2018-11-08T15:17:27-06:00 2018-06-30 621517792 PYA P C ONE CHEROKEE MILLS 2220 SUTHERLAND AVE KNOXVILLE TN 379192363 990 2017-07-01 626002604 EAST TENNESSEE CHILDREN'S HOSPITAL ASSOCIATION INC EAST 8655418154 PO BOX 15010 KNOXVILLE TN 379015010 CARYN HAWTHORNE VP OF FINANCE AND CFO 8655418154 2018-11-05 1 DEBORAH O ERNSBERGER P00364912 8656730844 35.136.33.75 2018-11-08 15:17:24 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 C933B529A1AB80BD3F3F4E67FF1D7B62E966208F 2017 2018-06-14 16:35:46Z KEITH D GOODWIN PO BOX 15010 KNOXVILLE TN 379015010 214809532 0 X HTTPS://WWW.ETCH.COM X 1937 TN AT ETCH, CHILDREN ARE OUR ONLY CONCERN, PROVIDING THE BEST HEALTHCARE TO EVERY CHILD SERVED. 18 13 2124 12724 24962 21566 7189212 4441595 184163653 193429776 8056398 12351769 2229263 2910917 201638526 213134057 111819 80801 0 0 105050491 102252238 0 0 850360 85499447 90446186 190661757 192779225 10976769 20354832 447212918 457062079 159800891 159824586 287412027 297237493 X AT EAST TENNESSEE CHILDREN'S HOSPITAL ("ETCH"), CHILDREN ARE OUR ONLY CONCERN, AND THAT DRIVES OUR MISSION TO IMPROVE THE HEALTH OF CHILDREN THROUGH EXCEPTIONAL, COMPREHENSIVE FAMILY-CENTERED CARE, WELLNESS AND EDUCATION. IT IS A MISSION THAT CENTERS ON A PROFOUND AND UNCHANGING COMMITMENT TO THE PHYSICAL, EDUCATIONAL AND EMOTIONAL NEEDS OF EACH CHILD. 0 0 166913392 80801 194903168 EAST TENNESSEE CHILDREN'S HOSPITAL ("ETCH") IS THE ONLY COMPREHENSIVE REGIONAL PEDIATRIC CENTER IN EAST TENNESSEE. SINCE 1937, ETCH HAS PROVIDED EXCELLENT PEDIATRIC HEALTH CARE FOR CHILDREN FROM BIRTH TO 21 YEARS OF AGE. ETCH OFFERS MORE PEDIATRIC SUBSPECIALTIES THAN ANY OTHER HOSPITAL IN THE REGION, SERVING CHILDREN FROM EAST TENNESSEE, SOUTHWEST VIRGINIA, SOUTHEAST KENTUCKY AND WESTERN NORTH CAROLINA. THE SUBSPECIALTIES AVAILABLE AT ETCH INCLUDE: ADOLESCENT GYNECOLOGYADOLESCENT MEDICINE(SUBSPECIALTY LIST CONTINUED ON SCHEDULE O)CHILD ABUSE PEDIATRICSDEVELOPMENTAL-BEHAVIORAL PEDIATRICSNEONATOLOGYPEDIATRICSPEDIATRIC ALLERGY & IMMUNOLOGYPEDIATRIC ANESTHESIOLOGYPEDIATRIC CARDIOLOGY CLINICAL GENETICSPEDIATRIC CRITICAL CAREPEDIATRIC DENTISTRY/PEDODONTICSPEDIATRIC DERMATOLOGYPEDIATRIC EMERGENCY MEDICINEPEDIATRIC ENDOCRINOLOGYPEDIATRIC FORENSIC MEDICINEPEDIATRIC GASTROENTEROLOGYPEDIATRIC GYNECOLOGYPEDIATRIC HEMATOLOGY/ONCOLOGYPEDIATRIC INFECTIOUS DISEASESPEDIATRIC NEPHROLOGYPEDIATRIC NEUROLOGYPEDIATRIC NEUROSURGERYPEDIATRIC OPHTHALMOLOGYPEDIATRIC ORTHOPEDICSPEDIATRIC OTOLARYNGOLOGYPEDIATRIC PHYSIATRYPEDIATRIC PLASTIC/RECONSTRUCTIVE SURGERYPSYCHOLOGYPEDIATRIC PULMONOLOGYPEDIATRIC RADIOLOGYPEDIATRIC RHUMATOLOGYPEDIATRIC SLEEP MEDICINEPEDIATRIC SURGERYPEDIATRIC UROLOGYPERINATOLOGYSLEEP MEDICINEIN ADDITION, ETCH PROVIDES THE FOLLOWING: MEDICAL/SURGICAL SERVICES:THE EMERGENCY DEPARTMENT IS STAFFED WITH BOARD CERTIFIED PEDIATRIC PHYSICIANS AND NURSING PERSONNEL TO PROVIDE TREATMENT FOR ALL TYPES OF EMERGENCIES 24 HOURS A DAY, SEVEN DAYS A WEEK. THE DEPARTMENT PROVIDES EVALUATION AND TREATMENT FOR PATIENTS UP TO 21 YEARS OF AGE WITH VARYING LEVELS OF ILLNESS AND INJURY, FROM MINOR TO LIFE THREATENING. THE HOSPITAL'S PEDIATRIC INTENSIVE CARE UNIT (PICU) PROVIDES SOPHISTICATED, 24-HOUR-A-DAY TREATMENT FOR CRITICALLY ILL AND INJURED CHILDREN. THE PICU IS STAFFED WITH FELLOWSHIP TRAINED, BOARD CERTIFIED, CRITICAL CARE PHYSICIANS AND NURSES SPECIFICALLY TRAINED AND EXPERIENCED IN THE CARE OF CRITICALLY ILL CHILDREN. PATIENTS IN THE PICU RECEIVE A HIGH LEVEL OF MONITORING AND/OR TREATMENT UNTIL THEY ARE WELL ENOUGH TO BE TRANSFERRED TO A REGULAR PATIENT ROOM OR DISCHARGED HOME.IN THE NEONATAL INTENSIVE CARE UNIT (NICU), TINY AND FRAGILE INFANTS BORN PREMATURELY OR FACING LIFE-THREATENING ILLNESSES RECEIVE TREATMENT FROM A TEAM OF BOARD-CERTIFIED NEONATOLOGISTS, WITH VALUABLE ASSISTANCE FROM SPECIALLY TRAINED NURSES, RESPIRATORY THERAPISTS, LACTATION CONSULTANTS AND OTHER MEDICAL PROFESSIONALS. THE NICU TREATS MORE THAN 700 NEWBORNS EACH YEAR, AND 97 PERCENT OF THE BABIES GO HOME. AS A REGIONAL REFERRAL CENTER FOR EAST TENNESSEE, ETCH OFFERS NEONATAL AND PEDIATRIC TRANSPORT FROM OUTLYING HOSPITALS IN LIFELINE, A MOBILE INTENSIVE CARE UNIT SPECIALLY DESIGNED TO MAINTAIN THE SAME QUALITY OF CARE DURING TRANSPORT AS PATIENTS RECEIVE IN THE HOSPITAL'S CRITICAL CARE UNITS. LIFELINE CARRIES ALMOST 1,000 SUPPLIES TO ADMINISTER CARE TO PATIENTS, FROM THE TINIEST PREMATURE INFANT TO AN ADULT-SIZE PEDIATRIC PATIENT, DURING TRANSPORT TO THE HOSPITAL. IN ADDITION TO THE SPECIAL EQUIPMENT, THE LIFELINE MEDICAL TEAM MAY INCLUDE A NEONATOLOGIST, NEONATAL NURSE PRACTITIONER, PEDIATRIC/NEONATAL RN, RESPIRATORY THERAPIST AND AN EMT, DEPENDING ON THE CONDITION OF THE PATIENT. THE HOSPITAL'S TWO LIFELINE VEHICLES TRAVEL TENS OF THOUSANDS OF MILES EACH YEAR TO DOZENS OF DIFFERENT HOSPITALS IN TENNESSEE AND SURROUNDING STATES AND TRANSPORT HUNDREDS OF PEDIATRIC PATIENTS TO ETCH.ETCH MEETS A WIDE RANGE OF PEDIATRIC SURGICAL NEEDS, FROM COMMON OUTPATIENT PROCEDURES SUCH AS TONSILLECTOMIES TO MORE COMPLICATED PROCEDURES, SUCH AS RECONSTRUCTIVE SURGERY OR NEUROSURGERY. FIVE DEPARTMENTS COMPRISE ETCH'S SURGICAL SERVICES: OUTPATIENT SURGERY, SURGERY, POST-ANESTHESIA (THE OPERATING ROOMS) CARE UNIT ("WAKE UP OR RECOVERY ROOM), INPATIENT