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Nonprofiteer
← CLAIBORNE MEDICAL CENTER

Form 990 for tax year 2023

Filed by CLAIBORNE MEDICAL CENTER.

Totals

Total revenue
$36,596,205
Total expenses
$37,447,955
Contributions and grants received
$20,900
Grants paid
$5,574
Program service revenue
$36,431,950
Investment income
$19,681
Other revenue
$123,674
Total assets, end of year
$14,194,553
Total liabilities, end of year
$3,809,750
Net assets or fund balances, end of year
$10,384,803
Program services expenses (Part IX)
$35,768,784
Management and general expenses
$1,679,171
Fundraising expenses
$0
Program service expenses (Part III)
$35,768,784

Program services were 95.5% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1e · Government grants (contributions)

    $4,000

  • 1f · All other contributions, gifts and grants

    $16,900

  • 2a · Program service revenue: Net Patient Revenue

    total $26,014,926 · related or exempt $26,014,926

  • 2b · Program service revenue: Nursing Home Revenue

    total $7,905,892 · related or exempt $7,905,892

  • 2c · Program service revenue: Ambulance Services

    total $2,468,946 · related or exempt $2,468,946

  • 2d · Program service revenue: Laboratory

    total $27,534 · unrelated business $27,534

  • 2e · Program service revenue: Rental - Exempt Affiliates

    total $14,652 · related or exempt $14,652

  • 3 · Investment income

    total $18,181 · excluded $18,181

  • 6a · Gross rents

    real property $155,682

  • 6b · Less rental expenses

    real property $98,867

  • 6c · Rental income or loss

    real property $56,815

  • 6d · Net rental income or loss

    total $56,815 · unrelated business $12,246 · excluded $44,569

  • 7a · Gross sales of assets other than inventory

    other assets $1,500

  • 7b · Less cost or other basis and sales expenses

    other assets $0

  • 7c · Gain or loss

    other assets $1,500

  • 7d · Net gain or loss

    total $1,500 · excluded $1,500

  • 11a · Other revenue: Cafeteria

    total $25,292 · excluded $25,292

  • 11b · Other revenue: Miscellaneous

    total $22,355 · excluded $22,355

  • 11c · Other revenue: Gift Shop

    total $19,212 · excluded $19,212

  • 11e · Other revenue, total

    $66,859

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $5,574 · program services $5,574

  • 7 · Other salaries and wages

    total $16,043,904 · program services $15,492,713 · management and general $551,191

  • 8 · Pension plan contributions

    total $237,816 · program services $224,991 · management and general $12,825

  • 9 · Other employee benefits

    total $2,494,956 · program services $2,352,660 · management and general $142,296

  • 10 · Payroll taxes

    total $1,084,930 · program services $1,026,420 · management and general $58,510

  • 11a · Fees: management

    total $2,204,184 · program services $2,128,272 · management and general $75,912

  • 11b · Fees: legal

    total $22,402 · management and general $22,402

  • 11g · Fees: other

    total $3,415,735 · program services $3,283,798 · management and general $131,937

  • 12 · Advertising and promotion

    total $19,978 · management and general $19,978

  • 13 · Office expenses

    total $136,190 · program services $133,137 · management and general $3,053

  • 16 · Occupancy

    total $662,181 · program services $572,954 · management and general $89,227

  • 17 · Travel

    total $12,595 · program services $12,583 · management and general $12

  • 19 · Conferences, conventions and meetings

    total $7,142 · program services $6,707 · management and general $435

  • 22 · Depreciation, depletion and amortization

    total $1,253,841 · program services $1,253,841

  • 23 · Insurance

    total $227,271 · program services $204,446 · management and general $22,825

  • 24a · Other expenses: Medical Supplies

    total $3,435,556 · program services $3,435,556

  • 24b · Other expenses: Bad Debt

    total $3,063,616 · program services $3,063,616

  • 24c · Other expenses: Minor Equipment

    total $1,654,446 · program services $1,130,464 · management and general $523,982

  • 24d · Other expenses: Business Dues & License

    total $586,708 · program services $562,122 · management and general $24,586

  • 24e · All other expenses

    total $878,930 · program services $878,930

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $2,311,836 · end of year $1,043,381

