2019-11-14T06:59:38-06:00 2018-12-31 990 2018-01-01 620790132 Cumberland Medical Center CUMB 8653743140 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 JOHN T GEPPI EVP/CFO 8653746872 2019-10-03 168.85.177.4 2019-11-14 07:59:19 ES P 9FAA1952C08CFF6F9E2CB5A334C8BD7C4DA173D5 9FAA1952C08CFF6F9E2CB5A334C8BD7C4DA173D5 2018 2020-03-31 21:24:44Z James D VanderSteeg 100 Ft Sanders W Blvd Knoxville TN 37922 79465264 0 X www.cmchealthcare.org X 1967 TN Cumberland Medical Center is a 189-bed full service, acute care hospital located in Crossville, TN. It is a member of the Covenant Health system. 18 16 851 136 1043893 0 54271 36575 84260901 76325920 207765 821743 1787232 1631161 86310169 78815399 2385 3634 0 0 31946500 34573841 0 0 0 53285795 44017000 85234680 78594475 1075489 220924 86828269 85259543 16331227 14874505 70497042 70385038 X Cumberland 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 the patient's ability to pay. 0 0 76465235 3634 76299123 Cumberland Medical Center ("Cumberland"),an acute-care hospital located on the Cumberland Plateau of Tennessee, has served the community for more than 65 years and joined Covenant Health in 2014.SERVICECumberland offers specialized services not usually found in more rural areas, making health care resources more accessible to local residents. Currently licensed for 182 beds, Cumberland has more than 200 affiliated physicians working with nearly 700 employees and about 125 dedicated volunteers who deliver quality care to patients. Physician specialties include anesthesiology, cardiology, neurology, obstetrics, ophthalmology, oncology, orthopedics, pediatrics, radiology, radiation oncology and urology services.Cumberland served 123,552 patients in 2018. Of these, 118,758 were outpatients and 4,794 were inpatients with an average length-of-stay of 3.58 days. PUTTING PATIENTS FIRSTAdvanced medical and surgical care is provided at Cumberland, including telemetry-monitored beds and an intensive care unit. Additionally, Cumberland offers an outpatient imaging center, same-day surgery unit, cardiac and pulmonary rehab programs, a sleep disorders center, a regional breast center offering 3D mammography, a regional cancer center, hyperbaric medicine, and wound care. The hospital is also a member of Covenant Health's stroke hospital network, which links Covenant Health's member hospitals in providing access to rapid diagnosis and treatment of stroke. Cumberland also has an in-house cardiac catheterization lab, inpatient dialysis services, and an inpatient rehabilitation unit. A full-service laboratory, medical imaging department, physical medicine and rehabilitation, and cardiopulmonary services department are also available. Cumberland's surgery department includes six main operating rooms, four of which are equipped with high-definition endoscopic video equipment. Cumberland is accredited by The Joint Commission. The medical center has earned the Commission on Cancer's Accredited Cancer Program designation and accreditation in radiation oncology by the American College of Radiology. IMPROVING THE COMMUNITY'S QUALITY OF LIFE THROUGH BETTER HEALTHEmergency physicians are on duty 24 hours a day, seven days a week, while general and specialty surgeons provide round-the-clock coverage and treatment. Cumberland opened a new emergency department in 2016 that includes over 17,000 square feet of new space, new equipment and technology, and 24 patient care rooms, including specialty rooms for cardiac and trauma.In 2018, Cumberland Medical Center: - Organized 11 health fairs with free screenings throughout community and employer groups; reaching more than 5,550 people - Added a portable lung function machine for free health fair screenings and used the device for 290 screenings. Several participants were encouraged to schedule follow-up appointments with their physicians as a result of the screenings. - Installed the state's first iSuite Operating Room System, a $750,000 investment - Installed 3D mammography equipment in nearby Fairfield Glade, a $280,000 investment - Launched a "Hike to Recovery" program to encourage cancer patients, survivors, and friends to participate in one-mile guided hikesCOVENANT HEALTH SYSTEMCumberland is a member of Covenant Health. Covenant Health is a comprehensive, community-owned health system dedicated to improving the health of the people it serves. Established in 1996 by the consolidation of Fort Sanders Health System, Knoxville, Tennessee, and MMC HealthCare System in Oak Ridge, Covenant Health is governed by a voluntary board of directors comprised of community leaders and medical professionals. With more than 10,000 employees, affiliated physicians and volunteers, Covenant Health is the Knoxville area's largest employer and has been named by Forbes as a Best Employer four years in a row. Covenant Health includes nine acute care hospitals in East Tennessee: Methodist Medical Center of Oak Ridge, Fort Sanders Regional Medical Center and Parkwest Medical Center in Knoxville, Fort Loudoun Medical Center in Lenoir City, LeConte Medical Center in Sevierville, Morristown-Hamblen Healthcare System in Morristown, Roane Medical Center in Harriman, Claiborne Medical Center in Tazewell and Cumberland Medical Center in Crossville. It also includes Peninsula, a division of Parkwest Medical Center, a behavioral health hospital in Blount County, Tennessee.Affiliated organizations include Thompson Cancer Survival Center, Thompson Oncology Group, Fortress Corporation and Subsidiaries, Covenant HomeCare, and Fort Sanders Perinatal Center. Philanthropic organizations include Fort Sanders Foundation and the Thompson Cancer Survival Center Foundation in Knoxville, Methodist Medical Center Foundation in Oak Ridge, Dr. Robert F. Thomas Foundation in Sevierville, and Morristown-Hamblen Hospital Foundation in Morristown. Funds raised by the foundations provide services, equipment and other resources for excellence in patient care.Cumberland, 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. 