SURGERY AND ANESTHESIA. THESE DEPARTMENTS WORK TOGETHER TO MAKE SURE EACH CHILD'S SURGERY AND RECOVERY IS AS QUICK AND PAINLESS AS POSSIBLE. THE DOCTORS, NURSES, ANESTHESIOLOGISTS AND OTHER SURGICAL STAFF ARE TRAINED IN PEDIATRIC MEDICINE. AT ANY GIVEN TIME AND FOR VARIOUS REASONS, A CHILD MAY NEED TO BE ADMITTED TO ETCH AS AN INPATIENT. DOCTORS AND NURSES CONTINUOUSLY MONITOR AND TREAT INPATIENTS ACCORDING TO THEIR INDIVIDUAL NEEDS. ALONG WITH PROVIDING COMPREHENSIVE MEDICAL AND NURSING CARE, ETCH IS DEDICATED TO MAKING A CHILD'S STAY IN THE HOSPITAL AS COMFORTABLE AS POSSIBLE. EACH ROOM HAS A TV/DVD PLAYER WITH ACCESS TO MOVIE CHANNELS, AND PLAY ROOMS ARE LOCATED ON EACH FLOOR. OTHER SERVICES SUCH AS CHILD LIFE, NUTRITION, PASTORAL CARE AND SOCIAL WORK PROVIDE FOR THE PHYSICAL AND EMOTIONAL NEEDS OF THE CHILD. THE RESPIRATORY CARE DEPARTMENT AT ETCH IS STAFFED WITH LICENSED AND ACCREDITED RESPIRATORY THERAPISTS WHOSE ROLES INCLUDE TREATING PATIENTS WITH LUNG AND/OR HEART DISEASES SUCH AS ASTHMA, PNEUMONIA, PREMATURE LUNGS AND CYSTIC FIBROSIS. TREATMENTS PROVIDED BY RESPIRATORY THERAPISTS INCLUDE AEROSOL MEDICATIONS, DELIVERY OF OXYGEN AND OTHER MEDICAL GASES, VENTILATOR MANAGEMENT AND MANY OTHER PROCEDURES. RESPIRATORY THERAPISTS HELP PATIENTS THROUGHOUT THE HOSPITAL, FROM THE EMERGENCY DEPARTMENT TO THE NICU. THEY ARE ALSO MEMBERS OF THE PEDIATRIC TRANSPORT TEAM THAT HELPS BRING SICK AND INJURED CHILDREN TO THE HOSPITAL FOR SPECIALIZED CARE. EDUCATION IS ALSO A KEY ROLE OF RESPIRATORY THERAPISTS; THEY TEACH PATIENTS AND THEIR FAMILIES HOW TO CARE FOR CERTAIN CONDITIONS AT HOME. THE PULMONARY FUNCTION LAB, A VITAL PART OF THE RESPIRATORY CARE DEPARTMENT, PERFORMS TESTS TO DIAGNOSE LUNG AND HEART DISEASES. THE DEPARTMENT IS STAFFED BY SPECIALLY TRAINED RESPIRATORY THERAPISTS. SERVICES PROVIDED INCLUDE SPIROMETRY TESTING, METABOLIC STUDIES, CARDIAC STRESS TESTING, LUNG VOLUMES AND THE CYSTIC FIBROSIS CLINIC. ECHOCARDIOGRAMS ARE PERFORMED IN THE ECHO LAB. PATIENTS IN A VARIETY OF HOSPITAL DEPARTMENTS MAY BENEFIT FROM SEDATION DURING SOME PAINFUL TESTS AND PROCEDURES. IN ADDITION, YOUNG CHILDREN MAY NEED SEDATION TO REMAIN STILL DURING LONG TESTS, SUCH AS A MAGNETIC RESONANCE IMAGING (MRI). TO MEET THESE NEEDS, ETCH OFFERS PEDIATRIC ANALGESIA AND SEDATION SPECIALISTS (PASS). WHILE THE HOSPITAL CANNOT ELIMINATE PAIN FOR SOME CHILDREN, IT IS OUR GOAL TO KEEP PAINFUL OR UNCOMFORTABLE SITUATIONS TO A MINIMUM. PASS IS A DEDICATED SERVICE THAT UTILIZES THE MOST CURRENT SEDATION TECHNIQUES TO HELP CHILDREN UNDERGOING LENGTHY OR PAINFUL PROCEDURES AT ETCH. A MULTISPECIALTY TEAM SEES EACH CHILD, INCLUDING A PEDIATRIC SEDATION PHYSICIAN AND PEDIATRIC NURSES WHO ARE SPECIFICALLY PREPARED TO WORK WITH CHILDREN'S SEDATION. DIAGNOSTIC SERVICES:THE CLINICAL LAB IS RESPONSIBLE FOR ALL DIAGNOSTIC TESTING, WHICH INCLUDES THE FOLLOWING AREAS: HEMATOLOGY, CHEMISTRY, MICROBIOLOGY, IMMUNOLOGY, SEROLOGY AND BLOOD BANK.NEUROLOGY LAB - THE NEUROLOGY LAB OFFERS A VARIETY OF DIAGNOSTIC TESTS FOR PATIENTS DEALING WITH SEIZURES, HEARING PROBLEMS, SLEEP DISORDERS AND OTHER CONDITIONS INVOLVING THE BRAIN. THE MOST COMMON TESTS OFFERED IN THE NEUROLOGY LABORATORY ARE THE ELECTROENCEPHALOGRAM (EEG) FOR CHILDREN HAVING SEIZURES AND OTHER NEUROLOGICAL PROBLEMS AND THE BRAINSTEM AUDITORY EVOKED RESPONSE (BAER) HEARING TEST, OFFERED MOST OFTEN TO INFANTS WHO FAIL NEWBORN HEARING SCREENINGS AND TODDLERS WHO ARE SPEECH DELAYED. CHILDREN'S SLEEP MEDICINE CENTER - THE CHILDREN'S SLEEP MEDICINE CENTER OFFERS SLEEP STUDY TESTING FOR CHILDREN WHO ARE HAVING PROBLEMS WITH SLEEP. THE SLEEP STUDIES TAKE PLACE OVERNIGHT, DURING THE CHILD'S REGULAR SLEEP CYCLE, TO FIND THE CAUSE OF SUCH PROBLEMS AS SLEEP TERRORS AND SLEEPWALKING. ETCH IS ACCREDITED AS THE ONLY SLEEP MEDICINE CENTER DEDICATED TO PEDIATRICS IN EAST TENNESSEE.THE RADIOLOGY DEPARTMENT SERVES AS AN "IMAGING" CENTER FOR CHILDREN. THESE IMAGES INCLUDE X-RAY, ULTRASOUND, CT SCAN, NUCLEAR MEDICINE, MRI, AND FLUOROSCOPY.OUTPATIENT SERVICES:CHILDREN'S HOSPITAL HOME HEALTH CARE, WHICH IS A HOSPITAL-BASED HOME HEALTH AGENCY, SUPPORTS THE PHILOSOPHY, MISSION AND POLICIES OF ETCH AND IS DEDICATED TO MEETING THE NEEDS OF CHILDREN. HOME HEALTH PROVIDES FOLLOW-UP SUPPORTIVE CARE TO PATIENTS NEWBORN TO 21 YEARS OF AGE WHO DO NOT REQUIRE HOSPITALIZATION OR CONSTANT SKILLED SUPERVISION. HOME HEALTH IS LICENSED TO PROVIDE SERVICES IN 16 EAST TENNESSEE COUNTIES. ALL PATIENTS ARE ACCEPTED ON THE BASIS OF PHYSICIAN REFERRAL, THE ABILITY OF HOME HEALTH TO MEET THE PATIENT'S SPECIFIC NEEDS, AND WHEN THE PHYSICIAN, CHILD'S FAMILY AND THE HOME HEALTH STAFF AGREE THAT IN-HOME CARE WOULD BE AN APPROPRIATE AND EFFECTIVE MEANS OF TREATMENT. AVAILABLE SERVICES INCLUDE REGISTERED NURSING, RESPIRATORY THERAPY, HOME INFUSION, NUTRITIONAL SUPPORT, HOME MEDICAL EQUIPMENT, SUPPLIES, PHYSICAL THERAPY, SPEECH THERAPY AND OCCUPATIONAL THERAPY. 166913392 1 1 0 0 0 0 0 0 0 1 1 0 1 1 1 1 0 1 0 0 0 0 0 0 1 1 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 1 285 5 1 2124 1 1 1 0 0 0 0 1 1 0 0 0 0 X 18 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 TN X CARYN HAWTHORNE 8655418154 PO BOX 15010 KNOXVILLE TN 379015010 X ANDREA ANNE WHITE BOARD MEMBER 2.00 X 0 0 0 BARBARA SUMMERS MD BOARD MEMBER 2.00 X 0 0 0 BRIAN T FERGUSON BOARD MEMBER 2.00 X 0 0 0 CAMERON J SEARS MD BOARD MEMBER 2.00 X 0 0 0 CATHY ACKERMANN BOARD MEMBER 2.00 X 0 0 0 DANIEL K CARTER BOARD MEMBER 2.00 X 0 0 0 DAVID A NICKELS MD BOARD MEMBER/PED. 