  • 4 · Accounts receivable

    beginning of year $1,942,642 · end of year $2,990,271

  • 8 · Inventories for sale or use

    beginning of year $260,589 · end of year $235,409

  • 9 · Prepaid expenses and deferred charges

    beginning of year $349,046 · end of year $413,387

  • 10a · Land, buildings and equipment: cost or other basis

    $14,879,872

  • 10b · Land, buildings and equipment: accumulated depreciation

    $9,617,029

  • 10c · Land, buildings and equipment, net

    beginning of year $5,040,224 · end of year $5,262,843

  • 14 · Intangible assets

    beginning of year $4,002,840 · end of year $4,002,840

  • 15 · Other assets

    beginning of year $1,038,843 · end of year $246,422

  • 17 · Accounts payable and accrued expenses

    beginning of year $3,564,295 · end of year $3,219,214

  • 25 · Other liabilities

    beginning of year $145,172 · end of year $590,536

  • 27 · Net assets without donor restrictions

    beginning of year $11,236,553 · end of year $10,384,803

Mission and programs · 2023

Mission

Claiborne 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 a patient's ability to pay.

Activities or mission (Part I)

Claiborne Medical Center is an 85-bed full service, acute care hospital located in Tazewell, TN. It also operates the Claiborne Health and Rehabilitation Center which is licensed for 100 beds. It is a member of the Covenant Health system.

  • Withheld by Nonprofiteer: this text may name a private individual.

    Expenses $35,768,784 · Grants $5,574 · Revenue $36,404,416

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here. A text marked withheld matched a screen for wording that may name a private individual, such as an honorific or "in memory of". Most of what it withholds names no one; it is withheld so that what does is never shown.

Listed in Part VII

  • Gerald Boyd

    Director

    Total calculated
    $977
    From this org
    $0
    From related orgs
    $977
    Other
    $0
    Hours/week
    0 + 1 related

  • Willard Campbell MD

    Director

    Total calculated
    $0
    Hours/week
    0 + 1 related

  • Michael Casey MD

    Director

    Total calculated
    $0
    Hours/week
    0 + 1 related

  • Ronni Chandler

    Fmr Director (through June 2023)

    Total calculated
    $0
    Hours/week
    0 + 1 related

  • Mitchell Dickson MD

    Director

    Total calculated
    $796
    From this org
    $0
    From related orgs
    $796
    Other
    $0
    Hours/week
    0 + 1 related

  • Stephanie Flood

    Director

    Total calculated
    $808
    From this org
    $0
    From related orgs
    $808
    Other
    $0
    Hours/week
    0 + 1 related

  • James Gibson

    Director

    Total calculated
    $1,008
    From this org
    $0
    From related orgs
    $1,008
    Other
    $0
    Hours/week
    0 + 1 related

  • Edgar Gray

    Director

    Total calculated
    $1,054
    From this org
    $0
    From related orgs
    $1,054
    Other
    $0
    Hours/week
    0 + 1 related

  • Leslye Hartsell

    Director

    Total calculated
    $1,027
    From this org
    $0
    From related orgs
    $1,027
    Other
    $0
    Hours/week
    0 + 1 related

  • Donald Hickman

    Director

    Total calculated
    $1,498
    From this org
    $0
    From related orgs
    $1,498
    Other
    $0
    Hours/week
    0 + 1 related

  • Timothy Matthews

    Director

    Total calculated
    $1,196
    From this org
    $0
    From related orgs
    $1,196
    Other
    $0
    Hours/week
    0 + 1 related

  • Janice McKinley

    Director

    Total calculated
    $1,222
    From this org
    $0
    From related orgs
    $1,222
    Other
    $0
    Hours/week
    0 + 1 related

