SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
Medium right arrow Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
Medium right arrow Attach to Form 990.
Medium right arrow Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
Name of the organization
Morristown-Hamblen Hospital Association
 
Employer identification number

62-0545814
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 criteria used 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
Yes
 
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
 
No
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) . . . 		    4,553,100   4,553,100 4.110 %
b Medicaid (from Worksheet 3, column a) . . . . .     29,376,095 25,788,584 3,587,511 3.240 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     21,811 30,293 0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . .     33,951,006 25,818,877 8,140,611 7.350 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     109,854   109,854 0.100 %
f Health professions education (from Worksheet 5) . . .     629   629 0 %
g Subsidized health services (from Worksheet 6) . . . .     7,598,698 3,240,041 4,358,657 3.930 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     30,229   30,229 0.030 %
j Total. Other Benefits . .     7,739,410 3,240,041 4,499,369 4.060 %
k Total. Add lines 7d and 7j .     41,690,416 29,058,918 12,639,980 11.410 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
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            
2 Economic development            
3 Community support     11,029   11,029 0.010 %
4 Environmental improvements            
5 Leadership development and
training for community members		     1,971   1,971 0 %
6 Coalition building            
7 Community health improvement advocacy     92   92 0 %
8 Workforce development            
9 Other            
10 Total     13,092   13,092 0.010 %
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 Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
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
7,943,991
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
1,022,258
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
19,185,686
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
16,246,590
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
2,939,096
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 %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2022
Schedule H (Form 990) 2022
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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General Medical and Surgical Children's Hospital Teaching Hospital Critical Access Hospital Research Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 Morristown-Hamblen Healthcare System
908 W Fourth North St
Morristown,TN37814
www.covenanthealth.com/morristown-hamb
00000073 		X X         X      
Schedule H (Form 990) 2022
Page 4
Schedule H (Form 990) 2022
Page 4
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)
Morristown-Hamblen Hospital Association
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 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 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 22
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): See Part V, Page 8
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a 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)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, 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) 2022
Page 5
Schedule H (Form 990) 2022
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
Morristown-Hamblen Hospital Association
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
https://www.covenanthealth.com/patients-visitors/financial-assistance
b
https://www.covenanthealth.com/patients-visitors/financial-assistance
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2022
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Schedule H (Form 990) 2022
Page 6
Part VFacility Information (continued)

Billing and Collections
Morristown-Hamblen Hospital Association
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 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 individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2022
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Schedule H (Form 990) 2022
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
Morristown-Hamblen Hospital Association
Name of hospital facility or letter of facility reporting group  
Yes No
22 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
23 During the tax year, did the hospital facility charge any FAP-eligible individual 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? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2022
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Schedule H (Form 990) 2022
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Morristown-Hamblen Hospital Association Part V, Section B, Line 5: Morristown-Hamblen Hospital Association dba Morristown-Hamblen Healthcare System ("Morristown-Hamblen") conducted its fourth Community Health Needs Assessment ("CHNA") in 2022. A Steering Committee was formed to guide the assessment process and included the Hamblen County Health Department, Morristown Hamblen Healthcare System, Hamblen County Health Council, and the Tennessee Department of Public Health. Each of these community organizations serve the broader community and, in particular, the low-income, uninsured and chronically ill. The Steering Committee worked with the University of Tennessee-Knoxville Social Work Office of Research and Public Service ("UT-SWORPS") to devise a Hamblen County household survey and to host four focus groups of community leaders, each of which represented a part of the overall Hamblen County public health system. The household survey collected information from 407 Hamblen County residents. Participation in the survey was diverse and reflected the demographic profile of the county for the attributes of educational level, income, ethnicity and age. The primary research was analyzed and combined with county demographics, mortality, and secondary data from more than 60 health indicators. A Data Team was formed to analyze the data and determine the most significant findings from the assessment. The Data Team included members of the Steering Committee as well as representatives from the Morristown Task Force on Diversity, Hamblen County Senior Center, Hispanic community advocates, Citizen Tribune, Morristown Parks and Recreation, Healthy Hamblen, Hamblen County Board of Health, and Coordinated School Health.