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AND SUBSIDIARIES AUDITED CONSOLIDATED FINANCIAL STATEMENTS: THE HOSPITAL IS CLASSIFIED AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS RELATED TO THE 501(C)(3) ORGANIZATION. EAST TENNESSEE CHILDREN'S HOSPITAL PRIMARY CARE CENTER, INC. AND COLLECTOR'S INC. OF KNOXVILLE ARE TAXABLE ENTITIES. THE HOSPITAL HAS NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2018 OR 2017. AT JUNE 30, 2018, TAX RETURNS FOR FISCAL YEARS 2015 THROUGH 2017 ARE SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE. FANTASY OF TREES 976586 306311 670275 75283 9936 568980 GOLF TOURNAMENT 123778 116663 7115 9095 7686 2 253761 117360 136401 31476 117691 1354125 540334 813791 115854 9936 694357 820147 -6356 33653 6500 1778 1 1.00000 33653 6500 1778 8278 25375 TN 1 0 1 0 1.00000 LESA HAWKINS PO BOX 15010 KNOXVILLE TN 379015010 0 PATRICIA SCOTT PATRICIA SCOTT IS THE COMMUNITY DEVELOPMENT OFFICER AND THE COORDINATOR FOR THE FANTASY OF TREES. THE DEVELOPMENT DEPARTMENT IS RESPONSIBLE FOR THE FANTASY OF TREES EVENT. THE RAFFLE TREE IS THE GAMING EVENT HELD WITHIN THE FANTASY OF TREES. THE DEVELOPMENT DEPARTMENT FOSTERS THE RELATIONSHIP WITH RAFFLE SPONSORS AND DECIDES WHERE/ HOW THE AREA IS DESIGNED ON THE FLOOR. THE DEVELOPMENT DEPARTMENT RECRUITS VOLUNTEERS TO SELL RAFFLE TICKETS, LOCK THE DRUM, AND ARRANGE THE TICKET DRAWING AND DELIVERY. X 1 1 1 1 X 1 X 1 1 1 0 1 1 870997 870997 0.00450 105224472 83051849 22172623 0.11500 106095469 83051849 23043620 0.11950 172489 1016277 179537 836740 0.00430 4033 1867383 100924 1766459 0.00920 112881 324358 4904 319454 0.00170 289403 3208018 285365 2922653 0.01520 289403 109303487 83337214 25966273 0.13470 89 11714 2220 9494 0.00000 37056 0 37056 0.00020 6085 192326 36673 155653 0.00080 8 303927 0 303927 0.00160 6182 545023 38893 506130 0.00260 1 2913179 10607 27629 -17022 X 1 1 1 CHILDREN'S WEST SURGERY CENTER LLC MEDICAL SURGERY CENTER 0.50000 0.50000 1 1 EAST TENNESSEE CHILDREN'S HOSPITAL PO BOX 15010 KNOXVILLE TN 379015010 HTTP://WWW.ETCH.COM/ X X EAST TENNESSEE CHILDREN'S HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X HTTPS://WWW.ETCH.COM X 1 15 1 HTTPS://WWW.ETCH.COM/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX 0 1 X 200.000000000000 200.000000000000 0 1 X X X 1 X HTTP://WWW.ETCH.COM/ X HTTP://WWW.ETCH.COM/ X HTTP://WWW.ETCH.COM/ X X 1 0 1 X 0 0 EAST TENNESSEE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 5: ETCH TOOK INTO ACCOUNT INPUT FROM KEY INFORMANTS, COMMUNITY MEMBERS, AND NOT-FOR-PROFIT ORGANIZATIONS IN ITS CHNA AS WELL AS SECONDARY DATA FROM EXISTING PUBLIC DOCUMENTS AND OTHER PUBLISHED MATERIAL. THE PURPOSE OF THE KEY INFORMANT INTERVIEWS IS TO COLLECT INFORMATION FROM A WIDE RANGE OF PEOPLE, INCLUDING COMMUNITY LEADERS, PROFESSIONALS, AND RESIDENTS WHO HAVE FIRST-HAND KNOWLEDGE ABOUT THE HEALTH OF THE COMMUNITY AND POPULATION SERVED, WHICH IN THIS CASE, IS CHILDREN AND YOUNG ADOLESCENTS. ETCH SOLICITED THE HELP OF THE KNOX COUNTY HEALTH DEPARTMENT ("KCHD") IN IDENTIFYING AND INTERVIEWING KEY INFORMANTS. KATHLEEN C. BROWN, PHD, MPH, CHES, KCHD DIRECTOR OF COMMUNITY ASSESSMENT AND HEALTH PROMOTION, COORDINATED AND SUPERVISED THE KEY INFORMANT INTERVIEWS, WHICH WERE CONDUCTED BY FRAN PISANO, MD, PEDIATRICIAN AND STUDENT IN THE MASTERS OF PUBLIC HEALTH PROGRAM AT THE UNIVERSITY OF TENNESSEE. DR. PISANO CONDUCTED 14 FACE-TO-FACE INTERVIEWS, ONE OF WHICH WAS CONDUCTED WITH A SMALL GROUP OF THREE INDIVIDUALS. A TOTAL OF 16 INDIVIDUALS WERE INTERVIEWED. THE INDIVIDUALS INTERVIEWED INCLUDED REPRESENTATIVES FROM THE KNOX COUNTY SCHOOLS, THE KNOX COUNTY JUVENILE COURT SYSTEM, VARIOUS LOW-INCOME ORGANIZATIONS, ETCH EMERGENCY PHYSICIANS, AND CENTRO HISPANO DE EAST TENNESSEE. IN ORDER TO SUPPLEMENT OTHER SOURCES OF DATA AVAILABLE TO ASSESS THE HEALTH NEEDS OF THE COMMUNITY, ETCH CONDUCTED A COMMUNITY OPINION SURVEY THROUGHOUT EAST TENNESSEE. A WRITTEN SURVEY OF THE GENERAL PUBLIC WAS MAILED TO 500 HOUSEHOLDS WHO PRESENTED THEIR CHILDREN IN ETCH'S EMERGENCY ROOM OCTOBER THROUGH NOVEMBER 2012. SIXTY PERCENT OF THE 500 PATIENTS WHOSE HOUSEHOLDS WERE TARGETED FOR MAILING WERE INSURED THROUGH TENNCARE. TENNCARE IS THE STATE OF TENNESSEE'S MEDICAID PROGRAM. ETCH TARGETED THESE HOUSEHOLDS SPECIFICALLY IN AN EFFORT TO SOLICIT THE OPINION OF LOWER-INCOME HOUSEHOLDS. FOCUS GROUP MEETINGS CONSISTING OF PEDIATRICIANS AND PEDIATRIC SUBSPECIALISTS SERVING IN AND AROUND KNOX COUNTY WERE CONDUCTED ON ETCH'S BEHALF BY AN OUTSIDE THIRD-PARTY. THE PURPOSE OF THESE MEETINGS WAS TO CREATE AN INTERACTIVE SETTING WHERE PARTICIPANTS COULD CONVERSE FREELY WITH OTHER GROUP MEMBERS ABOUT THEIR PERCEPTIONS AND EDUCATED OPINIONS REGARDING THE HEALTH OF THE CHILDREN WITHIN THE COMMUNITY.ADDITIONALLY, ETCH REQUESTED INPUT FROM THE FOLLOWING GROUPS REGARDING THE NEEDS THEY PERCEIVE TO BE THE HEALTH CARE NEEDS OF THE CHILDREN SERVED BY ETCH:- ETCH NURSING MAGNET LEADERSHIP GROUP. - ETCH BOARD OF