  • Dave Miller

    Director

    Total calculated
    $1,044
    From this org
    $0
    From related orgs
    $1,044
    Other
    $0
    Hours/week
    0 + 1 related

  • Bill Myers

    Director

    Total calculated
    $0
    Hours/week
    0 + 1 related

  • Alvin Nance

    Director

    Total calculated
    $1,044
    From this org
    $0
    From related orgs
    $1,044
    Other
    $0
    Hours/week
    0 + 1 related

  • Linda Ogle

    Director

    Total calculated
    $0
    Hours/week
    0 + 1 related

  • King Purnell

    Director/Chair

    Total calculated
    $1,630
    From this org
    $0
    From related orgs
    $1,630
    Other
    $0
    Hours/week
    0 + 1 related

  • Jorge Sanabria

    Director

    Total calculated
    $1,234
    From this org
    $0
    From related orgs
    $1,234
    Other
    $0
    Hours/week
    0 + 1 related

  • William Seale

    Director

    Total calculated
    $1,321
    From this org
    $0
    From related orgs
    $1,321
    Other
    $0
    Hours/week
    0 + 1 related

  • Cosby Stone

    Director

    Total calculated
    $1,595
    From this org
    $0
    From related orgs
    $1,595
    Other
    $0
    Hours/week
    0 + 1 related

  • Joe Sutter

    Director

    Total calculated
    $1,462
    From this org
    $0
    From related orgs
    $1,462
    Other
    $0
    Hours/week
    0 + 1 related

  • James Tramontana MD

    Director

    Total calculated
    $1,196
    From this org
    $0
    From related orgs
    $1,196
    Other
    $0
    Hours/week
    0 + 1 related

  • James D VanderSteeg

    President & CEO

    Total calculated
    $3,115,259
    From this org
    $0
    From related orgs
    $2,762,691
    Other
    $352,568
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,523,002 related
    Bonus
    $0 + $1,039,500 related
    Other
    $0 + $200,189 related
    Deferred
    $0 + $322,565 related
    Nontaxable benefits
    $0 + $30,003 related
    Filer's total
    $0 + $3,115,259 related

  • John T Geppi

    Fmr EVP/CFO (through June 2023)

    Total calculated
    $995,771
    From this org
    $0
    From related orgs
    $971,426
    Other
    $24,345
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $349,550 related
    Bonus
    $0 + $292,063 related
    Other
    $0 + $329,813 related
    Deferred
    $0 + $12,200 related
    Nontaxable benefits
    $0 + $12,145 related
    Filer's total
    $0 + $995,771 related

  • Joseph C Dolan

    EVP/CFO

    Total calculated
    $397,454
    From this org
    $0
    From related orgs
    $358,890
    Other
    $38,564
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $284,875 related
    Bonus
    $0 + $60,000 related
    Other
    $0 + $14,015 related
    Deferred
    $0 + $29,667 related
    Nontaxable benefits
    $0 + $8,897 related
    Filer's total
    $0 + $397,454 related

  • Patricia J Ketterman

    President & CAO

    Total calculated
    $296,346
    From this org
    $0
    From related orgs
    $264,987
    Other
    $31,359
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $201,578 related
    Bonus
    $0 + $54,000 related
    Other
    $0 + $9,409 related
    Deferred
    $0 + $10,723 related
    Nontaxable benefits
    $0 + $20,636 related
    Filer's total
    $0 + $296,346 related

  • Jacqueline H Hounshell

    VP - Financial Services

    Total calculated
    $258,674
    From this org
    $0
    From related orgs
    $219,225
    Other
    $39,449
    Hours/week
    15 + 35 related

    Schedule J breakdown matched by us

    Base
    $0 + $149,784 related
    Bonus
    $0 + $31,000 related
    Other
    $0 + $38,441 related
    Deferred
    $0 + $8,753 related
    Nontaxable benefits
    $0 + $30,696 related
    Filer's total
    $0 + $258,674 related

  • Anthony W Rowe

    Pharmacist

    Total calculated
    $180,210
    From this org
    $146,508
    From related orgs
    $0
    Other
    $33,702
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $137,173
    Bonus
    $0
    Other
    $9,335
    Deferred
    $4,604
    Nontaxable benefits
    $29,098
    Filer's total
    $180,210

  • Vicki L Cornelius

    VP - Chief Nursing Officer

    Total calculated
    $120,646
    From this org
    $106,592
    From related orgs
    $0
    Other
    $14,054
    Hours/week
    50

  • Robert B Davis

    Physical Therapist

    Total calculated
    $127,559
    From this org
    $103,182
    From related orgs
    $0
    Other
    $24,377
    Hours/week
    50

  • Tyler W Brock

    Supervisor Paramedic

    Total calculated
    $131,903
    From this org
    $100,400
    From related orgs
    $0
    Other
    $31,503
    Hours/week
    50

  • Jodi L Whitaker

    Fmr VP - CNO

    Total calculated
    $211,895
    From this org
    $0
    From related orgs
    $176,290
    Other
    $35,605
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $150,105 related
    Bonus
    $0 + $25,000 related
    Other
    $0 + $1,185 related
    Deferred
    $0 + $6,238 related
    Nontaxable benefits
    $0 + $29,367 related
    Filer's total
    $0 + $211,895 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 2 · Substantiation required before reimbursing expenses
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

Part I, Line 3
Covenant Health, the parent company of Claiborne Medical Center, used the following methods in establishing the compensation of President/CEO, James D. VanderSteeg: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board or compensation committee. Additional detail is provided in response to Form 990, Part VI, Section B, Lines 15a and 15b within Schedule O.
Part I, Line 4b
Covenant Health maintains a nonqualified deferred compensation ("NQDC") plan intended to support retention of President and CEO, James D. VanderSteeg, and EVP and CFO, Joseph C. Dolan (plan effective 8-1-2023). Employer contributions of $340,032 are reported as deferred compensation on Schedule J, Part II, Column C. Contributions along with 2023 earnings of $92,131 are subject to a substantial risk of forfeiture. Amounts are combined with other compensation and considered for reasonableness. Compensation procedures are discussed in detail in Schedule O (Form 990, Part VI, Section B, Line 15a). Please note that the amounts included in Part II, Column C as contributions to the NQDC plan for James D. VanderSteeg and other executive leaders are deferred but NOT received during the filing year. We report compensation in both the year earned and the year paid, as required by IRS guidelines; however, wages appear overstated due to dual reporting of compensation earned in one year and distributed in a subsequent year.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Disregarded entities

Part I: entities that legally are the filer and file no return of their own.

  • Claiborne EMS LLC

    Ambulance service · TN · income $2,468,946 · assets $1,693,916

    Directly controlled by Claiborne Medical Center

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • Covenant-AmSurg ASC Ventures LLC

    Management company · TN

  • Covenant-KEC ASC Ventures LLC

    Management company · TN

  • TEC North LLC

    Physician services · TN

  • The Endoscopy Center of Knoxville LLC

    Physician services · TN

  • Boulevard ENT-Surgery Center LLC

    Surgical services · TN

  • CHUC LLC

    Physician services · TN

  • Surgery Center of Oak Ridge LLC

    Surgical services · TN

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • Fortress Corporation

    C · Management company · TN

  • Covenant Medical Group Inc

    C · Physician practice management · TN · controlled entity

  • Knoxville Heart Group

    C · Cardiology medical practice · TN · controlled entity

  • East TN Cardiovascular Surgery Group Inc

    C · Cardiovascular surgical practice · TN

  • TenHats LLC

    C · Data storage · TN

Provenance

Return type
form_990
Tax year
2023
Filed
13 November 2024
IRS schema version
2023v5.1
Source object
202413189349306256

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