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      <Desc>At Thompson Cancer Survival Center, leading cancer specialists use the most advanced technologies to achieve breakthrough successes in treating many types of cancer. Our network of cancer care providers, including those in Thompson Oncology Group (our own medical oncology, hematology, and gynecologic oncology practice), is supported by a team of patient navigators, oncology pharmacists, dietitians, genetics counselors, clinical trial specialists, physicists, therapists, technologists, oncology nurses, social workers, and counselors, all working to treat and beat cancer. In addition to innovative technologies and treatment methodologies, Covenant Health added a new proton therapy center to the treatment options at Thompson Cancer Survival Center. Patients can now receive proton therapy as part of Covenant Health's umbrella of cancer services offered at Thompson Cancer Survival Center locations throughout the region and the Covenant Cancer Network. One of only 45 proton therapy facilities in the United States, Thompson Proton Center offers an advanced form of radiation therapy that uses beams of high-energy protons to treat various forms of cancer, while protecting nearby healthy tissue and vital organs from unnecessary radiation. Thompson Proton Center treated 354 patients in 2023.SERVICEThompson Cancer Survival Center ("TCSC") offers a range of cancer support services with the aim of providing patients receiving cancer treatment the best possible outcome for their individual situations. Support services include cancer outreach services, treatment care coordination and oncology clinical trials.Covenant Health facilities identify and refer patients to the TCSC Social Services Department. In 2023, there were 2,585 new patient referrals to Social Services and 7,064 follow-up patients. The Social Services department includes a nutritional counseling and education program and a genetics clinic. The nutritional counseling and education program had 3,641 new patient referrals in 2023 with 5,725 follow-up assessments and 4,934 education encounters to support patients. In 2023, the genetics clinic received referrals for 930 new patients who were in need of genetic counseling. Of these patients, 760 were scheduled, 576 completed genetic counseling, and 457 elected to pursue genetic testing. All patients were able to receive full personal and family history reviews, allowing for a thorough risk assessment for the potential of a hereditary cancer syndrome or other familial risk factors possibly not accounted for through genetic testing. The patients received education and counseling regarding their pursuit of genetic testing. When appropriate, patients received information about support resources for individuals in similar circumstances. Finally, all patients received recommendations for risk-reduction strategies personalized for their individual health history, family history, and genetic test results when available. A goal of TCSC is to provide treatment care coordination for each patient. This goal is achieved by two means: the Multidisciplinary Treatment program and the Nurse Navigator program.Multidisciplinary Treatment is a process of individual patient consultation with members of the patient's oncology care team, where treatment options are discussed based on that individual's circumstances. This approach gives the physician the opportunity to relate one-on-one with the oncology patient and explain treatment choices in layperson's language. Patients needing care coordination come from various Covenant Health organizations and other facilities. In 2023, the program added 3 navigators to expand service locations.The TCSC Nurse Navigator program was developed to help oncology patients overcome multiple barriers to healthcare, depending on their needs. Common barriers include financial, education, transportation, language, emotional, and the complexities of navigating a health care system. The TCSC Nurse Navigators guide patients to sources of financial support, help complete paperwork, educate patients on diagnoses and medical procedures, arrange and coordinate appointments with multiple providers, help with transportation, assist with housing, communicate with providers about unique patient needs, ensure medical records arrive at scheduled appointments, direct patients to support groups or counseling services, and attend patient appointments for support. Nurse Navigators work diligently to meet the needs of patients and families and become their liaisons between all physicians and services. There were 34,505 oncology patient education encounters in 2023, and 2,249 patients were assisted with their treatment by TCSC Nurse Navigators. For those patients who receive curative treatment, over 235 Survivorship Care Plans were completed by Nurse Navigators and discussed with patients in 2023.The Nurse Navigator is actively involved in the multidisciplinary care of patients. Nurse Navigators currently schedule, organize, oversee, summarize, and provide follow-up for four to five multidisciplinary cancer conferences per week. In 2023, 1,367 patients were presented at multidisciplinary conferences, with 174 of those patients being seen in our clinics where a Nurse Navigator is in attendance. TCSC continued all conferences in-person as well as via virtual format. In 2022, Fort Sanders Regional Medical Center became the first hospital in Tennessee to receive accreditation from the National Accreditation Program for Rectal