DIRECTORS. - ETCH FAMILY ADVISORY COUNCIL. EAST TENNESSEE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 11: HEALTH NEEDS IDENTIFIED DURING THE CHNA THAT WERE NOT IDENTIFIED AS PRIORITIES BY ETCH INCLUDE: CHILD IMMUNIZATION, TEEN PREGNANCY, TEEN SUBSTANCE ABUSE, AND HANDICAP ACCESS. WHILE ETCH WILL FOCUS THE MAJORITY OF ITS EFFORT ON THE IDENTIFIED PRIORITIES, ALL OF THE NEEDS IDENTIFIED IN THE CHNA WILL BE REVIEWED FOR FUTURE COLLABORATION AND WORK. THESE NON-PRIORITIES, WHILE STILL IMPORTANT TO THE HEALTH OF THE CHILDREN IN THE COMMUNITY, WILL BE MET THROUGH OTHER HEALTH CARE ORGANIZATIONS WITH ASSISTANCE FROM ETCH AS NEEDED. THE COMMUNITY NEEDS NOT ADDRESSED BY ETCH WILL CONTINUE TO BE ADDRESSED BY GOVERNMENTAL AGENCIES AND EXISTING COMMUNITY-BASED ORGANIZATIONS. PART I, LINE 7: A COST-TO-CHARGE RATIO, DERIVED FROM THE SCHEDULE H APPLICABLE WORKSHEETS, INCLUDING WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES, WAS USED TO DETERMINE CHARITY CARE. ACTUAL EXPENSE DATA IS ACCUMULATED WITHIN THE ETCH GENERAL LEDGER WHICH ADDRESSES ALL PATIENT SEGMENTS INCLUDING INPATIENT, OUTPATIENT, EMERGENCY ROOM, COMMERCIAL INSURANCE, GOVERNMENT INSURANCE, UNINSURED AND SELF-PAY. THE TOTAL OPERATING EXPENSE WAS DIVIDED BY PATIENT REVENUES TO CALCULATE AN OVERALL RATIO THAT WAS THEN APPLIED TO INDIGENT AND CHARITY CARE CHARGES TO ARRIVE AT COST. THE STATE OF TENNESSEE'S COVERKIDS PROGRAM PROVIDES COVERAGE FOR THE VAST MAJORITY OF CHILDREN WHO REQUIRE MEDICAL CARE BUT ARE UNINSURED. ETCH REPRESENTATIVES WORK EXTENSIVELY WITH PATIENTS' FAMILIES TO HELP THEM UNDERSTAND AVAILABILITY OF STATE AID AND TO ASSIST THEM IN BECOMING ENROLLED IN THE PROGRAM. FOR THAT REASON, THE AMOUNT OF TRUE "CHARITY CARE" RENDERED BY ETCH IS CONSIDERABLY SMALLER THAN LEVELS EXPERIENCED BY COMMUNITY HOSPITALS OR OTHER FACILITIES SERVING THE ADULT POPULATION. PART II, COMMUNITY BUILDING ACTIVITIES: ETCH PROVIDES NUMEROUS BENEFITS TO THE PUBLIC AND PROMOTES THE HEALTH OF THE COMMUNITY IN THE FOLLOWING WAYS:1. COMMUNITY SUPPORT. ETCH EMPLOYEES VOLUNTEER TIME TO THE FOLLOWING NEIGHBORHOOD SUPPORT GROUPS: RONALD MCDONALD HOUSE, HABITAT FOR HUMANITY, FRIENDS OF LITERACY, AND SHOES FOR SCHOOLS. THE TIME VOLUNTEERED TO THESE ORGANIZATIONS IS COMPENSATED BY ETCH. IN ADDITION TO EMPLOYEE TIME, ETCH PROVIDED SEMINAR SPACE FREE OF CHARGE TO SUPPORT AND TRAINING FOR EXCEPTIONAL PARENTS (STEP). STEP IS A PROGRAM PROVIDING SERVICES FOR FAMILIES OF CHILDREN WITH DISABILITIES. STEP ADDRESSES ISSUES FACED BY CHILDREN WITH DISABILITIES AT SCHOOL. STEP HELD ITS EARLY CHILDHOOD TRANSITIONS EDUCATIONAL SEMINAR IN THE ETCH CONFERENCE ROOM. STEP HELD A SECOND INDIVIDUALIZED EDUCATION PROGRAM (IEP) WORKSHOP IN THE ETCH CONFERENCE ROOM DURING WHICH AN ETCH-EMPLOYED SOCIAL WORKER PARTICIPATED.2. LEADERSHIP DEVELOPMENT AND TRAINING FOR COMMUNITY MEMBERS. ETCH EMPLOYEES FACILITATED A NUMBER OF MEETINGS FOR COMMUNITY RESIDENTS SUCH AS: STEPHEN MINISTRY PEER GROUP SUPERVISION MEETINGS, A STRATEGIC PLANNING MEETING FOR THE EAST TENNESSEE FOUNDATION BOARD OF DIRECTORS, AND A LEADERSHIP PRESENTATION FOR THE TENNESSEE BAR ASSOCIATION. ETCH COMPENSATED THEIR EMPLOYEES FOR THE TIME DEDICATED TO THESE ACTIVITIES AND FOR ANY TRAVEL EXPENSES INCURRED.3. COALITION BUILDING. ETCH PARTICIPATED IN THE FOLLOWING COMMUNITY COALITIONS TO ADDRESS HEALTH AND SAFETY ISSUES SPECIFIC TO CHILDREN: 1. TOGETHER! HEALTHY KNOX (T!HK). ETCH IS A PARTNER IN THIS INITIATIVE OF THE COMMUNITY HEALTH COUNCIL SERVING THE CITY OF KNOXVILLE, KNOX COUNTY, AND THE TOWN OF FARRAGUT. THE MISSION OF TOGETHER! HEALTHY KNOX IS "A COMMUNITY APPROACH TO BETTER HEALTH." T!HK HOPES TO ENCOURAGE A BROAD DEFINITION OF HEALTH IN THE COMMUNITY: PHYSICIAN, MENTAL, SPIRITUAL AND SOCIAL. 2. KNOXVILLE AREA COALITION ON CHILDHOOD OBESITY. THIS COALITION, FOR WHICH ETCH IS THE LEAD ORGANIZATION, WORKS TO IMPROVE THE HEALTH OF CHILDREN THROUGH A COMMUNITY-WIDE PARTNERSHIP. THE GOAL OF THE COALITION IS TO REVERSE THE INCIDENCE OF CHILDHOOD OBESITY AND BECOME ONE OF AMERICA'S FITTEST CITIES FOR CHILDREN. THE COALITION INCLUDES MORE THAN 35 COMMUNITY AGENCIES AND ORGANIZATIONS AND IS REPRESENTED BY OVER 90 INDIVIDUALS. 3. TENNESSEE INITIATIVE FOR PERINATAL QUALITY CARE (TIPQC). AN ETCH EMPLOYEE SERVES AS A PROJECT MEMBER FOR THE TIPQC HUDDLE 21 INITIATIVE. ETCH COMPENSATES THIS EMPLOYEE FOR THE TIME DEDICATED ON A MONTHLY BASIS TO THIS ACTIVITY. TIPQC SEEKS TO IMPROVE HEALTH OUTCOMES FOR MOTHERS AND INFANTS IN TENNESSEE BY ENGAGING KEY STAKEHOLDERS IN A PERINATAL QUALITY COLLABORATIVE THAT WILL IDENTIFY OPPORTUNITIES TO OPTIMIZE BIRTH OUTCOMES AND IMPLEMENT DATA-DRIVEN PROVIDER- AND COMMUNITY-BASED PERFORMANCE IMPROVEMENT INITIATIVES.4. COMMUNITY HEALTH IMPROVEMENT ADVOCACY. ETCH LENDS ITS EMPLOYEES TO SUPPORT POLICIES AND PROGRAMS TO SAFEGUARD CHILDREN AND IMPROVE CHILDREN'S HEALTH AND THEIR ACCESS TO HEALTH CARE SERVICES. ETCH EMPLOYEES PARTICIPATE IN THE FOLLOWING PROGRAMS: KNOX COUNTY CHILD FATALITY REVIEW AND HUMAN RIGHTS COMMITTEE BOARD.5. WORKFORCE DEVELOPMENT. ETCH RECRUITS PHYSICIAN SPECIALTIES AND OTHER HEALTH PROFESSIONALS DEDICATED TO SERVING THE ADOLESCENT POPULATION TO MEDICAL SHORTAGE AREAS OR OTHER AREAS DESIGNATED AS UNDERSERVED. PART