4A (Expenses $ 121267059 including grants of $ 25446) (Revenue $ 135527155)
"LeConte Medical Center (""LeConte"") provides care to the 14 million people who visit Sevier County each year and the nearly 100,000 residents that call Sevier County home. Previously a member of the former Fort Sanders Health Alliance, it became a member of Covenant Health when the health system was formed in 1996. Located in the foothills of the Great Smoky Mountains, it is a full-service, state-of-the-art hospital with 79 beds.SERVICEThe hospital is best known for women's services, including labor and delivery, emergency care, outpatient diagnostic services, and cardiopulmonary rehabilitation.The American College of Radiology recognizes LeConte as one of the select facilities in Tennessee designated as a Lung Cancer Screening Center. LeConte's Comprehensive Breast Center is an American College of Radiology Breast Imaging Center of Excellence. In addition, the radiology department has accreditation in every advanced imaging procedure.The Dolly Parton Birthing Unit is a family-centered facility featuring state-of-the-art monitoring systems for the safety of moms and babies. LeConte has been named a Best Maternity hospital by Newsweek, a Bronze ""Safe Sleep"" Hospital, and was previously designated a BEST for Babies hospital by the Tennessee Health Department and Tennessee Hospital Association.In 2021, the hospital served 122,515 patients. Of these, 117,652 were outpatients and 4,863 were inpatients with an average length-of-stay of 4.05 days. PUTTING PATIENTS FIRSTAs part of a growing community and a popular vacation destination for visitors from around the country, the emergency department at LeConte is one of the busiest in the region and is open 24 hours a day, seven days a week. It is equipped with a helicopter pad and an observation area. As part of Covenant Health's stroke hospital network, LeConte provides rapid diagnosis and treatment of stroke and is certified by The Joint Commission as an Advanced Primary Stroke Center. LeConte was recognized with the American Heart Association/American Stroke Association's Get With The Guidelines-Stroke Gold Plus Quality Achievement Award. The award recognizes LeConte's commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.Leapfrog awarded LeConte an ""A"" grade for safety in both spring and fall of 2021. In addition, LeConte was name a Top Rural Hospital by Leapfrog; a recognition only given to 23 rural hospitals in the nation. It was also voted the number one healthcare facility in Sevier County by the Mountain Press in the Reader's Choice awards, held in November.IMPROVING THE COMMUNITY'S QUALITY OF LIFE THROUGH BETTER HEALTHLocated inside the Dolly Parton Center for Women's Services, the LeConte Comprehensive Breast Center offers 3D mammography, stereotactic breast biopsy, bone density screenings, and has certified patient navigators available to help cancer patients manage their health care regimen. The Center's ""Paint the Mountains Pink"" program educates the community about the importance of regular mammograms and provides mammograms to women in Sevier County who qualify for mammography screening but cannot afford it. The LeConte Wellness Center is a full-service fitness center located in the Pigeon Forge Community Center. It offers members a safe and family-friendly atmosphere in which to exercise, in addition to hosting health and education programs throughout the year. LeConte's certified sports medicine athletic trainers work with coaches and students at high schools and sports tourism venues in Sevier and surrounding counties, bringing awareness of injury prevention and safety issues on and off the field. In 2021, LeConte sports medicine was also selected by the TSSAA to be the healthcare provides for the State Golf Championship held in Sevierville, TN. For the past 11 years, LeConte Medical Center has partnered with Dollywood's Splash Country (a 35-acre water park located in nearby Pigeon Forge) to host a Water Safety Day. This event is designed to provide children and parents with life-saving water safety skills, and builds awareness about the importance of teaching children to swim. Participants also learn about boating safety, skin cancer prevention, emergency first aid, general water safety, and recognizing the signs of stroke. COVENANT HEALTH LeConte 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.LeConte 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."

LeConte Medical Center
"Part V, Section B, Line 5: LeConte Medical Center (""LMC"") conducted its third Community Health Needs Assessment (""CHNA"") in 2020. A Steering Committee was formed to guide the assessment process and included the Sevier County Health Department, LeConte Medical Center, the Sevier County Health Council and the Tennessee Department of Health. 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 Sevier County household survey and to host four focus groups of community leaders, each of which represented a part of the overall Sevier County public health system. The household survey collected information from nearly 225 Sevier 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 Cherokee Health Systems, East Tennessee State University, Sevier County Sheriff's Office, Covenant Medical Group, Sevier County School System, and Gatlinburg Recreation Department."

