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Nonprofiteer
← CLAIBORNE MEDICAL CENTER

Form 990 for tax year 2022

Filed by CLAIBORNE MEDICAL CENTER.

Totals

Total revenue
$37,539,623
Total expenses
$36,670,586
Contributions and grants received
$2,859,456
Grants paid
$6,130
Program service revenue
$34,564,695
Investment income
$12,205
Other revenue
$103,267
Total assets, end of year
$14,946,020
Total liabilities, end of year
$3,709,467
Net assets or fund balances, end of year
$11,236,553
Program services expenses (Part IX)
$35,042,602
Management and general expenses
$1,627,984
Fundraising expenses
$0
Program service expenses (Part III)
$35,042,602

Program services were 95.6% 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)

    $2,669,731

  • 1f · All other contributions, gifts and grants

    $189,725

  • 2a · Program service revenue: Net Patient Revenue

    total $25,100,711 · related or exempt $25,100,711

  • 2b · Program service revenue: Nursing Home Revenue

    total $6,485,612 · related or exempt $6,485,612

  • 2c · Program service revenue: Ambulance Services

    total $2,936,142 · related or exempt $2,936,142

  • 2d · Program service revenue: Laboratory

    total $27,890 · unrelated business $27,890

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

    total $14,340 · related or exempt $14,340

  • 3 · Investment income

    total $12,205 · excluded $12,205

  • 6a · Gross rents

    real property $142,015

  • 6b · Less rental expenses

    real property $107,736

  • 6c · Rental income or loss

    real property $34,279

  • 6d · Net rental income or loss

    total $34,279 · unrelated business $1,772 · excluded $32,507

  • 11a · Other revenue: Cafeteria

    total $28,918 · excluded $28,918

  • 11b · Other revenue: Miscellaneous

    total $22,213 · excluded $22,213

  • 11c · Other revenue: Gift Shop

    total $14,328 · excluded $14,328

  • 11d · All other revenue

    total $3,529 · excluded $3,529

  • 11e · Other revenue, total

    $68,988

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $6,130 · program services $6,130

  • 7 · Other salaries and wages

    total $16,168,480 · program services $15,621,577 · management and general $546,903

  • 8 · Pension plan contributions

    total $206,742 · program services $195,893 · management and general $10,849

  • 9 · Other employee benefits

    total $2,158,974 · program services $2,045,709 · management and general $113,265

  • 10 · Payroll taxes

    total $1,081,770 · program services $1,025,004 · management and general $56,766

  • 11a · Fees: management

    total $2,138,837 · program services $2,066,108 · management and general $72,729

  • 11b · Fees: legal

    total $8,407 · management and general $8,407

  • 11g · Fees: other

    total $3,423,602 · program services $3,307,185 · management and general $116,417

  • 12 · Advertising and promotion

    total $15,555 · management and general $15,555

  • 13 · Office expenses

    total $85,631 · program services $81,421 · management and general $4,210

  • 16 · Occupancy

    total $706,156 · program services $613,959 · management and general $92,197

  • 17 · Travel

    total $12,421 · program services $12,407 · management and general $14

  • 19 · Conferences, conventions and meetings

    total $5,396 · program services $2,735 · management and general $2,661

  • 22 · Depreciation, depletion and amortization

    total $1,131,162 · program services $1,131,162

  • 23 · Insurance

    total $255,325 · program services $237,141 · management and general $18,184

  • 24a · Other expenses: Medical Supplies

    total $4,078,716 · program services $4,078,716

  • 24b · Other expenses: Bad Debt

    total $2,258,401 · program services $2,258,401

  • 24c · Other expenses: Minor Equipment

    total $1,649,226 · program services $1,112,397 · management and general $536,829

  • 24d · Other expenses: Business Dues & License

    total $663,784 · program services $630,921 · management and general $32,863

  • 24e · All other expenses

    total $615,871 · program services $615,736 · management and general $135

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $1,772,318 · end of year $2,311,836

  • 4 · Accounts receivable

    beginning of year $2,798,327 · end of year $1,942,642

  • 8 · Inventories for sale or use

    beginning of year $530,307 · end of year $260,589

  • 9 · Prepaid expenses and deferred charges

    beginning of year $435,787 · end of year $349,046

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

    $13,482,271

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

    $8,442,047

  • 10c · Land, buildings and equipment, net

    beginning of year $4,340,877 · end of year $5,040,224

  • 14 · Intangible assets

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

  • 15 · Other assets

    beginning of year $2,567,927 · end of year $1,038,843

  • 17 · Accounts payable and accrued expenses

    beginning of year $5,794,542 · end of year $3,564,295

  • 25 · Other liabilities

    beginning of year $286,325 · end of year $145,172

  • 27 · Net assets without donor restrictions

    beginning of year $10,367,516 · end of year $11,236,553

Mission and programs · 2022

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 $35,042,602 · Grants $6,130 · Revenue $34,536,805

As filed on the 2022 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
    $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

    Director

    Total calculated
    $0
    Hours/week
    0 + 1 related

  • Mitchell Dickson MD

    Director

    Total calculated
    $268
    From this org
    $0
    From related orgs
    $268
    Other
    $0
    Hours/week
    0 + 1 related

  • Stephanie Flood

    Director

    Total calculated
    $849
    From this org
    $0
    From related orgs
    $849
    Other
    $0
    Hours/week
    0 + 1 related

  • James Gibson

    Director

    Total calculated
    $74
    From this org
    $0
    From related orgs
    $74
    Other
    $0
    Hours/week
    0 + 1 related

  • Edgar Gray

    Director

    Total calculated
    $1,432
    From this org
    $0
    From related orgs
    $1,432
    Other
    $0
    Hours/week
    0 + 1 related

