4A (Expenses $ 379636911 including grants of $ 291562) (Revenue $ 402715728)
"Parkwest Medical Center (""Parkwest"") admitted its first patient on December 10, 1973. It became a not-for-profit hospital in 1990 and joined the Covenant Health system in 1996. Peninsula, a division of Parkwest Medical Center (""Peninsula"") is the behavioral services division of Parkwest Medical Center and the region's largest provider of behavioral health services. Peninsula has a 155-bed hospital in Blount County providing mental health services for adolescents and adults. Peninsula also provides outpatient services in four counties. SERVICEWest Knoxville's largest medical center, Parkwest has an organizational culture focused on treating every patient and visitor with courtesy, compassion and respect. It is best known for excellence in orthopedics, cardiology, surgical and behavioral health. Parkwest Medical Center and Peninsula Behavioral Hospital, a division of Parkwest, served 266,027 patients in 2021. Of these, 247,155 were outpatients and 22,571 were inpatients with an average length-of-stay of 4.81 days. PUTTING PATIENTS FIRSTIn 2021, Parkwest was recognized by U.S. News & World Report as the #4 Best hospital in Tennessee, the #1 hospital in Knoxville metro area, and rated as a high performing hospital by US News & World Report for hip and knee replacements, COPD, colon cancer surgery, heart attack and heart failure measures. BlueCross BlueShield gave the hospital a Blue Distinction Center+ designation for knee replacement and hip surgery, spine surgery and maternity care, and a Blue Distinction Center designation for bariatric surgery. Parkwest was named a Top 50 Cardiovascular Hospital by IBM Watson Health, for the second year in a row. The Joint Commission has designated the hospital as an Advanced Primary Stroke Center, and Parkwest is a member of Covenant Health's stroke hospital network, which links Covenant Health's member hospitals in providing rapid diagnosis and treatment of stroke. Parkwest was recognized with GoldPlus Stroke Quality Achievement Award by the American Heart Association/American Stroke Association. Parkwest has earned the GoldPlus Quality Award from the American Heart Association, recognizing consistent compliance with evidence-based quality measures for care of patients experiencing heart attacks, and a Gold award for non-STEMI quality measures. The Childbirth Center at Parkwest Medical Center was recognized by the Tennessee Department of Health and Tennessee Hospital Association with a BEST for Babies Award (2020 designation, presented in 2021) for efforts to reduce infant deaths. The award focuses on hospital excellence for breastfeeding support, early elective delivery reduction and safe sleep for Tennessee babies. IMPROVING THE COMMUNITY'S QUALITY OF LIFE THROUGH BETTER HEALTHIn 2021, Parkwest provided over $100,000 worth of taxi/transportation vouchers to patients who needed transportation to receive treatment or had been discharged and needed transportation home. In 2021, Parkwest participated in the Greater Knoxville Heart Walk, raising funds and awareness for heart disease. In non-COVID years, employees have participated in the March of Dimes March for Babies, which focuses on improving the health of newborns and infants. Parkwest also usually participates in local health fair screenings for area businesses and groups, providing carotid ultrasound screenings and physical therapy ergonomic education, as well as stroke education. In 2021 the employees at Parkwest exceeded fundraising goals for the Chaplain's fund which helps employees with emergency assistance when needed.As a member of Covenant Health, Parkwest and Peninsula have adopted the ""We Honor Veterans"" program, recognizing and celebrating patients and employees who are veterans in our facility. When a patient is identified as a veteran they are recognized with a certificate and pinning ceremony."

Part V, Section B
Facility Reporting Group A

Facility Reporting Group A consists of:
- Facility 1: Parkwest Medical Center, - Facility 2: Peninsula, a division of PW Med Ctr.

Group A-Facility 1 -- Parkwest Medical Center Part V, Section B, line 5:
"Facility Group AIn conducting its most recent Community Health Needs Assessment (""CHNA""), Parkwest Medical Center (""Parkwest"") partnered with the Knox County Health Department (""KCHD"") and the Community Health Council (""Health Council""). Community hospitals worked collaboratively with KCHD and the Health Council along with local healthcare providers, governmental agencies, and dozens of community stakeholders. KCHD convened monthly data group meetings with assessment partners to organize and coordinate the qualitative and quantitative data collection efforts. The qualitative data consisted of 10 focus groups consisting of 66 participants, 10 key informant interviews, and a quality of life survey with more than 600 responses. A Behavioral Risk Factor Survey (BRFS) and Youth Risk Factor Survey (YRFS) were conducted as well. Epidemiology staff compared local and state level data, data from the surveys, and mortality and disease prevalence data. KCHD released a summary of initial Community Health Assessment findings to the public in June 2019. Feedback was solicited via presentations to community groups and an online and paper survey."