LeConte Medical Center
Part V, Section B, Line 6b: LMC's 2020 CHNA was conducted with the following organizations: - Cherokee Health System - Department of Children's Services - Dollywood - East Tennessee State University - Family Resource Center - First Baptist Church - Helen Ross McNabb - Local Law Firm - Mountain Hope Clinic - Safe Harbor CAC - Sevier County Health Department - UT Extension - Sevier County Emergency Medical Services - Seymour Farmers Market - Sevier County Schools - Dr. Robert F. Thomas Foundation - Sevier County Sheriff's Office

LeConte Medical Center
Part V, Section B, Line 11: The primary findings from the assessment were access to healthcare, senior health, poverty, tobacco use, mental health, awareness of resources, substance abuse, obesity, health education, and chronic disease management. After discussion, the Data Team developed a consensus around the most significant issues and narrowed the initial list of health concerns to a list of the top four.In rank order as determined by the Data Team: 1. Mental Health 2. Obesity - Adult and Child 3. Health Education 4. Substance Abuse.1. Mental HealthBehavioral Health Services Expansion - Psychiatric consultation service is now being provided for patients in the Emergency Department and for inpatients at LMC via tele-video through Peninsula Behavioral Health, a department of Parkwest Medical Center. - LMC's patients can be referred to Peninsula's Outpatient Psychiatric Clinic, which is located less than a mile away from the hospital. - LMC, with funding support from the Covenant Health Office of Philanthropy, implemented Emergency Department Diversion Program in 2021. A team of medical and behavioral specialists will conduct a behavioral assessment and develop a treatment plan to meet the identified needs. An outreach specialist will follow up with patients to oversee the implementation plan. 2. Adult and Childhood ObesityCovenant Kids Run - Each year, as part of the Covenant Health Knoxville Marathon, children in kindergarten through 8th grades participate in the Covenant Kids Run. Participants work on completing 26.2 miles of activity with the final mile taking place on race day of the marathon. The intent of the program is to get youth to engage in physical activity and develop healthy habits. LMC, the Knoxville Track Club and Covenant Health's marketing department will coordinate with Sevier County Schools to encourage participation. Due to COVID delays the Kids Run, which is usually held in spring, was held on October 2nd, 2021.Walk Across the Smokies - Community Hikes - LMC will sponsor a series of Spring and Fall community hikes, led by Missy Kane. This is an on-going collaboration with the Friends of the Smokies organization.3. Substance AbusePeninsula Drug Treatment Program - LMC can now refer patients to Peninsula's Medication Assistance Treatment program through the Center's Outpatient Services for Substance Abuse. This program offers specialized medications and intensive therapy to treat substance abuse disorders. Cherokee Health Navigator Program - LMC has an agreement with Cherokee Health via a grant program to provide counseling and resources for overdose patients in the Emergency Department or as inpatients.HEAL Coalition - LMC will continue to support this multi-disciplinary coalition to address the incidence of Neonatal Abstinence Syndrome in Sevier County. - LMC will continue to support its Women's Recovery Support Group for women dealing with addiction. The group is held each Monday at the medical center.Opioid Lite Program - LMC's Emergency Department is participating in a Covenant Health system-wide initiative to curb the use of hospital-prescribed opioids. Physicians are prescribing non-opioid drugs when indicated for pain management during treatment and at discharge. - LMC works in conjunction with other community resources, including Helen Ross McNabb and Sevier County Alcohol and Drug Education, to address substance-related issues, including tobacco use. 4. Health EducationDollywood Partnership - LMC is a member of Covenant Health, which is the health partner for Dollywood, Sevier County's largest employer. LMC periodically provides speakers for Dollywood's safety team. Cardiac Rehab Education - LMC also provides cardiac rehabilitation education. Community Stroke Education - LMC provides chronic disease education (e.g., diabetes) in conjunction with University of Tennessee Agricultural Extension agents. - LMC's stroke coordinator regularly provides stroke education to the community.

LeConte 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.lecontemedicalcenter.com/community-health-needs-assessment/

Part V, Line 10a, Implementation Strategy Website
https://www.lecontemedicalcenter.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""), LMC 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 LMC 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 cost of providing OB and neonatal care exceeded the payments by $42,549. The organization has included $3,160,419 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 $9,247,023.

Part II, Community Building Activities:
LMC 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 LeConte Medical Center 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: LMC 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. LMC obtains additional community information through the service of its employees with the Chamber of Commerce, Sevier County Health Council, and Rotary Club, and through partnerships with the Boys and Girls Club and the Mountain Hope Good Shepherd Clinic for the uninsured. 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 III, Line 9b:
"LMC 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 72% discount on charges based on the facility's calculated AGB. Federal poverty guidelines are utilized in the determination of charity care eligibility. Patients who are unable to pay and have exhausted all sources of payment assistance may qualify for charity care. A sliding scale is used for extending charity care utilizing the income levels reported under the federal poverty guidelines. Patients/guarantors with income that falls below 200% of the federal poverty guidelines receive 100% charity care. Patients/guarantors with income of 201-300% of the federal poverty guidelines receive 90% charity care. For catastrophic illness, exceptions to income and asset limitations may be made on a case-by-case basis. The amount considered for charity will be based upon the evaluation of the patient's/guarantor's ability to pay.LMC 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 LMC 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. LMC 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. LMC does not sell any accounts receivable accounts to outside firms. All accounts remain property of and under the policies set by LMC. LMC 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. LMC 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 LeConte 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 LeConte Medical Center will provide, at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling 865-446-8687, Monday through Friday between the hours of 8 a.m.-4 p.m. Additional information regarding financial assistance is also available on our website at LeConteMedicalCenter.com. Signage at the registration areas state the following:It is LeConte 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 LeConteMedicalCenter.com. A financial counselor is available to assist you with these matters by calling 865-446-8687, Monday through Friday between the hours of 8 a.m.-4 p.m.

Part VI, Line 4:
Sevier County, Tennessee, is the primary market for LMC. It is a rural community within close proximity to the metropolitan Knoxville area. LMC is the only hospital in the county. According to internal hospital data for 2021, 68% of the inpatient encounters and 60% of the outpatient encounters originate from Sevier County, the focus of the assessment.The following statistics are taken from the 2021 County Health Rankings data of the Robert Wood Johnson Foundation. The population of Sevier County is 98,250 and is predominantly female(51%). Persons over the age of 65 account for 20.3% of the population. Nearly 21% of adults are uninsured as are 7% of children. The unemployment rate is 3.3%. Three-fourths of the population works in the hospitality/tourism sector, and the median household income is $54,500.According to the 2021 County Health Rankings Report of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, Sevier County residents have the following health indicators that are above the national benchmarks: Sevier - TN - National Adult Smoking: 25% - 21% - 16% Adult Obesity: 44% - 33% - 26% Children in Poverty: 20% - 19% - 10% Teen Birthrate: 34 - 29 - 12 of every 1,000 teenage girls Poor or Fair Health: 23% - 21% - 14% Physical Inactivity: 37% - 27% - 19% Drug Overdose Deaths 39 - 28 - 11 per 100,000 population

Part VI, Line 5:
LMC, 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 LMC's board. The board is comprised of independent community leaders with diverse educational and professional backgrounds. The board provides governance and oversight of LMC. LeConte 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:
"LMC, 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.LMC'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, bariatric surgery center, pulmonary rehabilitation programs, and ambulatory infusion centers.Thompson Cancer Survival Center participates with LMC in educating the community about cancer prevention and treatment by providing information and materials at the Sevier County annual Relay for Life event. The Robert F. Thomas Foundation (""Foundation""), a not-for-profit fundraising organization, conducts fundraising events. A portion of the funds are donated to LMC for the purpose of purchasing healthcare related equipment. In addition, the Foundation donates funds to be used for the continuing education of physical therapists employed by LMC.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."