4A (Expenses $ 36426138 including grants of $ 1000) (Revenue $ 40728313)
Fort Loudoun Medical Center has been located in Lenoir City, Tennessee, since 2004, after serving the area from a previous location in Loudon County for many years. SERVICEFort Loudoun Medical Center is known for quality and safety and has earned accolades for top performance on core measures for inpatient care. The medical center is in the top 10 percent of hospitals nationwide in the prevention of hospital-acquired infections. The medical center is certified by The Joint Commission as an Advanced Primary Stroke Center. As part of Covenant Health's stroke hospital network, Fort Loudoun Medical Center provides rapid diagnosis and treatment of stroke. In 2021, the hospital saw 63,666 patients. Of these, 61,369 were outpatients and 2,297 were inpatients with an average length-of-stay of 4.37 days. PUTTING PATIENTS FIRSTFort Loudoun Medical Center Descriptive Highlights - 87,000-square-foot facility, with an adjacent two-story medical office building - 50 beds with bedside charting technology - State-of-the-art imaging: X-Ray, CT, MRI and nuclear medicine. The hospital's Picture Archiving and Communications System (PACS) allows for digital capture, storage and transmission of medical images - Emergency department with 12 private suites, open 24/7, 365 days a year - Surgical suites for endoscopy; ear, nose and throat; gynecology; ophthalmology; orthopedic; podiatry; pulmonology, and general non-invasive procedures - Women's Imaging Department offers mammography, ultrasound and bone density testing - Private family waiting areas in each unit - Central registration area - Spacious private and semi-private rooms - Helipad for emergency transportation - Physicians representing various medical specialties provide a growing community with increased access to convenient, local care.IMPROVING THE COMMUNITY'S QUALITY OF LIFE THROUGH BETTER HEALTHBecause of COVID-19, many of Fort Loudoun's community-focused health events were put on hold. Previously, hospital staff, including the chief administrative officer and chief nursing officer, provided stroke education to the community through tours and luncheons offered at the hospital as well as external presentations to churches, schools, neighborhoods, fire departments, EMS, and local organizations. Fort Loudoun Medical Center collaborated with local schools to provide tobacco education to students, offering health-related information to students who are caught using tobacco products on school property.Friday Fitness, a local hiking program through Covenant Health, provided quarterly community hikes throughout the year. Fort Loudoun looks forward to resuming these community events.COVENANT HEALTH Fort Loudoun 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.Fort Loudoun Medical Center, 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.

Fort Loudoun Medical Center
"Part V, Section B, Line 5: Fort Loudoun Medical Center (""FLMC"") conducted its third Community Health Needs Assessment (""CHNA"") in 2020. A Steering Committee was formed to guide the assessment process and included the Loudon County Health Department, Loudon County United Way, Fort Loudoun Medical Center, Loudon County Health Council, and the Prevention Alliance of Loudon County. 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 Loudon County household survey and to host three focus groups of community leaders, each of which represented a part of the overall Loudon County public health system. The household survey collected information from 353 Loudon 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, Prevention Alliance of Loudon County, and several community leaders."

Fort Loudoun Medical Center
Part V, Section B, Line 6b: Though Fort Loudoun'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 Loudon County Health Department and the Loudon County Health Council.Additionally, focus groups were beneficial in discussing and identifying community needs in Loudon County. Organizations and individuals participating in the focus groups include:- Align 9 - Boys and Girls Club - Cherokee Health System - Edward Jones Financial- Good Samaritan Center - Community Hispanic advocate - Community Volunteer - Senior Advocate - District Attorney's Office- Loudon Co. Coordinated School Health - Loudon Co. Health Department- Loudon Co. Health Council - Loudon Co. Government - Loudon Co. United Way - News Herald - Prevention Alliance of Loudon Co. - Tate and Lyle - Tellico Recreation Center - UT Extension Service - Veterans Affairs - Victim Advocate YWCA