Cancer (NAPRC), affirming a commitment to providing the best possible care to patients with rectal cancer. Oncology clinical trials offer cancer patients access to proven standard cancer treatments and to newly developed cutting-edge therapies. Since the opening of TCSC in 1988, the Clinical Trials Department has enrolled 2,713 patients in oncology clinical trials. The TCSC Clinical Trials department currently has 11 active-treatment patients and 99 patients in follow-up studies. Because of the excellent research reputation of Dr. David Chism and the research team, TCSC continues to have new clinical trial opportunities offered to the team on a weekly basis. To help with screening efforts, Research Nurse Coordinators are assigned to specific physician schedules and to specific locations for coverage, including Thompson Oncology Groups in Oak Ridge, Sevierville, West Knoxville, Downtown Knoxville, and Lenoir City. Opening new studies increases referrals locally and regionally and gives current patients the ability to be treated with state-of-the-art care in their own communities. Involvement in prevention and treatment trials offers improved health strategies for individuals at risk for certain cancers.Other TCSC programs in place to support Covenant Health patients undergoing cancer treatment include the East Tennessee Cancer Registry and Cancer Outreach Services.</Desc>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Bill Myers</PersonNm>
        <TitleTxt>Director</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Alvin Nance</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>1044</ReportableCompFromRltdOrgAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Linda Ogle</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>King Purnell</PersonNm>
        <TitleTxt>Director/Chair</TitleTxt>
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        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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        <OfficerInd>X</OfficerInd>
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        <ReportableCompFromRltdOrgAmt>1630</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Jorge Sanabria</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>1234</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>William Seale</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>1321</ReportableCompFromRltdOrgAmt>
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      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Cosby Stone</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>1595</ReportableCompFromRltdOrgAmt>
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      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Joe Sutter</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>1462</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>James Tramontana MD</PersonNm>
        <TitleTxt>Director</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>1.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>1196</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>0</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>James D VanderSteeg</PersonNm>
        <TitleTxt>President &amp; CEO</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>50.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>2762691</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>352568</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>John T Geppi</PersonNm>
        <TitleTxt>Fmr EVP/CFO (through June 2023)</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>50.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
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        <ReportableCompFromRltdOrgAmt>971426</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>24345</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Joseph C Dolan</PersonNm>
        <TitleTxt>EVP/CFO</TitleTxt>
        <AverageHoursPerWeekRt>0.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>50.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
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        <ReportableCompFromRltdOrgAmt>358890</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>38564</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>R Scott Warwick</PersonNm>
        <TitleTxt>Fmr Pres/CAO (through July 2023)</TitleTxt>
        <AverageHoursPerWeekRt>30.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>20.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
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        <ReportableCompFromRltdOrgAmt>360712</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>19525</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Benjamin J Devore</PersonNm>
        <TitleTxt>President &amp; CAO</TitleTxt>
        <AverageHoursPerWeekRt>30.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>20.00</AverageHoursPerWeekRltdOrgRt>
        <OfficerInd>X</OfficerInd>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>35945</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Mitzi F Anderson</PersonNm>
        <TitleTxt>VP - Financial Services</TitleTxt>
        <AverageHoursPerWeekRt>7.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>43.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>27391</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Chester R Ramsey</PersonNm>
        <TitleTxt>Chief Medical Physicist</TitleTxt>
        <AverageHoursPerWeekRt>5.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>45.00</AverageHoursPerWeekRltdOrgRt>
