Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
Fort Sanders Regional Medical Center
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1420 Centerpoint Blvd Bldg C
 
Room/suite
City or town, state or country, and ZIP + 4
Knoxville, TN379321960
D Employer identification number

62-0528340
E Telephone number

G Gross receipts $ 339,628,741
F Name and address of principal officer:
Anthony L Spezia
100 Ft Sanders W Blvd
Knoxville,TN37922
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.fsregional.com
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1954
M State of legal domicile: TN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: FSRMC provides quality hospital and other health services in the Knoxville metro area. (see Sch. O)Fort Sanders Regional Medical Center is located in the Fort Sanders community of downtown Knoxville, Tennessee, and is a member of the Covenant Health system. It serves as a regional referral center, where other hospitals send their most difficult cases. Fort Sanders Regional includes a full-service acute care hospital with 517 beds serving many specialty areas, the 24-bed Fort Sanders Transitional Care Unit, the Patricia Neal Rehabilitation Center, and specialized outpatient centers. In early 2011, Fort Sanders Regional opened its Gamma Knife Center, which houses the first advanced system in Tennessee and is one of only 30 in the United States.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 22
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 18
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 2,181
6 Total number of volunteers (estimate if necessary) ............. 6 2,119
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 3,348,739
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 331,276
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 308,604 721,126
9 Program service revenue (Part VIII, line 2g) ......... 306,053,117 324,121,456
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 48,688 23,838
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 7,552,516 10,673,384
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 313,962,925 335,539,804
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 149,860 353,902
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 96,442,806 94,613,824
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 199,080,085 226,349,258
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 295,672,751 321,316,984
19 Revenue less expenses. Subtract line 18 from line 12....... 18,290,174 14,222,820
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 164,611,848 179,732,943
21 Total liabilities (Part X, line 26)............. 34,051,396 35,018,112
22 Net assets or fund balances. Subtract line 21 from line 20..... 130,560,452 144,714,831
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: Fort Sanders Regional Medical Center provides quality healthcare, in alignment with Covenant Health's mission to serve the community by improving the quality of life through better health, regardless of the patient's ability to pay.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 73,594,647 including grants of $   ) (Revenue $ 59,297,186 )
Orthopedics, Neurology and Rehabilitation:The Ortho/Neuro/Rehab program at Fort Sanders Regional Medical Center is a comprehensive program of inpatient and outpatient services designed to restore optimal function and independence to individuals who are impaired due to orthopedic or neurological illness or injury. More information about these services is on Schedule O.Orthopedics, Neurology and Rehabilitation: Expenses - $73,594,647; Revenue - $59,297,186.From hip, knee and shoulder replacement to other commonly performed orthopedic procedures like hand, foot and ankle and spine and back surgery, Fort Sanders Regional (FSR) possesses a commitment to service excellence and to improving the patient experience in every way. These commitments are reflected in the comprehensive care provided orthopedic surgery patients, including:* In-depth education that fully prepares patients for surgery and recovery;* Infection prevention protocols that minimize infection risks;* Experienced, specialized surgeons and operating room teams that use state-of-the-art techniques;* A dedicated inpatient orthopedic nursing unit staffed by expert nurses and caregivers who know how to help patients recover from orthopedic surgery; and* A wide array of rehabilitation and therapy services, inpatient and outpatient, to help patients return to an active lifestyle.At the FSR Joint and Spine Center, patients undergoing knee or hip replacement surgeries are not treated as "sick" but as healthy adults undergoing a procedure that will allow them to return to an active life. The goal is to get patients out of bed and moving as quickly as possible. This is accomplished through education, surgical expertise and intense physical therapy. Patients are provided information about joint replacement and are challenged to take the lead in their recovery. Patients go through the program with a family member, who is designated as the patient's "Coach" and is taught how to assist the patient at home.Outpatient rehabilitation services are provided on the hospital campus and at a network of community based outpatient therapy centers. These centers offer a wide variety of therapy services, many of which are unique in the community. They include: * Physical, occupational and speech therapy, * Wound care, * Aquatic therapy, * Lymphedema treatment, * Low-vision and adaptive driving programs, * Certified hand therapy, * Vestibular rehabilitation, and * Functional capacity evaluations.In 2012 the hospital recorded 10,393 Wound Care Center patient visits and 62,047 Outpatient Physical Therapy visits.Conditions and diseases of the brain, spinal cord and nervous system can affect how people walk, talk, comprehend and function. FSR's neurologists specialize in the diagnosis and treatment of epilepsy, tumors, stroke, Alzheimer's disease, dementia, Parkinson's disease and multiple sclerosis. As a Neuro-Spine Center of Excellence, FSR has made the commitment to offer the latest advancements in neurology, neurosurgery, spine surgery, and neuro-interventional radiology. Whether a patient needs medical, surgical or neuro-radiological intervention, the goal is to provide the most appropriate care to optimize patient outcome. In 2012 there were 281 Interventional neuro-radiology cases - made up of 195 Aneurysm coilings, 66 IVC Filter placements, and 20 stroke treatments.At the Fort Sanders Sleep Disorders Center, the area's first accredited sleep center, neurologists work with patients who suffer from a host of sleep/wake disorders including sleep apnea, insomnia, narcolepsy, and restless leg syndrome. The Center treated 778 patients in 2012.Fort Sanders' neurosurgeons provide surgical intervention for brain tumors, aneurysms and hemorrhages, as well as a host of spine conditions. They also provide surgical relief for issues caused by nerve and muscle diseases, carpal tunnel syndrome, chronic back pain and conditions resistant to medical management, like Parkinson's disease.An example of the hospital's commitment to state-of-the-art technology is the StealthStation Treon, which helps guide FSR's neurosurgeons through a variety of operations, including neurological and spinal procedures. This innovative 3D-imaging system uses global positioning technology to give physicians real time views inside the body, without radiation. This innovative technology allows less invasive operations and helps avoid brain and nerve damage.Strokes are the third leading cause of death in the United States and affect more than 795,000 Americans each year. As a Stroke Center of Excellence, the care provided by FSR and Patricia Neal Rehabilitation Center physicians and staff utilizes state-of-the-art diagnostic, treatment and rehabilitation modalities. The hospital holds a Primary Stroke Center certification from the Joint Commission (one of only a handful in the state of Tennessee) as well three separate stroke accreditations from the Commission on the Accreditation of Rehabilitation Facilities (CARF). In 2012, FSR's aggregate score related to strokes was 98.47%, and it had 379 Ischemic and 66 Hemorrhagic stroke patient admissions.FSR was the first facility in the area to combine CT and bi-plane angiography with a full-time neuro-interventional radiologist to provide our region with new, minimally-invasive options for treating stroke, aneurysms, and other vascular diseases in the brain. With this system, neuro-interventional radiology procedures can be performed that would have previously required surgery and an extended hospital stay or would not have been options for some patients.Bi-plane technology improves imaging and resolution creating comprehensive 3D views of the blood vessels in the brain. Having a more precise picture of an abnormality makes it easier to diagnose and repair. A team of specialized technologists and nurses work to assist the performing radiologist with each procedure. All technologists are certified by the American Association of Radiological Technologists. Micro-catheters are inserted through the groin and then guided to the area of treatment to administer medications, coil aneurysms or retrieve clots. These new procedures often involve very short hospital stays, all while keeping radiation exposure to a safe minimum and avoiding major surgery.The Patricia Neal Rehabilitation Center (PNRC) is East Tennessee's recognized leader in helping stroke, spinal cord, brain injury, orthopedic and cancer patients rebuild their lives through the delivery of optimal rehabilitation services. Opened in 1978 as an integral part of the Ortho/Neuro/Rehab program at FSR, the PNRC offers a comprehensive team approach to care. Physical, occupational, recreational, behavioral medicine and speech language therapists work with nurses and physiatrists - doctors whose specialty is physical medicine and rehabilitation. This team develops the best individual care plan to return patients to their recovery potential as quickly as possible. Rehabilitation nurses and other specialists also educate patients, teaching them self-care skills to function as well as possible upon returning home. The Center holds 15 separate accreditations from the Commission on the Accreditation of Rehabilitation Facilities (CARF) and provides a comprehensive array of inpatient rehabilitation services that would otherwise be unavailable in the community.FSR is committed to maintaining access to unique services such as those at the PNRC. Through donations and other community support, the hospital, through the Fort Sanders Foundation, provides scholarships to allow patients with limited resources access to the rehab center's services.The Patricia Neal Innovative Recreation Cooperative (IRC) was created in 1994 to meet the needs of individuals who have suffered a life-changing illness or injury. The program was designed to be part of the continuum of care in the rehabilitation process. Its scope is to host clinics under an umbrella of education and awareness: education to teach leisure skills to enhance quality of life in a safe environment and awareness to heighten the understanding of disabilities to the community. In its existence, the IRC has seen over 7,000 participants and volunteers. The goal is to remove all the barriers to develop each individual's right to self-directed leisure for a healthier lifestyle. This program is supported by community donations, grants and a hospital subsidy.Older adults are a significant portion of the patient population in Ortho/Neuro/Rehab. FSR is committed to special health care for older adults and was the first NICHE-certified (Nurses Improving Care for Health System Elders) facility in the East Tennessee region. Care is provided to help prevent complications such as skin breakdowns, falls/injuries, pain, acute confusion, and the loss of strength and mobility.
4b (Code:   ) (Expenses $ 64,566,473 including grants of $   ) (Revenue $ 50,287,733 )