III, LINE 4: A COST-TO-CHARGE RATIO WAS ALSO USED TO DETERMINE BAD DEBT COST. THE TOTAL OPERATING EXPENSE WAS DIVIDED BY PATIENT REVENUES TO CALCULATE AN OVERALL RATIO THAT WAS THEN APPLIED TO THE BAD DEBT EXPENSE TO ARRIVE AT COST.ETCH'S FINANCIAL STATEMENTS READ AS FOLLOWS: "PATIENT ACCOUNTS RECEIVABLE ARE REPORTED NET OF BOTH AN ESTIMATED ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS. THE CONTRACTUAL ALLOWANCE REPRESENTS THE DIFFERENCE BETWEEN ESTABLISHED BILLING RATES AND ESTIMATED REIMBURSEMENT FROM MEDICAID, TENNCARE AND OTHER THIRD-PARTY PAYMENT PROGRAMS. CURRENT OPERATIONS INCLUDE A PROVISION FOR BAD DEBTS ESTIMATED BASED UPON THE AGE OF THE PATIENT ACCOUNTS RECEIVABLE, HISTORICAL WRITEOFFS AND RECOVERIES AND ANY UNUSUAL CIRCUMSTANCES (SUCH AS LOCAL, REGIONAL OR NATIONAL ECONOMIC CONDITIONS) WHICH AFFECT THE COLLECTIBILITY OF RECEIVABLES, INCLUDING MANAGEMENT'S ASSUMPTIONS ABOUT CONDITIONS IT EXPECTS TO EXIST AND COURSES OF ACTION IT EXPECTS TO TAKE. ADDITIONS TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS RESULT FROM THE PROVISION FOR BAD DEBTS. PATIENT ACCOUNTS WRITTEN OFF AS UNCOLLECTIBLE ARE DEDUCTED FROM THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. PATIENT SERVICE REVENUE IS RECORDED PRIOR TO ASSESSING THE PATIENT'S ABILITY TO PAY, AND AS SUCH, THE PROVISION FOR BAD DEBTS IS RECORDED AS A DEDUCTION FROM PATIENT SERVICE REVENUE, NET OF CONTRACTUAL ALLOWANCES IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS.THE HOSPITAL'S POLICY DOES NOT REQUIRE COLLATERAL OR OTHER SECURITY FOR PATIENT ACCOUNTS RECEIVABLE. THE HOSPITAL ROUTINELY ACCEPTS ASSIGNMENT OF, OR IS OTHERWISE ENTITLED TO RECEIVE, PATIENT BENEFITS PAYABLE UNDER HEALTH INSURANCE PROGRAMS, PLANS OR POLICIES." PART III, LINE 8: A COST-TO-CHARGE RATIO WAS USED TO DETERMINE THE AMOUNT OF MEDICARE ALLOWABLE COSTS. THE TOTAL OPERATING EXPENSE WAS DIVIDED BY PATIENT REVENUES TO CALCULATE AN OVERALL RATIO THAT WAS THEN APPLIED TO MEDICARE CHARGES TO ARRIVE AT COST.THE SHORTFALL OF $XXXXXX AS REPORTED IN PART III, LINE 7, SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE, ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR CHARITY CARE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF GOVERNMENT ARE RELIEVED WITH RESPECT TO THESE INDIVIDUALS. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. ALSO, THERE IS A SIGNIFICANT POSSIBILITY THAT CONTINUED REDUCTION IN REIMBURSEMENT MAY ACTUALLY CREATE DIFFICULTIES IN ACCESS FOR THESE INDIVIDUALS, AND THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS. PART III, LINE 9B: UNDER ETCH'S POLICIES AND PROCEDURES, ETCH UNDERTAKES MEASURES TO COMMUNICATE WITH THE FAMILIES OF PATIENTS WITH SELF-PAY BALANCES. IN MANY CASES, ETCH AND FAMILIES WORK TOGETHER TO OBTAIN COVERAGE THROUGH THE STATE OF TENNESSEE'S COVERKIDS PROGRAM. IN CASES WHERE COVERKIDS COVERAGE IS NOT AVAILABLE, ETCH SEEKS TO OBTAIN INFORMATION NECESSARY TO DETERMINE THE PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER ETCH'S CHARITY CARE PROGRAM. ONCE A PATIENT'S ELIGIBILITY FOR FREE OR DISCOUNTED CARE HAS BEEN DETERMINED, THE BALANCE ON THE PATIENT'S ACCOUNT IS ADJUSTED ACCORDINGLY. IN ADDITION, ETCH PERSONNEL WORK CLOSELY WITH FAMILIES TO DETERMINE THEIR ABILITY TO PAY THE ADJUSTED BALANCES; SUCH EFFORTS OFTEN RESULT IN PAYMENT PLANS INTENDED TO PERMIT THE GRADUAL PAYMENT OF AMOUNTS DUE WITHOUT IMPOSING UNDUE FINANCIAL HARDSHIP ON FAMILIES ALREADY DEALING WITH THE CHALLENGES OF CHILDREN'S HEALTH ISSUES. UNFORTUNATELY, THERE REMAIN CIRCUMSTANCES WHERE PATIENTS CANNOT BE DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE DUE TO THE INACCESSIBILITY OF THE FAMILY OR THE FAMILY'S INABILITY OR REFUSAL TO PROVIDE THE REQUIRED INFORMATION. IN SUCH CASES, ETCH FOLLOWS AN ESTABLISHED MULTI-STEP PROCESS CONSISTING OF MAILED NOTICES AND PHONE CALLS IN AN EFFORT TO REACH OUT TO THE FAMILY AND PROVIDE THEM WITH INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE PROGRAM. ETCH'S COLLECTION PRACTICES APPLY TO ALL PATIENTS, CHARITY CARE AND NON-CHARITY CARE PATIENTS. ACCOUNTS ARE SENT TO COLLECTIONS (ETCH CONTRACTS WITH AN ORGANIZATION WITH SUBSTANTIAL EXPERIENCE IN COLLECTION OF PATIENT ACCOUNTS) ONLY AFTER ALL ESTABLISHED STEPS HAVE BEEN UNDERTAKEN, WITHOUT SUCCESS. PART VI, LINE 2: IN COMPLIANCE WITH 501(R)(C) OF THE INTERNAL REVENUE CODE, ETCH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA"). USING THE RESULTS OF THE CHNA, ETCH SEEKS TO IMPROVE THE HEALTH OF THE CHILDREN IN THE COMMUNITY BY EMPOWERING PARENTS AND CAREGIVERS WITH INFORMATION, AWARENESS OF POTENTIAL HEALTH ISSUES, AND KNOWLEDGE OF RESOURCES AVAILABLE TO TREAT THE ISSUES. IN MAY 2016, THE ETCH BOARD OF DIRECTORS APPROVED A PLAN OF ACTION TO ADDRESS THE HEALTH NEEDS IDENTIFIED AS PRIORITIES DURING THE CHNA, ALONG WITH A PROJECTED BUDGET TO SUPPORT ETCH EFFORTS.ETCH DID NOT ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY SERVED IN ADDITION TO THE CHNA REPORTED IN PART V, SECTION B AND SUMMARIZED ABOVE. PART VI, LINE 3: ETCH RECOGNIZES THAT UNEXPECTED MEDICAL PROBLEMS CAN CREATE UNEXPECTED FINANCIAL PROBLEMS. ETCH IS AVAILABLE TO ASSIST PATIENTS' FAMILIES IN FINDING RESOURCES THAT HELP TO COVER MEDICAL EXPENSES. AS INDICATED