4A (Expenses $ 40635019 including grants of $ 1750) (Revenue $ 44633946)
"Roane County Medical Center, doing business as Roane Medical Center (""Roane""), located in Harriman, Tennessee, has been serving the community since 2008 and previously served the community as a county hospital. A new state-of-the-art hospital was built and opened in February 2013.SERVICERoane is a 54-bed hospital offering quality medical, surgical and critical care, emergency services, rehabilitation support, diagnostic imaging and health education. Roane's dedicated staff provides specialized care in cardiac and pulmonary rehabilitation, women's services, inpatient/outpatient rehabilitation and sleep services.The hospital served 59,454 patients in 2021. Of these, 56,571 were outpatients and 2,883 were inpatients with an average length-of-stay of 3.96 days. PUTTING PATIENTS FIRSTRoane is certified by The Joint Commission as an Advanced Primary Stroke Center and is a member of Covenant Health's stroke hospital network, providing rapid diagnosis and treatment of stroke. The hospital is also accredited in magnetic resonance imaging by the American College of Radiology. Roane's cardiac diagnostics and interventional services provide comprehensive heart care to patients in the surrounding community. These services meet evidence-based standards recommended by organizations such as the American Heart Association, American College of Cardiology, Society of Nuclear Medicine and Molecular Imaging, and the American Society of Echocardiography. Roane's emergency room has 15 suites with dedicated rooms for cardiac, major treatment and orthopedic emergencies. It is staffed 24 hours a day by healthcare professionals with advanced training in adult and pediatric emergencies. A helicopter pad makes air medical transport services available when needed. Like the rest of Covenant Health facilities in 2021, Roane added tele-ICU services to better serve critical care patients. This technology enables constant monitoring of the patient's vital signs and the ability to have consults with doctors and specialists not on-site. Roane also began an in-patient only hemo-dialysis program in March 2021, allowing the facility to support acute and chronic renal failure patients in our community while admitted to our facility.IMPROVING THE COMMUNITY'S QUALITY OF LIFE THROUGH BETTER HEALTHAs an active organizational participant in community outreach programs, Roane partners with Mid-East Senior Services and UT Extension Services to expand access for seniors to participate in a congregate feeding program, which regularly offers meals at the hospital. Because of COVID-19, many community-focused health events were put on hold. In previous years, hospital staff, including the chief administrative officer and chief nursing officer, offered community stroke education through tours and luncheons at the hospital, as well as presentations to churches, schools, fire departments, EMS and local organizations. COVENANT HEALTHRoane 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.Roane 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."

Roane Medical Center
"Part V, Section B, Line 5: Roane County Medical Center d/b/a Roane Medical Center (""RMC"") conducted its third Community Health Needs Assessment (""CHNA"") in 2019. A Steering Committee was formed to guide the assessment process and included the Roane County Health Department, Roane County United Way, Roane Medical Center, Roane County Health Council, and the Roane County Anti-Drug Coalition. Each of these community organizations serve the broader community and, in particular, the low-income, uninsured, and chronically ill. The Steering Committee worked with the University of Tennessee-Knoxville Social Work Office of Research and Public Service (""UT-SWORPS"") to devise a Roane County household survey and to host two focus groups of community leaders, each of which represented a part of the overall Roane County public health system. The household survey collected information from nearly 350 Roane County residents. Participation in the survey was diverse and reflected the demographic profile of the county for the attributes of educational level, income, ethnicity and age. The primary research was analyzed and combined with county demographics, mortality, and secondary data for more than 60 health indicators. A Data Team was formed to begin the analysis of the data and determine the most significant findings from the assessment. The Data Team included members of the Steering Committee as well as representatives from the Tennessee Department of Public Health, Office on Aging, UT Extension Office, and several community leaders."

Roane Medical Center
Part V, Section B, Line 6b: Though RMC's CHNA was issued as a stand-alone report, many non-hospital organizations assisted with the report. Research partners provided expertise on survey design, focus group facilitation, data collection, data sources, and analysis. UT-SWORPS was an integral participant, as well as the Roane County Health Department and the Tennessee Department of Public Health (Nashville, TN).Additionally, focus groups were beneficial in discussing and identifying community needs in Roane County. Organizations and individuals participating in the focus groups include:- Local pastor - Roane County Health Department- Leadership Roane County - Mid-East Office on Aging- Michael Dunn Center - Roane Alliance- Free Medical Clinic - Local nurses and physicians- Kingston Rotary Club - Roane County Anti-Drug Coalition- Boys and Girls Club - Regions Bank- Roane County Chamber of Commerce - Roane County Schools- UT Extension Office - Roane County United Way - Roane County Sheriff's Office - Child Advocacy Center - Roane County Health Council