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        <ReportableCompFromOrgAmt>245461</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>44057</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Jessica N Hodge</PersonNm>
        <TitleTxt>Director of Oncology Pharmacy Svcs</TitleTxt>
        <AverageHoursPerWeekRt>50.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>157409</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>41574</OtherCompensationAmt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Carol S Micki</PersonNm>
        <TitleTxt>Director of Radiation Oncology</TitleTxt>
        <AverageHoursPerWeekRt>50.00</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>0.00</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Deborah K Bowles</PersonNm>
        <TitleTxt>Director of Cancer Support Svcs</TitleTxt>
        <AverageHoursPerWeekRt>50.00</AverageHoursPerWeekRt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Nicholeah J Lewallen</PersonNm>
        <TitleTxt>Pharmacy Manager</TitleTxt>
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      <Form990PartVIISectionAGrp>
        <PersonNm>Lucas D Johnson Sr</PersonNm>
        <TitleTxt>Fmr Pres/CAO; Fmr EVP-Phys Ent</TitleTxt>
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        <ReportableCompFromRltdOrgAmt>337127</ReportableCompFromRltdOrgAmt>
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        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>East TN Radiation Oncology PC</BusinessNameLine1Txt>
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        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO Box 24120</AddressLine1Txt>
            <CityNm>Knoxville</CityNm>
            <StateAbbreviationCd>TN</StateAbbreviationCd>
            <ZIPCd>37933</ZIPCd>
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      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Image Construction</BusinessNameLine1Txt>
          </BusinessName>
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        <ContractorAddress>
          <USAddress>
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            <CityNm>Louisville</CityNm>
            <StateAbbreviationCd>TN</StateAbbreviationCd>
            <ZIPCd>37777</ZIPCd>
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      <ProgramServiceRevenueGrp>
        <Desc>Clinical Trials</Desc>
        <BusinessCd>622110</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>767522</RelatedOrExemptFuncIncomeAmt>
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      <ProgramServiceRevenueGrp>
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        <BusinessCd>621400</BusinessCd>
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      <ProgramServiceRevenueGrp>
        <Desc>Management Fees</Desc>
        <BusinessCd>561000</BusinessCd>
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        <RelatedOrExemptFuncIncomeAmt>542469</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>East TN Cancer Registr</Desc>
        <BusinessCd>622110</BusinessCd>
        <TotalRevenueColumnAmt>311354</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>311354</RelatedOrExemptFuncIncomeAmt>
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      <TotalOthProgramServiceRevGrp>
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        <RelatedOrExemptFuncIncomeAmt>34518</RelatedOrExemptFuncIncomeAmt>
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      <TotalProgramServiceRevenueAmt>5083624</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>15446</TotalRevenueColumnAmt>
        <ExclusionAmt>15446</ExclusionAmt>
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        <OtherAmt>338537</OtherAmt>
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      <GainOrLossGrp>
        <OtherAmt>338537</OtherAmt>
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      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>338537</TotalRevenueColumnAmt>
        <ExclusionAmt>338537</ExclusionAmt>
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        <ExclusionAmt>353983</ExclusionAmt>
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      <GrantsToDomesticOrgsGrp>
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        <ProgramServicesAmt>19500</ProgramServicesAmt>
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      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>107700</TotalAmt>
        <ProgramServicesAmt>107700</ProgramServicesAmt>
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        <TotalAmt>423402</TotalAmt>
        <ManagementAndGeneralAmt>423402</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>3193786</ProgramServicesAmt>
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        <ProgramServicesAmt>221542</ProgramServicesAmt>
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        <ProgramServicesAmt>661004</ProgramServicesAmt>
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        <ProgramServicesAmt>302178</ProgramServicesAmt>
        <ManagementAndGeneralAmt>38507</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>1645180</ProgramServicesAmt>
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        <ManagementAndGeneralAmt>102333</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>62707</ProgramServicesAmt>
        <ManagementAndGeneralAmt>15601</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>1319477</ProgramServicesAmt>
        <ManagementAndGeneralAmt>73511</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>11030</ProgramServicesAmt>
        <ManagementAndGeneralAmt>2940</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>8430</ProgramServicesAmt>
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        <ProgramServicesAmt>2246356</ProgramServicesAmt>
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      <InsuranceGrp>
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        <ManagementAndGeneralAmt>995</ManagementAndGeneralAmt>
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        <Desc>Minor Equipment</Desc>
        <TotalAmt>421756</TotalAmt>
        <ProgramServicesAmt>404035</ProgramServicesAmt>
        <ManagementAndGeneralAmt>17721</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>Medical Supplies</Desc>
        <TotalAmt>21510</TotalAmt>
        <ProgramServicesAmt>21510</ProgramServicesAmt>
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        <TotalAmt>17976</TotalAmt>
        <ProgramServicesAmt>17027</ProgramServicesAmt>
        <ManagementAndGeneralAmt>949</ManagementAndGeneralAmt>
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      <OtherExpensesGrp>
        <Desc>UBI Tax</Desc>
        <TotalAmt>17000</TotalAmt>
        <ManagementAndGeneralAmt>17000</ManagementAndGeneralAmt>
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      <AllOtherExpensesGrp>
        <TotalAmt>63920</TotalAmt>
        <ProgramServicesAmt>37007</ProgramServicesAmt>
        <ManagementAndGeneralAmt>26913</ManagementAndGeneralAmt>
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      <TotalFunctionalExpensesGrp>
        <TotalAmt>12677535</TotalAmt>
        <ProgramServicesAmt>10910300</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1767235</ManagementAndGeneralAmt>
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      <CashNonInterestBearingGrp>
        <BOYAmt>300</BOYAmt>
        <EOYAmt>300</EOYAmt>
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      <SavingsAndTempCashInvstGrp>
        <BOYAmt>-142689</BOYAmt>
        <EOYAmt>-28632</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
        <BOYAmt>81413</BOYAmt>
        <EOYAmt>51238</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>83146041</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>25747831</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>59207581</BOYAmt>
        <EOYAmt>57398210</EOYAmt>
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      <OtherAssetsTotalGrp>
        <BOYAmt>739510</BOYAmt>
        <EOYAmt>1019979</EOYAmt>
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      <TotalAssetsGrp>
        <BOYAmt>59886115</BOYAmt>
        <EOYAmt>58441095</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
        <BOYAmt>1246032</BOYAmt>
        <EOYAmt>1361598</EOYAmt>
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      <OtherLiabilitiesGrp>
        <BOYAmt>458498</BOYAmt>
        <EOYAmt>498475</EOYAmt>
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        <FormAndLineReferenceDesc>Part I, Line 3</FormAndLineReferenceDesc>
        <ExplanationTxt>Covenant Health, the parent company of Thompson Cancer Survival 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.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Form 990, Part III, Line 4a</FormAndLineReferenceDesc>
        <ExplanationTxt>COVENANT HEALTH TCSC is a member of Covenant Health. Covenant Health is a community-owned, clinically integrated healthcare enterprise dedicated to being the region's premier healthcare network through service, community and innovation. Our mission is to improve the quality of life in our region through better health. Established in 1996 by the consolidation of Fort Sanders Health System, Knoxville, Tennessee, and MMC HealthCare System in Oak Ridge, Covenant Health is governed by a voluntary board of directors comprised of community leaders and medical professionals. With more than 11,000 employees, affiliated physicians and volunteers, Covenant Health is the Knoxville area's largest employer and has been named a Best Employer by Forbes. Covenant Health includes nine acute care hospitals in East Tennessee: Fort Sanders Regional Medical Center and Parkwest Medical Center in Knoxville, Methodist Medical Center of Oak Ridge, Fort Loudoun Medical Center in Lenoir City, LeConte Medical Center in Sevierville, Morristown-Hamblen Healthcare System in Morristown, Roane Medical Center in Harriman, Claiborne Medical Center in Tazewell and Cumberland Medical Center in Crossville. It also includes Peninsula, a division of Parkwest Medical Center, a behavioral health hospital in Blount County, Tennessee. The health system also includes Covenant Medical Group, which includes more than 200 physicians and advanced practice clinicians in office locations throughout East Tennessee. Affiliated organizations include TCSC, Thompson Oncology Group, Fortress Corporation and Subsidiaries, Covenant HomeCare, and Fort Sanders Perinatal Center. Philanthropic organizations include Fort Sanders Foundation and the Thompson Cancer Survival Center Foundation in Knoxville, Methodist Medical Center Foundation in Oak Ridge, Dr. Robert F. Thomas Foundation in Sevierville, and Morristown-Hamblen Hospital Foundation in Morristown. Funds raised by the foundations provide services, equipment and other resources for excellence in patient care. TCSC, 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.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7a</FormAndLineReferenceDesc>
        <ExplanationTxt>Covenant Health's board of directors also serves as the board of directors for Thompson Cancer Survival Center.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section A, line 7b</FormAndLineReferenceDesc>
        <ExplanationTxt>Governance decisions of Thompson Cancer Survival Center are subject to approval of the sole member, Covenant Health.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 11b</FormAndLineReferenceDesc>
        <ExplanationTxt>The Covenant Health board of directors has delegated to its Finance Committee the full power and authority of the board to receive, review, approve, authorize the filing of, address and resolve audit or review issues, and otherwise take all action required or appropriate relative to IRS Forms 990 and other applicable tax filings. Prior to filing Form 990, management reviews with the committee the returns, discusses any material variations in the Form 990 as compared to those to be filed by the organization's affiliates, and answers any questions. At the conclusion of review and discussion, the Finance Committee approves the Form 990.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 12c</FormAndLineReferenceDesc>
        <ExplanationTxt>Board members, officers, and employees are required to adhere to rules and policies regarding conflicts of interest. Covenant Health distributes a board-approved Code of Conduct to all employees. The Code covers among other subjects, conflicts of interest, and requires disclosure and resolution of employee conflicts of interest. Additionally, officers, employed physicians, and highly compensated employees are required to complete and sign an annual conflict of interest disclosure statement. Board members' conflicts of interests are addressed 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 Chief Compliance Officer reviews 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. Officers and other employees are expected to report conflicts to the Chief Compliance Officer as they arise. Depending on the nature of the conflict and the circumstances surrounding the conflict and transaction, the Chief Compliance Officer, senior leadership, or the board of directors may review the conflict of interest. When appropriate, these parties 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 Chief Compliance Officer in conjunction with Covenant Health Executive Leadership determines how to appropriately manage the conflict. In any conflict involving a board member, such member is expected to recuse himself or herself from voting on matters related to the conflict.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section B, line 15</FormAndLineReferenceDesc>
        <ExplanationTxt>Form 990, Part VI, Section B, Line 15a: Overall compensation policies for Thompson Cancer Survival Center, Covenant Health (Parent Company), and affiliates are set by the Covenant Health Chief Executive Officer (CEO) in consultation with appropriate Executive Vice Presidents and the Senior Vice President-Human Resources, after review by and discussion with the executive compensation consultant ("the Consultant") to ensure that total compensation for each executive is reasonable and within a fair market value range. The Covenant Health CEO is compensated by Covenant Health, and a detailed description of the compensation process is included on Covenant Health's Form 990. The process for TCSC's CEO is included in response to Part VI, Section B, line 15b. Form 990, Part VI, Section B, Line 15b: Base salary and annual bonus opportunities for Benjamin DeVore, President and Chief Administrative Officer, are set by the Covenant Health CEO in consultation with appropriate Executive Vice Presidents and the Senior Vice President-Human Resources, 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 reviewed with the Committee conditioned upon receipt of a written opinion from the Consultant that total compensation for the executive is reasonable and consistent with fair market value. Base salary for the CAO is initially targeted at the 25th percentile and may vary according to market conditions, performance, tenure, experience, special skills or qualifications, recruitment and retention challenges, and other relevant factors. 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 salaries and annual bonus opportunities for other officers and key employees are based on targets established by historical compensation consultant data and the Covenant Health Compensation department. 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 may vary according to market conditions, performance, tenure, experience, special skills or qualifications, recruitment and retention challenges, and other relevant factors. Annual bonuses are designed to award 0 - 20% of base salary based upon system performance and accomplishment of certain targets established by Executive Leadership.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Section C, line 19</FormAndLineReferenceDesc>
        <ExplanationTxt>Per its tax exempt bond provisions, Covenant Health, the parent company of the organization, is required to file quarterly and annual consolidated and obligated group financial statements and other documentation with various bond insurers and other agencies, including the Electronic Municipal Market Access (EMMA) service of the Municipal Securities Rulemaking Board (MSRB). Any member of such a repository has access to these financial statements. The organization's governing documents and conflict of interest policy are not made publicly available.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, line 9:</FormAndLineReferenceDesc>
        <ExplanationTxt>Transfers of Capital 3,019,120.</ExplanationTxt>
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          <AddressLine1Txt>216 Centerview Drive Ste 100</AddressLine1Txt>
          <CityNm>Brentwood</CityNm>
          <StateAbbreviationCd>TN</StateAbbreviationCd>
          <ZIPCd>37027</ZIPCd>
        </USAddress>
        <EIN>621609262</EIN>
        <PrimaryActivitiesTxt>Physician services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>TN</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <DisproportionateAllocationsInd>0</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>0</GeneralOrManagingPartnerInd>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblPartnershipGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Surgery Center of Oak Ridge LLC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>944 Oak Ridge Tpke Ste 200</AddressLine1Txt>
          <CityNm>Oak Ridge</CityNm>
          <StateAbbreviationCd>TN</StateAbbreviationCd>
          <ZIPCd>378306960</ZIPCd>
        </USAddress>
        <EIN>621801416</EIN>
        <PrimaryActivitiesTxt>Surgical services</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>TN</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <DisproportionateAllocationsInd>0</DisproportionateAllocationsInd>
        <GeneralOrManagingPartnerInd>0</GeneralOrManagingPartnerInd>
      </IdRelatedOrgTxblPartnershipGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Fortress Corporation</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>1420 Centerpoint Blvd Bldg C</AddressLine1Txt>
          <CityNm>Knoxville</CityNm>
          <StateAbbreviationCd>TN</StateAbbreviationCd>
          <ZIPCd>379321960</ZIPCd>
        </USAddress>
        <EIN>621308885</EIN>
        <PrimaryActivitiesTxt>Management company</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>TN</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Covenant Medical Group Inc</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>1420 Centerpoint Blvd Bldg C</AddressLine1Txt>
          <CityNm>Knoxville</CityNm>
          <StateAbbreviationCd>TN</StateAbbreviationCd>
          <ZIPCd>379321960</ZIPCd>
        </USAddress>
        <EIN>621282917</EIN>
        <PrimaryActivitiesTxt>Physician practice management</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>TN</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
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      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>Knoxville Heart Group</BusinessNameLine1Txt>
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        <USAddress>
          <AddressLine1Txt>1420 Centerpoint Blvd Bldg C</AddressLine1Txt>
          <CityNm>Knoxville</CityNm>
          <StateAbbreviationCd>TN</StateAbbreviationCd>
          <ZIPCd>379321960</ZIPCd>
        </USAddress>
        <EIN>271528941</EIN>
        <PrimaryActivitiesTxt>Cardiology medical practice</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>TN</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>East TN Cardiovascular Surgery Group Inc</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>1420 Centerpoint Blvd Bldg C</AddressLine1Txt>
          <CityNm>Knoxville</CityNm>
          <StateAbbreviationCd>TN</StateAbbreviationCd>
          <ZIPCd>379321960</ZIPCd>
        </USAddress>
        <EIN>621018541</EIN>
        <PrimaryActivitiesTxt>Cardiovascular surgical practice</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>TN</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1Txt>TenHatsLLC</BusinessNameLine1Txt>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1Txt>1420 Centerpoint Blvd Bldg C</AddressLine1Txt>
          <CityNm>Knoxville</CityNm>
          <StateAbbreviationCd>TN</StateAbbreviationCd>
          <ZIPCd>379321960</ZIPCd>
        </USAddress>
        <EIN>814563094</EIN>
        <PrimaryActivitiesTxt>Data storage</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>TN</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <EntityTypeTxt>C</EntityTypeTxt>
        <ControlledOrganizationInd>0</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>1</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>1</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>0</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>0</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>0</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>0</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>1</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>1</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>1</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>1</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>1</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>1</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>1</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>1</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>1</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Thompson Oncology Group</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>A</TransactionTypeTxt>
        <InvolvedAmt>2684457</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>FMV</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1Txt>Thompson Oncology Group</BusinessNameLine1Txt>
        </OtherOrganizationName>
        <TransactionTypeTxt>L</TransactionTypeTxt>
        <InvolvedAmt>134902</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>Cost</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>