Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
|||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | ||||||




| Facts And Circumstances Test |
|---|
| Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990, Part VI, Section B, line 11 | A summary of Fort Sanders Perinatal Center's 2010 Form 990 was prepared and presented to the Covenant Health Finance Committee and Board of Directors at their 2011 September & October meetings, respectively. This entity is one member of a large, integrated healthcare system which files a total of twelve (12) Form 990s. Prior to filing, the Board of Directors and Finance Committee had access to the 990s of all Covenant Health Facilities. | |
| Form 990, Part VI, Section B, line 12c | Board members, officers and employees are required to adhere to rules and policies regarding conflicts of interest. Covenant Health, the parent company of the organization, distributes a board approved employee handbook to all employees. The handbook covers among other subjects, conflicts of interest. Additionally managers are required to complete and sign an annual management certification that addresses conflicts of interest. Board members' conflicts of interests are dealt with in the corporate bylaws and board members are required to complete and sign a conflict of interest questionnaire on an annual basis. The Integrity Compliance Office maintains records that contain conflict of interest information obtained from board members, officers and employees. These records are available to be queried prior to engaging in business transactions. The Integrity Compliance Officer initially reviews all conflict of interest data. Based on this information, the officer determines what conflicts of interest exist at that point in time. Between times when surveys are collected board members are expected to disclose any new conflicts that have arisen that affect pending board decisions. As well, managers and other employees are expected to report conflicts to the Integrity Compliance Officer as they arise. Depending on the nature of the conflict and the circumstances surrounding the conflict and transaction, the Integrity Compliance Officer, Senior Leadership, or the Board of Directors may review the conflict of interest. Where appropriate these bodies may also consult legal counsel. Restrictions imposed on persons with a conflict of interest are determined on a case by case basis. For Covenant Health employees, the Integrity Compliance Officer, in conjunction with Executive Leadership determines how to appropriately handle the conflict. In any conflict involving a Board member, such member is expected to excuse himself or herself from voting on matters that give rise to the conflict. | |
| Form 990, Part VI, Section B, line 15 | Form 990, Part VI, Section B, Line 15A: Overall compensation policies for Fort Sanders Perinatal Center, Covenant Health (Parent Company), and affiliates are set by the Compensation Committee of the Board of Directors which is composed of independent members of the board. The Committee is guided in its decision making process by an independent, nationally recognized executive compensation consultant experienced in advising nonprofit hospital boards. Compensation policies for Anthony Spezia and John Geppi are reported on the 2010 Form 990 of Covenant Health, EIN 62-1646734, Parent Company to Fort Sanders Perinatal Center. Line 15b: Base salaries and annual bonus opportunities for Keith Altshuler, President/CAO and David McReynolds, VP Financial Services, ("Key Executives") are set by the Covenant Health CEO or Executive Vice President-Human Resources and/or Executive Vice President-Operations, subject to approval of the Compensation Committee of the Covenant Health Board of Directors ("the Committee"), after review by and discussion with the executive compensation consultant ("the consultant") to insure that total compensation for each executive is reasonable and within a fair market value range. Salary ranges for each executive position are based upon the recommendations of the consultant made after comparison with similar jobs in similar size health systems across the nation. Bonuses are recommended by the CEO and approved by the Committee conditioned upon receipt of a written opinion from the consultant that total compensation for each key executive is reasonable and consistent with fair market value. Base salaries are initially targeted at midpoint and vary according to the individual's experience, market conditions and competition. Annual bonuses are designed to award 0-35% for the CAO's and 0-20% for the VP Financial Services' of base salary based upon system performance and accomplishment of certain targets established by the CEO. | |
| Form 990, Part VI, Section C, line 19 | Form 990, Part VI, Section C, Line 19: Per its tax exempt bond provisions, the parent company, Covenant Health, is required to file quarterly and annual consolidated and obligated group financial statements, in addition to other documentation, with various bond insurers and other agencies, including Nationally Recognized Municipal Securities Information Repositories. Any member of such a repository has access to these financial statements. | |
| Form 990, Part XII, Line 2c: | The Finance Committee of the Board of Directors assumes responsibility for oversight of the audit of the consolidated financial statements and selection of an independent accountant. | |
| Contact Addresses for Officers, Directors, Etc: | Form 990, Part VI, Line 9 and Part VII | Anthony L. Spezia Covenant Health 100 Ft Sanders West Blvd. Knoxville, TN 37922 John T. Geppi, Francis Olmstead, and all Directors: Covenant Health 1410 Centerpoint Blvd., Suite 401 Knoxville, TN 37932 Keith Altshuler and David McReynolds Fort Sanders Regional Medical Center 1901 W. Clinch Ave. Knoxville, TN 37916 All other persons listed in Part VII, Section A may be contacted at the organization's address. |
