SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
EAST TENNESSEE CHILDREN'S HOSPITAL
ASSOCIATION INC
Employer identification number

62-6002604
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    1,470,950   1,470,950 0.760 %
b Medicaid (from Worksheet 3, column a) . . . . .     103,175,697 88,350,800 14,824,897 7.690 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     104,646,647 88,350,800 16,295,847 8.450 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).   161,043 1,349,244 219,284 1,129,960 0.590 %
f Health professions education (from Worksheet 5) . . .   4,488 3,011,405 135,346 2,876,059 1.490 %
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .     188,759   188,759 0.100 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .   138,640 758,997 5,861 753,136 0.390 %
j Total. Other Benefits . .   304,171 5,308,405 360,491 4,947,914 2.570 %
k Total. Add lines 7d and 7j .   304,171 109,955,052 88,711,291 21,243,761 11.020 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     33,675 0 33,675 0.020 %
4 Environmental improvements     37,524 0 37,524 0.020 %
5 Leadership development and
training for community members		            
6 Coalition building   5,098 6,903 0 6,903 0 %
7 Community health improvement advocacy            
8 Workforce development   8 332,117 0 332,117 0.170 %
9 Other            
10 Total   5,106 410,219   410,219 0.210 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
1,755,232
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
2,958
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
7,002
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-4,044
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
11 CHILDREN'S WEST SURGERY CENTER LLC
  		MEDICAL SURGERY CENTER 50.000 %   50.000 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 EAST TENNESSEE CHILDREN'S HOSPITAL
PO BOX 15010
KNOXVILLE,TN379015010
HTTP://WWW.ETCH.COM/ 		    X       X      
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
EAST TENNESSEE CHILDREN'S HOSPITAL
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 18
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTPS://WWW.ETCH.COM/COMMUNITY/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
EAST TENNESSEE CHILDREN'S HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14   No
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
HTTP://WWW.ETCH.COM/
b
HTTP://WWW.ETCH.COM/
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Billing and Collections
EAST TENNESSEE CHILDREN'S HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
EAST TENNESSEE CHILDREN'S HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
EAST TENNESSEE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 5: THE FOLLOWING FOCUS GROUPS PARTICIPATED IN THE ETCH 2019 CHNA:SIX FOCUS GROUPS WERE CONDUCTED BY EXPERT EVALUATORS FROM THE COLLEGE OF SOCIAL WORK OFFICE OF RESEARCH AND PUBLIC SERVICE (SWORPS) AT THE UNIVERSITY OF TENNESSEE. THE FOCUS GROUPS WERE CONDUCTED WITH: 1. EAST TENNESSEE CHILDREN'S HOSPITAL FAMILY ADVISORY COUNCIL2. REGIONAL COORDINATED SCHOOL DIRECTORS3. REGIONAL HEALTH DEPARTMENT DIRECTORS4. PRIMARY CARE PHYSICIANS5. EAST TENNESSEE CHILDREN'S HOSPITAL BOARD OF DIRECTORS6. EAST TENNESSEE CHILDREN'S HOSPITAL MANAGEMENT TEAMA SURVEY FOR THE GENERAL POPULATION WAS CREATED TO GAIN INPUT FROM COMMUNITY RESIDENTS AND KEY STAKEHOLDERS ABOUT THE TOP HEALTH NEEDS AND PRIORITIES OF CHILDREN. WE PROMOTED THE SURVEY ON THE CHILDREN'S HOSPITAL WEBSITE AND SOCIAL MEDIA TO ENCOURAGE PEOPLE TO COMPLETE AN ONLINE, CONFIDENTIAL SURVEY.THE GATHERING AND ANALYZING PHASE OF THE CHNA INCLUDES INTERVIEWING KEY INFORMANTS, CONDUCTING FOCUS GROUPS AND COLLECTING INFORMATION THROUGH AN ONLINE SURVEY. DATA FROM THE KEY INFORMANT INTERVIEWS, FOCUS GROUPS, AND COMMUNITY SURVEY WERE ANALYZED TO TRIANGULATE FINDINGS AND IDENTIFY COMMON THEMES. THREE PRIMARY HEALTH ISSUES OF CONCERN EMERGED: MENTAL AND BEHAVIORAL HEALTH, OBESITY, AND SUBSTANCE ABUSE-RELATED ISSUES -- INCLUDING, BUT NOT LIMITED TO: NEONATAL ABSTINENCE SYNDROME (NAS), ADDICTION AND INCARCERATION OF PARENTS, AND DRUG EXPERIMENTATION BY CHILDREN.