Oncology Services: Fort Sanders Regional Medical Center features extensive inpatient and outpatient oncology care provided by exceptional oncologists who practice throughout the Knoxville area. In 2012 FSR had 1,477 admissions to the Oncology unit with 8,667 patient days. More information about oncology services is on Schedule O.Oncology Services: Expenses - $64,566,476; Revenue - $50,287,733.The Oncology Center of Excellence at Fort Sanders offers a comprehensive approach to patient care which minimizes patient disruption and maximizes clinical quality and efficiency. Cancer patients and their families can be assured their loved ones will receive the most complete and exceptional oncology care available. Safety is the number one priority in the Oncology Center of Excellence. Due to the nature and potency of the medications used in this area, strict safety processes are performed by doctors, pharmacists and certified nurses who work as a team to double and triple check these medications for accuracy. Chemotherapy-trained nurses work with oncologists to make sure each patient receives the correct chemotherapy drug, in the right dosage cycle, every time. Within the Oncology Center of Excellence, many of the nurses are also oncology certified at a national level. They have dedicated more than 1,000 hours caring for cancer patients and have successfully completed a national certification examination demonstrating their specialized knowledge in this field. Staff attends special lectures and conferences hosted by local and national medical oncologists and radiation oncologists to keep up with the newest innovative treatments available.Fort Sanders' emphasis on oncology knowledge and expertise isnt just limited to nurses. Each staff member on the oncology unit is also uniquely trained in the care of cancer patients. The oncology team includes a dedicated oncologic pharmacist, dietitian, social worker, and RN case manager. This team communicates regularly to ensure excellent patient care from admission to discharge. From dietitians, to pharmacists and radiologists, to housekeeping staff, Fort Sanders has done a lot of work to provide oncology education to every employee who may come in contact with patients. By completing this 360-degree education, Fort Sanders provides better patient care. The Oncology Center of Excellence at Fort Sanders Regional holds the prestigious Certificate of Approval from the Commission on Cancer. The Commission on Cancer Certification is awarded only to facilities with oncology programs committed to providing the best comprehensive cancer care. The Oncology Nursing Unit also serves as the inpatient component of the Stem Cell Center which is based at the Thompson Cancer Survival Center. This Stem Cell treatment center in conjunction with our Oncology Nursing Unit has accomplished accreditation by the Foundation of Accreditation for Cellular Therapy, also known as FACT.Surgical oncology is the branch of surgery which focuses on the surgical management of cancer. The Medical Staff at Fort Sanders Regional Medical Center includes general surgical oncologists as well as thoracic surgical oncologists, gynecologic oncologists and other sub-specialists that specialize in treating cancer patients. Outcomes in surgical cancer care are positively associated to surgeon volume -- i.e. the more cancer cases a surgeon treats, the more proficient he becomes, thus improving overall outcomes and survival rates. In 2012 FSR had 205 surgical oncology cases.Due to the close proximity of Fort Sanders Regional Medical Center to Thompson Cancer Survival Center, the surgeons and staff at Fort Sanders Regional work closely with the cancer center's multidisciplinary treatment teams in the collaboration of care and treatment plans for patients with chest and breast cancer. A team of cancer specialists in differing areas of expertise, including surgeons, gather and evaluate each patient's case to determine possible treatment options. Each specialist then meets individually with the patient to go over treatment choices and answer questions. As part of outpatient Oncology care, Fort Sanders Regional has opened four outpatient Infusion Centers in the area providing many of the chemotherapy medications for cancer patients. There were 61,303 infusion visits to the infusion centers in 2012.Fort Sanders Regional Medical Center, through the Patricia Neal Rehabilitation Center is the only place in East Tennessee, and one of a handful in the country, who offers a cancer rehabilitation program. The cancer program combines many of the rehabilitation techniques currently used for patients with brain and spinal cord injuries and strokes because the impairments cancer patients experience can be very similar to those of traumatic injuries. The health-care team includes:* Each patient's personal physician * Medical, radiation and surgical oncologists * Physiatrists doctors whose specialty is physical medicine and rehabilitation * Rehabilitation nurses * Physical, occupational and recreational therapists * Psychologists * Speech language pathologists * Pharmacists * Dietitians * Case managers At Patricia Neal, the cancer rehab team creates a special care plan for each patient with the goal of helping patients regain as much ability and independence as possible. The center treats many of the impairments that can result from cancer, cancer surgery, radiation therapy, chemotherapy and other treatments, such as:* Fatigue * Muscle wasting * Weakness * Pain * Skin breakdown * Impaired mobility * Anxiety * Depression * Adjustment problems * Overall deconditioning * Lymphedema swelling * Weight loss * Communication difficulty * Impaired thinking or memory loss Patricia Neal has a positive, encouraging atmosphere and is known for outstanding resources, from a rooftop therapy park to a computer life-skills lab. The center also offers:* Fully-equipped therapy gyms * Special adaptive equipment programs * Animal therapy * Support groups * Community outings * Family and caregiver training * Tools to improve communication * Adaptive driving programs* Balance programs * An adaptive living apartment to ease the transition back to everyday life
4c (Code:   ) (Expenses $ 39,156,792 including grants of $   ) (Revenue $ 28,164,512 )
Cardiovascular Services:From diagnosis to rehabilitation, Fort Sanders Regional's award-winning Heart Center has the most comprehensive cardiac services available. Our advanced diagnostics, interventional technologies, cardiovascular surgery, and clinical trials are tailored to meet each patients cardiac needs. More information about cardiology services is on Schedule O. Cardiovascular Services: Expenses - $39,156,792; Revenue - $28,164,512.The team of cardiologists, cardiovascular surgeons, nurses, and technologists has the right treatment and the right people to give heart patients the best possible care. Cardiopulmonary rehabilitation is an integral part of the healing process for many cardiac patients. Fort Sanders Regional's program is designed to help patients regain their strength and stamina. Fort Sanders Regional Medical Center's Cardiology Department is the recipient of the 2012 American College of Cardiology Foundations NCDR ACTION Registry 2012 GWTG Platinum Performance Achievement Award. FSRMC is one of just 164 hospitals nationwide to receive this designation. The award recognizes the hospital's commitment and success in implementing a higher standard of care for heart attack patients. Honored hospitals have maintained a rate of performance of 90% or better for eight consecutive quarters, ending quarter four in 2011. Coronary artery disease is the term used to identify the presence of atherosclerosis in the arteries that carry blood to the heart muscle. Atherosclerosis is a buildup up of fatty substances on the inner walls of blood vessels which can block or restrict blood flow. Atherosclerosis is a major risk factor of heart attacks. For some patients, medications are the best course of action. For others, surgical intervention may be necessary. Before a plan of treatment is chosen, a definitive diagnosis is needed.Even the most complex cardiovascular problems can now be treated in Knoxville. Covenant Health is debuting "valve centers" at Fort Sanders Regional Medical Center and its sister hospitals. Covenant Health is also the first health system in East Tennessee and only one of 140 nationwide to offer TAVR, a breakthrough procedure for replacing heart valves. State-of-the-Art Cardiac DiagnosticsYou may have heard the phrase "time is muscle." This refers to heart attack survivability. When blood flow does not reach heart tissue and muscle, it dies. The faster someone can receive medical care, the better their chances for recovery. That is why a fast, accurate diagnosis of a heart condition is so important. State-of-the-art diagnostic tools available at Fort Sanders Regional include:* The area's first Lightspeed 64-slice VCT Scanner captures an incredibly precise image of the heart in just five heartbeats. * Vivid 7 echocardiography uses ultrasound to produce a moving cardiac image in real time. * Nuclear stress tests find difficult-to-detect problems in the heart's outer covering. * Electrocardiograms provide reliable diagnostics and stress tests performed right in the hospital assure immediate care if a problem is discovered. The Latest MedicinesPhysicians at Fort Sanders Regional participate in clinical trials of new medicines for a wide range of heart conditions. Three potentially life-saving medicines for unstable angina and heart attacks are currently being tested. A new trial is investigating a drug to prevent heart attacks and strokes in acute coronary syndrome patients. Minimally-Invasive TreatmentGreat strides have been made in minimally-invasive procedures for heart-related issues. Minimally-invasive procedures allow physicians to implant valves and repair holes in the heart wall without a major incision.* The new Innova 2100-IQ all-digital cath lab gives cardiologists unprecedented image clarity to better view hard-to-see blood vessels, with less radiation exposure for patients and physicians. * Radiofrequency ablation controls rapid heartbeats with radio waves. * Drug-eluting stents open blocked arteries and help prevent a recurrence of the blockage. Cardiovascular SurgeryCardiovascular surgery includes surgical procedures to correct abnormalities within the heart and/or great vessels. Some of the more common procedures are coronary artery bypass, valve repair or replacement, correction of congenital heart defects and repair of aortic aneurysms.Coronary Artery Bypass Surgery Coronary Artery Bypass Surgery, also referred to as CABG, is a treatment option for coronary artery disease. Based on the size, number, and locations of artery blockages, your doctor may decide that bypass surgery is the best treatment. Valve Repair and Replacement Heart valves work like gates which open to let blood move forward and close to allow the heart chamber to fill with more blood. Problems occur when a valve does not open wide enough (stenosis) or close tight enough (regurgitation). When these problems occur, the heart cannot pump enough blood forward which causes problems over time like shortness of breath or heart failure. Your doctor may suggest that you have the valve repaired or replaced. Aortic Aneurysm Repair The aorta is the large artery which carries blood from the heart to the major organs and other areas. This artery can develop a weakening in the wall of the vessel. If this occurs your doctor may suggest that you have it repaired. Robotically-Assisted SurgeryThe daVinci robotics system gives surgeons the capability to perform select heart procedures without opening the patient's chest and patients usually experience fewer side effects and faster recovery times. Cardiac RehabilitationLeaving the hospital is just the first step in recovering from a heart attack, heart surgery or angioplasty. Heart patients often need to strengthen weakened heart muscles and learn heart-healthy practices. Fort Sanders Regional's complete Cardiac Rehabilitation Outpatient Program (CROP) combines education, exercise, counseling, and more to help heart patients regain their functional capacity and reduce the possibility of future heart problems. Information for Heart Failure Patients - Fort Sanders Regional has developed a resource booklet for patients who are being treated for heart failure. This booklet includes details about heart failure, how it is diagnosed and treated, and lifestyle information for those seeking to be as healthy and active as possible while dealing with heart failure. The booklet also contains tracking sheets to record information that will be helpful for you and your healthcare provider, as well as a list of related resources and services within Covenant Health.
(Code:   ) (Expenses $ 136,295,344 including grants of $ 353,902 ) (Revenue $ 185,857,401 )
As a full-service acute care hospital and regional referral center, Fort Sanders Regional Medical Center treats patients across a broad spectrum of medical specialties in addition to those highlighted above.
4d Other program services (Describe in Schedule O.)
(Expenses $ 136,295,344 including grants of $ 353,902 ) (Revenue $ 185,857,401 )
4e Total program service expensesMediumBullet313,613,256
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part II........
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
311
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
2,181
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
22
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
18
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
Yes
 
