4A (Expenses $ 90951721 including grants of $ 25070) (Revenue $ 92900437)
"Cumberland Medical Center (""Cumberland""), an acute-care hospital located on the Cumberland Plateau of Tennessee, has served the Cumberland community since 1950 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 189 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 118,592 patients in 2021. Of these, 113,556 were outpatients and 5,036 were inpatients with an average length-of-stay of 4.91 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 diagnostics center, same-day surgery unit, cardiac and pulmonary rehab programs, a sleep disorders center, a breast center offering 3D mammography, a cancer center, and hyperbaric and wound care. The hospital also has a 12-bed maternity suite for labor and delivery. As a member of Covenant Health, Cumberland is part of the region's only stroke hospital network, which links Covenant Health's member hospitals in providing access to rapid diagnosis and treatment of stroke. Cumberland holds Advanced Primary Stroke Center certification from The Joint Commission. Cumberland has an in-house cardiac catheterization lab, inpatient dialysis services and an inpatient rehabilitation unit. A full-service laboratory, medical imaging department, physical therapy 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. It has also earned the Commission on Cancer's Accredited Cancer Program designation and is accredited by the American College of Radiology in Radiation Oncology, Positron Emission Tomography (PET) Imaging and Breast Imaging Center of Excellence. 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 around-the-clock coverage and treatment. A new emergency department was opened in 2016 that has allowed Cumberland to better serve patients with updated equipment and technology, new patient care rooms, and specialty cardiac and trauma rooms.Outreach programs were adapted to support social distancing to reduce potential spread of COVID-19 in 2021; however, the following milestones were accomplished:-Featured a variety of patient featured stories on topics and education surrounding breast health, diabetes, stroke, moving more, etc. -Supported a ""Hike for Health"" 12-week series of local one-mile paved trails-Partnered with the Cumberland County Playhouse to record a Breast Cancer Awareness video with potentially more than 20,000 online viewers COVENANT HEALTHCumberland Medical Center is a member of Covenant Health. Covenant Health is a comprehensive, community-owned health system dedicated to improving the health of the people it serves. Established in 1996 by the consolidation of Fort Sanders Health System, Knoxville, Tennessee, and MMC HealthCare System in Oak Ridge, Covenant Health is governed by a voluntary board of directors comprised of community leaders and medical professionals. With more than 11,000 employees, affiliated physicians and volunteers, Covenant Health is the Knoxville area's largest employer and has been named a Best Employer seven times by Forbes. Covenant Health includes nine acute care hospitals in East Tennessee: Methodist Medical Center of Oak Ridge, Fort Sanders Regional Medical Center and Parkwest Medical Center in Knoxville, Fort Loudoun Medical Center in Lenoir City, LeConte Medical Center in Sevierville, Morristown-Hamblen Healthcare System in Morristown, Roane Medical Center in Harriman, Claiborne Medical Center in Tazewell and Cumberland Medical Center in Crossville. It also includes Peninsula, a division of Parkwest Medical Center, a behavioral health hospital in Blount County, Tennessee. The health system also includes Covenant Medical Group, which includes more than 200 physicians and advanced practice clinicians in office locations throughout East Tennessee.Affiliated organizations include Thompson Cancer Survival Center, Thompson Oncology Group, Fortress Corporation and Subsidiaries, Covenant HomeCare, and Fort Sanders Perinatal Center. Philanthropic organizations include Fort Sanders Foundation and the Thompson Cancer Survival Center Foundation in Knoxville, Methodist Medical Center Foundation in Oak Ridge, Dr. Robert F. Thomas Foundation in Sevierville, and Morristown-Hamblen Hospital Foundation in Morristown. Funds raised by the foundations provide services, equipment and other resources for excellence in patient care.Cumberland Medical Center, as a member of Covenant Health, benefits from the collaboration among all affiliated organizations to promote quality improvement, patient safety and efficient delivery of care for the communities served."

Cumberland Medical Center
"Part V, Section B, Line 5: Cumberland Medical Center (""CMC"") conducted its third Community Health Needs Assessment (""CHNA"") in 2019. A Steering Committee was formed to guide the assessment process and included staff from the Cumberland County Health Department, United Fund, CMC, Cumberland County Emergency Medical Services, Cumberland County government, Crossville City Manager, Cumberland Heights, and Fairfield Glade Resident Services. 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 Cumberland County household survey and to host two focus groups of community leaders, each of which represented a part of the overall Cumberland County public health system. The household survey collected information from 623 Cumberland 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 analyze the data and determine the most significant findings from the assessment. The Data Team included Steering Committee members as well as representatives from the University of Tennessee/TN State University Extension Service, Coordinated School Health, Cumberland County Hospice, and Cumberland County Rising Anti-Drug Coalition."