ABOVE, ETCH WORKS CLOSELY WITH PATIENTS' FAMILIES TO HELP THEM UNDERSTAND AND ENROLL IN MEDICAL ASSISTANCE PROGRAMS AVAILABLE THROUGH THE STATE OF TENNESSEE AND, WHERE APPROPRIATE, FEDERAL PROGRAMS. WHERE SUCH PROGRAMS ARE NOT AVAILABLE, HOWEVER, PATIENTS MAY BE ELIGIBLE FOR FREE OR DISCOUNTED CARE UNDER ETCH'S ESTABLISHED POLICIES AND PROCEDURES. THE AVAILABILITY OF FINANCIAL ASSISTANCE IS PUBLICIZED THROUGHOUT THE ETCH FACILITY AND THROUGH VARIOUS MEASURES, INCLUDING INFORMATION ON ETCH'S WEBSITE AND WRITTEN BROCHURES OR OTHER MATERIALS PROVIDED TO PATIENT'S FAMILIES. INFORMATION (IN BOTH ENGLISH AND SPANISH) IS MADE AVAILABLE AT ALL POINTS OF REGISTRATION (INTAKE AND DISCHARGE) AS WELL AS ON THE ETCH WEBSITE. THE MOST SIGNIFICANT EDUCATION, HOWEVER, OCCURS IN DIRECT DIALOGUE BETWEEN PATIENT FAMILIES AND ETCH'S TRAINED PATIENT ACCOUNT REPRESENTATIVES. ETCH MAKES EXTENSIVE EFFORTS TO PERMIT FACE-TO-FACE DIALOGUE, AS WELL AS COMMUNICATION VIA TELEPHONE AND OTHER MEANS, AS NECESSARY TO ENSURE THAT FAMILIES ARE PROVIDED WITH SUFFICIENT INFORMATION REGARDING FREE OR DISCOUNTED CARE, AS WELL AS THE BILLING AND COLLECTION PROCESS. ALL STAFF WITH PATIENT CONTACT ARE KNOWLEDGEABLE ABOUT THE CHARITY CARE POLICY (ADMITTING AND BILLING CLERKS, NURSING AND MEDICAL STAFF, SOCIAL WORKERS, ETC.). PART VI, LINE 4: ALTHOUGH ETCH SERVES THE ENTIRE EAST TENNESSEE REGION AS A COMPREHENSIVE REGIONAL PEDIATRIC CENTER, NEARLY HALF OF ETCH'S TOTAL PATIENT VISITS ARE FROM KNOX COUNTY RESIDENTS. CHILDREN RESIDING IN NEIGHBORING BLOUNT AND SEVIER COUNTIES GENERATE THE NEXT HIGHEST PATIENT VISITS. HIGHLIGHTS FROM THE COUNTY STATISTICS PRESENTED IN THE 2015 CHNA INCLUDE THE FOLLOWING: IN GENERAL, THE STATE OF TENNESSEE IS UNHEALTHY COMPARED TO THE UNITED STATES AS A WHOLE; WHEN COMPARED TO TENNESSEE AS A WHOLE, BLOUNT, SEVIER, AND KNOX COUNTY, ESPECIALLY, FARE BETTER HEALTH-WISE; LOW BIRTHRATE IS A CONCERN IN EACH OF THE COUNTIES PRESENTED; PHYSICAL INACTIVITY IS A CONCERN, ESPECIALLY IN KNOX AND BLOUNT COUNTIES; AND SEVIER COUNTY HAS A HIGH PERCENTAGE OF CHILDREN IN POVERTY. PART VI, LINE 5: ETCH'S PHILOSOPHY IS THAT, BECAUSE CHILDREN ARE SPECIAL, THEY DESERVE THE BEST POSSIBLE HEALTH CARE GIVEN IN A POSITIVE, CHILD/FAMILY CENTERED ATMOSPHERE OF FRIENDLINESS AND COOPERATION REGARDLESS OF RACE, RELIGION, OR ABILITY TO PAY. ETCH IS COMMITTED TO CARING FOR VULNERABLE POPULATIONS SUCH AS CHILDREN WITH SPECIAL MEDICAL NEEDS, ADVOCATING FOR THE HEALTH AND SAFETY OF CHILDREN AS PART OF THE COMMON GOOD AND EFFECTIVELY STEWARDING COMMUNITY RESOURCES. ETCH OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO THE ABILITY TO PAY. ETCH USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND, OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION AND RESEARCH PROGRAMS. ETCH'S BOARD OF DIRECTORS CONSISTS PRIMARILY OF INDIVIDUALS REPRESENTING THE COMMUNITY. ETCH MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTH CARE PROFESSIONALS. IN THESE AND OTHER RESPECTS, ETCH IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND, THEREFORE, FULFILLS CHARITABLE PURPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3).ADDITIONALLY, PLEASE REFER TO THE STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS AS PROVIDED IN SCHEDULE O FOR FURTHER DOCUMENTATION REGARDING ETCH'S COMMITMENT WITHIN ITS COMMUNITY. PART VI, LINE 6: ETCH IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES TN 1 TENNESSEE EMERGENCY MEDICAL SERVICES FOR CHILDREN 2007 TERRACE PLACE NASHVILLE TN 37203 202802786 501(C)(3) 10000 GENERAL SUPPORT THE RONALD MCDONALD HOUSE 1705 WEST CLINCH AVENUE KNOXVILLE TN 37916 581510276 501(C)(3) 5000 GOLF TOURNAMENT SPONSORSHIP UNIVERSITY OF TENNESSEE COLLEGE OF NURSING 1200 VOLUNTEER BLVD KNOXVILLE TN 37996 626001636 115 6000 GENERAL SUPPORT VARIETY OF EASTERN TENNESSEE 7132 REGAL LANE KNOXVILLE TN 37918 331025696 501(C)(3) 10000 GENERAL SUPPORT KNOXVILLE AREA CHAMBER PARTNERSHIP 17 MARKET SQUARE 201 KNOXVILLE TN 37902 620262640 501(C)(6) 5560 GENERAL SUPPORT AMERICAN HEART ASSOCIATION PO BOX 1590 HAGERSTOWN MD 21741 135613797 501(C)(3) 5000 GENERAL SUPPORT 5 1 PART I, LINE 2: THE ORGANIZATION HAS GUIDELINES IN PLACE THAT ARE TO BE USED IN REVIEWING THE ELIGIBILITY OF GRANTEES. ALL GRANTS REQUIRE WRITTEN DOCUMENTATION AND APPROPRIATE LEVELS OF APPROVAL. 1 X X X X 0 1 0 0 0 0 0 0 0 KEITH D GOODWIN BOARD MEMBER/PRES & CEO 671053 0 0 0 629964 0 94434 0 16265 0 1411716 0 620873 0 CARYN HAWTHORNE VP/CHIEF FINANCIAL OFFICER 328641 0 0 0 4759 0 36037 0 23278 0 392715 0 0 0 CARLTON LONG VP DEVELOPMENT 204097 0 0 0 102652 0 29268 0 16265 0 352282 0 100542 0 CATHY SHUCK VP OF LEGAL SERVICES 198209 0 0 0 1414 0 27103 0 550 0 227276 0 0 0 HELLA EWING VP OF PATIENT SERVICES/CNO 258609 0 0 0 1290 0 32725 0 16265 0 308889 0 0 0 STEVEN GODBOLD VP FOR OPERATIONS 283252 0 0 0 606 0 63153 0 23278 0 370289 0 0 0 SUE WILBURN VP HUMAN RESOURCES 237061 0 0 0 13839 0 33125 0 23278 0 307303 0 11917 0 CARLOS A ANGEL MD PEDIATRIC SURGEON 570620 0 139648 0 3564 0 5529 0 7934 0 727295 0 0 0 DAVID RIDEN MD PEDIATRIC UROLOGIST 467179 0 393797 0 1450 0 5539 0 23278 0 891243 0 0 0 ERIC JENSEN MD PEDIATRIC SURGEON 563828 0 15000 0 810 0 4094 0 23278 0 607010 0 0 0 SUMEET SHARMA MD PEDIATRIC