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
Yes
 
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletNancy Beck1420 Centerpoint Blvd Bldg CKnoxvilleTN379321960 (865) 374-6864
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Anthony L Spezia........................................................................
President & CEO
 0.00
.......................50.00 		X   X       0 1,526,847 230,374
(2) Gerald Boyd........................................................................
Director
 0.00
.......................1.00 		X           0 679 0
(3) Dr Richard Brinner........................................................................
Director
 0.00
.......................1.00 		X           0 1,291 0
(4) Dr Mitchell Dickson........................................................................
Director
 0.00
.......................1.00 		X           0 1,914 0
(5) Pamela P Fansler........................................................................
Director
 0.00
.......................1.00 		X           0 0 0
(6) James Fitzsimmons........................................................................
Director
 0.00
.......................1.00 		X           0 1,742 0
(7) Kimberly Greene........................................................................
Director
 0.00
.......................1.00 		X           0 937 0
(8) Wayne Heatherly........................................................................
Director
 0.00
.......................1.00 		X           0 752 0
(9) Jim Johnson Jr........................................................................
Director
 0.00
.......................1.00 		X           0 1,642 0
(10) Karla Lane........................................................................
Director
 0.00
.......................1.00 		X           0 924 0
(11) Eddie Mannis........................................................................
Director
 0.00
.......................1.00 		X           0 0 0
(12) Larry Mauldin........................................................................
Chairman
 0.00
.......................1.00 		X           0 834 0
(13) Dr Joseph Metcalf........................................................................
Director
 0.00
.......................3.00 		X           0 15,603 0
(14) George Miller........................................................................
Director
 0.00
.......................1.00 		X           0 978 0
(15) Alvin Nance........................................................................
Director
 0.00
.......................1.00 		X           0 966 0
(16) Linda Ogle........................................................................
Director
 0.00
.......................1.00 		X           0 0 0
(17) Mitchell Steenrod........................................................................
Director
 0.00
.......................1.00 		X           0 805 0
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Carl Storms........................................................................
Director
 0.00
.......................1.00 		X           0 1,641 0
(19) Joseph E Sutter........................................................................
Director
 0.00
.......................1.00 		X           0 1,313 0
(20) Richard Swanson........................................................................
Director
 0.00
.......................1.00 		X           0 0 0
(21) Joe Ben Turner........................................................................
Director
 0.00
.......................1.00 		X           0 783 0
(22) David C Verble........................................................................
Director
 0.00
.......................1.00 		X           0 958 0
(23) John T Geppi........................................................................
EVP/CFO
 0.00
.......................50.00 		    X       0 673,095 27,138
(24) Keith Altshuler........................................................................
Pres. & CAO - FSRMC
 44.00
.......................6.00 		    X       0 349,933 30,339
(25) Ronnie S Beeler........................................................................
VP-Financial Services
 30.00
.......................10.00 		    X       176,459 0 29,666
(26) Jennifer L Hanson........................................................................
VP-Chief Nursing Officer
 45.00
.......................   		      X     216,372 0 8,638
(27) Mary E Dillon MD........................................................................
Medical Director
 40.00
.......................   		        X   163,712 0 3,769
(28) Christopher Norris........................................................................
Pharmacy Director
 40.00
.......................   		        X   144,023 0 25,891
(29) Marianne Oliveira........................................................................
Sr. Instructor - Nursing S
 40.00
.......................   		        X   135,142 0 25,101
(30) Gary Bush........................................................................
Director of Surgery
 40.00
.......................   		        X   138,591 0 6,832
(31) Nancy Granger........................................................................
Pharmacy Manager
 40.00
.......................   		        X   132,846 0 26,326
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 1,107,145 2,583,637 414,074
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet33
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
GE HealthcarePO Box 402076AtlantaGA303842076 Service Contracts/ Equipment Maintenance 3,431,327
Medic Regional Blood Center1601 Ailor AvenueKnoxvilleTN37921 Blood Processing 1,869,305
Angelica Textile Services IncPO Box 535122AtlantaGA30353 Linen Service 1,357,625
Summit Medical Group1225 E Weisgarber Rd Ste 200KnoxvilleTN37909 Hospitalist Fees 1,164,442
Sodexo Inc and AffiliatesPO Box 536922AtlantaGA303536922 Housekeeping Services 821,273
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet34
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 559,469
e Government grants (contributions)1e 101,657
f All other contributions, gifts, grants, and
similar amounts not included above1f 		60,000
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 721,126
Program Service Revenue Business Code
2a Medical Services 622110 320,808,658 320,808,658    
b Laboratory 621500 2,535,507   2,535,507  
c Rental Inc - Exempt Affiliate 531120 777,291 777,291    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 324,121,456
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 33,037     33,037
4 Income from investment of tax-exempt bond proceeds..MediumBullet 364 364    
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 4,174,650 46,953
b Less: rental expenses 4,005,100 74,174
c Rental income or (loss) 169,550 -27,221
d Net rental income or (loss).......MediumBullet 142,329   -31,786 174,115
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory   100
b Less: cost or other basis and sales expenses   9,663
c Gain or (loss)   -9,563
d Net gain or (loss)..........MediumBullet -9,563     -9,563
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a Pharmacy 900099 3,876,348     3,876,348
b Food Services 722212 2,691,873     2,691,873
c Maintenance 811000 1,253,190 1,238,172 15,018  
d All other revenue .... 2,709,644 782,347 830,000 1,097,297
e Total. Add lines 11a–11d ...... MediumBullet 10,531,055
12 Total revenue. See Instructions......MediumBullet 335,539,804 323,606,832 3,348,739 7,863,107
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 318,292 318,292
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 35,610 35,610
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 431,135   431,135  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 76,145,487 75,392,092 753,395  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 2,385,259 2,356,597 28,662  
9 Other employee benefits ....... 10,148,483 10,032,699 115,784  
10 Payroll taxes ........... 5,503,460 5,424,559 78,901  
11 Fees for services (non-employees):        
a Management ...... 20,417,724 19,655,487 762,237  
b Legal ......... 96,126   96,126  
c Accounting ........... 32,280   32,280  
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 21,308,257 20,321,239 987,018  
12 Advertising and promotion .... 840,617 828,323 12,294  
13 Office expenses ....... 3,154,656 2,534,305 620,351  
14 Information technology ......        
15 Royalties ..        
16 Occupancy ........... 6,651,172 4,883,619 1,767,553  
17 Travel ............ 78,791 76,444 2,347  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 319,013 257,069 61,944  
20 Interest ........... 315,566 315,318 248  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 12,342,693 10,776,097 1,566,596  
23 Insurance .............. 749,963 734,306 15,657  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Unrelated Business Inco 90,260   90,260  
b Supplies and Equipment 93,659,763 93,598,303 61,460  
c Charity Care 35,195,660 35,195,660 0  
d Bad Debts 23,773,009 23,773,009 0  
e All other expenses 7,323,708 7,104,228 219,480  
25 Total functional expenses. Add lines 1 through 24e 321,316,984 313,613,256 7,703,728 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 5,380 1 5,678
2 Savings and temporary cash investments ......... -1,131,729 2 -248,849
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 24,498,510 4 25,455,368
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net ............. 44,555 7 44,555
8 Inventories for sale or use .............. 7,201,110 8 6,738,665
9 Prepaid expenses and deferred charges .......... 581,288 9 491,390
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 365,557,069
b Less: accumulated depreciation ..... 10b 250,060,969 118,164,008 10c 115,496,100
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 15,248,726 15 31,750,036
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 164,611,848 16 179,732,943
Liabilities 17 Accounts payable and accrued expenses ......... 21,690,427 17 24,131,966
18 Grants payable .................   18  
19 Deferred revenue ................ 300,599 19 237,390
20 Tax-exempt bond liabilities ............. 7,420,361 20 5,710,243
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 98,486 23 110,284
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 4,541,523 25 4,828,229
26 Total liabilities. Add lines 17 through 25......... 34,051,396 26 35,018,112
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 130,560,452 27 144,714,831
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 130,560,452 33 144,714,831
34 Total liabilities and net assets/fund balances ........ 164,611,848 34 179,732,943
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
335,539,804
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
321,316,984
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
14,222,820
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
130,560,452
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-68,441
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
144,714,831
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Fort Sanders Regional Medical Center
 
Employer identification number

62-0528340
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(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 monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
Fort Sanders Regional Medical Center
 
Employer identification number

62-0528340
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
Fort Sanders Regional Medical Center
  		Employer identification number

62-0528340
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
Fort Sanders Regional Medical Center
  		Employer identification number

62-0528340
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
Fort Sanders Regional Medical Center
  		Employer identification number

62-0528340
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Fort Sanders Regional Medical Center
 