Cumberland Medical Center
Part V, Section B, Line 6b: Though CMC's CHNA was issued as a stand-alone report, many non-hospital organizations assisted throughout the process. Research partners provided expertise on survey design, focus group facilitation, data collection, data sources, and analysis. UT-SWORPS was an integral contributor, as well as the Cumberland County Health Department and the Tennessee Department of Public Health (Nashville, TN).Additionally, focus groups were beneficial in discussing and identifying community needs in Cumberland County. Organizations and individuals participating in the focus groups included: - Cumberland County Health Department - Cumberland County United Fund- Cumberland County Schools - Cumberland County Hospice- Bread of Life Rescue Mission - Coordinated School Health- Plateau Pediatric Group - Crab Orchard Mayor- Local Pharmacist - Local Nurse Practitioner- Fairfield Glade Retirement Community- Wynd Ridge Health and Rehabilitation Center - Cumberland County Rising Anti-drug Coalition

Cumberland Medical Center
"Part V, Section B, Line 11: At the conclusion of the 2019 assessment process, the Data Team identified a top ten list of health priorities and further refined this list into the top 5 most significant health issues. The top five identified community needs (in order of priority) are: Health Education for Chronic Diseases, Substance Abuse Disorder, Mental Health Access, ACES, and Health Care Providers for Specialty Services. CMC updated its 2019 Implementation Plan based on the identified needs and plans to address four of the five identified issues in the following ways:1. Health Education for Chronic Disease Conditions ""Breast Cancer Awareness"" Events - CMC launched an annual Breast Cancer Awareness Party that welcomes community members to hear guest speakers and receive educational information in support of annual mammogram screenings. Cancer Navigators - CMC now has two nurse navigators serving in the Breast and Cancer Centers to provide education to patients going through cancer treatment. Community Baby Shower - CMC participates in a community wide baby shower in partnership with the Health Department and Cumberland County Rising Anti-Drug Coalition. Expectant mothers are provided key information about their child's upcoming birth as well as vital community resource information to help those who are economically disadvantaged with resources, such as the Women, Infant, and Children program offered through the Health Department. COPD Support Group - CMC holds a free monthly support group for caregivers and patients with Chronic Obstructive Pulmonary Disease. Diabetes - CMC has expanded a Diabetes Center to help with metabolic associated conditions. The Cumberland Diabetes Center offers a free monthly support group for ongoing information and support. - For prevention and management of disease, CMC will hold regular hiking opportunities with Missy Kane, Covenant Health's health promotion coordinator, and the annual Cumberland County Hiking Marathon.Health Fairs - CMC has annual health education and screening fairs across the community. Events are held at local community and senior centers and local businesses.Patient Education - Signs and symptoms of Stroke and Heart Attack are provided to every inpatient upon discharge.2. Substance Abuse DisorderCumberland County Anti-Drug Coalition - CMC is committed to staying on the forefront of the latest trends affecting the community (such as vaping) by attending Cumberland County Rising Anti-Drug Coalition meetings and bridging information with hospital resources as opportunities arise.Opioid Light Protocol - CMC has adopted the Covenant Health protocol to reduce the amount of narcotics prescribed in our Emergency Department. Narcotics are reserved for acute pain, and other non-narcotic methods of pain control are offered to patients with more chronic pain. Patient Education - CMC teaches in-patients how to better manage pain with alternatives such as repositioning, ice packs, and pain scales (1-10). Prescription Drug Take Back - CMC continues to support Drug Take Back at Health Fairs and special events.3. Mental Health Access Covenant Health - As a member of Covenant Health, CMC will advocate and support the system's behavioral health services to assist area residents.Inpatient Education - CMC Case Management helps educate patients and families with resources available for those struggling with addiction. Mobile Crisis Services - CMC works with local and statewide agencies including the Tennessee Department of Mental Health & Substance Abuse Service's Mobile Crisis Services.Senior Perspectives - CMC supports Senior Perspectives in its effort to help caregivers and patients with Alzheimer's and Dementia. 4. Adverse Childhood Experiences (ACEs) ACEs is outside the scope of care provided by CMC because it is performed in a physician office setting as part of the patient's overall health management. 5. More Healthcare Providers for Specialty Services CMC is committed to supporting specialty services by: - Recruitment efforts for primary and specialty physicians, - Cultivated relationships with Covenant Health specialists not available in Cumberland County, and - Use of advancements for telehealth utilization (such as CMC's implementation of Tele-Nephrology in 2019) to help provide care to patients locally."