Fort Loudoun Medical Center
Part V, Section B, Line 11: At the conclusion of the 2020 assessment process, the Data Team identified a list of 7 health priorities. The primary findings from the assessment were chronic disease management, mental health, substance abuse, COVID-19, tobacco, homelessness and non-English speaking residents. The top four most significant issues in rank order as determined by the Data Team were: 1. Substance Abuse Disorder 2. Chronic Disease Management 3. Mental Health 4. Tobacco Fort Loudoun Medical Center updated its 2020 Implementation Plan based on the identified needs and plans to address all of the identified issues in the following ways:1. Mental HealthBehavioral Health Services Expansion - Psychiatric consult service is now being provided for patients in the Emergency Department and for inpatients at FLMC via tele-video through Peninsula Behavioral Health, a department of Parkwest Medical Center. - FLMC, with funding support from the Covenant Health Office of Philanthropy, implemented an Emergency Department Diversion Program in 2021. A team of medical and behavioral specialists will conduct a behavioral assessment and treatment plan to propose measures to meet the identified needs. An outreach specialist will follow up with patients to oversee the implementation plan. 2. Chronic Disease ManagementPulmonary Outreach Programs - Fort Loudoun Medical Center is offering a grant-funded pulmonary rehab program that addresses Chronic Obstructive Pulmonary Disease and Post-COVID Syndrome. Information is given to medical providers for community members who would benefit from the program.Community Stroke Education - FLMC will continue to promote and implement a community-wide stroke education program in Loudon County to improve and ensure awareness of stroke, stroke symptoms and the need for rapid treatment.3. Substance AbusePeninsula Drug Treatment Program - FLMC can now refer their patients to Peninsula Medication Assistance Treatment program's Center for Outpatient Services for Substance Abuse. This program offers specialized medications and intensive therapy to treat substance abuse disorders. Opioid Lite Program - FLMC's Emergency Department is participating in a Covenant Health system-wide initiative to curb the use of hospital prescribed opioids (tobacco products were identified as well). Physicians are prescribing non-opioid drugs when indicated for pain management, both during treatment and upon discharge from the hospital. - FLMC will work in conjunction with other community resources, including Helen Ross McNabb, Loudon County Health Department and the Prevention Alliance of Loudon County to address opioid-related issues. 4. Tobacco CessationVaping Impact Program - FLMC, in partnership with the Prevention Alliance of Loudon County, is co-developing education and prevention videos and other content for use in Loudon County Schools to reduce the incidence of vaping among students.

Fort Loudoun 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.ftloudoun.com/community-health-needs-assessment/

Part V, Line 10a, Implementation Strategy Website
https://www.ftloudoun.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""), FLMC 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 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 FLMC 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 organization has included $2,167,977 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 $2,600,201.

Part II, Community Building Activities:
FLMC 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 FLMC 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: Fort Loudoun Medical Center 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. FLMC obtains additional community information through the service of its employees with the local health council, United Way of Loudon County, Chamber of Commerce, and Rotary Clubs. 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:
FLMC, 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 FLMC's board. The board is comprised of independent community leaders with diverse educational and professional backgrounds. The board provides governance and oversight of FLMC.FLMC 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:
"FLMC 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.FLMC 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 FLMC 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. FLMC 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. FLMC does not sell any accounts receivable accounts to outside firms. All accounts remain property of and under the policies set by FLMC. FLMC 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. FLMC 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 Fort Loudoun 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 Fort Loudoun Medical Center will provide, at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling 865-271-6219 or 865-271-6223, Monday through Friday between the hours of 8:30 a.m.-5:00 p.m. Additional information regarding financial assistance is also available on our website at FtLoudoun.com. Signage at the registration areas state the following:It is Fort Loudoun 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 FtLoudoun.com. A financial counselor is available to assist you with these matters by calling 865-271-6219 or 865-271-6223, Monday through Friday between the hours of 8:30 a.m.-5 p.m.

Part VI, Line 4:
Loudon County, Tennessee, is the primary market for FLMC. Loudon is a rural community within close proximity to the metropolitan Knoxville area. FLMC is the only hospital in the county. According to internal hospital data for 2021, over 72% of inpatient and 70% of outpatient encounters were Loudon County residents. The following statistics are taken from the 2021 County Health Rankings data, Robert Wood Johnson Foundation. The population of Loudon County is 54,068. Persons over the age of 65 account for 26.9% of the population. The racial makeup of the population is 87.1% white persons, non-Hispanic, 9.2% Hispanic, and less than three percent of other races. Loudon is one of several counties in East Tennessee that is experiencing a significant increase in the Hispanic population. In 2021, 16% of the adults were uninsured as were 6% of the children. The median income of Loudon County is $65,200 per household. Unemployment is at 3.4%, and the manufacturing sector accounts for 22.7% of the labor market. According to the 2021 County Health Rankings Report of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, Loudon County residents have the following health indicators that are above the national benchmarks: Loudon - TN - National Adult Smoking: 22% - 21% - 16% Adult Obesity: 25% - 33% - 26% Alcohol Impaired Driving Deaths: 26% - 25% - 11% Teen Birthrate: 31 - 29 - 12 of every 1,000 teenage girls Poor or Fair Health: 20% - 21% - 14% Physical Inactivity: 26% - 27% - 19% Drug Overdose Deaths: 35 - 28 - 11 per 100,000 population

Part VI, Line 6:
FLMC, 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.FLMC 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.Fort Sanders Foundation seeks out community financial support for FLMC and other Covenant Health hospitals. Funds are used for indigent patient care, medical equipment, outreach programs, services and staff.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.