Employer identification number

62-0528340
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 113,809 103,913 65,000 25,000 25,000
b Contributions ........ 15,617 9,896 38,913 40,000  
c Net investment earnings, gains, and losses 3,914 4,390 4,233 567 999
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		3,914 4,390 4,233 567 999
f Administrative expenses ....          
g End of year balance ...... 129,426 113,809 103,913 65,000 25,000
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet100.000 %
c
Temporarily restricted endowment SchDMd Bullet0 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ................. 100,345 7,271,989 7,372,334
b Buildings ................ 81,230,219 92,533,159 93,370,015 80,393,363
c Leasehold improvements ............   2,530,246 1,333,448 1,196,798
d Equipment ................   180,764,369 154,372,240 26,392,129
e Other .................   1,126,742 985,266 141,476
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 115,496,100
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Assets Limited as to Use 1,894,079
(2) Bond Issuance Costs, Net 16,537
(3) Deferred Compensation 919,816
(4) Due from Affiliates, Net 28,474,211
(5) Miscellaneous Non-Affiliate Receivables 329,525
(6) Rental Income Receivable 115,868



Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 31,750,036
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
Due to Third Party Payors 2,673,328
Long-term Deferred Compensation 119,066
Long-term Reserve for Workers Comp 2,035,835






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 4,828,229
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Description of Intended Use of Endowment Funds: Part V, Line 4: Fort Sanders Foundation mantains two permanent endowments for the purpose of providing a permanent source of income for the following programs at Fort Sanders Regional Medical Center: The Pastoral Care Fund and the Caroline Can! Fund. The principal of the endowments will be kept intact in perpetuity. Only the income generated will be distributed to FSRMC to provide support for the aforementioned programs.
Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: Note B to the consolidated audited financial statements of Covenant Health, parent company to Fort Sanders Regional Medical Center, reads in part: "Income Taxes: Covenant and certain of its subsidiaries or controlled entities are exempt from income taxes pursuant to Section 501(c)(3) of the Internal Revenue Code. Accordingly, no provision for income taxes on qualifying activities has been made for these entities in the accompanying consolidated financial statements. However, certain entities and operations are subject to income taxes which are accounted for in accordance with Financial Accounting Standards Board (FASB) Accounting Standards Codification (ASC) 740, Income Taxes (See Note G)." Note G reads in part: "Covenant had no unrecognized tax benefits at December 31, 2012 and 2011. As such, no interest or penalties were recognized in the Consolidated Statements of Operations related to unrecognized tax benefits. At December 31, 2012, tax returns for 2009 through 2012 are subject to examination by the Internal Revenue Service. Covenant has no uncertain tax positions that would require financial statement recognition or disclosure under generally accepted accounting principles at December 31, 2012 or 2011."
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Fort Sanders Regional Medical Center
 
Employer identification number

62-0528340
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    21,440,255 6,428,461 15,011,794 5.050 %
b Medicaid (from Worksheet 3,
column a) .... 		    54,724,638 36,665,523 18,059,115 6.070 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		    2,164,930 812,788 1,352,142 0.450 %
d Total Financial Assistance
and Means-Tested
Government Programs . 		    78,329,823 43,906,772 34,423,051 11.570 %
Other Benefits
     99,639 18,353 81,286 0.030 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    88,339 9,208 79,131 0.030 %
g Subsidized health services
(from Worksheet 6) .. 		    26,884,620 21,284,188 5,600,432 1.880 %
h Research (from Worksheet 7)     0 0    
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    224,714 43,031 181,683 0.060 %
j Total. Other Benefits ..     27,297,312 21,354,780 5,942,532 2.000 %
k Total. Add lines 7d and 7j .     105,627,135 65,261,552 40,365,583 13.570 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing     27,836 0 27,836 0.010 %
2 Economic development     38,869 0 38,869 0.010 %
3 Community support     20,149 0 20,149 0.010 %
4 Environmental improvements     0 0    
5 Leadership development and training for community members     1,495 0 1,495 0 %
6 Coalition building     0 0    
7 Community health improvement advocacy     0 0    
8 Workforce development     0 0    
9 Other     0 0    
10 Total     88,349   88,349 0.030 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
23,773,009
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
10,412,578
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
65,488,960
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
56,284,663
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
9,204,297
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
11 NONE
  		       