| Form 990, Part VII, Section A, Column B | The President/CEO, EVP/CFO, and Board of Directors serve Covenant Health, EIN 62-1646734, parent company of an integrated health care delivery system, of which Fort Sanders Perinatal Center is a member, as a whole. The hours these individuals devoted to the system in 2010 are reported on Covenant Health's Form 990, Part VII. | |
| Form 990, Part III, Line 1 - Report to the Community: | Service to the people and communities of East Tennessee is the cornerstone of the mission of Covenant Health, hereinafter referred to as "the System," a community-owned health system which includes acute care hospitals, outpatient facilities and clinics, and numerous specialty services. The System's mission, "we serve the community by improving the quality of life through better health," has been the foundation of the services and programs offered by the System and its member organizations since it was formed through the consolidation of Fort Sanders Health System in Knoxville and MMC Healthcare System in Oak Ridge in 1996. The System is a community-owned healthcare system and provides comprehensive health services throughout East Tennessee. Headquartered in Knoxville, Tennessee, the System includes seven acute care hospitals with a total of more than 1,700 licensed beds, as well as numerous outpatient services and clinics. The System also includes specialty providers of behavioral, oncology, and rehabilitation services, along with home care, physician clinics, community wellness programs and managed care products and services. The System has more than 1,000 affiliated physicians and 9,000 employees. Covenant Health, a tax-exempt entity pursuant to section 501(c)(3) of the Internal Revenue Code, is the parent company and sole member of several controlled entities: Fort Loudoun Medical Center, Fort Sanders Regional Medical Center, LeConte Medical Center, Methodist Medical Center of Oak Ridge, Morristown-Hamblen Hospital Association, Parkwest Medical Center, Peninsula, a Division of Parkwest Medical Center, Roane Medical Center, Thompson Cancer Survival Center, Covenant HomeCare and Fort Sanders Perinatal Center. These entities were established to provide healthcare services primarily to East Tennesseans in the surrounding 16-county area. Operating as an integrated network of health services, Covenant Health and its affiliates seek to provide affordable, superior healthcare to patients through continued operation of both acute care and non-hospital programs. The history of the System demonstrates a clear and consistent charitable purpose: the provision of healthcare services to all residents of the community without regard to age, race, gender, creed, national origin, ability to pay, or physical or mental handicap. Beyond the services documented in this report are countless acts of generosity by employees that will never be completely captured and reported, nor will they be forgotten by those who benefited from them. One of the most tangible expressions of the System's charitable purpose is the provision of care to people unable to pay. The System embraces its purpose and strives to grow the types of services not provided by other area health care providers; examples of such services include but are not limited to services provided by Peninsula, a Division of Parkwest, which provides inpatient and outpatient behavioral health services, and the Hope Center, which provides comprehensive support services for patients with HIV/AIDS and other serious illnesses, and their families and caregivers. The System provides medically necessary services to all people, regardless of their ability to pay. Patients who fall below 300 percent of the federal poverty income guidelines for a 12-month period, who are unable to pay, and who have exhausted all sources of payment assistance may be eligible for charity care. According to policy, patients whose annual income falls between 0 - 200% of federal poverty guidelines receive 100% discount while those whose income is between 201 - 300% of the federal poverty guidelines receive a 70% discount. For those who do not fall below the guidelines but are facing difficult economic circumstances, ability to pay is determined on a case-by-case basis. In particular, cases involving serious illness and/or unusually high-cost care are individually evaluated, and expectation of payment by the System is adjusted to recognize the reasonable ability of the individual patient to pay for services received. For the year ending December 31, 2010, the System provided services under the previously stated policy which resulted in significant losses to the System. Both inpatients and outpatients were provided care under the aforementioned policy. No patient was refused necessary medical care on the basis of his or her ability to pay. In addition to the level of services identified above, the System is an active participant in the State of Tennessee TennCare program. The System is the area's largest TennCare provider of services to residents of East Tennessee. The TennCare program seeks to provide payment for healthcare services to individuals who meet certain financial and categorical requirements. Financial requirements include evaluation of both assets and income. TennCare program reimbursement rates are substantially below Medicare reimbursement rates. In addition to the provision of care without expectation of payment or the provision of care to TennCare-eligible people at rates substantially below charges, the System provided services to people covered under the federal Medicare program. Medicare recipients were the largest single payor classification of patients served by the System. The payment rate for inpatient services was on a per case rate, calculated based on the diagnostic-related group into which the patient was categorized, coupled with other factors related to area wage rates, capital costs and other variables. Outpatient services were reimbursed on a pre-determined case rate. Moreover, the System works diligently throughout the year to achieve its mission by supporting community health education and outreach programs. The System