76465235 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 63 0 1 851 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 18 16 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Amy DeLong 8653743140 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 Gerald Boyd Director 0.00 1.00 X 0 1237 0 Willard Campbell MD Director 0.00 1.00 X 0 0 0 Michael Casey MD Director 0.00 1.00 X 0 1572 0 Ronni Chandler Director 0.00 1.00 X 0 0 0 Mitchell Dickson MD Director 0.00 1.00 X 0 1612 0 James Fitzsimmons Director/Chair 0.00 1.00 X X 0 1081 0 James Gibson Director 0.00 1.00 X 0 1081 0 Timothy Matthews Director 0.00 1.00 X 0 1438 0 Larry Mauldin Director 0.00 1.00 X 0 1429 0 Joseph Metcalf MD Director 0.00 1.00 X 0 14046 0 Linda Ogle Director 0.00 1.00 X 0 0 0 Roger Osborne Director 0.00 1.00 X 0 0 0 Cosby Stone Director 0.00 1.00 X 0 0 0 Carl Storms Director 0.00 1.00 X 0 1563 0 Richard Swanson Director 0.00 1.00 X 0 0 0 David C Verble Director 0.00 1.00 X 0 0 0 Amber Wisner Director 0.00 1.00 X 0 1438 0 James D VanderSteeg President & CEO 0.00 50.00 X X 0 1578890 192255 John T Geppi EVP/CFO 0.00 50.00 X 0 951309 27744 Anthony L Spezia CEO - Emeritus 0.00 40.00 X 0 606147 15119 David V Bunch President & CAO 50.00 0.00 X 0 319996 22749 April A VonAchen VP - Financial Services 50.00 0.00 X 119576 0 25075 Thomas A Allingham MD Physician/Chief of Staff 50.00 0.00 X 460855 0 7950 Stephen L Mahan Senior Medical Physicist 40.00 0.00 X 190266 0 28990 John W Grinder Pharmacist 40.00 0.00 X 134412 0 13106 Rebecca D Foster Chief Nursing Officer 50.00 0.00 X 116641 0 27531 Robert E Black Pharmacist 40.00 0.00 X 110972 0 16821 Jeremy H Biggs Former CMC Pres/CAO; Curr MMC Pres/CAO 0.00 50.00 X 0 425051 14835 Amanda G Halford MD Former CMC CMO; Curr CH VP - Care Coord. 0.00 50.00 X 0 362347 32634 Elis Abou-Zeid MD Former CMC HCE; Curr CMG Physician 0.00 50.00 X 0 580256 17355 Elmer R Gibbs MD Former CMC HCE; Curr CMG Physician 0.00 50.00 X 0 428007 22173 Sivalingam Kanagasegar MD Former CMC HCE; Curr CMG Physician 0.00 50.00 X 0 489524 26188 1132722 5768024 490525 8 1 1 0 The Christman Company 2400 Sutherland Avenue Knoxville TN 37919 Construction 574873 Restorix Health 445 Hamilton Avenue Suite 800 White Plains NY 10601 Wound Care Management Fees 558998 Mobile Tech Service 201 N White Street 1 Athens TN 37303 Mobile PET-CT Scans 309130 Team Environmental Group 440 Park Avenue Lebanon TN 37088 Construction 267375 Cloudwave Healthcare Solutions Dept CH 19800 Palatine IL 60055 Professional Services 256464 9 36575 36575 Medical Services 622110 76276218 76276218 Laboratory 621511 49702 49702 76325920 822427 822427 779541 865 648231 0 131310 865 132175 65722 66453 950 1634 -684 -684 -684 Wellness Center 713940 928469 928469 Cafeteria 722514 445904 445904 Medical Records 900099 35816 35816 88797 22905 65892 1498986 78815399 76299123 1043893 1435808 X 3634 3634 144651 144651 29046521 27919247 1127274 417085 401905 15180 3055879 2965795 90084 1909705 1834856 74849 1513224 1476899 36325 1940 1940 8450 8142 308 12942503 12720607 221896 204692 181219 23473 414807 348086 66721 1089824 1075253 14571 2618300 2513407 104893 58405 51013 7392 69521 36739 32782 6153992 6153992 156515 156515 Unrelated Business Inco 11791 11791 Medical Supplies 10262340 10262340 Bad Debt 5477565 5477565 Minor Equipment 1888254 1888254 1144877 977976 166901 78594475 76465235 2129240 0 2322816 1988657 6387930 6649580 1337751 1326211 689510 866201 156007856 91456793 65847125 64551063 439751 89821 9452680 9452680 350706 335330 86828269 85259543 6461739 6500596 9869488 8373909 16331227 14874505 X 70497042 70385038 70497042 70385038 86828269 85259543 220924 -332928 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2619122 2619122 88415266 41088407 47326859 2687314 1431979 1255335 61502106 48936407 12565699 784048 784048 64551063 Due to Affiliates, Net 7266404 Due to Third Party Payors 657981 Long-term Deferred Compensation 33417 Long-term Reserve for Workers Compensation 403195 Security Deposits 12912 8373909 X Part X, Line 2: Excerpt from the consolidated audited financial statements of Covenant Health (Covenant), parent company to Cumberland Medical Center: Covenant and certain of its subsidiaries or controlled entities are exempt from income taxes pursuant to Section 501(c)(3) of the Internal Revenue Code. Accordingly, no provision for income taxes on qualifying activities has been made for these entities in the accompanying consolidated financial statements. However, certain entities and operations are subject to income taxes. Covenant had no unrecognized tax benefits at December 31, 2018. As such, no interest or penalties were recognized in the consolidated financial statements related to unrecognized tax benefits. At December 31, 2018, tax returns for 2015 through 2018 are subject to examination by the Internal Revenue Service. Covenant has no uncertain tax positions that would require financial statement recognition or disclosure under GAAP at December 31, 2018. 