Roane 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: Substance Abuse Disorder, Suicides, Health Education for Chronic Diseases, Mental Health Services, and Improving Access to Healthcare.RMC updated its 2019 Implementation Plan based on the identified needs and plans to address all of the identified issues in the following ways:1. Substance Abuse DisorderRoane County Anti-Drug Coalition - RMC will continue to actively participate in the Anti-Drug Coalition and its outreach activities.Opioid Light Protocol - RMC will continue to build upon the successes of its Emergency Department use of Opioid Light. Emergency Department physicians, when possible, are using non-opioid pain medications during treatment and at discharge.In-patient Pain Management Initiative - RMC is teaching in-patients how to better manage pain with alternatives like repositioning, ice packs, and pain scales (1-10).2. SuicidesTelehealth Options for early Screening and Detection - RMC will explore collaborations with Ridgeview Behavioral Health, Mobile Crisis, and Peninsula Behavioral Health on development of telehealth services for Roane County residents at-risk of suicide. - The Roane County Health Council has adopted suicide as a primary topic of focus. As a member of the Health Council, RMC will work with the goals and tactics developed to reduce suicides in Roane County.3. Health Education for Chronic DiseaseDiabetes Education - RMC will continue working with UT Extension Office on its 6-week diabetes program for community members.Community Walking Program - RMC will continue its monthly Friday Fitness program in conjunction with Methodist Medical Center. A monthly hike is open to all interested residents, and hike locations rotate between Roane and Anderson County parks, greenways, and hiking trails. Stroke Education - RMC will regularly provide community education programs on Stroke Signs and Symptoms to emphasize the importance of getting someone to the hospital for better outcomes. Additionally, the Unit Practice Council of Nurses will expand community education outreach to include stroke, organ donation, and advance directives.4. Mental Health ServicesTelehealth Options for Psychiatric Access - RMC will begin investigating Telehealth options for patients with mental health needs. Additionally, training opportunities are being considered for physicians with regard to certain medications to be administered earlier in the Emergency Department psychosis visit.5. Improving Access to HealthcareRound about Roane - RMC was a founding member in the design and implementation of Round about Roane, a community transportation program for seniors. RMC continues to support the program with outreach efforts and referrals to the program.Free Medical Clinic of Oak Ridge - RMC is a partner with the Free Medical Clinic in Roane County. The hospital provides lab and imaging services to the Clinic's patients at no charge.Pharmacy Advocate Program - RMC provided a Pharmacy Advocate for two years to help discharging hospital patients and primary care clinic patients without insurance find programs to assist in maintenance medicines for chronic medical conditions. This program was transferred to the Free Medical Clinic in 2021.

Roane Medical Center
Part V, Section B, Line 16j: All other ways in which the hospital widely publicizes the FAP are discussed in detail in Part VI, Line 3.

Part V, Line 7a, CHNA website
https://www.roanemedical.com/community-health-needs-assessment/

Part V, Line 10a, Implementation Strategy Website
https://www.roanemedical.com/community-health-needs-assessment/

Part V, Line 20d, Presumptive Eligibility Determinations
The hospital follows the eligibility procedures as detailed within the FAP and does not make presumptive eligibility determinations.

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

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

Part I, Line 7g:
Subsidized health services includes the difference between the cost of services and the payments for those services. The organization has included $1,300,696 in physician sponsorship fees in total subsidized health services. All subsidized health services included on line 7g are for services that would otherwise be unavailable in the community or be below the community's needs.

Part I, Ln 7 Col(f):
The Bad Debt expense included on Form 990, Part IX, Line 24a, but subtracted for purposes of calculating the percentage in this column is $3,142,761.

Part II, Community Building Activities:
RMC 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:
At regular intervals, the Vice President of Revenue Cycle analyzes all self-pay accounts receivables to identify patients who may have been eligible for charity care during a particular period or year. Because this analysis does not yield a final determination of eligibility due to various factors including but not limited to charity applications still in process, failure of eligible patients to submit their charity application, and applications still under consideration, further analysis of the accounts comprising the self-pay accounts receivable is conducted. The accounts for which a patient was contacted to apply for charity care include an identifier; these charity-identified accounts are then categorized according to status. A ratio of the dollar amounts of those accounts whose charity application is in process or has been approved divided by the total self-pay accounts receivable is computed. This ratio is applied to the bad debt expense total to determine the estimated amount of the bad debt expense attributable to patients eligible for charity care according to the hospital's policy.

Part III, Line 4:
Note B to the 2021 Audited Consolidated Financial Statements of the Covenant Health system, of which RMC 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: RMC 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. RMC obtains additional community information through the service of its employees with the Roane County Chamber of Commerce, Roane County Health Council, local Rotary Clubs, and Roane ElderWatch, and by partnering with the local justice system to combat prescription drug abuse. Covenant Health, the parent organization, maintains community benefit professionals working year-round to ensure that all hospitals are assessing and addressing the needs of the communities served.