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, and primary website address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Fort Sanders Regional Medical Center
1901 Clinch Avenue
Knoxville,TN37916
www.fsregional.com 		X X   X     X      
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Fort Sanders Regional Medical Center
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1    
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20  
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3    
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4    
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5    
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7    
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a    
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 300.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?19
Name and address Type of Facility (describe)
1 FSR Infusion Services TCSC
1915 White Avenue
Knoxville,TN37916 		Pharmacy - Infusion Services
2 FSR Infusion Services Oak Ridge
200 New York Avenue Suite 230
Oak Ridge,TN37830 		Pharmacy - Infusion Services
3 Thompson Infusion Center
215 BMH Cancer Center Drive
Maryville,TN37804 		Pharmacy - Infusion Services
4 Fort Sanders Regional MRI Dept
1915 White Avenue
Knoxville,TN37916 		Magnetic Resonance Imaging (Diagnostics)
5 Patricia Neal Rehabilitation Center
1901 Clinch Avenue
Knoxville,TN37916 		Rehabilitation Unit
6 Fort Sanders Wound Care Center
2001 Laurel Avenue Suite G-6
Knoxville,TN37916 		Wound Care
7 FSR Infusion Services Lenoir City
576 Fort Loudoun Med Ctr Dr Ste 204
Lenoir City,TN37772 		Pharmacy - Infusion Services
8 Fort Sanders West Diagnostic Center
MOB-3 Ste 210 Ft Sanders West Blvd
Knoxville,TN37922 		Diagnostic Center
9 Fort Sanders Regional Infusion Svcs
1901 Clinch Avenue
Knoxville,TN37916 		Pharmacy - Infusion Services
10 FSR Gamma Knife Center
1915 White Avenue 1st Floor
Knoxville,TN37916 		Gamma Knife Center
11 FSRMC Transitional Care Unit
1901 Clinch Avenue
Knoxville,TN37916 		Skilled Nursing Facility
12 FS Neurodiagnostics & Sleep Center
Ft Sanders POB Ste 303 501 20th St
Knoxville,TN37916 		Neurodiagnostics and Sleep Center
13 Fort Sanders Regional Breast Center
1915 White Avenue
Knoxville,TN37916 		Breast Center (Diagnostics)
14 Fort Sanders Regional Laser Center
1915 White Avenue
Knoxville,TN37916 		Center for Barrett's Esophagus
15 FSR Therapy Center - Downtown
2001 Laurel Avenue Ste 504
Knoxville,TN37916 		Physical Rehabilitation Therapy Center
16 Diabetes Center Outreach Program
MOB-2 Ste 205 220 FSW Blvd
Knoxville,TN37922 		Diabetes Center
17 FSR Cardiopulmonary Rehab
Ft Sanders POB Ste 301 501 20th St
Knoxville,TN37916 		Cardiopulmonary Rehab Therapy Center
18 FSR Therapy Center - Halls
6679 Maynardville Hwy
Knoxville,TN37918 		Physical Rehabilitation Therapy Center
19 FSR Therapy Center - Powell
3515 Emory Road Suite P-9
Powell,TN37849 		Physical Rehabilitation Therapy Center
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
    Part I, Line 6a: Covenant Health, the parent company of Fort Sanders Regional Medical Center 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: The organization has included $1,887,910 in physician sponsorship fees in total subsidized health services.
    Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 23773009.
    Part II: Fort Sanders Regional Medical Center 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 finding 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. In 2012 contributions were made to organizations meeting the community's needs by providing: *Affordable, permanent housing and case management services to foster self-sufficiency - Knoxville's Community Development Corporation (KCDC) *Residential and foster care for children, special education services, and support services to reunite families and keep them together - Holston Home for Children *The basic needs of life including temporary shelter, food and clothing - Catholic Charities, Family Promise, Ladies of Charity, and others *Youth mentoring and development and after-school programs - Emerald Youth Foundation and Boy Scouts of America *Business recruitment and marketing initiatives that boost economic development - East Tennessee Economic Development Agency (ETEDA) and Innovation Valley *Leadership development programs and workshops - Leadership Knoxville *Assistance and special programs for at risk, physically challenged, abused and neglected children - Variety of Eastern Tennessee (local chapter of Variety-The Children's Charity)
    Part III, Line 4: Part III, Line 2: Bad debt expense on Line 2 is the amount recorded in the organization's financial statements. Discounts and payments on patient accounts are netted against bad debt.Part III, Line 3: In 2011, the hospital reviewed all self-pay accounts receivable to identify patients who might have qualified for financial assistance. As of year end, the hospital could not make a final determination as to their qualification for financial assistance due to all information not yet being received but felt strongly that the patient was in need of some form of assistance. Notes in the patient record were examined to see if a charity care application had been sent to the patient or guarantor or if the account was being analyzed by a business office employee for approval for charity care. The percentage of patient accounts being analyzed as a percent of total self-pay accounts receivable has been applied to the current year total bad debt expense on Line 2 to arrive at the amount reported on Line 3.It is our belief that the amount of bad debt on Line 3 should be included as community benefit. As a tax-exempt hospital, we must provide necessary services regardless of the patient's ability to pay for the service provided. As a not-for-profit, patient care is provided to all, regardless of ability to pay for that care. Making quality patient care available to all in our community, regardless of economic means, qualifies bad debts as a community benefit.Part III, Line 4: Note B to the 2012 Audited Consolidated Financial Statements of the Covenant Health system, of which Fort Sanders Regional Medical Center is a member, reads in part: "Patient accounts receivable are reported net of both an estimated allowance for uncollectible accounts and an estimated allowance for contractual adjustments. The contractual allowance represents the difference between established billing rates and estimated reimbursement from Medicare, TennCare and other third-party payment programs. The allowance for uncollectible accounts is estimated based upon the age of the patient accounts receivable, prior experience and any unusual circumstances (such as local, regional or national economic conditions) which affect the collectability of receivables, including management's assumptions about conditions it expects to exist and courses of action it expects to take. 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 Sanders Regional 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 III, Line 9b: Self-pay patients automatically receive a minimum 47% discount on charges. 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 70% 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.Patients/guarantors who qualify for partial financial assistance are responsible for paying any balance remaining after the charity adjustment and third party payments. Once an account has been processed through routine collection channels internally, it may be assigned to an attorney/agency for collection. The patient/guarantor will be billed for all collection costs as may be applicable. Credit reports will be filed no earlier than 30 days following the assignment on all nonpaid balances.
Fort Sanders Regional Medical Center   Part V, Section B, Line 14g: Please see the explanation to Part VI, Line 3.
Fort Sanders Regional Medical Center   Part V, Section B, Line 20d: Please see the explanation to Part III, Line 9b.
    Part VI, Line 2: Covenant Health, on behalf of its affiliated hospitals, is engaged in conducting community health needs assessments. Covenant has chosen to complete the assessment process in partnership with the local health department, free health clinics, community based health councils, United Way and chambers of commerce.The assessment is utilizing a variety of data collection methods to ensure that at risk populations have a voice in the process. Qualitative research is being conducted using focus groups of community leaders, key informant interviews, and household surveys of 500-600 per county. In working with area health departments, a variety of health statistics have been gathered including demographics, social-cultural indicators, morbidity and mortality data, health rankings, KIDS COUNT data, health professional needs per population, and behavioral risk factor data.Upon completion of data collection, a community based data synthesis team will begin to meet, discuss, and prioritize the significant findings. Each hospital will proceed with the assessment's significant findings and translate that into an action plan to address the identified needs.
    Part VI, Line 3: Part VI, Line 3: Fort Sanders Regional Medical Center informs patients and other persons who may be billed for services about its financial assistance policies by posting signs in highly visible areas of the hospital and including information about the financial assistance policy in patient booklets provided to inpatients during the registration process.The following sign is posted in the main registration area, main lobby area and in the Emergency Department registration lobby area: Financial Assistance: 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, staff of Fort Sanders Regional Medical Center is 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 Sanders Regional Medical Center,in compliance with Tennessee Code Annotated, Title 47, Chapter 18 and Title 68, will provide at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling 865.541.1112, Monday through Friday between the hours of 8 a.m. and 4:30 p.m.Signs are also posted at each registration desk stating: Financial Assistance: It is Fort Sanders Regional 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 or through our Financial Counselor's office.To apply for financial aid, please ask our registration staff or contact the Counselor's office at 541-1112. The Financial Counselor is available Monday - Friday, 8 a.m. - 4:30 p.m.Fort Sanders Regional Medical Center employs a full time financial counselor and has a contract employee from First Source Solutions that meets with each uninsured patient. In addition, Fort Sanders Regional Medical Center assists with completion of a TennCare application and ensures the application is directed to the appropriate Department of Human Services.The Charity Care Policy states that patients who are unable to pay and have exhausted all sources of payment assistance may be screened for potential charity care eligibility. According to the policy, the financial counselor initiates screening of the patient and/or guarantor by obtaining income and other financial information to determine eligibility for charity care or discounted services.
    Part VI, Line 4: Fort Sanders Regional Medical Center is located in downtown Knoxville, Tennessee. Although located in metropolitan Knox County, Fort Sanders Regional Medical Center 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 2012, more than 56% of the inpatients discharged were Knox County residents. Sevier County provides Fort Sanders Regional with the second highest number of admissions compared to other counties in the region, slightly more than 9% of the total.According to 2010 data of the U.S. Census Bureau, the collective population of the 16-county region is 1,176,033, of which 51.2% are female and 48.8% are male. The racial makeup of the population is 94% Caucasian, 4.6% black, and 1.4% other races. There are 22 hospitals in the 16-county area which, with one exception, are tax exempt. The average household income and percentage of the population with incomes below the federal poverty guideline within the 16 counties ranges from a low of $28,563 and 27% in Cocke County to a high of $47.277 and 13.7% in Knox County.According to a recently released study by the Robert Wood Johnson Foundation/ University of Wisconsin Population Health Institute, Knox County residents have the following health indicators that are above the national benchmarks: Knox - TN - National Adult Smoking: 19% - 23% - 13% Adult Obesity: 31% - 32% - 25% Excessive Drinking: 10% - 10% - 7% Teen Birthrate: 37 - 50 - 21 of every 1,000 teenage girls Poor or Fair Health: 16% - 19% - 10% Physical Inactivity: 28% - 30% - 21%
    Part VI, Line 5: Fort Sanders Regional Medical Center (FSRMC), 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 FSRMC's board. It is comprised of independent community leaders with diverse educational and professional backgrounds. The board sets policies and provides oversight of FSRMC.FSRMC 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: Fort Sanders Regional 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. As a system, Covenant assures that business processes are in place in 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. Fort Sanders Regional, as a regional referral hospital, provides a wide range of acute care services, many of which are unique in the Covenant system. These services are therefore more easily accessible by other affiliated hospitals and health care organizations through transfer or referral helping to create a seamless continuum of care. The hospital, through its Patricia Neal Rehabilitation Center division, is the only acute inpatient rehabilitation facility in the Covenant system and the largest such provider in the service area. Programming includes specialized services for stroke, brain injury, spinal cord injury and other difficult patient populations with the primary goal of returning the patient home with the greatest gain in functional ability possible. Fort Sanders Regional also provides hospital-based skilled nursing care which serves as either a bridge back home or as an important step along the continuum of care to other long term care resources.In 2011 Fort Sanders Regional opened its Gamma Knife Center located at Thompson Cancer Survival Center, an affiliated cancer treatment center. The Gamma Knife Center features the newest and most advanced Leksell Gamma Knife Perfexion, a non-invasive radiosurgical tool used to treat brain tumors and other disorders. Patients undergoing Gamma Knife procedures benefit from reduced treatment times and minimized surgical complications. Fort Sanders Regional also provides other important services unique to the Covenant system including high risk obstetrical services and home infusion. It's outpatient diabetes center serves a large community-based population with educational, dietary and other supportive medical services that would otherwise be unavailable or difficult to access. Co-located with the diabetes center, the Coumadin clinic serves to educate another vulnerable population as well as to monitor the therapeutic effectiveness of this drug. These services, the diabetes center and the Coumadin clinic, are important to preventing unnecessary hospitalizations through the provision of effective community-based care. Fort Sanders Regional also provides other extensive outpatient services through its ambulatory infusion centers, physical therapy centers, a wound care center, and its cardiac and pulmonary rehabilitation programs. Fort Sanders Regional's patients benefit from the availability of and ease of access to Covenant 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 which 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. Home health and hospice services are also an important part of the continuum of care for a large portion of the hospital's patient population. 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.The Fort Sanders Foundation seeks out community support for Fort Sanders Regional and other Covenant Health hospitals through a variety of fund raising mechanisms. For example, the Fort Sanders Foundation helps to arrange sponsorship for significant fund raising activities of the Patricia Neal Rehabilitation Center division of the hospital including an annual golf tournament that has become the largest, single day fundraising event in the state of Tennessee. The proceeds of these events help fund needed equipment and facilities for the center as well as to provide access to the center's services for uninsured or underinsured individuals who are in need of intensive rehabilitation but may otherwise be denied such services due to the lack of resources. The Foundation also provides temporary residential services through the Fellowship Center for patients of the hospital and their families that travel to Knoxville to receive needed care but are unable to afford the costs involved.The Fort Sanders Nursing Department at Tennessee Wesleyan College is an important affiliate of Fort Sanders Regional. The school provides a baccalaureate nursing education, helping to alleviate a shortage of registered nurses to serve a growing and aging population. It is a continuation of a nursing education tradition of the hospital that began more than eighty years ago. The hospital provides a substantial financial contribution to support the program. Training qualified nursing professionals to serve the current or future needs of the community is an important hospital mission.Fort Sanders Regional is integrated with its community in a number of ways including its active participation in the development of a Fort Sanders Neighborhood District Long Range Plan. Fort Sanders is a densely populated urban neighborhood in the City of Knoxville. With its proximity to downtown and with the location of two regional referral hospitals (East Tennessee Children's Hospital being the other) and the flagship campus of the University of Tennessee in its boundaries, it provides an ideal location for convenient access for residents and as a gateway to visitors. With these assets, it is imperative that the city and neighborhood leaders work together in order to coordinate quality growth while maintaining the rich character and history that give Fort Sanders its unique identity.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.
Schedule H (Form 990) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Fort Sanders Regional Medical Center
 
Employer identification number
62-0528340
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Thompson Cancer Survival Center
1915 White Avenue
Knoxville,TN37916 		62-1250943 501(c)(3) 75,192       Financial support of Fellowship Center
(2) Fort Sanders Foundation
280 Fort Sanders West Blvd Suite
100
Knoxville,TN37922 		62-1748601 501(c)(3) 202,060       Fellowship Center maintenance and food fund
(3) Joni and Friends Ministry Knoxville
1540 Robinson Road
Knoxville,TN37923 		62-1458199 501(c)(3) 7,500       Support & ministry to the disabled
(4) American Heart Association
4708 Papermill Road
Knoxville,TN37909 		13-5613797 501(c)(3) 24,890       Support for cardiovascular disease education and research
