EAST TENNESSEE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 11: THE NEEDS ASSESSMENT PROCESS ALLOWS CHILDREN'S HOSPITAL TO IDENTIFY THE PEDIATRIC HEALTH CARE NEEDS IN OUR REGION AND DIRECT OUR COMMITMENT TO PROVIDING RESOURCES TO HELP POSITIVELY IMPACT CHILD HEALTH. IN ADDITION TO THE MANY VALUABLE, INNOVATIVE PROGRAMS AND SERVICES AVAILABLE AT CHILDREN'S HOSPITAL, THE HEALTH NEEDS IDENTIFIED THROUGH THE INFORMATION GATHERING PROCESS INCLUDE: CHILDHOOD OBESITY, MENTAL AND BEHAVIORAL HEALTH, AND NAS. IN MAY 2019, THE CHILDREN'S HOSPITAL BOARD OF DIRECTORS UNANIMOUSLY APPROVED THE PRIORITIZED FOCUS AREAS DESCRIBED BELOW TO BE THE FOUNDATION OF OUR IMPLEMENTATION STRATEGY.WHILE MENTAL AND BEHAVIORAL HEALTH, OBESITY, AND SUBSTANCE ABUSE-RELATED ISSUES HAVE BEEN THE MOST UNIVERSALLY IDENTIFIED THUS FAR, MANY OTHER IMPORTANT HEALTH ISSUES AND SOCIAL DETERMINANTS HAVE BEEN DISCUSSED IN THE COURSE OF THE CHNA PROCESS AND ARE WORTHY OF CONSIDERATION IN THE LATER STRATEGIC PLANNING PHASE. THESE ISSUES INCLUDE BUT ARE NOT LIMITED TO: - ACCESS TO TRANSPORTATION- ADVERSE CHILDHOOD EXPERIENCES (ACESS)- ASTHMA AND ALLERGIES- ATTENTION DEFICIT AND HYPERACTIVITY- AUTISM AND SENSORY PROCESSING DISORDERS- DENTAL CARE ACCESS- DOMESTIC VIOLENCE- DURABLE MEDICAL EQUIPMENT FOR CHILDREN WITH SPECIAL NEEDS- ECONOMIC UNDERDEVELOPMENT- FOOD INSECURITY- LOW-QUALITY HOUSING- MULTI-GENERATIONAL POVERTY- PARENTING EDUCATION- SEX EDUCATION- SMOKING AND NICOTINE VAPING- SOCIAL MEDIA AND CYBERBULLYING- SUICIDE PREVENTION- UNEMPLOYMENTWHILE CHILDREN'S HOSPITAL WOULD CONTINUE FOCUS ON THE MAJORITY OF EFFORTS OUTLINED IN OUR IMPLEMENTATION STRATEGY, ALL NEEDS IDENTIFIED WILL BE REVIEWED FOR FUTURE CONSIDERATION AND COLLABORATION. THESE AREAS, WHILE STILL IMPORTANT TO THE HEALTH OF CHILDREN IN THE COMMUNITY, WILL BE MET THROUGH OTHER HEALTH CARE ORGANIZATIONS WITH ASSISTANCE FROM CHILDREN'S HOSPITAL AS NEEDED. THE COMMUNITY NEEDS NOT ADDRESSED BY CHILDREN'S HOSPITAL WILL CONTINUE TO BE ADDRESSED BY GOVERNMENTAL AGENCIES AND EXISTING COMMUNITY-BASED ORGANIZATIONS.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
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 I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 4,821,980.
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, SHOES FOR SCHOOLS, UNITED WAY AND BOARD SUPPORT FOR ORGANIZATIONS. 2. COALITION BUILDING AND COMMUNITY HEALTH IMPROVEMENT ADVOCACY: ETCH PARTICIPATED IN THE FOLLOWING COMMUNITY COALITIONS TO ADDRESS HEALTH AND SAFETY ISSUES SPECIFIC TO CHILDREN. A. EAST TENNESSEE CHILDHOOD OBESITY COALITION WHOSE MISSION IS TO PREVENT AND REDUCE CHILDHOOD OBESITY BY PROMOTING HEALTHY, ACTIVE LIFESTYLES THROUGH FAMILY, COMMUNITY AND INTER-PROFESSIONAL COLLABORATIONS. ETCH PROMOTES THESE ACTIVITIES THROUGH THE HEALTH KIDS CLUB PROGRAM TO AREA ELEMENTARY SCHOOLS. B. SAFEKIDS. THE ETCH INJURY PREVENTION PROGRAM IS THE LEADER OF A COALITION TO PREVENT ACCIDENTAL INJURY. THE SAFE TRAVELS PROGRAM TRAINS LOCAL AGENCY MEMBERS ON CHILD PASSENGER SAFETY AND DISTRIBUTES CAR SEATS TO THOSE IN NEED ALONG WITH INSTALLATION TRAINING. THE PROGRAM ALSO PROVIDES BIKE HELMETS AND HELPS EDUCATE KIDS AND PARENTS ABOUT HELMET USE AND INJURY PREVENTION. ALSO, WE PROVIDE A WIDE SCOPE OF PUBLIC EDUCATION ON WATER SAFETY AND HEAT STROKE PREVENTION. C. ETCH PROVIDES TRAINING FOR AED USAGE AND CPR ADMINISTRATION IN MANY PUBLIC SCHOOLS AND AREAS. D. ETCH PROVIDES ASTHMA SCREENINGS IN LOCAL COMMUNITY THROUGH THE BREATHE EASY PROGRAM ALONG WITH FOLLOW-UP CALLS TO THOSE WHO HAVE AN ABNORMAL SCREENING RESULT. E. OTHER ACTIVITIES INCLUDE SAFESITTER CLASSES, CPR TRAINING, CAMPS FOR CHILDREN, HELLO HOSPITAL, MEDIC BLOOD DRIVES, VOLUNTEEN PROGRAM AND INFANT AND CHILD TRAINING FOR ADULT HOSPITALS AND EMERGENCY AGENCIES.3. WORKFORCE DEVELOPMENT: ETCH RECRUITS PHYSICIAN SPECIALTIES AND OTHER HEALTH PROFESSIONALS DEDICATED TO SERVING THE CHILD & ADOLESCENT POPULATION TO MEDICAL SHORTAGE AREAS OR OTHER AREAS DESIGNATED AS UNDERSERVED. PROJECT SEARCH IS A YEAR-LONG PROGRAM PROVIDING ADULTS WITH DISABILITIES THE EDUCATION AND EXPERIENCE THEY NEED FOR SUCCESSFUL EMPLOYMENT. 4. EDUCATION OF HEALTH PROFESSIONALS: ETCH PROVIDES EDUCATIONAL PROGRAMS FOR PHYSICIANS, RESIDENTS, NURSES, NURSING STUDENTS AND OTHER HEALTH PROFESSIONALS. 5. RESEARCH: ETCH PARTICIPATES IN RESEARCH IN HEMATOLOGY, PULMONOLOGY AND ENDOCRINOLOGY.
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: USING A PORTFOLIO APPROACH, THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. IN ADDITION, FOR UNINSURED PATIENTS, THE HOSPITAL REDUCES CHARGES FROM CURRENT RATES BASED ON AVERAGE DISCOUNTS PROVIDED TO CERTAIN THIRD-PARTY PAYERS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. ADJUSTMENTS FOR SUCH CHANGES IN THE ESTIMATED TRANSACTION PRICE WERE NOT SIGNIFICANT FOR THE YEAR ENDED JUNE 30, 2020. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. NO SIGNIFICANT AMOUNT OF BAD DEBT EXPENSE WAS REPORTED FOR THE YEARS ENDED JUNE 30, 2020 AND 2019.
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 $4,044 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: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS IS THE FOUNDATION FOR IMPROVING AND PROMOTING THE HEALTH STATUS OF OUR COMMUNITY'S CHILDREN. THE PLANNING, ACTIVITIES AND DATA REVIEW NECESSARY FOR THE DEVELOPMENT OF THE MOST RECENT ASSESSMENT TOOK PLACE BEGINNING JANUARY 2018 AND EXTENDED THROUGH SPRING 2019 AND INCLUDES STATE AND COUNTY-SPECIFIC DATA COLLECTION AND PRIMARY DATA OBTAINED THROUGH SURVEYS AND INTERVIEWS WITH INDIVIDUALS FROM LOCAL COMMUNITIES.THROUGHOUT THE CHNA, HIGH PRIORITY WAS GIVEN TO DETERMINING THE HEALTH STATUS AND AVAILABLE RESOURCES WITHIN A 16-COUNTY SERVICE AREA INCLUDING ANDERSON, BLOUNT, CAMPBELL, CLAIBORNE, COCKE, GRAINGER, HAMBLEN, JEFFERSON, KNOX, LOUDON, MONROE, MORGAN, ROANE, SCOTT, SEVIER AND UNION. THESE COUNTIES WERE IDENTIFIED AS CORE COUNTIES BASED ON PATIENT POPULATION DATA. AFTER CAREFUL EVALUATION OF ALL PRIMARY AND SECONDARY DATA, HEALTH PRIORITIES WERE IDENTIFIED. THE PLANNING PROCESS FOR THE FISCAL YEAR 2019 CHNA BEGAN IN JANUARY 2018. AN INTERNAL TEAM WAS FORMED TO IDENTIFY AND APPROVE RESOURCES AND TIMELINES FOR CONDUCTING THE NECESSARY STEPS FOR FORMATION OF THE NEEDS ASSESSMENT. A SCHEDULE WAS ESTABLISHED TO ALLOW SUFFICIENT TIME AND RESOURCES TO IDENTIFY AND ENGAGE COMMUNITY PARTNERS IN KEY INFORMANT INTERVIEWS AND FOCUS GROUPS. THE INTERNAL TEAM USED A MODIFIED VERSION OF THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) PROCESS. THIS PROCESS IS COMMONLY USED TO ASSIST COMMUNITY HEALTH ORGANIZATIONS DURING THE NEEDS ASSESSMENT PROCESS. THE MAPP PROCESS PROVIDED THE FRAMEWORK FOR CHILDREN'S HOSPITAL TO ORGANIZE, VISUALIZE, ASSESS, STRATEGIZE, FORMULATE GOALS AND TAKE ACTION. KEY INFORMANTS WERE IDENTIFIED IN SIXTEEN COUNTIES AND BY USING THE FOLLOWING CRITERIA:1. THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH; 2. AT LEAST ONE STATE, LOCAL, TRIBAL, OR REGIONAL GOVERNMENT PUBLIC HEALTH DEPARTMENT (OR EQUIVALENT DEPARTMENT OR AGENCY) OR STATE OFFICE OF RURAL HEALTH WITH KNOWLEDGE, INFORMATION, OR EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THAT COMMUNITY; 3. MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS IN THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, OR INDIVIDUAL OR ORGANIZATIONS SERVING OR REPRESENTING THE INTEREST OF SUCH POPULATIONS; 4. MEMBERS OF MEDICALLY UNDERSERVED POPULATIONS INCLUDE POPULATIONS EXPERIENCING HEALTH DISPARITIES OR AT RISK OF NOT RECEIVING ADEQUATE MEDICAL CARE AS A RESULT OF BEING UNINSURED OR UNDERINSURED OR DUE TO GEOGRAPHIC, LANGUAGE, FINANCIAL OR OTHER BARRIERS. EACH INTERVIEWER WAS CONTACTED USING A UNIFORM SCRIPT. THESE FACE-TO-FACE INTERVIEWS WERE CONDUCTED BY CHILDREN'S HOSPITAL ADMINISTRATIVE AND COMMUNITY BENEFIT STAFF AT SCHEDULED TIMES.
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.THERE ARE SIGNIFICANT DISPARITIES IN SOCIOECONOMIC CONDITIONS BETWEEN THE 16 COUNTIES SERVED BY EAST TENNESSEE CHILDREN'S HOSPITAL. THE RATE OF CHILDREN LIVING IN POVERTY IS EQUIVALENT OR EXCEEDS 25% OF THE CHILDHOOD POPULATION IN 10 OF THE 16 COUNTIES. THE PERCENTAGE OF CHILDREN WHO ARE PARTICIPATING IN FREE OR REDUCED LUNCH PROGRAMS AT SCHOOL APPROACHES 50% FOR ALL COUNTIES AND EXCEEDS 70% IN FOUR COUNTIES. POVERTY AND FOOD INSECURITY ARE GROWING CONCERNS BECAUSE OF THE LINKAGES BETWEEN THESE SOCIAL DETERMINANTS AND POOR HEALTH OUTCOMES.
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
Schedule H (Form 990) 2019
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