CARDIOLOGIST 331053 0 259944 0 540 0 20863 0 20465 0 632865 0 0 0 WILLIAM GLAZE VAUGHAN MD PEDIATRIC SURGEON 566477 0 54357 0 2848 0 5529 0 20465 0 649676 0 0 0 BRUCE ANDERSON FORMER KEY EMPLOYEE 140015 0 0 0 0 0 1481 0 0 0 141496 0 0 0 PART I, LINE 4B SUPPLEMENTAL NONQUALIFIED EXECUTIVE RETIREMENT PLAN: THE SUPPLEMENTAL EXECUTIVE 457(F) RETIREMENT PLAN IS INTENDED TO SUPPORT RETENTION OF KEY EXECUTIVES AND TO OFFER A COMPETITIVE TOTAL RETIREMENT BENEFIT. THESE BENEFITS ARE PART OF A RETIREMENT PROGRAM THAT PROVIDES RETIREMENT INCOME FOR THE EXECUTIVE'S TOTAL YEARS OF SERVICE WITH THE ORGANIZATION PURSUANT TO A WRITTEN PLAN AGREEMENT AS APPROVED BY INDEPENDENT MEMBERS OF THE BOARD OF DIRECTORS. THESE BENEFITS ARE AT RISK AND WILL NOT BE PAID UNLESS THE EXECUTIVE PROVIDES SUBSTANTIAL FUTURE SERVICES TO THE ORGANIZATION IN ACCORDANCE WITH A VESTING SCHEDULE. AN ESTIMATE OF THE ANNUAL INCREASE IN ACTUARIAL VALUE IS REPORTED AS DEFERRED COMPENSATION IN PART VII AND IN SCHEDULE J, COLUMN (C) FOR THE APPLICABLE EXECUTIVES. EMPLOYER CONTRIBUTION TO 457(F) EXECUTIVE RETIREMENT BENEFIT PLAN: KEITH GOODWIN $88,786 STEVEN GODBOLD $55,900 CATHY SHUCK $20,079 CARYN HAWTHORNE $31,605 HELLA EWING $25,679 SUE WILBURN $24,694 CARLTON LONG $20,101 SUMEET SHARMA $16,709 EMPLOYER PAYMENT FROM 457(F) PLAN (INCLUDING VESTED EARNINGS ON PREVIOUSLY REPORTED COMPENSATION): KEITH GOODWIN $620,873 SUE WILBURN $ 11,917 CARLTON LONG $100,542 A THE HEALTH EDUCATIONAL AND HOUSING FACILITY BOARD OF KNOX COUNTY TENNESSEE 621220275 NONEAVAIL 2014-10-01 60000000 FUTURE CAPITAL PROJECT 0 0 0 B THE HEALTH EDUCATIONAL AND HOUSING FACILITY BOARD OF KNOX COUNTY TENNESSEE 621220275 NONEAVAIL 2013-08-20 37465000 REFINANCE 2003 ISSUE 0 0 0 A 60465000 206349 0 0 1 1 B 37465000 208500 1 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0.01000 0.01000 0 0 1 A 0 1 0 0 0 0 0 0 0 B 1 0 0 0 0 0 A 1 B 1 X 15 12691 MARKET VALUE X EVENT SUPPLIES 45 34549 MARKET VALUE X AUCTION ITEMS 34 11663 MARKET VALUE 0 0 1 0 FORM 990, PART III, LINE 4A, CONTINUED THE CHILDREN'S HOSPITAL REHABILITATION CENTER WAS ESTABLISHED IN 1947 BY A GROUP OF PARENTS WHOSE CHILDREN HAD CEREBRAL PALSY, AND IT HAS BEEN AN ETCH DEPARTMENT SINCE 1995. THE CENTER PROVIDES REHAB EVALUATION AND TREATMENT SERVICES TO INPATIENTS AT ETCH AND THE CENTER, AS WELL AS HOME HEALTH REHAB THROUGH CHILDREN'S HOSPITAL HOME HEALTH CARE. PATIENTS RANGE FROM THOSE WITH MILD DEVELOPMENTAL DELAYS TO MULTIPLE HANDICAPPING CONDITIONS. ALL SERVICES ARE DESIGNED TO HELP CHILDREN REACH THEIR GREATEST INDEPENDENT FUNCTION AND DEVELOPMENTAL POTENTIAL. IN ADDITION TO OUTPATIENT PHYSICAL AND OCCUPATIONAL THERAPY AND SPEECH PATHOLOGY AT THE CENTER, OUTPATIENT SERVICES ALSO INCLUDE THE CHILDREN'S CORNER MEDICAL DAY TREATMENT PROGRAM, NUTRITION, PSYCHOLOGY, SUMMER DAY CAMP, TRANSPORTATION, PARENT TRAINING AND OUTPATIENT CLINICS AT ETCH. THE CENTER ALSO PROVIDES HIGH-RISK FOLLOW-UP AND SEATING CLINICS. THE CHILDREN'S HOSPITAL REHABILITATION CENTER IS A UNITED WAY AGENCY. ETCH ALSO PROVIDES COMPREHENSIVE CONSULTATION, EVALUATION, DIAGNOSTIC SERVICES AND TREATMENT FOR PEDIATRIC PATIENTS WITH ACUTE, CHRONIC AND/OR COMPLEX CONDITIONS THROUGH THE JAMES S. BUSH OUTPATIENT CARE CENTER. SEVERAL CLINICS FOR SPECIFIC CONDITIONS ARE OFFERED INCLUDING CRANIOFACIAL, CYSTIC FIBROSIS, DERMATOLOGY, DIABETES, GYNECOLOGY, HEMATOLOGY/ONCOLOGY, HIGH RISK, INFECTIOUS DISEASES, METABOLIC DISEASES, MULTISPECIALITY, RHEUMATOLOGY, SPECIAL ATTENTION AND SPASTICITY. A CLINIC VISIT MAY INCLUDE TREATMENT AND CONSULTATION WITH PHYSICIANS, NURSES AND STAFF FROM NUTRITION, SOCIAL WORK, CHILD LIFE, REHABILITATION OR RESPIRATORY CARE. ADDITIONAL SERVICES: THE SOCIAL WORK DEPARTMENT AT ETCH HELPS PATIENTS AND THEIR FAMILIES DEAL WITH EMOTIONAL STRESS CAUSED BY ILLNESS, INJURY OR THE HOSPITALIZATION ITSELF. SOCIAL WORK SERVICES INCLUDE INFORMATION AND REFERRAL; SHORT-TERM SUPPORTIVE COUNSELING FOR PATIENTS AND PARENTS; CRISIS INTERVENTION ASSISTANCE; DISCHARGE PLANNING; FINANCIAL ASSISTANCE; INFORMATION ON SUPPORT AND ADVOCACY GROUPS; AND ASSISTANCE WITH CONCRETE NEEDS, INCLUDING RONALD MCDONALD HOUSE REFERRALS. THE DEPARTMENT ALSO COORDINATES TRANSLATION OF MUCH OF THE HOSPITAL'S PRINTED MATERIAL INTO SPANISH TO GIVE THE HISPANIC POPULATION COMMUNICATION ACCESS WHEN MEDICAL SERVICES ARE PROVIDED. SOCIAL WORK ALSO PROVIDES SEVERAL INTERPRETATION SERVICES FOR ETCH. OPTIMAL PHONE INTERPRETERS IS A TELEPHONE SERVICE THAT PROVIDES INTERPRETERS IN MORE THAN 204 LANGUAGES AND DIALECTS. INTERPRETERS CAN BE ARRANGED FOR FACE-TO-FACE INTERACTIONS BETWEEN SPANISH-SPEAKING PATIENTS AND PARENTS AND THE PHYSICIAN AND/OR OTHER HOSPITAL STAFF MEMBER. SIGN LANGUAGE INTERPRETERS ARE ALSO AVAILABLE FOR HEARING IMPAIRED PATIENTS AND FAMILIES. HOSPITALIZATION, MEDICAL PROCEDURES, ILLNESS AND PAIN ARE OFTEN FEARFUL TIMES FOR PEOPLE OF ALL AGES. THE CHILD LIFE DEPARTMENT AT ETCH IS RESPONSIBLE FOR HELPING CHILDREN COPE WITH THEIR HOSPITALIZATION THROUGH EDUCATION, MEDICAL PLAY AND ACTIVITIES. THE CHILD LIFE STAFF ASSESSES THE CHILD'S FEARS AND NEEDS, EXPLAIN PROCEDURES IN LANGUAGE CHILDREN CAN UNDERSTAND AND USE DISTRACTIONS TO MAKE PROCEDURES, SUCH AS THE PLACEMENT OF AN IV LINE, LESS