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
4
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) Provided indigent patients with medications to facilitate discharge or to prevent readmission. 413   29,404 Cost Prescription medications
(2) Paid rental to supplier for LifeVest wearable defibrillator for patient 1 2,900      
(3) Paid nursing home bill for specific patient 1 1,090      
(4) Paid mortuary for burial expenses for a deceased patient 1 700      
(5) Provided indigent PTCA/Stent patients at discharge with antiplatelet medication to prevent stent thrombosis. 1   1,516 Cost Prescription medications




Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The hospital provides for the post-hospitalization transportation and medication needs of its patients when there is a demonstrated need as attested to by a social services worker. The determination is made by Case Management based on the judgment of the social services worker after working with the patient and the patient's family. Assistance is approved on a case-by-case basis by Case Management, and this approval is verified upon approval of any invoices to be paid.
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Fort Sanders Regional Medical Center
 
Employer identification number

62-0528340
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)Anthony L SpeziaPresident & CEO (i)
(ii)		 0
941,953 		0
379,600 		0
205,294 		0
213,800 		0
16,574 		0
1,757,221 		0
0
(2)John T GeppiEVP/CFO (i)
(ii)		 0
421,940 		0
171,991 		0
79,164 		0
9,800 		0
17,338 		0
700,233 		0
0
(3)Keith AltshulerPres. & CAO - FSRMC (i)
(ii)		 0
256,759 		0
53,791 		0
39,383 		0
9,800 		0
20,539 		0
380,272 		0
0
(4)Ronnie S BeelerVP-Financial Services (i)
(ii)		 152,937
0 		10,000
0 		13,522
0 		7,463
0 		22,203
0 		206,125
0 		0
0
(5)Jennifer L HansonVP-Chief Nursing Officer (i)
(ii)		 174,845
0 		10,000
0 		31,527
0 		0
0 		8,638
0 		225,010
0 		0
0
(6)Mary E Dillon MDMedical Director (i)
(ii)		 162,931
0 		0
0 		781
0 		0
0 		3,769
0 		167,481
0 		0
0
(7)Christopher NorrisPharmacy Director (i)
(ii)		 143,016
0 		0
0 		1,007
0 		8,689
0 		17,202
0 		169,914
0 		0
0
(8)Marianne OliveiraSr. Instructor - Nursing S (i)
(ii)		 130,806
0 		0
0 		4,336
0 		8,280
0 		16,821
0 		160,243
0 		0
0
(9)Nancy GrangerPharmacy Manager (i)
(ii)		 130,659
0 		0
0 		2,187
0 		8,058
0 		18,268
0 		159,172
0 		0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
  Part I, Line 3 Covenant Health, the parent company of Fort Sanders Regional Medical Center, used one or more of the methods listed in establishing the compensation of Anthony L. Spezia. Please see the statement to Core Part VI, Section B, Line 15a on Schedule O.
  Part I, Lines 4a-b Part I, Line 4a: Gary Bush's reportable compensation includes $44,575 for severance. Part I, Line 4b: Anthony L. Spezia was a participant in two nonqualified deferred compensation plans, which will be referred to as Plan A and Plan B. In 2011 Mr. Spezia vested in Plan A, and the accumulated balance as of August 1, 2011 was included in his 2011 taxable income. An Amendment to Plan A was adopted effective August 1, 2011 which terminated further accruals (contributions) to the plan. However, the Amendment does allow the accrual of interest on undistributed amounts which will be subject to risk of forfeiture until such time as indicated in the Amendment. Interest earned by Plan A in 2012 amounted to $71,781.22 and is not required to be reported in Part II, as Mr. Spezia is not substantially vested in earnings accumulated after July 31, 2011. Plan B was established in 2011. Employer contributions to Plan B during 2012 totaled $204,000, which is reported in Column C of Schedule J, Part II. Interest earned by Plan B during 2012 of $17,909.59 is not required to be reported in compensation in Part II, as Mr. Spezia is not substantially vested in Plan B.
Schedule J (Form 990) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
Fort Sanders Regional Medical Center
 