Morristown-Hamblen Hospital Association Part V, Section B, Line 6b: Though Morristown-Hamblen's CHNA was issued as a stand-alone report, many non-hospital organizations assisted throughout the process. Research partners provided expertise on survey design, focus group facilitation, data collection, data sources, and analysis. UT-SWORPS was an integral contributor, as well as the Hamblen County Health Department and the Tennessee Department of Public Health (Nashville, TN).Additionally, focus groups were beneficial in discussing and identifying community needs in Hamblen County. Organizations and individuals participating in the focus groups included:- Morristown Task Force on Diversity - Hamblen Co. Health Dept.- Chamber of Commerce - NAACP- Cherokee Health System - Pregnancy Crisis Center- McNabb Center - Reunion of Ages- Morristown Utility Company - Walter State Community College- Hamblen Co. Senior Citizen Center - Helping Hands Clinic- Men of Vision - Tennessee Voices- Smoky Mountain Home Health and Hospice - Morristown Police Dept.- United Way of Hamblen County - Hamblen Co. School Health Coordinator - Morristown Parks and Recreation Dept.- Morristown Hamblen Healthcare System
Morristown-Hamblen Hospital Association Part V, Section B, Line 11: At the conclusion of the 2022 assessment process, the Data Team identified a top ten list of health priorities and further refined this list into the top 5 most significant health issues. Due to the impact of COVID-19 during this assessment cycle, the Data Team's recommendation was to continue with the same top five identified community needs from 2019: obesity, tobacco use and vaping, substance abuse disorder, access to mental health services, and cancer.Morristown-Hamblen updated its 2022 Implementation Plan based on identified needs and plans to address all of the identified issues in the following ways:1. Substance Abuse DisordersLow-Dose CT Screening - Morristown-Hamblen will continue to advertise and encourage community members who meet the criteria to participate in Low-Dose CT screening. This initiative will help diagnosis and treat cancer during earlier stages instead of finding the cancer at an advanced stage. Opioid Light Protocol - Morristown-Hamblen has adopted the Covenant protocol to reduce the amount of narcotics prescribed in our Emergency Department. Narcotics are reserved for acute pain, and other non-narcotic methods of pain control are offered to patients with more chronic pain. 2. Access to Mental Health Services - Morristown-Hamblen has chosen to focus resources on tangible, effective local efforts and will continue to collaborate with local mental health providers as needed and as resources are available. For example, Morristown-Hamblen collaborated with Helen Ross McNabb to place an Alcohol & Drug counselor based in our emergency department to help identify patients and appropriate resources to expedite getting patients help in a timelier manner. - Our Case Management Department has been educated on local group home resources that are available to those struggling with addiction. - Senior Behavioral Health Services are collaborating with local resources such as ALPS or local dementia adult care centers.3. CancerLow-Dose CT Screening - Morristown-Hamblen offers Low-dose CT scans as a diagnostic screening for those at higher risk for lung cancer. The procedure is painless and takes about ten seconds; it is non-invasive and requires no medication. Low-dose CT must be ordered by a physician. Community outreach efforts are being made to educate primary care physicians on the benefits of this screening procedure. Data from scans are logged into the American College of Radiology Database for further analysis and study."Think Pink" Event - Morristown-Hamblen now offers an annual "Think Pink" event inviting the community to come and be educated and involved in encouraging ladies in our community to have annual mammograms.Jingle Run - Morristown Regional Cancer Center has developed the Jingle Run, a 5k walk or run, to raise awareness about cancer screening and prevention and to raise money for our cancer patient support fund used to help patients with the cost of take home medications, gas cards to assist with transportation to and from treatments, utility bill assistance, etc. while patients are unexpectantly out of work and undergoing cancer treatment.4. ObesityMorristown Landing - Morristown-Hamblen will be the official health care provider of the new community center, Morristown Landing. This will include health tips throughout the facility to educate the