1 1 X 1 X 1 X 1 1 1 0 1 1 11894936 11894936 0.16270 8612794 5313827 3298967 0.04510 20507730 5313827 15193903 0.20780 773 773 0.00000 5227488 263089 4964399 0.06790 12383 12383 0.00020 5240644 263089 4977555 0.06810 25748374 5576916 20171458 0.27590 34 34 0.00000 1184 1184 0.00000 7429 7429 0.00010 164 164 0.00000 8811 8811 0.00010 1 5477565 772337 27541812 25669883 1871929 X 1 1 1 1 Cumberland Medical Center Inc 421 South Main St Crossville TN 38555 www.cmchealthcare.org 00000020 X X X Cumberland Medical Center 1 0 0 1 X X X X X X X X 16 1 0 1 1 X See Part V, Page 8 X 1 16 1 See Part V, Page 8 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X 1 X https://www.cmchealthcare.org/financial-assistance/ X https://www.cmchealthcare.org/financial-assistance/ X https://www.cmchealthcare.org/financial-assistance/ X X X X X X 1 X 0 X X X 1 X 0 0 Cumberland Medical Center Part V, Section B, Line 5: Cumberland Medical Center ("CMC") was guided in the assessment process by representatives of several community organizations whose expertise and relationships helped the hospital access the general population as well as the most vulnerable residents of Cumberland County. Assessment partners were recruited from the broader public health system including staff from the local health department, United Way director, local school system, court system, public safety, senior programs, and social service organizations that serve the needs of the community's most vulnerable and at-risk population. The assessment process began with a half-day community health forum using an assessment tool "Forces of Change" by the Center for Disease Control. Thirty-three participants representing a diverse make up of stakeholders gave input into the significant issues facing Cumberland County. The Data Team members represented the health department, United Way, Crossville city government, Bradford Rehabilitation, and the Cumberland Health Council. These community leaders analyzed and distilled volumes of data into a short list of the most significant health issues affecting Cumberland County.Part V, Section B, Line 4:It was determined that while the Community Health Needs Assessment ("CHNA") was prepared as of December 31, 2015, it was completed in May, 2016 with Advisory Board approval. It was later approved in 2017 by the Governing Board, when it was determined that was the correct board to issue approval. Cumberland Medical Center Part V, Section B, Line 6b: CMC's CHNA was conducted with the following organizations: - House of Hope - Fairfield Glade - Plateau Pregnancy Center - Mayor of Crossville - Habitat for Humanity - Mayor of Cumberland County - United Fund - Cumberland Mountain Mental Health - Cumberland County Schools - Fair Park Senior Center - Cumberland County Sheriff - Rural Health Clinic - Cumberland County Health Department - Crossville Police Department - Uplands Village - Upper Cumberland Human Resource Agency - Bradford Rehabilitation - Cumberland County Bank - Cumberland County Emergency Services - Cumberland County Health Council - City of Crossville - TN College of Applied Technology - Crossville Parks and Recreation Cumberland Medical Center Part V, Section B, Line 11: Based on input from CMC's Leadership and Community Summit, the following actions were agreed upon and form the foundation of Cumberland County's health initiatives:Substance Abuse 1. Partners with Bradford Health Services to provide a medical conference to educate community physicians. Hosted a Prescription Recovery Conference in 2017 attended by over 100 health care professionals. 2. Partners with Cumberland County Rising (local drug coalition). Hospital staff visit schools and community events with models of smoker lungs and tobacco mouth. 3. Sponsors drug take back events at Fairfield Glade and Crossville Wellness complexes and hospital sponsored health fairs. 4. Implemented and hosts smoking cessation series at the hospital. Physical Inactivity 1. Participates in the Healthier Tennessee Initiative - a partnership with the local health department, City of Crossville, Cumberland County school system and the University of Tennessee. 2. Implemented a "Healthier U Challenge" that brought community members together for health education and exercise. Participants reduced weight and statistically added years to their life. Valued investment was nearly $7000. 3. Conducts hiking events with Missy Kane, Covenant Health's health promotion coordinator and local celebrity. 4. Supported a county-wide Hiking Marathon attended by nearly 1000 participants. Obesity 1. Implemented an exercise and health education program for community members. 2. Hosted a Health Block Party Access and Affordability of Healthcare 1. Sponsors health fairs to provide low-cost access to screenings (blood pressure, blood sugar, cholesterol, and other lab tests). 2. Healthier-TN Crossville/Cumberland was recognized by the Governor's Office as a top three, state-wide finalist for his "Community of the Year" award. Cumberland 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. Cumberland Medical Center Part V, Section B, Line 20e: The hospital follows the eligibility procedures as detailed within the FAP and does not make presumptive eligibility determinations. Part V, Line 7a, CHNA website https://www.cmchealthcare.org/community-health-needs-assessment/ Part V, Line 10a, Implementation Strategy Website https://www.cmchealthcare.org/community-health-needs-assessment/ Part V, Line 20d, Presumptive Eligibility Determinations The hospital follows the eligibility procedures as detailed within the FAP and does not make presumptive eligibility determinations. 9 1 - CMC Outpatient Imaging Center 28 Hayes St Crossville TN 38555 Medical Imaging and PET Scan 2 - CMC Cancer Center 421 South Main St Crossville TN 38555 Oncology Radiation Therapy 3 - CMC Hyperbaric Medicine & Wound Ctr 124 Hayes St Crossville TN 38555 Wound and Hyperbaric Treatment 4 - CMC Endoscopy Center 116 Brown Ave Crossville TN 38555 Outpatient Endoscopy Center 5 - Sleep Disorders Center 49 Cleveland St Suite 200 Crossville TN 38555 Sleep Study Center 6 - Cumberland Medical Center at FFG 130 Stonehenge Dr Crossville TN 38555 Wellness, Physical Therapy, X-ray and Mammography 7 - CMC Outpatient Physical Therapy & Rehab 118 Brown Ave Suite 104 Crossville TN 38555 Physical Therapy and Occupational Therapy 8 - Cumberland Physicians Group 133 Hayes St Crossville TN 38555 General and Specialty Physicians 9 - CMC Wellness Complex 130 Woodmere Mall Crossville TN 38555 Wellness Management Part I, Line 3c: In addition to the FPG (federal poverty guidelines), CMC utilizes an asset test as a factor in determining eligibility for free or discounted care. Ten percent (10%) of the patient/guarantor's net assets will be added to income for determination of total annual income. The guidelines for determining assets include, but are not limited to, primary dwelling (and attached land), automobiles, liquid assets, investments, farm land, business property, rental property, farm and/or business equipment including livestock and crops. All real property will be considered at fair market value. The values of both real and personal property will be reduced by any existing liabilities incurred by the applicant in obtaining the assets (net assets). Part I, Line 6a: Covenant Health, the parent company of CMC and other affiliated acute care hospitals, prepares an annual Report to the Community on behalf of the entire system. Part I, Line 7: Amounts on Lines 7a-7c and certain program costs included on Line 7g are from the hospital's cost accounting system, which addresses all patient segments. Other community benefit expenses are at cost from the general ledger. Part I, Line 7g: Subsidized health services includes the difference between the cost of services and the payments received for those services. The subsidy of $4,964,399 is the difference between the cost of services provided in the hospital's physician offices and the Wound Care Center, and the payments received for those 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.The physician offices include family, internal medicine, OB/GYN, surgeons, and other specialty physicians. Although patients with Medicare or commercial insurance coverage are provided services, these physician offices were established to provide services for patients without insurance coverage or with Tenncare/Medicaid. 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 $5,477,565. Part II, Community Building Activities: CMC cares for the whole person and recognizes that improved social and economic conditions may lead to the improved health and well-being of the community. The hospital's community building activities and those of its parent organization, Covenant Health, address many of the root causes of health problems, such as poverty and homelessness, and help find solutions to alleviate the symptoms.An allocation of the Parent's community building expenditures has been made to each member hospital in proportion to the financial contribution of each to the health system. Covenant Health is not a hospital and does not file Schedule H with its Form 990. Contributions in 2018 were made to organizations meeting the community's needs by providing: - The basic needs of life including temporary shelter, food and clothing (Catholic Charities and Ladies of Charity) - Youth mentoring, development and after-school programs (Emerald Youth Foundation, Boys and Girls Club, The Change Center, Young Life, Williams Creek Youth Foundation and the Dollywood Foundation) - Business recruitment and marketing initiatives that boost economic development (East Tennessee Economic Development Agency and Knoxville Urban League) - Leadership development programs and workshops (Leadership Knoxville and Junior Achievement) - Assistance and special programs for at risk older adults, people with physical and mental challenges, and abused and neglected children (Senior Citizens Home Assist, Sertoma Center, Inc., East TN Technology Access Center, and Variety-The Children's Charity of Eastern Tennessee) - Improve access to health services (Interfaith Health Clinic, St. Mary's Legacy Clinic, and Knoxville Academy of Medicine) - Programs supporting patients and their families (Alzheimer's Tennessee, Cancer Support Community, Inc. and Random Acts of Flowers) Part III, Line 2: Bad debt expense on Part III, Line 2 is the amount recorded in the organization's financial statements. Discounts and payments on patient accounts are netted against bad debt. The allowance for bad debt is determined based on management's assessment of factors including the age of the accounts, historical collections data, and industry standards. Part III, Line 3: The amount reported on Line 3 was estimated by multiplying self-pay bad debt by the percentage of the population living below the poverty level on a county-by-county basis. It is our belief that the amount of bad debt on Line 3 should be included as community benefit. As a tax-exempt hospital, we must provide necessary services regardless of the patient's ability to pay for the service provided. As a not-for-profit, patient care is provided to all, regardless of ability to pay for that care. Making quality patient care available to all in our community, regardless of economic means, qualifies bad debts as a community benefit. Part III, Line 4: Note B to the 2018 Audited Consolidated Financial Statements of the Covenant Health system, of which CMC 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: CMC used a combination of sources in calculating Medicare allowable costs on Part III, Line 6 including its cost accounting system, general ledger accounting system, and facility-specific analyses and calculations. Part III, Line 9b: CMC utilizes a look-back method to determine amounts generally billed ("AGB") to establish the maximum amount that will be charged to individuals eligible under the financial assistance policy ("FAP") for emergency or other medically necessary care. Self-pay patients automatically receive a 69% discount on charges based on the facility's calculated AGB. Federal poverty guidelines are utilized in the determination of charity care eligibility. Patients who are unable to pay and have exhausted all sources of payment assistance may qualify for charity care. A sliding scale is used for extending charity care utilizing the income levels reported under the federal poverty guidelines. Patients/guarantors with income that falls below 200% of the federal poverty guidelines receive 100% charity care. Patients/guarantors with income of 201-300% of the federal poverty guidelines receive 90% charity care. For catastrophic illness, exceptions to income and asset limitations may be made on a case-by-case basis. The amount considered for charity will be based upon the evaluation of the patient's/guarantor's ability to pay.CMC makes reasonable efforts to determine a patient's eligibility under the facility FAP. All collection activity will be halted if a charity application is received and will remain on hold until a determination is made by CMC and communicated in writing to the responsible party. If the charity application is approved, all collection activities taken will be reversed and any amounts paid above the amount required will be refunded. Patients/guarantors who qualify for partial financial assistance are responsible for paying any balance remaining after the charity adjustment and third party payments. CMC will not engage in extraordinary collection actions ("ECA") before it makes reasonable efforts to determine whether an individual who has an unpaid bill is eligible for financial assistance. Reasonable efforts to determine whether the individual who has an unpaid bill is eligible for financial assistance include notification to the individual of the financial assistance policy, contacting individuals who have submitted incomplete financial assistance applications regarding how to complete the application, and allowing a reasonable time period to do so, and reviewing completed applications for financial assistance eligibility.CMC does not sell any accounts receivable accounts to outside firms. All accounts remain property of and under the policies set by CMC. CMC will not defer or deny medically necessary care because of nonpayment for previously provided care whether it was covered or not covered under the charity program. Part VI, Line 2: While the CHNA is a formal means by which the health system assesses the needs of the community, there are many informal networks that give the Covenant Health hospitals a sense of community issues and needs. CMC obtains additional community information through the service of its employees with the Chamber of Commerce, the local Health Council, Rotary Clubs, and local not-for-profit boards. 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: CMC informs patients and other persons who may be billed for patient care about its FAP by posting signs in highly visible areas of the hospital and including information about the FAP in patient booklets placed in all inpatient rooms. In addition, the FAP and application are available via the facility website and notice of the availability of financial assistance is communicated via patient billing statements. The following sign is posted in the main registration area and Emergency Department registration entrance:Financial Assistance: Covenant Health is committed to providing quality health services in a caring environment. It is the expressed philosophy of Covenant Health, and its member hospitals, that no one should be denied necessary medical care because of the inability to pay. In conjunction with this philosophy, staffs of Cumberland 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, Cumberland Medical Center, in compliance with Tennessee Code Annotated, Title 47, Chapter 18 and Title 68, will provide at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling 931-484-9511 or 931-459-7281, Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.CMC contracts with full time financial counselors who meet with each uninsured patient. In addition, those counselors assist patients with completion of a TennCare application and ensures the application is directed to the appropriate Department of Human Services.The FAP states that patients who are unable to pay and have exhausted all sources of payment assistance may be screened for potential charity care eligibility. According to the policy, the financial counselors initiate screening of the patient and/or guarantor by obtaining income and other financial information to determine eligibility for charity care or discounted services. Part VI, Line 4: Cumberland County, Tennessee is located on the Cumberland Plateau and is home to the cities of Crossville, Crab Orchard and Pleasant Hill. Cumberland is a rural county located approximately 60 miles from the metropolitan Knoxville area. Cumberland County is the primary market for Cumberland Medical Center, the only hospital in the county. In 2018, 81% of the patient encounters (inpatient and outpatient) came from Cumberland county, the focus of the health assessment. The following statistics are taken from the 2018 County Health Rankings report of the Robert Wood Johnson Foundation. The population of Cumberland County numbers roughly 58,665 people and is predominantly female, 51%. Persons over the age of 65 account for 29.7% of the population. The uninsured rate for adults is 17% and 4% for children. The unemployment rate is steadily improving and is at 6%. Healthcare and social assistance make up 22% (2016) of the workforce and is the largest employer category in Cumberland County. In 2018, the median household income was $43,500.According to the 2018 County Health Rankings Report of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, Cumberland County residents have the following health indicators that are above the national benchmarks: Cumberland - TN - National Adult Smoking: 20% - 22% - 14% Adult Obesity: 33% - 32% - 26% Alcohol impaired driving deaths 33% - 28% - 13% Teen Birthrate: 52 - 36 - 15 of every 1,000 teenage girls Poor or Fair Health: 19% - 19% - 12% Physical Inactivity: 32% - 30% - 20% Drug Overdoses 17 22 10 per 100,000 population Part VI, Line 5: CMC, in conjunction with its parent company, Covenant Health, uses any available surplus of receipts over disbursements to expand and modernize the facility and to support the education of healthcare professionals, both of which serve to improve patient care and serve the unmet needs of the community.Covenant Health's Board of Directors serves as CMC's board. The board is comprised of independent community leaders with diverse educational and professional backgrounds. The board sets policies and provides oversight of Cumberland.CMC maintains an open medical staff, with privileges available to all qualified physicians. Additionally, the hospital operates an active and accessible emergency department that accepts all patients regardless of ability to pay. Part VI, Line 6: CMC, as a member of the Covenant Health system, benefits from the collaboration among all affiliated organizations to promote quality improvement, patient safety and efficient delivery of care for the communities served.As a system, Covenant assures that business processes are in place at each facility to measure and report quality; to increase the role of compliance; and to integrate risk management, utilization review, peer review, mandatory reporting and quality improvement into one cohesive function. In this way, the system is able to use analytic tools to help identify any systemic inability to satisfy the various requirements on the part of the facilities.CMC patients benefit from the availability of and ease of access to Covenant Health affiliated entities for services not provided by the hospital itself. Transfer or referral to such services is expedited and coordinated to help create a seamless continuum of care. A full range of community mental health and psychiatric hospital services are available within the system that help support the hospital's emergency room as well as provide an accessible and efficient pathway for those patients who require such services post discharge. Other specialized services such as inpatient rehabilitation, cardiac care, cancer treatment, home health and hospice services are provided by affiliated entities. The Covenant Health system also enhances the patient's access to care through the provision of outpatient services in a variety of settings located throughout the service area. These include a diabetes center, wound care center, bariatric surgery center, pulmonary rehabilitation programs and ambulatory infusion centers.Through this combination of resources and the collective development, implementation and monitoring of clinical protocols and other improvement initiatives, the affiliated entities of Covenant Health are able to deliver higher quality care in a more efficient manner than could be achieved working independently. 0 1 0 0 0 0 0 0 0 James D VanderSteeg President & CEO 0 1023861 0 420000 0 135029 0 169408 0 22847 0 1771145 0 0 John T Geppi EVP/CFO 0 605182 0 251100 0 95027 0 10800 0 16944 0 979053 0 0 Anthony L Spezia CEO - Emeritus 0 49155 0 0 0 556992 0 10800 0 4319 0 621266 0 0 David V Bunch President & CAO 0 271230 0 48136 0 630 0 420 0 22329 0 342745 0 0 Thomas A Allingham MD Physician/Chief of Staff 444207 0 0 0 16648 0 7950 0 0 0 468805 0 0 0 Stephen L Mahan Senior Medical Physicist 189637 0 0 0 629 0 5061 0 23929 0 219256 0 0 0 Jeremy H Biggs Former CMC Pres/CAO; Curr MMC Pres/C 0 300090 0 76500 0 48461 0 0 0 14835 0 439886 0 0 Amanda G Halford MD Former CMC CMO; Curr CH VP - Care Co 0 265573 0 57120 0 39654 0 10800 0 21834 0 394981 0 0 Elis Abou-Zeid MD Former CMC HCE; Curr CMG Physician 0 297434 0 281982 0 840 0 8100 0 9255 0 597611 0 0 Elmer R Gibbs MD Former CMC HCE; Curr CMG Physician 0 320156 0 102695 0 5156 0 0 0 22173 0 450180 0 0 Sivalingam Kanagasegar MD Former CMC HCE; Curr CMG Physician 0 186042 0 301322 0 2160 0 8100 0 18088 0 515712 0 0 Part I, Line 3 Covenant Health, the parent company of Cumberland Medical Center, used the following methods in establishing the compensation of President/CEO, James D. VanderSteeg: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board or compensation committee. Additional detail is provided in response to Form 990, Part VI, Section B, Lines 15a and 15b within Schedule O. Part I, Line 4b Covenant Health maintains a nonqualified deferred compensation ("NQDC") plan intended to support retention of President and CEO, James D. VanderSteeg. Employer contributions of $158,608 are reported as deferred compensation on Schedule J, Part II, Column C. Contributions along with 2018 earnings of $19,018 are subject to a substantial risk of forfeiture. Amounts are combined with other compensation and considered for reasonableness. Compensation procedures are discussed in detail in Schedule O (Form 990, Part VI, Section B, Line 15a). Anthony L. Spezia retired as President and CEO in 2016 after serving Covenant Health for twenty years. Mr. Spezia was named CEO-Emeritus and continued serving the organization through early 2018 as a consultant. During 2018, Mr. Spezia received distributions from two NQDC plans resulting from contributions and associated earnings on contributions. Amounts vested in 2018 total $476,126 and are included in other reportable compensation on Schedule J, Part II, Column B(iii). Form 990, Part VI, Section A, line 4 In 2018, the Covenant Health system-wide bylaws were amended to provide that new directors who have not previously served on the board will be elected to an initial one-year term instead of three years (the previous standard). Amendments also grant authority to the compensation committee to negotiate and approve the CEO's compensation. The bylaws were also amended to authorize the board to establish special board committees which may be terminated by resolution of the board. The chairman of the board may establish special board committees to advise executive leadership, other board committees or the full board. Committees may be composed of elected or ex-officio board members. Also in 2018, Covenant Health adopted system-wide medical staff bylaws. The bylaws created two new