underwrites the cost of community screenings, health fairs, outreach programs for seniors, outdoor fitness programs, community exercise classes, support groups for new parents and other specific populations, smoking cessation classes, and local wellness education programs. Notable examples of these programs include: Covenant Health Check, a multi-county annual screening event, now in its 27th year, which has served more than 150,000 people; Body Works, a multi-location exercise program for adults; Passport, an organization promoting health and active lifestyles for adults 50 and older; Monthly Lunch 'n Learns and Health Nights in Knox and surrounding counties; Covenant Health at the Mall, freestanding health information kiosks at two local malls; Community fitness events such as the Covenant Health Knoxville Marathon and a bike ride and foot race held in conjunction with Knoxville's Dogwood Arts Festival; Wellness programs, support groups, and outreach services sponsored by Covenant Health's member hospitals. | |
| The system also funds two "hospitality house" outreach programs, one at Fort Sanders Regional Medical Center in Knoxville, and one at Methodist Medical Center in Oak Ridge. These facilities provide temporary "homes away from home" for non-local patients and caregivers who are receiving ongoing medical treatment care at Covenant Health member organizations. The System is committed to education in order to prepare qualified nurses and other healthcare workers for the future, and to provide continuing education for current healthcare professionals. This support is shown in multiple ways, including support of Tennessee Wesleyan College - Fort Sanders Nursing, a baccalaureate level nursing education program offered under the auspices of Tennessee Wesleyan College in Athens, Tennessee, with classroom and clinical training opportunities offered in Knoxville and at various Covenant Health facilities. The System also provides clinical training rotations at its hospitals and member facilities for students in area nursing and ancillary health education programs. Additional program support and scholarships are given to students and to schools providing healthcare education throughout the area. Special programs are offered to high school and middle school students who are interested in careers in healthcare. Continuing education opportunities are provided for physicians, nurses, and other healthcare professionals on a variety of topics. During 2010, the System subsidized services related to sports medicine, services for women and children, and behavioral health assessments. Subsidized services are those services which are typically provided to meet an identified community need. If no longer offered, the services would either be unavailable in the area or fall to the responsibility of the government or another not-for-profit system to provide. The system also designated specific amounts as Physician subsidies to support the recruitment by the System and its affiliates of physicians and other health professionals for areas underserved or specialties not adequately served in the community. High populations of Tenncare patients and uninsured patients typically reside in these areas. The System supported the important work of many unaffiliated organizations and charities during 2010. While the principal community donation by the System was in the area of indigent care, donations within the context of the organization's established charitable contribution policy were also made to other causes. More than 50 organizations received charitable contributions from Covenant Health and/or its member organizations in 2010, including: American Cancer Society American Heart Association Catholic Charities East Tennessee Children's Hospital Great Schools Partnership Holston Home for Children Innovation Valley Knoxville Track Club (for sponsorship of Covenant Health Knoxville Marathon) Senior Services Contributions and Sponsorships Susan G. Komen Foundation University of Tennessee Variety Children's Charity of East Tennessee Wellness Community Donations also included support of medical mission trips to Guatemala and Haiti. Community Building activities included cash, in-kind donations, and budgeted expenditures for the development of community health programs and partnerships. These activities include physical improvements and housing, economic development and support system enhancements like disaster readiness, mentoring programs, and youth asset development initiatives. In 2010 the System provided Community Building support to many organizations, including but not limited to: Boys & Girls Club Emerald Youth Foundation Family Promise of Knoxville Interfaith Health Clinic Knoxville Academy of Medicine Project Access Roane Alliance Second Harvest Food Bank United Way Wee Course Classic In a separate but related donation category, in 2010 employees of the System also contributed financially to the System's United Way drive and Covenant Health's We Care campaign, which raises funds for charitable services provided by the System such as patient assistance with medication costs, chaplain's fund for employees in need, hospitality houses for patients from outside the area, and nursing scholarship programs. The volunteer programs at the System's acute care organizations are active and vital parts of the System's success. Volunteers donate time and service to Fort Loudoun Medical Center, Fort Sanders Regional Medical Center, LeConte Medical Center, Methodist Medical Center, Morristown-Hamblen Hospital Association, Parkwest Medical Center, Thompson Cancer Survival Center, and Covenant HomeCare. At the acute care facilities, volunteers include adults, college students and teenagers working in a variety of settings such as inpatient and outpatient facility departments, patient reception areas, gift shops, fellowship centers, etc. Funds raised by volunteers are donated for hospital equipment, supplies and special projects, as well as to meet charitable community needs. |
| Software ID: | |
| Software Version: |