community on healthy lifestyles. In addition, Morristown-Hamblen will provide athletic trainers to ensure that athletes participating in events have access to quality care. Population Health / Occupational Medicine Initiative - The Population Health Manager and CAO of Morristown-Hamblen are meeting with companies to share how Covenant Health can assist in helping companies understand health risk factors of their employees, and then implement education and initiatives to meet the goal of reducing risk factors most prevalent within the company's employee population. One example is the "Biggest Winner" program implemented with our local utility company to help employees increase exercise and lose weight.5. Tobacco Use and VapingCommunity Education -Morristown-Hamblen has annual health education and screening fairs across the community. Events include education in the school systems about the dangers of smoking and vaping. - Hamblen County School System's "Be Smart, Don't Start" initiative is a joint effort by Morristown-Hamblen, the Hamblen County Department of Health and the Hamblen County Board of Education. The program encourages students to abstain from smoking and vaping. The program was suspended during COVID but all parties hope they will be able to resume it again in the future.Cancer Screening - As part of its Low-Dose CT screening, smoking education material will be distributed to individuals at risk for lung cancer.Expanded Health Care OptionsTo meet the healthcare needs of Morristown and the surrounding area, Morristown-Hamblen is currently building a $37 million outpatient facility. The proposed 50,000-square-foot facility will include a free-standing emergency department, diagnostic center and physician offices. The facility is scheduled to open in 2023 and will expand health care services throughout the Morristown-Hamblen community.
Morristown-Hamblen Hospital Association Part V, Section B, Line 16j: All other ways in which the hospital widely publicizes the FAP are discussed in detail in Part VI, Line 3.
Part V, Line 7a, CHNA Website https://www.covenanthealth.com/morristown-hamblen/chna/
Part V, Line 10a, Implementation Strategy Website https://www.covenanthealth.com/morristown-hamblen/chna/
Part V, Line 20d, Presumptive Eligibility Determinations The hospital follows the eligibility procedures as detailed within the FAP and does not make presumptive eligibility determinations.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2022
Page 9
Schedule H (Form 990) 2022
Page 9
Part VFacility Information (continued)

Section D. 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?2
Name and address Type of Facility (describe)
1 1 - Ambulatory Surgery Center
908 W Fourth North Street
Morristown,TN37814 		Outpatient Surgery Center
2 2 - Morristown Regional Diagnostic Center
901 W Fourth North Street
Morristown,TN37814 		Outpatient Diagnostic Center
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2022
Page 10
Schedule H (Form 990) 2022
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
Part I, Line 3c: In addition to the Federal Poverty Guidelines ("FPG"), Morristown-Hamblen utilizes an asset test as a factor in determining eligibility for free or discounted care. Ten percent (10%) of the patient/guarantor's net assets will be added to income for determination of total annual income. The guidelines for determining assets include, but are not limited to, primary dwelling (and attached land), automobiles, liquid assets, investments, farm land, business property, rental property, farm and/or business equipment including livestock and crops. All real property will be considered at fair market value. The values of both real and personal property will be reduced by any existing liabilities incurred by the applicant in obtaining the assets (net assets) with the exception of primary dwelling. The primary dwelling net asset will be the amount of equity above $100,000. Actual or potential third party liability to the patient, hospital, or the guarantor by common law, contract, statute or otherwise, shall be considered an asset and must be listed on the Hospital Financial Assistance application.
Part I, Line 6a: Covenant Health, the parent company of Morristown-Hamblen and other affiliated acute care hospitals, prepares an annual Report to the Community on behalf of the entire system.
Part I, Line 7: Amounts on Lines 7a-7c and certain program costs included on Line 7g are from the hospital's cost accounting system, which addresses all patient segments. Other community benefit expenses are at cost from the general ledger.