Employer identification number

62-0528340
Identifier Return Reference Explanation
Organization Mission Statement Form 990, Part III, Line 1 In 1996, Fort Sanders Health System and MMC Healthcare System of Oak Ridge consolidated to form Covenant Health, with a mission of serving its communities by improving the quality of life through better health. Covenant Health is a nationally recognized top health system in many areas: patient care, quality performance, cost, integration, information technology, finances, ethics and innovation. To meet the challenges and implications of healthcare reform, Covenant Health has committed to these imperatives: * Serving the community as a not-for-profit health system. * Leading in quality and service. * Outstanding governance and leadership. * An engaged work force with the right skill sets. * Being the practice environment of choice for physicians. * Reinvesting in communities, providing programs, services, technologies and facilities that improve local healthcare services and patient care. Covenant Health has invested more than a billion dollars in its communities since 2000 - a commitment no other healthcare organization has approached. Covenant Health has opened new hospitals, expanded services, and brought cutting-edge medical technology to the region. * Meeting the challenges of the healthcare environment through effective strategic planning and wise use of resources. * Providing excellent care to every patient, every time. This commitment to excellence will help the system accomplish its mission of improving the quality of life through better health. In order to deliver on the promise of excellence in today's healthcare environment, preparation is critical. Covenant Health's Board of Directors ("the Board") is committed to advancing its understanding of health care. The Board is continually learning about hospitals' operational challenges and how the current environment affects physicians and their practices. The healthcare universe is constantly shifting. The Board members are volunteers, but have a passion for Covenant Health's mission, and a desire to expand its knowledge in preparation for leading the organization. Dedication to a shared goal is essential. Very few community endeavors are as important as making high-quality health care available to its citizens. Our patients and their families are at vulnerable points in their lives, and the Board believes it is a privilege to meet their healthcare needs. Experience is a valuable asset. Covenant Health has a legacy of delivering high-quality care, which will help to weather the storms of change, including transitioning to value-based reimbursement. COVENANT HEALTH MEMBER ORGANIZATIONS AND SERVICES Covenant Health Board members and administrative leaders serve their communities through strategic planning and successful operation of these member organizations: Hospitals and Other Healthcare Providers: Covenant Homecare and Hospice Fort Loudoun Medical Center Fort Sanders Perinatal Center Fort Sanders Regional Medical Center LeConte Medical Center Methodist Medical Center of Oak Ridge Morristown-Hamblen Healthcare System Parkwest Medical Center Peninsula Hospital, a Division of Parkwest Medical Center Roane County Medical Center Thompson Cancer Survival Center Thompson Oncology Group Knoxville Heart Group Outpatient and Specialty Care Departments, and Joint Ventures: Fort Sanders West Diagnostic Center Fort Sanders West Outpatient Surgery Center Patricia Neal Rehabilitation Center Peninsula Outpatient Centers Fort Sanders Sevier Nursing Home Foundations: Fort Sanders Foundation Methodist Medical Center Foundation Morristown-Hamblen Hospital Foundation Thompson Cancer Survival Center Foundation BRINGING QUALITY CARE TO LOCAL COMMUNITIES Covenant Health delivers quality care, with services designed to meet the specific needs of people in the communities it serves. Seven acute care hospitals located in Knoxville and surrounding areas comprise the foundation of the health system. The hospitals offer comprehensive care, including emergency care, specialty services, and a full range of diagnostics and treatment, provided by board-certified medical staffs. Three Covenant Health hospitals - Fort Sanders Regional, Methodist, and Parkwest Medical Centers, were named among the top 10 hospitals in Tennessee in 2013 by U.S. News and World Report, recognizing excellence in both overall and specialty care. Several hospitals have been recognized for clinical accomplishments by VHA, Inc., a cooperative of non-profit healthcare organizations. In 2013, the community celebrated the opening of the new 50-bed Roane County Medical Center in Harriman. The new hospital brings expanded medical services and sophisticated technology to the people of Roane County. In addition to comprehensive hospital services, Covenant Health provides: * Innovative cancer care and technologies to deliver radiation therapy and other cancer treatment in Knox, Sevier, Anderson and Hamblen counties. * Nationally recognized care for patients suffering from physical disabilities, stroke and traumatic brain injury at Fort Sanders Regional Medical Center's Patricia Neal Rehabilitation Center. * Affiliated physician clinics throughout the region which offers convenient access to primary and specialty care. * Rehabilitation services including physical therapy, speech therapy, sports medicine, and specialized therapy such as hand therapy and vestibular (balance) rehabilitation. RACING AGAINST TIME AND DISTANCE IN STROKE CARE With Fort Sanders Regional Medical Center's "tele-stroke" robot, East Tennessee stroke patients can benefit from early consultation with the hospital's stroke experts - regardless of where patients are located across the region. Fort Sanders Regional Medical Center ("Fort Sanders") introduced robots to the region in 2012. The InTouch R7 robot is a mobile communications platform that enables stroke patients to receive consults from Fort Sanders' neurologists via its video screen "face." The robot allows neurologist's availability to patients in outlying areas 24 hours a day. Covenant Health stationed its first two robots in the emergency departments at Parkwest Medical Center in Knoxville and LeConte Medical Center in Sevierville. The telestroke network allows physicians in surrounding hospitals to use live Web video streaming to consult with Fort Sanders Stroke Center neurologists as soon as a patient arrives at the community hospital. The neurologist can remotely review patient information and examine and talk with the patient, family members and local clinicians to help determine the best course of treatment, all at the patient's bedside. A STROKE CENTER OF EXCELLENCE Fort Sanders is a Stroke Center of Excellence, and the only facility in the region to hold both a Comprehensive Stroke Center certification from the Joint Commission and three separate stroke accreditations from the Commission on the Accreditation of Rehabilitation Facilities. Fort Sanders has a team of experts available to treat patients 24 hours a day, seven days a week. The stroke team includes emergency room physicians, neurologists, neurosurgeons, neurointerventional radiologists, nurses and therapists who quickly diagnose patients and use the most technically advanced methods available to remove clots, repair broken arteries that cause strokes, and restore blood flow to the brain.
    TAVR - CHARTING NEW DIRECTIONS IN HEART CARE In 2012, Parkwest Medical Center ("Parkwest") performed its first transcatheter aortic valve replacement (TAVR) procedure. Parkwest is the first hospital in the area to offer TAVR as a minimally invasive procedure to help men and women with the progressive, life-threatening condition known as aortic stenosis. Within the first year, the TAVR team of physicians from Parkwest and Fort Sanders Regional Medical Centers performed surgery for nearly 60 people who were deemed inoperable for traditional open-heart surgery. The patients received new heart valves via a catheter tube inserted either into the femoral artery or through the rib cage. Recovery is markedly shorter than traditional open-heart surgery. In most cases the patients were discharged from the hospital within three to six days. An important aspect of TAVR is its multi-disciplinary approach. The TAVR team includes physicians specializing in cardiovascular and cardiothoracic surgery, interventional cardiology, and cardiac anesthesiology, as well as nurses and technicians with specialized training. The operating room used for TAVR procedures at Parkwest is also multi-disciplinary in design. The $2.6 million hybrid operating room combines the resources of a cardiac catheterization lab and an operating room, including the imaging equipment needed for minimally invasive procedures. ACHIEVING QUALITY THROUGH PARTNERSHIPS WITH PHYSICIANS Overall, Covenant Health's desire for alignment is driven by the need to fully evolve as a healthcare system. In pursuing its goal of outstanding quality and seamless continuum of care, Covenant Medical Management, Inc. (CMM), a for-profit entity in the Covenant Health system, has developed models with physicians that include both employment and joint ventures. CMM provides practice management services and support to over 120 primary care and specialty physicians in more than 60 practices in East Tennessee. CMM recently added Southern Medical Group and Family Care Specialists to its employed physician groups that include: * Cardiology Associates of East Tennessee * Crossville Medical Group * Fort Sanders Women's Specialists * Tennessee Brain and Spine CMM also acquired a new, separate corporation, East Tennessee Cardiovascular Surgery Group, in 2012. Prior to joining the Covenant Health system, the surgeons in this practice served as the primary cardiac surgeons for Fort Sanders Regional, Methodist, and Parkwest Medical Centers and worked in the system's Valve Centers and TAVR program. BEHAVIORAL HEALTH - A COMMITMENT TO ESSENTIAL SERVICES In 2012, Peninsula, a division of Parkwest Medical Center, faced an unprecedented challenge: Lakeshore, a state-funded mental health institute, would be closing its doors for good, and the majority of patients would funnel into Peninsula Hospital. The closing was a strategic move by the state Department of Mental Health to follow the national trend of moving behavioral health toward community-based care and away from state-funded care. With a multi-professional team made up of experienced people from across the continuum of mental health care, Peninsula laid out a plan to accommodate the influx of hospital admissions, reduce costs, and improve the quality of care for mental health patients. The team was challenged by not only having more patients, but patients with serious and complex mental disorders. Changes in staffing and processes helped create a smooth admission process and improvement of service. On average, Peninsula serves about a dozen more inpatients per day since Lakeshore closed. Even with the additional volume, Peninsula has been able to increase its customer satisfaction score and maintain or improve its performance in safety quality measures. Many of the changes which resulted in taking the patients from Lakeshore translated to better service. For example, a process was developed to assess and enroll the patients in CoverRX, the state-funded program for prescription coverage. Patients have benefited by increased collaborative efforts within the community such as regular meetings with a community providers group including representatives from local law enforcement, hospital emergency departments, mobile crisis, and a state mental health facility. The group works on the continuum of services for behavioral health patients in the area. Peninsula participates in the Crisis Intervention Training (CIT) for officers from the surrounding areas' police and sheriff's offices. The training facilitates understanding about mental illness, and when that happens, patients benefit. A partnership with the State of Tennessee brought improvements to the community based care of mental health patients, such as transportation and medications. As a result, more outpatients are keeping their first appointments, and there are a lower number of readmissions. In addition to the 155-bed inpatient psychiatric hospital in Blount County, Peninsula also has outpatient facilities in Knox, Blount, Loudon, and Sevier counties. SETTING THE STANDARD FOR TECHNOLOGY The recently enacted American Recovery and Reinvestment Act includes incentives and penalties designed to accelerate our nation's adoption and "meaningful use" of electronic health records, ("EHRs"). The implementation of meaningful use initiatives is changing the way healthcare is delivered not only at Covenant Health, but also across Tennessee, and throughout the U.S. With widespread adoption, EHRs can: * make a patient's current health information available in a single, secure, shared record, * provide real-time decision support designed to hardwire best practices and reduce care variability, * reduce paperwork, duplicate testing and other inefficiencies. Meaningful Use provides the technology infrastructure and electronic applications to connect care settings, reduce costs, improve efficiency and standardize quality. From 2015 forward, for every year that meaningful use requirements are not met, providers will receive penalties in the form of reduced reimbursement. At Covenant Health, interdisciplinary and multidisciplinary operational teams have been involved in developing and implementing applications and processes related to the main components of Meaningful Use: * E-prescription writing, and computerized patient order entry, * Interoperability, or exchanging key clinical information among providers and patients, * Automated quality reporting. Through Meaningful Use initiatives Covenant Health will transform the way it delivers care by improving patient outcomes, clinical quality, patient safety and organizational effectiveness. Covenant Health has installed a record number of applications related to Meaningful Use. Seven initiatives ranging from admission databases and medication reconciliation (important for patient safety) to computerized patient order entry and physician practice management software took place in 2012 and continued in 2013. The successful installation of multiple applications in a one-year period is unprecedented in the IT world. Quality assurance processes are in place to ensure delivery of the best applications and processes for patient care, clinical quality, and patient safety. "MOST WIRED"
    Hospitals & Health Networks magazine, the journal of the American Hospital Association, has named Covenant Health among the nation's Most Wired healthcare organizations in the 15th annual Most Wired Survey and Benchmarking Study. It is the 10th time that Covenant Health has been named to the Most Wired list. Although Covenant has been named among the nation's Most Wired many times, the health systems that made the list in recent years have had to meet the demands of a more stringent analytic structure. The Most Wired survey includes questions about IT initiatives that support Meaningful Use requirements. It measures IT achievements in four focus sections: infrastructure, business and administrative management, clinical quality and safety (hospital inpatient/outpatient) and clinical integration (ambulatory/physician/community). Participating organizations must meet specific criteria for each section in order to be named "Most Wired." Most Wired surveys were completed by 659 healthcare organizations representing 1,713 hospitals, or roughly 30 percent of all U.S. hospitals. PHILANTHROPY TURNS CHALLENGE INTO OPPORTUNITY The Covenant Health Office of Philanthropy coordinates the philanthropic contributions of individuals and businesses throughout East Tennessee and beyond in support of health care in the region. Fund raising efforts are led by volunteer boards and staff at four foundations: Fort Sanders Foundation, Methodist Medical Center Foundation, Morristown- Hamblen Hospital Foundation, and Thompson Cancer Survival Center Foundation. When Fort Sanders Health Systems created its first fund raising office, Fort Sanders Foundation, in the mid-1970s to raise funds to support Fort Sanders Regional Medical Center, it was a progressive move for a health care provider. Fund raising was not a need, but more in the category of 'nice to have.' This status has changed in today's era of healthcare reform. Financial resources have tightened and hospitals look to the community for charitable contributions that are now very much in the 'need to have' category if they are to continue to meet the healthcare needs of the people of East Tennessee. During the past year these foundations received contributions of approximately $3.7 million to help provide new equipment and facilities at the hospitals, staff training and patient care programs. While the Office of Philanthropy staff coordinates community events and fund raisers, local community leadership and involvement is critical to fund raising success. In an effort to expand the cadre of informed volunteer leaders in the community, the Office of Philanthropy launched a new education program this year, Covenant Answers: A Healthcare Leadership Academy. Inaugural Academy participants included representatives from the boards of Covenant Health, and Fort Sanders and TCSC foundations. Future Leadership Academy classes will include business and community representatives from throughout Covenant Health's service area. Over a five-month period, class members attended half-day sessions at five Covenant hospitals, which included behind-the-scenes tours and hands-on access to the latest technologies and treatments. Participants discussed the challenges of the current health care environment with Covenant physicians and clinicians, heard firsthand from patients whose recovery hinged on the excellent care provided at our hospitals, and even tried their hands at using adaptive rehab equipment and maneuvering a surgical robot. IMPROVING HEALTH BEYOND HOSPITAL WALLS One of the greatest challenges facing a healthcare organization is not only caring for the patients and families who receive direct services, but making a positive impact in the health of the surrounding community. That is the mission of Covenant Health: reaching beyond hospital walls to improve the quality of life through better health. In all the communities Covenant Health serves, local initiatives and partnerships create opportunities to interact with people of all ages and encourage healthier lifestyles. * In Knoxville more than 7,000 people participated in the annual Covenant Health Knoxville Marathon, which attracted local runners and hand cyclists, as well as competitors from throughout the U.S. and other countries. * The Covenant Health Biggest Winner Weight Loss Challenge is a friendly competition that encourages East Tennesseans to get off the couch and get moving for a fit and healthy lifestyle. Team members train together for five months, with the goal of crossing the finish line in Covenant Health Knoxville Marathon events. Participants challenge other East Tennesseans to start a health journey that will change their lives for the better. * Some of the funds raised through the Covenant Health Knoxville Marathon were contributed to The Patricia Neal Rehabilitation Center's Innovative Recreation Cooperative, a collaboration of groups and individuals who help disabled persons enjoy leisure and recreation activities such as water skiing and cycling. * The Covenant Kids Run attracted over 1,000 children who participated in a "marathon" of activities over a period of several weeks, culminating in a run to Neyland Stadium on the day before the Covenant Health Knoxville Marathon. * Covenant Health was the fitness sponsor of the Dogwood Arts Festival, held annually in April. Fitness activities included several outdoor walks, "Bikes and Blooms" bike rides on local Dogwood trails, and a Dogwood Mile run and Kids Race held in downtown Knoxville. * Covenant HomeCare Hospice helps children grieving the loss of a loved one through Katerpillar Kids Camp, offered with the support of Variety-The Children's Charity. The camp is staffed by health system volunteers and helps children in grades 1-12 express their feelings in a supportive environment while enjoying camp activities. * Morristown-Hamblen's Wellness of Women is dedicated to improving the lives of area women and their families. The program sponsors events such as an annual Girls Night Out, which offers free health screenings and encourages women to have fun while learning to stay healthy. UNCOMPENSATED CARE One of the most tangible expressions of the charitable purpose of Covenant Health is providing care to people in need. As a not-for-profit system, Covenant Health provides medically necessary services to people with limited resources. Covenant Health actively participates in the state's TennCare program, and collaborates with other area providers to identify and support efforts to make community healthcare resources available for those in need. The Community Benefit totals for uncompensated care are included on the Forms 990 for the individual Covenant Health hospitals.
  Form 990, Part VI, Section A, line 5 A surgery technician was linked to a national investigation involving selling surgical equipment and supplies to the gray market. The individual was apprehended, his employment terminated, and the government has seized all his assets. The exact amount of the theft cannot be determined but is estimated to be about $2 million.
  Form 990, Part VI, Section B, line 11 Covenant Health is a large integrated health system which files twelve Forms 990. Fort Sanders Regional Medical Center is one of these twelve entities. Annually, at the September Finance Committee meeting, one of the twelve 990s is selected (a different entity each year) for distribution to each member of the Committee. Management then reviews in detail each of the Form 990 schedules and describes variances between entities, if any. The remaining eleven Forms are made available for review by any committee member. The same presentation is made to the Covenant Health Board of Directors at the October meeting. All twelve Form 990s are then made available to all Board members for their review throughout the month of October.
  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 Code of Conduct to all employees. The Code 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 Regional Medical Center, Covenant Health (Parent Company), and affiliates are set by the Compensation Committee of the Board of Directors, which is comprised 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 2012 Form 990 of Covenant Health, EIN 62-1646734, parent company of Fort Sanders Regional Medical Center. Form 990, Part VI, Section B, Line 15b: Base salary and annual bonus opportunities for Keith Altshuler, President/CAO, are set by the Covenant Health CEO or Executive Vice President-Human Resources, 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 ensure that total compensation is reasonable and within a fair market value range. Salary ranges 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 the President/CAO 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% of base salary based upon system performance and accomplishment of certain targets established by the CEO. Base salary and annual bonus opportunities for Ronnie Beeler, VP-Financial Services, are based on established targets to insure that total compensation is reasonable and within a fair market value range. Salary ranges are based upon comparison with similar jobs in similar size health systems across the nation. Base salaries and bonuses are approved by Executive Leadership predicated upon performance, and are 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 0-20% of base salary based upon system performance and accomplishment of certain targets established by Executive Leadership.
  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 the Electronic Municipal Market Access, EMMA, website. Any member of such a repository has access to these financial statements. In addition, Fort Sanders Regional Medical Center files a Joint Annual Report containing financial information with the Tennessee Department of Health.
Contact Addresses for Officers, Directors, Etc.: Form 990, Part VI, Section A, Line 9 Anthony L. Spezia Covenant Health 100 Ft Sanders West Blvd. Knoxville, TN 37922 John T. Geppi, Larry Mauldin, and all Directors Covenant Health 1420 Centerpoint Blvd., Bldg. C Knoxville, TN 37932 Gary Bush 5046 Ridgemont Drive Knoxville, TN 37918-4525 All other persons listed in Part VII, Section A may be contacted at the organization's address, which is: Fort Sanders Regional Medical Center 1901 Clinch Avenue Knoxville, TN 37916
Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Intracompany Eliminations -74,946. Forgiveness of Affiliate Payables 6,505.
  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.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Fort Sanders Regional Medical Center
 