Group A-Facility 1 -- Parkwest Medical Center Part V, Section B, line 6a:
"Part V, Section B, line 6a: Facility Group AKnox County hospitals who participated in the ""Together! Healthy Knox"" initiative included Parkwest Medical Center, Fort Sanders Regional Medical Center, East Tennessee Children's Hospital, and The University of Tennessee Medical Center."

Group A-Facility 1 -- Parkwest Medical Center Part V, Section B, line 6b:
"Part V, Section B, line 6b: Facility Group AThe CHNA could not have been completed without the leadership of the Knox County Health Department and the ""Together! Healthy Knox"" Leadership Team. Their expertise, use of the national Mobilizing for Action through Planning and Partnerships (MAPP) process, meeting facilitation and guidance ultimately resulted in the most comprehensive health assessment process ever undertaken in Knox County. Other community organizations who participated in the CHNA process were Child and Family Tennessee, City of Knoxville, Knoxville Academy of Medicine, Knoxville Area Coalition on Childhood Obesity, Knoxville Chamber of Commerce, Knoxville Police Department, Knoxville Community Development Corporation, Helen Ross McNabb Center, Interfaith Health Clinic, Knox County Government, Metropolitan Drug Commission, and community members from many other organizations. A more extensive list is published in the assessment."

Group A-Facility 1 -- Parkwest Medical Center Part V, Section B, line 11:
Part V, Section B, line 11: Facility Group AOf the significant findings from the assessment, Parkwest is focusing its resources on the following:1. Mental HealthBehavioral Health Services Expansion - Psych consult services are now being provided for patients in the Emergency Department and for inpatients at Parkwest Medical Center via tele-video through Peninsula, a Division of Parkwest Medical Center. - Parkwest Medical Center, 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 develop a treatment plan proposal to meet the identified needs. An outreach specialist will follow up with patients to oversee the implementation plan.ComPASS Support Group - Peninsula, a division of Parkwest Medical Center, provides a monthly support group for those who have lost a family member, friend, or co-worker to suicide. This group provides a safe place of support, understanding and education during the journey of loss following the suicide death of a loved one. Survivors of Suicide Loss Day - Parkwest annually hosts Survivors of Suicide Loss Day on the Saturday before Thanksgiving in conjunction with the Tennessee Suicide Prevention Network. This day, designated by the United States Congress, is a day to provide support and healing to those affected by suicide. Knox Area Rescue Ministries - Covenant HomeCare and Peninsula are providing onsite physical and mental health services to clients of Knox Area Rescue Ministries. Clients are predominantly homeless and living in shelters and on the street. Peninsula has an outreach specialist on-site at KARM once a week and is currently expanding services in conjunction with Covenant HomeCare. 2. Substance AbusePeninsula Drug Treatment Program - Parkwest Medical Center can now refer their patients to the 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 - Parkwest Medical Center's Emergency Department is participating in a 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 hospital discharge.3. ObesityCovenant Health Knoxville Marathon - Parkwest Medical Center is a major supporter of the annual Covenant Health Knoxville Marathon which is held in partnership with the Knoxville Track Club. To prioritize community health and safety, the 17th annual event was held virtually and participants were encouraged to run or walk the course on their own over a 9-day virtual race period. Local neighborhoods, greenways, and trails are incorporated into the course. In 2021, 3,814 people participated in the event. HealthQuest Marathon Challenge - Parkwest employees participated in the first annual HealthQuest Marathon Challenge. Employees signed up to participate in one of the Covenant Health Knoxville Marathon virtual events including the marathon, half-marathon, 2- or 4- person relay teams or the 5K. Teams competed with other Covenant Health hospital member organizations for points. Nearly 185 employees system-wide participated in 2021.Center for Bariatric Surgery - Parkwest offers bariatric surgery to benefit morbidly obese people or those with obesity-related illness who have been unable to lose weight through other methods. Additionally, monthly support group meetings are available to provide insight and perspectives from people who are able to share their real-world experiences.

Group A-Facility 1 -- Parkwest 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.treatedwell.com/community-health-needs-assessment/

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

Part V, Section B
Facility Reporting Group A

Facility Reporting Group A consists of:
- Facility 1: Parkwest Medical Center, - Facility 2: Peninsula, a division of PW Med Ctr.

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""), Parkwest 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 Parkwest 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 in 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 in-patient and out-patient psych services exceeded the payments received by $2,120,978. The organization has also included $13,086,822 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 $11,568,295.