Part I, Line 7g: Subsidized health services includes the difference between the cost of services and the payments received for those services. The cost of providing in-patient behavioral health exceeded the payments received by $1,326,767, and the cost of providing OB and neonatal care exceeded payments by $63,919. The total also includes $2,967,971 in physician sponsorship fees. All subsidized health services included on line 7g are for services that would otherwise be unavailable in the community or be below the community's needs.
Part I, Ln 7 Col(f): The Bad Debt expense included on Form 990, Part IX, Line 24a, but subtracted for purposes of calculating the percentage in this column is $7,943,991.
Part II, Community Building Activities: Morristown-Hamblen cares for the whole person and recognizes that improved social and economic conditions may lead to the improved health and well-being of the community. The hospital's community building activities and those of its parent organization, Covenant Health, address many of the root causes of health problems, such as poverty and homelessness, and help find solutions to alleviate the symptoms.An allocation of the Parent's community building expenditures has been made to each member hospital in proportion to the financial contribution of each to the health system. Covenant Health is not a hospital and does not file Schedule H with its Form 990. Contributions in 2022 were made to organizations meeting the community's needs by providing: - The basic needs of life including temporary shelter, food and clothing (Ladies of Charity, City Shepherds, Safe Families for Children East TN and Second Harvest Food Bank) - Youth mentoring, development and after-school programs (Emerald Youth Foundation, Boys and Girls Club, Knox Education Foundation, First Tee of Greater Knoxville and Great Smoky Mountain Council) - Business recruitment and marketing initiatives that boost economic development (Knoxville Technology Council, Knoxville Zoological Garden and Pellissippi State Foundation) - Leadership development programs and workshops (Knoxville Area Urban League and Leadership Knoxville) - Assistance and special programs for at risk older adults, people with physical and mental challenges, and abused and neglected children (Senior Citizens Home Assist and Sertoma Center) - Improve access to health services (East TN Children's Hospital, Helen Ross McNabb Center, Interfaith Health Clinic, Knoxville Academy of Medicine, and Region II Emergency Medical Services) - Programs supporting patients and their families (Air Force Association, Alzheimer's Tennessee, American Cancer Society, American Heart Association, Angel Wings Memory Gowns, East TN Kidney Foundation, East TN Veteran Memorial Association, Juvenile Diabetes Research Foundation and Leukemia & Lymphoma Society, Wreaths Across America)
Part III, Line 2: Bad debt expense on Part III, Line 2 is the amount recorded in the organization's financial statements. Discounts and payments on patient accounts are netted against bad debt. The allowance for bad debt is determined based on management's assessment of factors including the age of the accounts, historical collections data, and industry standards.
Part III, Line 3: At regular intervals, the Vice President of Revenue Cycle analyzes all self-pay accounts receivables to identify patients who may have been eligible for charity care during a particular period or year. Because this analysis does not yield a final determination of eligibility due to various factors including but not limited to charity applications still in process, failure of eligible patients to submit their charity application, and applications still under consideration, further analysis of the accounts comprising the self-pay accounts receivable is conducted. The accounts for which a patient was contacted to apply for charity care include an identifier; these charity-identified accounts are then categorized according to status. A ratio of the dollar amounts of those accounts whose charity application is in process or has been approved divided by the total self-pay accounts receivable is computed. This ratio is applied to the bad debt expense total to determine the estimated amount of the bad debt expense attributable to patients eligible for charity care according to the hospital's policy.
Part III, Line 4: Note B to the 2022 Audited Consolidated Financial Statements of the Covenant Health system, of which Morristown-Hamblen is a member, states: Patient accounts receivable are reported net of an estimated allowance for contractual adjustments and an allowance for implicit price concessions. Covenant's policy does not require collateral or other security for patient accounts receivable and Covenant routinely accepts assignment of, or is otherwise entitled to receive, patient benefits payable under health insurance programs, plans or policies.
Part III, Line 8: Costing Methodology: Morristown-Hamblen 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: Morristown-Hamblen utilizes a look-back method to determine amounts generally billed ("AGB") to establish the maximum amount that will be charged to individuals eligible under the financial assistance policy ("FAP") for emergency or other medically necessary care. Self-pay patients automatically receive a 70% discount on charges based on the facility's calculated AGB. Federal poverty guidelines are utilized in the determination of charity care eligibility. Patients who are unable to pay and have exhausted all sources of payment assistance may qualify for charity care. A sliding scale is used for extending charity care utilizing the income levels reported under the federal poverty guidelines. Patients/guarantors with income that falls below 200% of the federal poverty guidelines receive 100% charity care. Patients/guarantors with income of 201-300% of the federal poverty guidelines receive 90% charity care. For catastrophic illness, exceptions to income and asset limitations may be made on a case-by-case basis. The amount considered for charity will be based upon the evaluation of the patient's/guarantor's ability to pay.Morristown-Hamblen makes reasonable efforts to determine a patient's eligibility under the facility FAP. All collection activity will be halted if a charity application is received and will remain on hold until a determination is made by Morristown-Hamblen and communicated in writing to the responsible party. If the charity application is approved, all collection activities taken will be reversed and any amounts paid above the amount required will be refunded. Patients/guarantors who qualify for partial financial assistance are responsible for paying any balance remaining after the charity adjustment and third party payments. Morristown-Hamblen will not engage in extraordinary collection actions ("ECA") before it makes reasonable efforts to determine whether an individual who has an unpaid bill is eligible for financial assistance. Reasonable efforts to determine whether the individual who has an unpaid bill is eligible for financial assistance include notification to the individual of the financial assistance policy, contacting individuals who have submitted incomplete financial assistance applications regarding how to complete the application, and allowing a reasonable time period to do so, and reviewing completed applications for financial assistance eligibility. Morristown-Hamblen does not sell any accounts receivable accounts to outside firms. All accounts remain property of and under the policies set by Morristown-Hamblen. Morristown-Hamblen will not defer or deny medically necessary care because of nonpayment for previously provided care whether it was covered or not covered under the charity program.
Part VI, Line 2: While the CHNA is a formal means by which the health system assesses the needs of the community, there are many informal networks that give the Covenant Health hospitals a sense of community issues and needs. Morristown-Hamblen obtains additional community information through the service of its employees with the Hamblen County Health Council, the Chamber of Commerce, and Rotary Clubs, and United Way. Covenant Health, the parent organization, maintains community benefit professionals working year-round to ensure that all hospitals are assessing and addressing the needs of the communities served.
Part VI, Line 3: The FAP states that patients who are unable to pay or have exhausted all sources of payment assistance may be considered for charity care. Signage about the policy is posted in highly visible areas of the hospital, such as lobbies and registration areas. Information about the FAP is posted in patient booklets provided to inpatients during the registration process and communicated via patient billing statements. In addition, the FAP and application are available on the facility website. Morristown-Hamblen employs full-time financial counselors to assist patients in applying for TennCare and screening for financial assistance. Office hours and the phone number for the counselors are included on the signage. Wall signs informing patients about available financial assistance state the following: Covenant Health is committed to providing quality health services in a caring environment. It is the expressed philosophy of Covenant Health and its member hospitals that no one should be denied necessary medical care because of the inability to pay. In conjunction with this philosophy, counselors at Morristown Hamblen are available to assist you with your financial needs. If you are an uninsured person with no public or private source of payment for medical services Morristown Hamblen will provide at a reduced rate, medically indicated services. A financial counselor is available to assist you with these matters by calling 423-492-5053, Monday through Friday between the hours of 8:00 a.m.-4:00 p.m. Additional information regarding financial assistance is also available on our website at www.morristownhamblen.com. Signage at the registration areas state the following:It is Morristown Hamblen's philosophy that no one shall be denied medically necessary services based on an inability to pay. Financial assistance applications for medically necessary services are available during the registration process, through a financial counselor, or on our website at www.morristownhamblen.com. A financial counselor is available to assist you with these matters by calling 423-492-5053, Monday through Friday between the hours of 8:00 a.m. - 4:00 p.m.