Employer identification number

62-0528340
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) Covenant Health

1420 Centerpoint Blvd Bldg C

Knoxville,TN379321960
62-1646734 		Supporting organization TN 501(c)(3) Line 11b, II N/A
 
No
(2) Parkwest Medical Center

9352 Park West Boulevard

Knoxville,TN37923
58-1897274 		Acute care hospital & behavioral health services TN 501(c)(3) Line 3 Covenant Health
 
 
No
(3) Methodist Medical Center

990 Oak Ridge Turnpike

Oak Ridge,TN37830
62-0636239 		Acute care hospital TN 501(c)(3) Line 3 Covenant Health
 
 
No
(4) LeConte Medical Center

742 Middle Creek Road

Sevierville,TN37862
62-1114867 		Acute care hospital TN 501(c)(3) Line 3 Covenant Health
 
 
No
(5) Roane County Medical Center dba Roane Medical Center

8045 Roane Medical Center Dr

Harriman,TN37748
68-0673354 		Acute care hospital TN 501(c)(3) Line 3 Covenant Health
 
 
No
(6) Fort Loudoun Medical Center

550 Fort Loudoun Medical Center Dr

Lenoir City,TN37772
62-1373691 		Acute care hospital TN 501(c)(3) Line 3 Covenant Health
 
 
No
(7) Thompson Cancer Survival Center

1915 White Avenue

Knoxville,TN37916
62-1250943 		Cancer treatment facility TN 501(c)(3) Line 3 Covenant Health
 
 
No
(8) Thompson Oncology Group

1915 White Avenue

Knoxville,TN37916
62-1619239 		Oncology services TN 501(c)(3) Line 3 Covenant Health
 
 
No
(9) Covenant Homecare

3001 Lake Brook Blvd Suite 101

Knoxville,TN37909
62-1623114 		Home health services TN 501(c)(3) Line 9 Covenant Health
 
 
No
(10) Fort Sanders Perinatal Center

501 19th Street Suite 304

Knoxville,TN37916
04-3760551 		High risk obstetrical services TN 501(c)(3) Line 3 Covenant Health
 
Yes
 
(11) Fort Sanders Foundation

280 Fort Sanders West Blvd Ste 202

Knoxville,TN37922
62-1748601 		Fundraising and patient outreach TN 501(c)(3) Line 11b, II Covenant Health
 
 
No
(12) Morristown-Hamblen Hospital Assoc dba M-H Healthcare System

908 W 4th North St

Morristown,TN37814
62-0545814 		Acute care hospital TN 501(c)(3) Line 3 Covenant Health
 
 
No
(13) Thompson Cancer Survival Center Foundation

1915 White Avenue

Knoxville,TN37916
58-2130450 		Fundraising and patient outreach TN 501(c)(3) Line 11a, I Thompson Cancer Survival Center
 
 
No
(14) Morristown Regional Cancer Center LLC

908 W 4th North St

Morristown,TN37814
20-0916364 		Cancer treatment facility TN 501(c)(3) Line 3 Morristown- Hamblen Hospital Association
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) Endoscopy Center of Oak Ridge LLC

988 Oak Ridge Turnpike Ste 200
Oak Ridge,TN37830
62-1667358 		Outpatient medical facility TN N/A
                  
(2) Fort Sanders West OP Surgery Ctr LLC

210 Fort Sanders West Blvd Ste 106
Knoxville,TN37922
62-1366907 		Outpatient surgery center TN N/A
                  
(3) Fort Sanders West Associates

280 Fort Sanders West Blvd Ste 214
Knoxville,TN37922
62-1384171 		Building ownership TN N/A
                  
(4) Assoc of the Meridian Health Outpatient Surgery Ctr LLC

908 W 4th North St
Morristown,TN37814
86-1167487 		Outpatient surgery center TN N/A
                  
(5) KOSC Properties LLC

260 Fort Sanders West Blvd Ste 200
Knoxville,TN37922
26-2444076 		Building ownership TN N/A
                  
(6) Knoxville Orthopaedic Surgery Center LLC

260 Fort Sanders West Blvd Ste 200
Knoxville,TN37922
26-2437385 		Orthopaedic surgery TN N/A
                  


Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) Fortress Corporation

280 Fort Sanders West Blvd Suite 21
Knoxville,TN37922
62-1308885 		Management company TN N/A
 C         No
(2) KASC Acquisition Company Inc

1420 Centerpoint Blvd Bldg C
Knoxville,TN37932
26-3400984 		Real estate holdings TN N/A
 C         No
(3) Covenant Medical Management Inc

1400 Centerpoint Blvd Bldg A Suite
Knoxville,TN37932
62-1282917 		Physician practice management TN N/A
 C         No
(4) Knoxville Heart Group

1819 Clinch Ave Suite 108
Knoxville,TN37916
27-1528941 		Cardiology medical practice TN Fort Sanders Regional Medical Center
  		C -2,371,987 207,404 100.000 %   No
(5) East TN Cardiovascular Surgery Group Inc

9125 Cross Park Dr Ste 200
Knoxville,TN37923
62-1018541 		Cardiovascular surgery practice TN N/A
 C         No




Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
Yes
 
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Fort Sanders Perinatal Center

 A 706,239 Cost
(2) Fort Sanders Perinatal Center

 L 46,446 Cost
(3) Fort Sanders Perinatal Center

 M 136,241 Cost
(4) Fort Sanders Perinatal Center

 N 289,622 Cost
(5) Fort Sanders Perinatal Center

 Q 165,941 Cost
(6) Knoxville Heart Group

 A 246,829 Cost
(7) Knoxville Heart Group

 N 69,499 Cost
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


Software ID:  
Software Version: