2011-05-10T11:04:53-05:00 2010-06-30 Pershing Yoakley & Associates P C One Cherokee Mills 2220 Sutherland Knoxville TN 379192363 990 2009-07-01 626002604 East Tennessee Children's Hospital Association Inc EAST 8655418154 PO Box 15010 Knoxville TN 379015010 ZANE GOODRICH 8655418154 2011-05-10 1 8656730844 2009 2016-02-24 21:20:13Z Keith D Goodwin PO Box 15010 Knoxville TN 379015010 151777442 0 X http://www.etch.com/ X 1937 TN AT ETCH, CHILDREN ARE OUR ONLY CONCERN, PROVIDING THE BEST HEALTHCARE TO EVERY CHILD SERVED. 16 11 2063 12096 0 0 5205354 4844759 130190693 143270067 -1258658 462984 2052783 1730308 136190172 150308118 23000 0 79071814 80868252 0 783433 56409621 61234572 135481435 142125824 708737 8182294 205423266 216274757 86439028 86237345 118984238 130037412 EAST TENNESSEE CHILDREN'S HOSPITAL ("ETCH") WILL IMPROVE THE HEALTH OF CHILDREN THROUGH EXCEPTIONAL COMPREHENSIVE FAMILY-CENTERED CARE, WELLNESS, AND EDUCATION. ETCH BELIEVES BECAUSE CHILDREN ARE SPECIAL, THEY DESERVE THE BEST POSSIBLE HEALTH CARE GIVEN IN A POSITIVE, CHILD/FAMILY CENTERED ATMOSPHERE OF FRIENDLINESS, COOPERATION, AND SUPPORT - REGARDLESS OF RACE, RELIGION, OR ABILITY TO PAY; THEIR MEDICAL NEEDS ARE CLOSELY RELATED TO THEIR EMOTIONAL AND INFORMATIONAL NEEDS; THEREFORE, THE TOTAL CHILD MUST BE CONSIDERED IN TREATING ANY ILLNESS OR INJURY; THEIR HEALTH CARE REQUIRES FAMILY INVOLVEMENT, SPECIAL UNDERSTANDING, SPECIAL EQUIPMENT, AND SPECIALLY TRAINED PERSONNEL WHO RECOGNIZE THAT CHILDREN ARE NOT MINIATURE ADULTS; THEIR HEALTH CARE CAN BEST BE PROVIDED BY A FACILITY WITH A WELL TRAINED MEDICAL AND HOSPITAL STAFF WHOSE ONLY INTERESTS AND CONCERNS ARE WITH THE TOTAL HEALTH AND WELL-BEING OF INFANTS, CHILDREN AND ADOLESCENTS. 0 0 125394076 144417005 East Tennessee Children's Hospital ("ETCH") is the only medical center in East Tennessee dedicated exclusively to the care of children. Since 1937, ETCH has provided excellent pediatric health care for children from birth to 21 years of age. ETCH is certified by the state of Tennessee as the only Comprehensive Regional Pediatric Center in East Tennessee. 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 MedicineNeonatologyPediatricsPediatric Allergy & ImmunologyPediatric AnesthesiologyPediatric Cardiology Pediatric Critical CarePediatric Dentistry/PedodonticsPediatric DermatologyPediatric Emergency MedicinePediatric EndocrinologyPediatric GastroenterologyPediatric Hematology/OncologyPediatric Infectious DiseasesPediatric NephrologyPediatric NeurologyPediatric NeurosurgeryPediatric OphthalmologyPediatric OrthopedicsPediatric OtolaryngologyPediatric PhysiatryPediatric Plastic/Reconstructive SurgeryPediatric PulmonologyPediatric RadiologyPediatric SurgeryPediatric UrologyPediatric PerinatologySleep MedicineIn Addition, ETCH provides the following: Medical/Surgical Services:The Emergency Department is staffed with licensed 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 doctors 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 600 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 care practitioners include aerosol medications, delivery of oxygen and other medical gases, ventilator management and many other procedures. Respiratory care practitioners 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 care practitioners; they teach patients and their families how to care for certain conditions at home. 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 MRIs. To meet these needs, ETCH offers PASS on Pain, provided by 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 on Pain 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 childrens' 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/Sleep 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.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 care practitioners. Services provided include spirometry testing, metabolic studies, cardiac stress testing, lung volumes and the cystic fibrosis clinic. The Radiology Department serves as an "imaging" center for children. These images include x-ray, ultrasound, CT scan, nuclear medicine, magnetic resonance imaging (MRI), echocardiogram 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. 125394076 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 1 91 6 1 2063 1 0 0 0 0 0 1 1 0 0 0 16 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 0 1 1 TN X Zane D Goodrich 8655418154 PO Box 15010 Knoxville TN 379015010 Dennis B Ragsdale 2.00 X 0 0 0 Jeff Jennings Md 2.00 X 0 0 0 Michael C Crabtree 2.00 X 0 0 0 Steven D Harb 2.00 X 0 0 0 Danni B Varlan 2.00 X 0 0 0 Debbie J Christiansen Md 2.00 X 0 0 0 Dawn Ford 2.00 X 0 0 0 Lewis W Harris Md 2.00 X 0 0 0 Dee Haslam 2.00 X 0 0 0 A David Martin 2.00 X 0 0 0 William F Terry MD 2.00 X 0 0 0 christopher A miller md 2.00 X 0 0 0 stephen a south 2.00 X 0 0 0 John Q Buchheit Md 2.00 X 0 0 0 j laurens tullock 2.00 X 0 0 0 Keith D Goodwin 40.00 X X 429242 0 42384 Rudolph Mckinley 40.00 X 247360 0 32793 laura preston barnes 40.00 X 179685 0 25361 paul c bates 40.00 X 193571 0 15723 zane d goodrich 40.00 X 181922 0 21287 Bryan Pabst 40.00 X 237588 0 6866 Bruce Anderson 40.00 X 200731 0 12349 Sue Wilburn 40.00 X 67470 0 683 Joe Childs 40.00 X 48796 0 6311 carmen diez tapiador 40.00 X 212467 0 12416 alexandra p eidelwein 40.00 X 183732 0 11597 Laszlo Hopp 40.00 X 231509 0 3301 Martha Sparrow 40.00 X 200439 0 1249 Kelly Boggan 40.00 X 160103 0 997 Robert F Koppel 40.00 X 1743725 0 7665 4518340 0 200982 52 1 1 0 Southeastern Emergency Physicians 1900 North Winston Road Knoxville TN 37919 Physician Services 12144877 CHildren's Anesthesiologists PC 2018 W Clinch Avenue Knoxville TN 37916 Physician services 7903719 Cardinal Health Pharmacy Division 7000 Cardinal Place Dublin OH 43017 Pharmacy Services 4649093 Owens & Minor 3551 Workman Road knoxville TN 37950 healthcare services 4052036 Oak RIdge Pediatric CLinic Pc 145 East Vance Road oak ridge TN 37830 Physician Services 1947162 137 1083044 3761715 4844759 Patient care revenue 623990 141839212 141839212 Other healthcare srvcs 621300 833494 833494 Passthrough revenue 621110 597361 597361 143270067 477475 477475 655200 655200 655200 655200 14491 -14491 -14491 -14491 687020 1083044 796503 -109483 -109483 37387 8633 28754 28754 642129 649697 -7568 -7568 Cafeteria Sales 722210 1048818 1048818 Miscellaneous 900099 114587 114587 1163405 150308118 144417005 0 1046354 23000 23000 3207932 2732708 441284 33940 58679462 49986780 8071960 620722 2741640 2364499 377141 11330547 9771914 1558633 4908671 4233433 675238 57103 57103 100511 100511 14181084 12576446 1598006 6632 2228192 2228192 209564 101734 103648 4182 2330554 2330554 6774715 6121483 651500 1732 1302785 1302785 supplies 22398879 21887241 495017 16621 bad debt 4729975 4729975 equipment rental/mnt 3903212 3865487 37725 Other 1110015 1089318 20697 dues & subscriptions 569559 569559 1338424 781753 477764 78907 142125824 125394076 15948315 783433 10675112 16312244 29085461 28865135 30864458 31974486 2436757 2610387 1859109 1972381 148705813 71684118 78528242 77021695 51690354 57256332 283773 262097 205423266 216274757 17876293 17810349 45626992 44674259 22935743 23752737 86439028 86237345 X 101420920 112412707 3754145 3608325 13809173 14016380 118984238 130037412 205423266 216274757 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13809173 207207 14016380 13587048 222625 500 13809173 1.00000 0 0 421201 8536966 8958167 91141222 39036170 52105052 47496923 32647948 14848975 1109501 1109501 77021695 Investment in subsidiaries 23752737 23752737 Part X: Description of Uncertain Tax Positions Under FIN 48: THE AUDIT FOR ETCH AND ITS SUBSIDIARIES IS PREPARED ON A CONSOLIDATED BASIS. EFFECTIVE FOR THE YEAR ENDED JUNE 30, 2010, THE COMPANY IS REQUIRED TO EVALUATE UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH FASB PROVISION NO. 740, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THIS EVALUATION WOULD INCLUDE A QUANTIFICATION OF TAX RISK IN AREAS SUCH AS UNRELATED BUSINESS TAXABLE INCOME AND THE TAXATION OF FOR-PROFIT SUBSIDIARIES. THE ENTITY WAS AUDITED BY AN UNRELATED, INDEPENDENT ACCOUNTING FIRM THAT DEEMED THAT THE ADOPTION OF FASB 740 DID NOT HAVE A MATERIAL EFFECT ON THE COMPANY'S STATEMENT OF OPERATIONS FOR THE YEAR ENDED JUNE 30, 2010. fantasy of trees 1439538 752518 687020 7500 59262 547364 Center Stage 301550 301550 51454 110799 1 28976 28976 1600 8060 10464 1770064 1083044 687020 1600 7500 118776 668627 796503 -109483 37387 7500 1133 1 1.00000 37387 7500 1133 8633 28754 TN 1 0 1 0 1.00000 Zane goodrich po box 15010 Knoxville TN 379015010 0 Elizabeth Thomas Elizabeth Thomas is the Director of Volunteer Services. THe volunteer services Department is responsible for the Fantasy of Trees. The Raffle Tree is the gaming event held within the Fantasy of trees. Volunteer Services fosters the relationship with raffle sponsors and decides where/ how the area is designed on the floor. Volunteer services recruits voluteers to sell raffle tickets, lock the drum, and arrange the ticket drawing and delivery. X 1 28755 1 1 1 X 1 X 1 1 1 0 1 1 89660 316976 29453 287523 0.00210 79940928 66078432 13862496 0.10090 89660 80257904 66107885 14150019 0.10300 287523 287523 0.00210 9823 776314 20466 755848 0.00550 54080 54080 0.00040 95296 312013 312013 0.00230 105119 1429930 20466 1409464 0.01030 194779 81687834 66128351 15559483 0.11330 2456 112238 955 111283 0.00080 2456 112238 955 111283 0.00080 1 1858880 0 15021 42928 -27907 X 1 1 children's west surgery center llc medical surgery center 0.50000 0.50000 East Tennessee Children's Hospital

PO Box 15010 Knoxville TN 379015010

X X Part I, Line 7: Cost is derived from the actual expense data accumulated within the ETCH general ledger which addresses all patient segments including inpatient, outpatient, emergency room, commercial insurance, government insurance, uninsured and self-pay. A cost-to-charge ratio was used to determine charity care. 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 I, Line 7f: Bad debt expense of $4,729,975 is included in total expenses on Form 990, Part IX, line 25, column (a), but excluded in calculating the percent of total expenses reported in column (f), on part I, line 7. 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: "Net patient service revenue is reported on the accrual basis in the period in which services are provided at the estimated net realizable amounts, including estimated retroactive adjustments under reimbursement agreements with certain third-party payors. Retroactive adjustments are accrued on an estimated basis in the period the related services are rendered and adjusted in future periods as final settlements are determined.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 are charged with an estimate provision for bad debts based upon historical experience, aging of receivables and any unusual circumstances which affect the collectability of receivables. 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. Receipts form the state of tennessee under the tenncare essential access, disproportionate share and trauma care programs are recognized as net patient service revenue when such amounts can be reasonably estimated.the hospital provides care, without charge, to patients who meet criteria under its charity care policy. because the hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue." 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 $27,907 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 amount 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 to 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: Currently, the organization relies on assessment data gathered from the State of Tennessee, Knox County and other resources to assess the needs of the community. ETCH does not formally assess the health care needs of the community it serves but is working to develop a formal community needs assessment that will be performed regularly, collaborating with local agencies, schools and community groups. ETCH is planning to partner with the University of Tennessee School of Social Work to examine the pediatric healthcare needs of Eastern Tennessee and the surrounding areas. The results will help to determine both short-term and long-term priorities as well as strategies for improving pediatric health. 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: ETCH is certified by the state of Tennessee as the only Comprehensive Regional Pediatric Center in East Tennessee. 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. ETCH's primary service area includes: Knox, Blount, Sevier, Cocke, Jefferson, Hamblen, Grainger, union, claiborne, anderson, campbell, scott, morgan, roane, loudon, and monroe counties. Fentress, cumberland, rhea, meigs, mcminn, hancock, hawkins, greene, washington and sullivan counties comprise ETCH's secondary service area. ETCH is accredited by the joint commission on accreditation of healthcare organizations. ETCH is a member of CHildren's hospital alliance of Tennessee, hospital alliance of tennessee, the national association of children's hospitals & related institutions, and tennessee hospital association. Part VI, Line 5: ETCH provides numerous benefits to the community it serves:1. An open-door policy. This is our most important benefit, as stated in our Statement of Philosophy. We offer medical services to all children, regardless of their parents' ability to pay. Not only that, but our Scott M. Niswonger Emergency Department is open 24 hours a day, meaning the door is always open!2. A dedicated pediatric facility. ETCH treats patients from birth through age 21. We offer 28 pediatric subspecialties and a full complement of pediatric medical and surgical services. This means families seldom need to travel to Nashville, Atlanta or even farther to receive specialized care for their children.3. Healthy Kids Community Education Program. The Healthy Kids program features parenting classes and newsletters on a variety of topics ranging from safety to development to health. Classes are primarily for parents, grandparents and guardians, but some are also designed for teens (such as the Safe Sitter babysitting course) and children. Most classes are free; if a fee is charged, it is only to cover the cost of purchased materials. Healthy Kids Newsletters are provided free to area schools and child care centers as well as to parents and caregivers.4. Community involvement. As an advocate for children, ETCH provides staff, volunteers, in-kind services (such as meeting space) and/or financial support to many community organizations whose goals are to improve the lives of children, including American Cancer Society, CoverKids, CureFinders, Cystic Fibrosis Foundation, Down Syndrome Awareness Group, Dream Connection, Girls on the Run, Juvenile Diabetes Research Foundation, Knox County Health Department, Knox County Schools' Partners in Education, Knoxville Area Pregnancy Prevention Initiative, Knoxville Police Department's Safety City, Knoxville Police Department's Think Fast Alcohol Awareness Program, Leukemia and Lymphoma Society, March of Dimes, a secret safe place for newborns of Tennessee, inc., Montgomery Village, Smoke-Free Knoxville, TENNder Care Coalition and United Way. In addition, ETCH is the lead organization for Safe Kids of the Greater Knox Area, a local chapter of this international non-profit dedicated to preventing unintentional injury in children ages 14 and under. ETCH is also a participating medical facility that will accept surrenders of newborns under the Safe Haven law, which allows mothers of newborns to surrender unharmed babies to designated medical facilities within 72 hours of the baby's birth, without fear of prosecution. 5. Partners in Education. ETCH participates in the Knox County School System's Partners in Education program. Our "adopted" schools are Karns Elementary School, Cedar Bluff Intermediate School and Fort Sanders Educational Development Center. Each school year, ETCH conducts programs for the students at each school and provides special treats for their teachers. We also provide the students an opportunity to create artwork to hang on the hospital's walls or at our affiliate sites or to be used in our publications and on our Web site. 6. Hello Hospital. The Child Life Department at ETCH and dozens of volunteers provide this free program to kindergarten classes in all Knox County elementary schools. "Hello Hospital" is designed to teach young children about what it is like to visit a hospital and ease some of their fears about the experience.7. The ETCH Web site. The ETCH Web site provides free access to a wide range of information regarding kids and their health, including thousands of pediatric health articles and "virtual visits," which help to teach kids (and their parents) about what to expect when they visit the hospital for a test, admission or surgery.8. Professional education. ETCH supports health care education by offering student internships, externships, nursing scholarships and training programs for student nurses, pre-med students, social work students, child development specialists and others pursuing health care as a career. Also, ETCH works jointly with the University of Tennessee Medical Center and University of Tennessee Medical School to provide medical school rotations in family practice and other specialties at our facility. ETCH also is the pediatric clinical training site for student nurses, respiratory therapists, radiology students and students in other health care disciplines. Furthermore, ETCH is an accredited Continuing Medical Education provider in Tennessee. As a CME provider, ETCH conducts and sponsors relevant CME programs for physicians and nurse practitioners who treat children. 9. Community events. ETCH takes part in a variety of health fairs at local schools and community events to provide health education to the public. At these events we provide free brochures and information sheets on many health topics.10. Summer camps. ETCH sponsors camps for a number of our patients with special medical needs who might be unable to attend a traditional camp. The camps for our hematology/oncology, diabetes and Rehab Center patients are staffed with health care professionals who provide supervision and needed medical care during the camping experience. Part VI, Line 6: 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 healthcare 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 7: ETCH is not part of an affiliated health care system. TN 1 Tennessee Emergency Medical Services for Children 2200 childrens way nashville TN 37232 202802786 501(c)(3) 5000 donation March of Dimes foundation 1275 mamaroneck avenue white plains NY 10605 131846366 501(c)(3) 3000 donation University of Tennessee 600 andy holt tower knoxville TN 37996 501(c)(3) 5000 2009 nursing nighting gala sponsor University HEalth Systems 1520 cherokee trail knoxville TN 37920 311626179 501(c)(3) 5000 an evening in orange sponsor Variety of Eastern Tennessee 7132 Regal Lane Knoxville TN 37918 331025695 501(c)(3) 5000 Kenny CHesney event sponsor 5 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, 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. X 1 1 X X X 0 1 0 0 0 0 0 0 0 Keith D Goodwin 428508 0 0 0 734 0 37482 0 4902 0 471626 0 0 0 Rudolph Mckinley 246626 0 0 0 734 0 31130 0 1663 0 280153 0 0 0 laura preston barnes 178251 0 700 0 734 0 23609 0 1752 0 205046 0 0 0 paul c bates 163557 0 29436 0 578 0 12551 0 3172 0 209294 0 0 0 zane d goodrich 181529 0 0 0 393 0 17800 0 3487 0 203209 0 0 0 Bryan Pabst 201975 0 35357 0 256 0 0 0 6866 0 244454 0 0 0 Bruce Anderson 198683 0 0 0 2048 0 11019 0 1330 0 213080 0 0 0 carmen diez tapiador 116676 0 95642 0 149 0 9076 0 3340 0 224883 0 0 0 alexandra p eidelwein 183578 0 0 0 154 0 7906 0 3691 0 195329 0 0 0 Laszlo Hopp 204294 0 26620 0 595 0 0 0 3301 0 234810 0 0 0 Martha Sparrow 165396 0 34329 0 714 0 0 0 1249 0 201688 0 0 0 Kelly Boggan 129502 0 29399 0 1202 0 0 0 997 0 161100 0 0 0 Robert F Koppel 139491 0 1603747 0 487 0 6106 0 1559 0 1751390 0 0 0 Part I, Line 1a Housing allowance or residence for personal use: In some cases an employment contract may provide for a temporary housing allowance. All such contracts are in writing and a real estate agent is consulted as to the appropriate allowance amount. At this time ETCH has one such contract. Part I, Line 4a Supplemental nonqualified plan Keith Goodwin $28,147 Rudolph McKinley 16,124 Bruce Anderson 8,865 Zane Goodrich 5,845 Laura Preston Barnes 11,936 Supplemental Information Part III Part II, Column (B)(ii), Robert F. Koppel: THE MAJORITY OF MR. KOPPEL'S COMPENSATION RELATES TO A PAYOUT OF DEFERRED COMPENSATION. MR. KOPPEL RETIRED FROM HIS POSITION AS CHIEF EXECUTIVE OFFICER OF ETCH AFTER SERVING 31 YEARS. Supplemental Information Part III 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. No payments of benefits occurred during the current year. 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. The Health Educational and Housing Facility board of knox county tennessee 621220275 499523ud8 2006-02-15 50000000 DEBT SERVICE AND FUTURE CAPITAL PROJECTS 0 0 49754946 3301550 6489075 1965576 2727895 35270850 2006 0 0 1 1 0 0 0 0 0 0.01000 0.01000 1 1 0 0 0 0 0 CHild Neurology services PC Provider of medical services to ETCH 420605 CHRISTOPHER MILLER, M.D., member of the ETCH board of directors, IS A SHAREHOLDER IN CHILD NEUROLOGY SERVICES, P.C. 0 Martin & Company Inc provider of financial services to etch 155378 DAVID MARTIN, member of the etch board of directors, IS THE PRESIDENT OF MARTIN & COMPANY, INC. 0 neurosurgical associates pc provider or medical services to etch 330510 LEWIS HARRIS, M.D., member of the etch board of directors, IS A SHAREHOLDER IN NEUROSURGICAL ASSOCIATES, P.C. 0 KNoxville Pediatric Cardiology PC provider or medical services to etch 738988 Jeff Jennings, M.d. is a shareholder in knoxville pediatric cardiology, P.C., which provides medical services to ETCH. 0 X gala auction items 107 40056 property selling price X Food/misc. support items 121 299876 market value 0 1 0 Form 990, Part VI, Section B, line 11 The 2009 Form 990 and the related schedules are prepared by an unrelated, independent accounting firm and then submitted to the ETCH CFO for internal review. A draft is also provided to the ETCH board of directors finance committee for review. The CFO is available to answer any questions received from the board and address any significant disclosures within the Form 990 and related schedules 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. These conflict of interest disclosures are reviewed by ETCH's general counsel to assure compliance with this policy. 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 15a The executive committee of the ETCH board of directors reviews and approves the compensation of the CEO. State and national comparability data is used to assist in determining appropriate compensation. While such review process was not in place for other officers and key employees of as June 30, 2010, the organization is planning to establish a review and approval process going forward. 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 and the conflict of interest policy is posted on ETCH's intranet. Form 990, Part IX, Line 2c THe process the audit committee uses to oversee the audit has not changed from the prior year. FORm 990, Part III, Line 4a Continuation of program service accomplishments 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 Relations 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, 2010 ETCH had 36,571 total inpatient days, 175,664 total outpatient visits and 72,031 emergency department visits. FOrm 990, Part Vi, Section B, Line 13: Whistle Blower Policy the organization does not presently have a formal written whistle blower policy; however, ETCH does have a non-retaliation policy. The organization is currently working to formalize a whistle blower policy. FOrm 990, Part VII Reimbursed compensation Bryan Pabst, Martha Sparrow and Kelly Boggan are employed and receive a Form W-2 from ETCH. However, compensation for these individuals is reimbursed by another organization. Children's West Surgery Center LLC 1020 CHildrens Way Knoxville TN 37922 621872553 Medical Surgery Center TN N/A related 597361 831388 0 0 children's primary care center PO Box 15010 knoxville TN 37901 621573297 pediatric clinic holding company TN N/A C 22735223 5203794 1.00000 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Children's Primary Care Center D 1131130