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.

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.

Part I, Line 3c:
"In addition to the Federal Poverty Guidelines (""FPG""), 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) 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 CMC and other affiliated acute care hospitals, prepares an annual Report to the Community on behalf of the entire system.

Part I, Line 7:
Amounts on Lines 7a-7c and certain program costs included on Line 7g are from the hospital's cost accounting system, which addresses all patient segments. Other community benefit expenses are at cost from the general ledger.

Part I, Line 7g:
Subsidized health services includes the difference between the cost of services and the payments received for those services. The total includes $4,812,800 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.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 $8,377,484.

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 2021 were made to organizations meeting the community's needs by providing: - The basic needs of life including temporary shelter, food and clothing (Catholic Charities, Ladies of Charity, Knoxville Area Urban League and Knox County Community Action Committee) - Youth mentoring, development and after-school programs (Emerald Youth Foundation, Boys and Girls Club, Knox Education Foundation, Young Life, City Shepherds, First Tee of Greater Knoxville and Great Smoky Mountain Council) - Business recruitment and marketing initiatives that boost economic development (Legacy Parks Foundation and Pellissippi State Foundation) - Leadership development programs and workshops (Knoxville Area Urban League and Leadership Knoxville) - Assistance and special programs for at risk older adults, people with physical and mental challenges, and abused and neglected children (Senior Citizens Home Assist, Sertoma Center, Inc. and Senior Citizens Love) - Improve access to health services (East TN Children's Hospital, Interfaith Health Clinic, St. Mary's Legacy Clinic and Region II Emergency Medical Services) - Programs supporting patients and their families (Alzheimer's Tennessee, American Cancer Society, Angel Wings Memory Gowns, Random Acts of Flowers, Cancer Support Community, Juvenile Diabetes Research Foundation and Leukemia & Lymphoma Society)

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. Cumberland uses the most recent data available from the U.S. Department of Agriculture Economic Research Service.

Part III, Line 4:
Note B to the 2021 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 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 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 provides governance and 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 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 68% 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 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. CMC 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 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 will provide, at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling 931-459-7281, Monday through Friday between the hours of 8 a.m.-5 p.m. Additional information regarding financial assistance is also available on our website at CMCHealthcare.org. Signage at the registration areas state the following:It is Cumberland 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 CMCHealthcare.org. A financial counselor is available to assist you with these matters by calling 931-459-7281, Monday through Friday between the hours of 8 a.m.-5 p.m.

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 2021, 78.6% of the patient encounters (inpatient and outpatient) came from Cumberland county, the focus of the health assessment. The following statistics are taken from the 2021 County Health Rankings report of the Robert Wood Johnson Foundation. The population of Cumberland County is 60,520 people and is predominantly female, 51.2%. Persons over the age of 65 account for 31.2% of the population. The uninsured rate for adults is 15% and 5% for children. The unemployment rate is steadily improving and was at 4.5% in 2021. Healthcare and social assistance make up 21% (2019) of the workforce and is the largest employer category in Cumberland County. In 2021, the median household income was $49,100.In support of the significant findings from the 2019 CHNA, the following data points support the conclusions of the 2019 assessment:Health Education for Chronic Diseases - Of the top 9 leading causes of death in Cumberland County, 8 are largely preventable: diseases of the heart, cancers, respiratory diseases, accidents, stroke, diabetes, flu and pneumonia.Substance Abuse Disorder - In a county with a population of 60,520 residents, 16,631 patients are receiving opioids for pain. - In Cumberland County there were 1,372 prescriptions written for every 1000 residents. - Alcohol was involved in 23% of driving deaths in 2021. - 81% of the survey respondents listed adult substance abuse (drugs and alcohol) as the number one health issue in Cumberland County. - Youth substance abuse (alcohol and drugs) was identified as the second most important health issue in Cumberland County.Mental Health Access - Residents were more dissatisfied with efforts to address mental health access than any other issue in the community survey. - In Cumberland County there is a ratio 2,950 residents per each mental health provider. The Tennessee statewide ratio is 700:1.Healthcare Providers for Specialty Services - Due to a very low wage index rating in the CMC service area, reimbursements are lower. Physician recruitment and retention are significant challenges. - In 2019, the wage index for several areas in Tennessee, including Cumberland County, was increased, which should help with specialty recruitment.

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.