130 0 151571 0 0 0 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, Lines 4a-b Patricia Ketterman, Former President and CAO, received a severance payment of $83,047 during 2024. The amount is included in taxable compensation. Her termination date was August 2, 2024. Covenant Health maintains a nonqualified deferred compensation ("NQDC") plan intended to support retention of President and CEO, James D. VanderSteeg, and EVP and CFO, Joseph C. Dolan. Employer contributions of $321,903 for James D. VanderSteeg and $72,802 for Joseph C. Dolan are reported as deferred compensation on Schedule J, Part II, Column C. Contributions along with 2024 earnings of $114,551 for James D. VanderSteeg and $4,468 for Joseph C. Dolan 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). Please note that the amounts included in Part II, Column C as contributions to the NQDC plan for James D. VanderSteeg and other executive leaders are deferred but NOT received during the filing year. We report compensation in both the year earned and the year paid, as required by IRS guidelines; however, wages appear overstated due to dual reporting of compensation earned in one year and distributed in a subsequent year. COVENANT HEALTH Claiborne is a member of Covenant Health. Covenant Health is a community-owned, clinically integrated healthcare enterprise dedicated to being the region's premier healthcare network through service, community, and innovation. Our mission is to improve the quality of life in our region through better health. Covenant Health provides patient-centered care that inspires clinical and service excellence and strives to be the first and best choice for the communities we serve. 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 composed 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 top employer by Forbes and Becker's Hospital Review. Covenant Health serves a 25-county area and includes nine acute care hospitals in East Tennessee: Fort Sanders Regional Medical Center and Parkwest Medical Center in Knoxville, Methodist Medical Center of Oak Ridge, 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. Peninsula provides behavioral health services at an inpatient hospital in Blount County and at outpatient locations in Knox, Blount, Loudon, and Sevier counties. The health system includes Covenant Medical Group, which serves patients at more than 90 office and clinic locations. CMG providers include primary care physicians and specialists in areas such as cardiology, gastroenterology, neurology, surgery, and other medical specialties. Covenant Health employs nearly 450 physicians and advanced practice clinicians throughout East Tennessee. Affiliated organizations include Thompson Cancer Survival Center, Thompson Oncology Group, Fortress Corporation and Subsidiaries, Covenant HomeCare, and Fort Sanders Perinatal Center. Covenant Health also operates Thompson Proton Center and offers innovative services such as Advanced Care at Home. Philanthropic organizations include Covenant Health Foundation and 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 to enhance patient care. Claiborne, as a member of Covenant Health, benefits from collaboration among all affiliated organizations to promote quality, patient safety, and excellence in delivering care. 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 makes available 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 the Covenant Health Executive Leadership Team 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 Claiborne 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 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 Gordon Lintz, 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 for the CAO 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 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. 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