INTIMIDATING. THE CHILD LIFE STAFF MEMBERS HOLD DEGREES IN EDUCATION, CHILD DEVELOPMENT OR THERAPEUTIC RECREATION. THEY HAVE EXPERTISE IN DEALING WITH A CHILD'S CONCERNS AND REACTIONS TO THE HOSPITAL AND HIS OR HER ILLNESS. IN ADDITION TO ITS WORK WITHIN THE HOSPITAL, THE CHILD LIFE DEPARTMENT ALSO COORDINATES SEVERAL ACTIVITIES FOR CHILDREN IN THE COMMUNITY. PASTORAL CARE - CHAPLAINS ARE AVAILABLE 24 HOURS A DAY TO PROVIDE SPIRITUAL AND EMOTIONAL SUPPORT TO PATIENTS, FAMILIES AND STAFF AT ETCH. CHAPLAINS ALSO PROVIDE CONSULTATION CONCERNING ETHICAL ISSUES RELATED TO PATIENT CARE. FOOD AND NUTRITION SERVICES - ETCH'S CAFETERIA IS OPEN DAILY. VENDING MACHINES ON THE GROUND FLOOR NEAR THE DINING ROOM AND IN THE SCOTT M. NISWONGER EMERGENCY DEPARTMENT WAITING AREA PROVIDE SANDWICHES, SNACKS AND BEVERAGES 24 HOURS A DAY. FOR PATIENTS WITH NO DIETARY RESTRICTIONS, FOOD AND NUTRITION SERVICES OFFERS A SELECTIVE MENU OF IN-ROOM MEALS. ALSO, REGISTERED DIETITIANS PROVIDE CLINICAL NUTRITION SERVICES, AND MEDICAL NUTRITION THERAPY IS AVAILABLE TO INPATIENTS AND OUTPATIENTS WHO ATTEND SPECIALTY CLINICS OR WHO HAVE INDIVIDUAL APPOINTMENTS. THESE SERVICES INCLUDE NUTRITION ASSESSMENT, FEEDING RECOMMENDATIONS, INTAKE EVALUATION AND NUTRITION COUNSELING. ETCH'S HEALTHY KIDS PROGRAM IS A COMMUNITY EDUCATION INITIATIVE OF THE COMMUNITY BENEFITS DEPARTMENT. THE PROGRAM SERVES AS AN EDUCATION RESOURCE FOR PARENTS, GRANDPARENTS AND OTHER CARETAKERS BY OFFERING CLASSES, LITERATURE, A QUARTERLY NEWSLETTER AND OTHER OPPORTUNITIES FOR LEARNING HOW TO IMPROVE THE HEALTH AND WELL-BEING OF CHILDREN. ETCH IS THE LEAD ORGANIZATION FOR AN IMPORTANT AREA COALITION: SAFE KIDS OF THE GREATER KNOX AREA. THE MISSION OF THE LOCAL SAFE KIDS COALITION IS TO REDUCE UNINTENTIONAL INJURIES IN CHILDREN UP TO AGE 14 IN THE EAST TENNESSEE REGION BY PROMOTING AWARENESS AND IMPLEMENTING PREVENTION INITIATIVES. THE LOCAL SAFE KIDS IS PART OF SAFE KIDS WORLDWIDE, A NETWORK OF COALITIONS WHOSE PRIMARY PURPOSE IS TO PREVENT UNINTENTIONAL INJURIES IN CHILDREN BY PROVIDING CHILDREN AND ADULTS CARING FOR THEM WITH INFORMATION ABOUT HOW TO STAY SAFE. HOPP IS HEMATOLOGY/ONCOLOGY PATIENTS AND PARENTS, AN OFFICIAL SUPPORT GROUP OF ETCH THAT PROVIDES SUPPORT FOR FAMILIES DEALING WITH A CHILD WITH CANCER. FOR THE YEAR ENDED JUNE 30, 2018 ETCH HAD 33,325 TOTAL INPATIENT DAYS, 174,702 TOTAL OUTPATIENT VISITS AND 63,199 EMERGENCY DEPARTMENT VISITS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND RELATED SCHEDULES ARE PREPARED BY AN UNRELATED, INDEPENDENT ACCOUNTING FIRM AND THEN SUBMITTED TO THE ETCH CHIEF FINANCE OFFICER FOR INTERNAL REVIEW. A DRAFT FORM IS ALSO PROVIDED TO SENIOR ADMINISTRATION AND TO ALL ETCH BOARD OF DIRECTORS MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C EACH MEMBER OF THE BOARD OF DIRECTORS IS ASKED TO REVIEW THE CONFLICT OF INTEREST POLICY AND PROVIDE DISCLOSURE OF ANY ACTIVITIES WHICH COULD CONSTITUTE A CONFLICT OF INTEREST OR POTENTIAL CONFLICT OF INTEREST ANNUALLY. THESE CONFLICT OF INTEREST DISCLOSURES ARE REVIEWED BY ETCH'S GENERAL COUNSEL TO ASSURE COMPLIANCE. ADDITIONALLY, BOARD MEMBERS ARE ASKED TO RECUSE THEMSELVES ON ANY MATTERS OF INTEREST BEFORE THE BOARD IN WHICH A CONFLICT OF INTEREST MAY EXIST. ANY SUCH RECUSAL IS DOCUMENTED WITHIN THE MINUTES OF THE BOARD OR COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE OF THE ETCH BOARD OF DIRECTORS UTILIZES THE SERVICES OF INDEPENDENT, OUTSIDE COMPENSATION CONSULTANTS TO PROVIDE THE COMMITTEE WITH RELEVANT MARKET DATA FROM STATE AND NATIONAL SALARY SURVEYS FOR COMPARABLE MARKETS. WITH THIS DATA AND THE ADVICE OF OUTSIDE CONSULTANTS, THE ETCH BOARD OF DIRECTORS EXECUTIVE COMMITTEE MAKES RECOMMENDATIONS ON PAY AND BENEFITS FOR THE ETCH PRESIDENT/CEO. FORM 990, PART VI, SECTION C, LINE 19 ALL ETCH GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. ADDITIONALLY, FINANCIAL STATEMENTS ARE PROVIDED TO BONDHOLDERS, LOCAL HOSPITALS AND DONORS. THE CONFLICT OF INTEREST POLICY IS POSTED ON ETCH'S INTRANET. FORM 990, PART VII, SECTION A, COMPENSATION: KEITH D. GOODWIN, MEMBER OF ETCH'S BOARD OF DIRECTORS, RECEIVED REPORTABLE COMPENSATION AS THE PRESIDENT AND CEO OF ETCH. HE DID NOT RECEIVE ANY COMPENSATION FOR SERVING ON THE BOARD OF DIRECTORS AS THE PRESIDENT. DAVID A. NICKELS, M.D., MEMBER OF ETCH'S BOARD OF DIRECTORS, RECEIVED REPORTABLE COMPENSATION AS A PEDIATRIC ENDOCRINOLOGIST AT ETCH. HE DID NOT RECEIVE ANY COMPENSATION FOR SERVING ON THE BOARD OF DIRECTORS. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 5,311,649. MANAGEMENT AND GENERAL EXPENSES 1,930,162. FUNDRAISING EXPENSES 174,997. TOTAL EXPENSES 7,416,808. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 19,217,378. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,217,378. FORM 990, PART XI, LINE 9: INTERCOMPANY DEBT FORGIVENESS -361,063. BOOK/TAX DIFFERENCE FOR PASSTHROUGH INVESTMENT -2,408,175. NET ASSETS RELEASED FROM RESTRICTIONS -1,652,714. CHILDREN'S PRIMARY CARE CENTER PO BOX 15010 KNOXVILLE TN 37901 621573297 PEDIATRIC CLINIC HOLDING COMPANY TN EAST TENNESEE CHILDREN'S HOSPITAL ASSOCIATION INC C 20839299 4984669 1.00000 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 CHILDREN'S PRIMARY CARE CENTER R 2091002 COST