committees: System Quality Committee and System Credentials and Clinical Standard Committee. The System Quality Committee consists of licensed physician voting board members, other appointed voting board members, Covenant Health's CEO, and the chiefs of staff of Covenant Health system hospitals. The committee shall review quality of patient care, perform other duties assigned in the system-wide medical staff documents, receive and review proposed amendments to the medical staff documents and make recommendations to the board, initiate quality-related investigations, and act as a Quality Improvement Committee as defined under Tennessee law. The System Credentials and Clinical Standard Committee consists of licensed physician voting board members and other appointed board members. Covenant Health's VP of Hospital Operations, Chief Medical Officer, and Chief Nursing Officer shall also serve as non-voting members of the committee. The committee shall develop and implement system-wide clinical standards, perform other duties as outlined in the medical staff documents, make determinations regarding routine credentialing matters and medial staff appointments/terminations, and act as a Quality Improvement Committee as defined under Tennessee law. Other 2018 amendments to the governing documents were not considered significant. Form 990, Part VI, Section A, line 6 Covenant Health is the sole member of Cumberland Medical Center. Form 990, Part VI, Section A, line 7a Covenant Health's board of directors also serves as the board of directors for Cumberland Medical Center. Form 990, Part VI, Section A, line 7b Governance decisions of Cumberland Medical Center are subject to approval of the sole member, Covenant Health. Form 990, Part VI, Section B, line 11b The Covenant Health board of directors has delegated to its Finance Committee the full power and authority of the board to receive, review, approve, authorize the filing of, address and resolve audit or review issues, and otherwise take all action required or appropriate relative to IRS Forms 990 and other applicable tax filings. Prior to filing Form 990, management reviews with the committee the returns, discusses any material variations in the Form 990 as compared to those to be filed by the organization's affiliates, and answers any questions. At the conclusion of review and discussion, the Finance Committee approves the Form 990. Form 990, Part VI, Section B, line 12c Board members, officers, and employees are required to adhere to rules and policies regarding conflicts of interest. Covenant Health, the parent company of the organization, distributes a board-approved Code of Conduct to all employees. The Code covers among other subjects, conflicts of interest. Additionally, managers are required to complete and sign a bi-annual management certification that addresses conflicts of interest. Board members' conflicts of interests are addressed in the corporate bylaws, and board members are required to complete and sign a conflict of interest questionnaire on an annual basis. The Integrity Compliance Office maintains records that contain conflict of interest information obtained from board members, officers, and key employees. These records are available to be queried prior to engaging in business transactions. The Chief Compliance Officer initially reviews all conflict of interest data. Based on this information, the officer determines what conflicts of interest exist at that point in time. Between times when surveys are collected, board members are expected to disclose any new conflicts that have arisen that affect pending board decisions. Officers and other employees are expected to report conflicts to the Chief Compliance Officer as they arise. Depending on the nature of the conflict and the circumstances surrounding the conflict and transaction, the Chief Compliance Officer, senior leadership, or the board of directors may review the conflict of interest. When appropriate, these parties may also consult legal counsel. Restrictions imposed on persons with a conflict of interest are determined on a case by case basis. For Covenant Health employees, the Chief Compliance Officer in conjunction with Covenant Health Executive Leadership determines how to appropriately manage the conflict. In any conflict involving a board member, such member is expected to recuse himself or herself from voting on matters related to the conflict. Form 990, Part VI, Section B, line 15 Overall compensation policies for Cumberland Medical Center, Covenant Health (Parent Company), and affiliates are set by the Compensation Committee of the board of directors ("the Committee"), which is comprised of independent members of the board. The Committee is guided in its decision-making process by an independent, nationally-recognized executive compensation consultant experienced in advising nonprofit hospital boards. The Covenant Health CEO is compensated by Covenant Health, and a detailed description of the compensation process is included on Covenant Health's 990. The process for Cumberland 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 David Bunch, President and Chief Administrative Officer, are set by the Covenant Health CEO in consultation with the Senior Vice President-Human Resources, subject to approval of the Compensation Committee of the Covenant Health board of directors ("the Committee"), after review by and discussion with the executive compensation consultant ("the Consultant") to ensure that total compensation is reasonable and within a fair market value range. Salary ranges are based upon the recommendations of the Consultant made after comparison with similar jobs in similar size health systems across the nation. Bonuses are recommended by the CEO and approved by the Committee conditioned upon receipt of a written opinion from the Consultant that total compensation for the executive