  • Leslye Hartsell

    Director

    Total calculated
    $889
    From this org
    $0
    From related orgs
    $889
    Other
    $0
    Hours/week
    0 + 1 related

  • Donald Hickman

    Director

    Total calculated
    $1,538
    From this org
    $0
    From related orgs
    $1,538
    Other
    $0
    Hours/week
    0 + 1 related

  • Timothy Matthews

    Director

    Total calculated
    $906
    From this org
    $0
    From related orgs
    $906
    Other
    $0
    Hours/week
    0 + 1 related

  • Janice McKinley

    Director

    Total calculated
    $1,097
    From this org
    $0
    From related orgs
    $1,097
    Other
    $0
    Hours/week
    0 + 1 related

  • Dave Miller

    Director

    Total calculated
    $1,208
    From this org
    $0
    From related orgs
    $1,208
    Other
    $0
    Hours/week
    0 + 1 related

  • Bill Myers

    Director

    Total calculated
    $0
    Hours/week
    0 + 1 related

  • Alvin Nance

    Director

    Total calculated
    $0
    Hours/week
    0 + 1 related

  • Linda Ogle

    Director

    Total calculated
    $0
    Hours/week
    0 + 1 related

  • King Purnell

    Director/Chair

    Total calculated
    $1,050
    From this org
    $0
    From related orgs
    $1,050
    Other
    $0
    Hours/week
    0 + 1 related

  • Jorge Sanabria

    Director

    Total calculated
    $1,485
    From this org
    $0
    From related orgs
    $1,485
    Other
    $0
    Hours/week
    0 + 1 related

  • William Seale

    Director

    Total calculated
    $1,251
    From this org
    $0
    From related orgs
    $1,251
    Other
    $0
    Hours/week
    0 + 1 related

  • Cosby Stone

    Director

    Total calculated
    $1,408
    From this org
    $0
    From related orgs
    $1,408
    Other
    $0
    Hours/week
    0 + 1 related

  • Joe Sutter

    Director

    Total calculated
    $979
    From this org
    $0
    From related orgs
    $979
    Other
    $0
    Hours/week
    0 + 1 related

  • James Tramontana MD

    Director

    Total calculated
    $1,208
    From this org
    $0
    From related orgs
    $1,208
    Other
    $0
    Hours/week
    0 + 1 related

  • James D VanderSteeg

    President & CEO

    Total calculated
    $2,662,703
    From this org
    $0
    From related orgs
    $2,346,646
    Other
    $316,057
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $1,425,507 related
    Bonus
    $0 + $742,500 related
    Other
    $0 + $178,639 related
    Deferred
    $0 + $284,975 related
    Nontaxable benefits
    $0 + $31,082 related
    Filer's total
    $0 + $2,662,703 related

  • John T Geppi

    EVP/CFO

    Total calculated
    $1,133,767
    From this org
    $0
    From related orgs
    $1,099,851
    Other
    $33,916
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $0 + $679,719 related
    Bonus
    $0 + $309,084 related
    Other
    $0 + $111,048 related
    Deferred
    $0 + $11,600 related
    Nontaxable benefits
    $0 + $22,316 related
    Filer's total
    $0 + $1,133,767 related

  • Patricia J Ketterman

    President & CAO

    Total calculated
    $299,056
    From this org
    $0
    From related orgs
    $268,493
    Other
    $30,563
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $0 + $195,862 related
    Bonus
    $0 + $63,232 related
    Other
    $0 + $9,399 related
    Deferred
    $0 + $10,108 related
    Nontaxable benefits
    $0 + $20,455 related
    Filer's total
    $0 + $299,056 related

  • Jacqueline H Hounshell

    VP - Financial Services

    Total calculated
    $248,362
    From this org
    $0
    From related orgs
    $209,727
    Other
    $38,635
    Hours/week
    15 + 35 related

    Schedule J breakdown matched by us

    Base
    $0 + $143,969 related
    Bonus
    $0 + $33,000 related
    Other
    $0 + $32,758 related
    Deferred
    $0 + $7,070 related
    Nontaxable benefits
    $0 + $31,565 related
    Filer's total
    $0 + $248,362 related

  • Anthony W Rowe

    Pharmacist

    Total calculated
    $178,853
    From this org
    $146,206
    From related orgs
    $0
    Other
    $32,647
    Hours/week
    50

    Schedule J breakdown matched by us

    Base
    $136,220
    Bonus
    $1,220
    Other
    $8,766
    Deferred
    $4,526
    Nontaxable benefits
    $28,121
    Filer's total
    $178,853

  • Jodi L Whitaker

    Fmr VP - CNO (through Oct 2022)

    Total calculated
    $185,223
    From this org
    $119,711
    From related orgs
    $28,664
    Other
    $36,848
    Hours/week
    0 + 50 related

    Schedule J breakdown matched by us

    Base
    $96,251 + $22,640 related
    Bonus
    $22,000
    Other
    $1,460 + $6,024 related
    Deferred
    $3,953 + $3,953 related
    Nontaxable benefits
    $24,463 + $4,479 related
    Filer's total
    $148,127 + $37,096 related

  • Robert B Davis

    Physical Therapist

    Total calculated
    $133,187
    From this org
    $103,444
    From related orgs
    $0
    Other
    $29,743
    Hours/week
    50

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. Employer contributions of $273,375 are reported as deferred compensation on Schedule J, Part II, Column C. Contributions along with 2022 earnings of $70,560 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).

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 $2,936,142 · assets $1,644,639

    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

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

  • VortexT Analytics Inc

    C · Computer programming services · TN

  • TenHats LLC

    C · Data storage · TN

Provenance

Return type
form_990
Tax year
2022
Filed
8 November 2023
IRS schema version
2022v5.0
Source object
202323179349305722

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