Part VI, Line 4: Hamblen County, Tennessee, is the primary market area for Morristown-Hamblen. Hamblen County is a rural community with close proximity to the metropolitan Knoxville area. Morristown-Hamblen is the only hospital in Hamblen County. According to internal hospital data for 2022, 45% of the inpatient encounters and 38% of the outpatients were residents of Hamblen County.According to 2022 data from the County Health Rankings, Robert Wood Johnson Foundation, the population of Hamblen County is 65,110. The population has slightly more women (51.1%). Persons 65 and older account for 18.7% of the population. Hamblen County has one of the largest Hispanic populations in East Tennessee at 12.1%. The median income of Hamblen County is $48,000 per household with 21% of the children living in poverty. Unemployment is at 7.1%.In support of the significant findings from the 2022 CHNA, the following data points support the conclusions of the 2022 assessment:Obesity - Forty-seven percent of school-aged youth in Hamblen County were classified as overweight or obese. - Thirty-eight percent of adults in Hamblen County are obese. Tobacco / Vaping - Twenty-four percent of adults in Hamblen County smoke. - School officials are seeing a dramatic rise in high school students who are vaping. - More than 50% of adults see youth smoking/vaping as a major problem in Hamblen County.Substance Abuse Disorder - Seventy-one percent of survey respondents identified drug abuse as the most significant health issue in Hamblen County. - In a county with a population of 65,110, the number of patients receiving opioids for pain is 12,543. - In Hamblen County, there are 830 opioid prescriptions written for every 1,000 residents. This is down from 1,430 for every 1,000 residents in 2019.Access to Mental Health Services - Mental health issues were identified as the second highest health concern by community leaders participating in the focus groups. - Although the ratio of mental health provider per resident is average, many residents do not have the financial means to access services.Health Literacy and Education - The leading causes of death in Hamblen County over the past decade include cancer, heart disease, respiratory disease, Alzheimer's disease, accidents, stroke, diabetes, flu, and pneumonia. Most all of these are to a large degree preventable. - Access to community health education programming is fragmented in Hamblen County.Cancer - Cancer is the leading cause of death in Hamblen County. - Many cancer cases are diagnosed late in the disease progression when prognosis is not as good.
Part VI, Line 5: Morristown-Hamblen, 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 Morristown-Hamblen's board. The board is comprised of independent community leaders with diverse educational and professional backgrounds. The board provides governance and oversight of Morristown-Hamblen.Morristown-Hamblen maintains an open medical staff, with privileges available to all qualified physicians and healthcare professionals. Additionally, the hospital operates an active and accessible emergency department open to all persons, regardless of the ability to pay.
Part VI, Line 6: Morristown-Hamblen, 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. Morristown-Hamblen's patients benefit from the availability of and ease of access to Covenant Health affiliated entities for services not provided by the hospital itself. Transfer or referral to such services is expedited and coordinated to help create a seamless continuum of care. A full range of community mental health and psychiatric hospital services are available within the system that help support the hospital's emergency room as well as provide an accessible and efficient pathway for those patients who require such services post discharge. Other specialized services such as inpatient rehabilitation, home health and hospice services are provided by affiliated entities. The Covenant Health system also enhances the patient's access to care through the provision of outpatient services in a variety of settings located throughout the service area. These include a diabetes center, wound care center, bariatric surgery center, pulmonary rehabilitation programs and ambulatory infusion centers.Foundation Support:Morristown-Hamblen Hospital Foundation was established in 1997 to acquire and accept charitable gifts for Morristown-Hamblen to help all those in need receive the highest quality of care regardless of the ability to pay. The Foundation is a separate, non-profit corporation which is governed by a volunteer Board of Directors, each of whom is a recognized leader in the communities Morristown-Hamblen serves. Annual fundraising events make it possible for the hospital to provide many important services to the community including: - Aid for cancer and palliative care, including specialized skin creams to aid in healing for radiation patients.- Assistance to patients and employees who find themselves in times of crisis.- Support to parents of stillborn or premature babies. 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) 2022
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