is reasonable and consistent with fair market value. Base salary is initially targeted at midpoint and may vary according to market conditions, performance, tenure, experience, special skills or qualifications, recruitment and retention challenges, and other relevant factors. Annual bonuses are designed to award 0-35% of base salary based upon system performance and accomplishment of certain targets established by the CEO. Base salaries and annual bonus opportunities for other officers and key employees are based on targets established by historical compensation consultant data and the Covenant Health Compensation department. Salary ranges are based upon comparison with similar jobs in similar size health systems across the nation. Base salaries and bonuses are approved by Executive Leadership predicated upon performance, and are reasonable and consistent with fair market value. Base salaries are 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 Cumberland Medical Center files a Joint Annual Report containing financial information with the Tennessee Department of Health. Per its tax-exempt bond provisions, Covenant Health, the parent company of the organization, is required to file quarterly and annual consolidated and obligated group financial statements and other documentation with various bond insurers and other agencies, including the Electronic Municipal Market Access (EMMA) service of the Municipal Securities Rulemaking Board (MSRB). Any member of such a repository has access to these financial statements. The organization's governing documents and conflict of interest policy are not made publicly available. Form 990, Part IX, line 11g Intercompany Purchased Services: Program service expenses 473,715. Management and general expenses 0. Fundraising expenses 0. Total expenses 473,715. Other Purchased Services: Program service expenses 7,258,809. Management and general expenses 221,896. Fundraising expenses 0. Total expenses 7,480,705. Sponsorship Fees: Program service expenses 4,988,083. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,988,083. Cumberland Physician Group LLC 421 S Main St Crossville TN 385555048 371539508 Physician services TN 0 33715 Cumberland Medical Center Covenant Health 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 621646734 Supporting organization TN 501(c)(3) Line 12b, II N/A 0 Claiborne Medical Center 1420 Centerpoint Blvd Bldg C knoxville TN 379321960 464420358 Acute care hospital TN 501(c)(3) Line 3 Covenant Health 0 Covenant Homecare 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 621623114 Home health services TN 501(c)(3) Line 10 Covenant Health 0 Fort Loudoun Medical Center 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 621373691 Acute care hospital TN 501(c)(3) Line 3 Covenant Health 0 Fort Sanders Regional Medical Center 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 620528340 Acute care hospital TN 501(c)(3) Line 3 Covenant Health 0 Fort Sanders Foundation 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 621748601 Fundraising and patient outreach TN 501(c)(3) Line 12b, II Covenant Health 0 Fort Sanders Perinatal Center 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 043760551 High risk obstetrical services TN 501(c)(3) Line 3 Fort Sanders Regional Medical Center 0 LeConte Medical Center 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 621114867 Acute care hospital TN 501(c)(3) Line 3 Covenant Health 0 Methodist Medical Center 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 620636239 Acute care hospital TN 501(c)(3) Line 3 Covenant Health 0 Morristown-Hamblen Hospital Association 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 620545814 Acute care hospital TN 501(c)(3) Line 3 Covenant Health 0 Parkwest Medical Center 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 581897274 Acute care hospital and behavioral health services TN 501(c)(3) Line 3 Covenant Health 0 Roane County Medical Center 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 680673354 Acute care hospital TN 501(c)(3) Line 3 Covenant Health 0 Thompson Cancer Survival Center 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 621250943 Cancer support center TN 501(c)(3) Line 3 Covenant Health 0 Thompson Oncology Group 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 621619239 Oncology services TN 501(c)(3) Line 3 Thompson Cancer Survival Center 0 Thompson Cancer Survival Center Foundation 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 582130450 Fundraising and patient outreach TN 501(c)(3) Line 12b, II Covenant Health 0 Fort Sanders West OP Surgery Center LLC 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 621366907 Outpatient surgery center TN N/A Fort Sanders West Associates 280 Fort Sanders West Blvd Ste 214 Knoxville TN 37922 621384171 Building ownership TN N/A KOSC Properties LLC 256 Fort Sanders West Blvd Ste 200 Knoxville TN 37922 262444076 Building ownership TN N/A Knoxville Orthopaedic Surgery Center LLC 256 Fort Sanders West Blvd Ste 200 Knoxville TN 37922 262437385 Orthopaedic surgery TN N/A KOC 260 Bldg LLC 260 Fort Sanders West Blvd Knoxville TN 37922 465228440 Land and building ownership TN N/A Knoxville Health Care Center LP PO Box 1398 Murfreesboro TN 371331398 621019281 Rehabilitation center TN N/A Fortress Corporation 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 621308885 Management company TN N/A C 0 Covenant Medical Group Inc 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 621282917 Physician practice management TN N/A C 1 Knoxville Heart Group 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 271528941 Cardiology medical practice TN N/A C 0 East TN Cardiovascular Surgery Group Inc 1420 Centerpoint Blvd Bldg C Knoxville TN 379321960 621018541 Cardiovascular surgical practice TN N/A C 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 1 1 Covenant Medical Group Inc A 356344 FMV