Part II, Community Building Activities:
Parkwest 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 Parkwest 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 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. Parkwest obtains additional community information through the service of its employees with the United Way of Greater Knoxville, local chambers of commerce and Rotary clubs, the Metropolitan Drug Commission, a local alternative high school, the Legacy Parks Foundation, and the Knoxville Area Coalition on Childhood Obesity. 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:
Parkwest, 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 Parkwest's board. The board is comprised of independent community leaders with diverse educational and professional backgrounds. The board provides governance and oversight of Parkwest.Parkwest 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 8:
Medicare Shortfall: Parkwest believes that all of the $5.6 million shortfall reported in Line 7 should be considered as community benefit. The IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. Medicare shortfalls must be absorbed by the hospital in order to continue treating the elderly in our community. This year, Medicare patients accounted for 24% of total patient days, (25,719 out of 107,015 total). The hospital provides care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries. Costing Methodology: Parkwest used a combination of sources in calculating Medicare allowable costs on Part III, Line 6 including its cost accounting system, general ledger accounting system, and facility-specific analyses and calculations.

Part III, Line 9b:
"Parkwest 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 of Parkwest automatically receive a 69% discount on charges based on the facility's calculated AGB. Self-pay patients of Peninsula receive a 60% discount. 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.Parkwest 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 Parkwest 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. Parkwest 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 FAP, 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.Parkwest does not sell any accounts receivable accounts to outside firms. All accounts remain property of and under the policies set by Parkwest. Parkwest 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. Parkwest 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 Parkwest 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 Parkwest Medical Center will provide, at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling 865-373-1244, Monday through Friday between the hours of 8 a.m.-4:30 p.m. Additional information regarding financial assistance is also available on our website at TreatedWell.com. Signage at the registration areas state the following:It is Parkwest 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 TreatedWell.com. A financial counselor is available to assist you with these matters by calling 865-373-1244, Monday through Friday between the hours of 8 a.m.-4:30 p.m.

Part VI, Line 4:
Parkwest is located in the west area of Knoxville, Tennessee. Although located in metropolitan Knox County, Parkwest receives many specialty referrals from outlying hospitals and physicians and serves patients from 16 diverse counties, a mix of urban, suburban and rural. According to internal hospital data for 2021, 45% of the inpatient and 46% of the outpatient cases came from Knox County residents.Parkwest also provides mental health services to the region through its behavioral health division, Peninsula. Peninsula is East Tennessee's leading provider of behavioral healthcare services. Peninsula offers a complete range of mental health and alcohol/drug treatment programs. In addition to outpatient centers in Blount, Knox, Loudon and Sevier counties, care is also offered at Peninsula, a 155-bed inpatient facility which serves on average more than 5,000 patients annually.According to 2021 data from the County Health Ranking report from the Robert Wood Johnson Foundation, the population of Knox County is 470,313. The percent of the population that is 65 years or older constitute 16.2% of the residents. The unemployment rate in 2021 was 2.9%. According to the 2021 County Health Rankings Report by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, Knox County residents have the following health indicators that are at or above the national benchmarks: Knox - TN - National Adult Smoking: 19% - 21% - 16% Adult Obesity: 29% - 33% - 26% Drug Overdose Deaths: 52 - 28 - 11 per 100,000 population Teen Birthrate: 19 - 29 - 12 of every 1,000 teenage girls

Part VI, Line 6:
Parkwest, 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.Parkwest operates a 462-bed acute care hospital in Knoxville, Tennessee, and provides a full range of inpatient and outpatient hospital services. Parkwest offers a full cardiovascular service line that includes coronary bypass surgery, a structural heart program, and diagnostic and interventional cardiac procedures. Patients may also receive treatment in one of Parkwest's specialty centers, which include: - The Senior Behavioral Center, a 16-bed unit for older psychiatric patients - A Bariatric Surgery Center of Excellence - A Joint Replacement Center - A surgical center that utilizes the latest technology, including robotics, for spine, brain, and ENT surgery.Parkwest also owns and operates Peninsula, a 155-bed psychiatric hospital located in Louisville, Tennessee. Peninsula has outpatient centers in Knox, Blount, Sevier and Loudon Counties. Peninsula is a valuable resource providing support for emergency rooms at the system's nine acute care hospitals. The affiliation makes for an accessible and efficient pathway for patients who require mental health services post-discharge.Parkwest and Peninsula patients benefit from the availability and ease of access to Covenant Health affiliated entities for services not provided by the hospitals themselves. Transfer or referral to such services is expedited and coordinated to help create a seamless continuum of care. Specialized services such as inpatient rehabilitation, 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 diabetes, wound care, and ambulatory infusion centers.The Fort Sanders Foundation seeks out community financial support for Parkwest and Peninsula. 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.