Part VI, Line 5:
RMC, 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 RMC's board. The board is comprised of independent community leaders with diverse educational and professional backgrounds. The board provides governance and oversight of RMC. RMC 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:
"RMC 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 66% 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.RMC 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 RMC 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. RMC 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. RMC does not sell any accounts receivable accounts to outside firms. All accounts remain property of and under the policies set by RMC. RMC 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. RMC employs full time financial counselors to assist patients in applying for TennCare and screening for eligibility for financial assistance. Office hours and the phone number for the counselors are included on the signage. Wall signs informing patients about available financial assistance state the following: Covenant Health is committed to providing quality health services in a caring environment. It is the expressed philosophy of Covenant Health and its member hospitals that no one should be denied necessary medical care because of the inability to pay. In conjunction with this philosophy, counselors at Roane Medical Center are available to assist you with your financial needs. If you are an uninsured person with no public or private source of payment for medical services Roane Medical Center will provide, at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling 865-316-2303, Monday through Friday between the hours of 8:00 a.m.-4:30 p.m. Additional information regarding financial assistance is also available on our website at www.roanemedical.com.Signage at the registration areas state the following:It is Roane Medical Center's philosophy that no one shall be denied medically necessary services based on an inability to pay. Financial assistance applications for medically necessary services are available during the registration process, through a financial counselor, or on our website at RoaneMedical.com. A financial counselor is available to assist you with these matters by calling 865-316-2303, Monday through Friday between the hours of 8 a.m.-4:30 p.m.

Part VI, Line 4:
Roane County is the primary market area for RMC. It is the only hospital in the county, which is in close proximity to the metropolitan Knoxville area. Although RMC serves patients from multiple counties, 70% of its inpatients and outpatient encounters come from Roane County.The following statistics are taken from the 2021 County Ranking Data from the Robert Wood Johnson Foundation. The population is 53,382, indicating very little change since the 2013 assessment. The population of Roane County is predominantly female (51%) and Caucasian (92.5%). The median household income is $50,600. The percentage of county residents over the age of 65 is 23.2%, and 18.6% of the population are under the age of 18. Nearly 13% of the adult population are uninsured as are 4% of children. The unemployment rate is 4.0% for 2021. The dominant labor force is from the manufacturing sector (20.3%).In support of the significant findings from the 2019 CHNA, the following data points support the conclusions of the 2019 assessment:Substance Abuse Disorder - With a county population of 53,382, there are 15,819 patients receiving opioids for pain. - There were 1,423 opioid prescriptions written for every 1,000 adults in Roane County. - 88% of the survey respondents identified substance abuse as the number one health problem in Roane County.Suicides - Roane County has a suicide rate of 33.9 per 100,000 population. This rate is twice the rate of state average of 17.3 per 100,000, and is one of the highest rates in the state. - Suicide has been in the top ten leading causes of death in Roane County for the past 10 years.Health Education for Chronic Diseases - The leading causes of death in Roane county over the past decade include, in rank order, heart disease and cancer (tied for #1), respiratory disease, accidents, stroke, Alzheimer's disease, diabetes, flu, and pneumonia. Most all of these are to a large degree preventable. - Access to community health education programming is lacking in Roane County.Mental Health Services - The Mental health provider ratio in Roane County is one provider per 2,210 residents. The State of Tennessee overall ratio is one provider per 700 residents. - Community leaders, when ranking the top health priorities, had substance abuse and mental health tied for first place.Improving Access to Healthcare - Transportation continues to be a barrier for many people trying to access health services. Existing services are focused on the senior population. - There is a lack of mental health providers in the county. - Many residents are under-insured, most having health insurance with high deductibles.

Part VI, Line 6:
RMC, 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.RMC's patients benefit from the availability of and ease of access to Covenant Health affiliated entities for services not provided by the hospital itself. Transfer or referral to such services is expedited and coordinated to help create a seamless continuum of care. A full range of community mental health and psychiatric hospital services are available within the system that help support the hospital's emergency room as well as provide an accessible and efficient pathway for those patients who require such services post discharge. Other specialized services such as inpatient rehabilitation, cardiac care, cancer treatment, home health and hospice services are provided by affiliated entities. The Covenant Health system also enhances the patient's access to care through the provision of outpatient services in a variety of settings located throughout the service area. These include a diabetes center, wound care center, pulmonary rehabilitation programs and ambulatory infusion centers.Through this combination of resources and the collective development, implementation and monitoring of clinical protocols and other improvement initiatives, the affiliated entities of Covenant Health are able to deliver higher quality care in a more efficient manner than could be achieved working independently.