2021-11-14T11:54:34-06:00 2020-12-31 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2020-01-01 131739922 BLYTHEDALE CHILDREN'S HOSPITAL BLYT 9145927555 95 BRADHURST AVE VALHALLA NY 10595 JOHN CANNING CFO 9148312412 2021-11-15 1 JOHN CANNING XXX-XX-XXXX CHRISTINE KAWECKI P00743140 5169187000 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z LARRY LEVINE 95 BRADHURST AVE VALHALLA NY 10595 209490400 0 X WWW.BLYTHEDALE.ORG X 1891 NY BLYTHEDALE CHILDREN'S HOSPITAL IS DEDICATED TO IMPROVING THE HEALTH & WELL-BEING OF CHILDREN. 21 21 586 105 -516 0 2918253 11475558 77177295 72083602 562867 2513835 4047771 4536755 84706186 90609750 0 0 0 0 56380618 56778834 0 0 726200 28553083 28620793 84933701 85399627 -227515 5210123 245197443 255207206 48635446 47861193 196561997 207346013 X BLYTHEDALE CHILDREN'S HOSPITAL IS DEDICATED TO IMPROVING THE HEALTH & WELL-BEING OF CHILDREN. BLYTHEDALE IS A LEADER IN THE DIAGNOSIS & TREATMENT OF CHILDREN WITH DISABLING AND COMPLEX MEDICAL CONDITIONS. 0 0 50340640 50427693 INPATIENT SERVICES - BLYTHEDALE CHILDREN'S HOSPITAL, FOUNDED IN 1891, IS A LICENSED ACUTE CARE FREE-STANDING CHILDREN'S HOSPITAL THAT SPECIALIZES IN THE CARE OF CHILDREN REQUIRING REHABILITATIVE, RESPIRATORY AND COMPLEX MEDICAL CARE. BLYTHEDALE IS DESIGNATED BY CMS AS A PPS EXEMPT, FREESTANDING CHILDREN'S HOSPITAL. WITHIN BLYTHEDALE CHILDREN'S HOSPITAL, WE PROVIDE A COMPREHENSIVE RANGE OF SERVICES WHICH INCLUDE BUT ARE NOT LIMITED TO GENERAL PEDIATRICS, ADOLESCENT MEDICINE, PEDIATRIC PULMONOLOGY, CHILD NEUROLOGY, PSYCHIATRY, ORTHOPEDICS, PHYSICAL MEDICINE, AND REHABILITATION OF MULTIPLE PEDIATRIC SPECIALTIES (SUCH AS CARDIOLOGY, INFECTIOUS DISEASE, ENT, OPHTHALMOLOGY, ETC.) BLYTHEDALE MAINTAINS A CORE GROUP OF FULL TIME SPECIALTY COVERAGE IN PEDIATRICS, PULMONOLOGY, ADOLESCENT MEDICINE, NEUROLOGY, AND PSYCHIATRY. OTHER SUBSPECIALTY COVERAGE IS MAINTAINED AND UTILIZED AS NEEDED THROUGH A VARIETY OF CONTRACTUAL RELATIONSHIPS WITH THE AREA'S LEADING ACADEMIC MEDICAL CENTERS. BLYTHEDALE ALSO PROVIDES OTHER VITAL CLINICAL SERVICES SUCH AS NURSING, RESPIRATORY THERAPY, PSYCHOLOGY, CHILD LIFE, RESPIRATORY, SPEECH, OCCUPATIONAL AND PHYSICAL THERAPY, THERAPEUTIC RECREATION, SOCIAL WORK AND CASE MANAGEMENT. THE INPATIENT SERVICES ARE PRIMARILY COMPOSED OF 4 MAJOR PROGRAMS, PHYSICAL MEDICINE AND REHABILITATION SERVICES, VENTILATOR WEANING, TRAUMATIC BRAIN INJURY AND MEDICAL THERAPIES FOR COMPLEX AND CHRONIC HEALTH CONDITIONS.IN 2020, THE HOSPITAL OPERATED 86 LICENSED ACUTE BEDS, AND 24 PEDIATRIC LONG TERM CARE BEDS FOR A TOTAL OF 110 LICENSED BEDS. THE HOSPITAL PROVIDED CARE TO OVER 75 INPATIENTS, AND 24 LONG TERM CARE PATIENTS PER DAY IN 2020. THE HOSPITAL RECEIVED OVER 695 REGIONAL REFERRALS IN THE YEAR AND ADMITTED 417 KIDS. OVER 80% OF OUR INPATIENT ADMISSIONS WERE REIMBURSED THROUGH THE MEDICAID PROGRAM (FFS & MANAGED) IN 2020. WHILE 100% OF THE HOSPITALS INPATIENT POPULATION IS REFERRED IN FROM OTHER ACUTE CARE HOSPITALS IN THE REGION, OVER 55% COME DIRECTLY FROM INTENSIVE CARE UNITS (ICU'S). THIS SPEAKS TO THE HIGH ACUITY OF THE PATIENT POPULATION BEING MANAGED AT BLYTHEDALE. IN 2020 ALMOST 71% OF PATIENTS TREATED WERE BELOW THE AGE OF 6 YEARS. THIS FACT PRESENTS MANY UNIQUE CHALLENGES TO THE DELIVERY OF CARE AS THE HOSPITAL PROVIDES HIGH QUALITY TO BOTH THE PATIENTS AND THE FAMILY. BLYTHEDALE CHILDREN'S HOSPITAL DOESN'T OPERATE PRIMARY CARE CLINICS, OR AN EMERGENCY DEPARTMENT OR OBSTETRICAL SERVICES. THESE SERVICES ARE OFTEN THE PRIMARY DRIVERS OF UNINSURED PATIENTS AT ACUTE CARE HOSPITALS. SECONDLY, CHILDREN, MORE SO THAN ADULTS HAVE GREATER ACCESS TO MEDICAID REIMBURSEMENT AS A PAYER OF LAST RESORT BECAUSE OF STATE CHILD HEALTH PLUS LAWS. THESE TWO FACTORS SIGNIFICANTLY IMPACT THE REPORTED AMOUNT OF CARE CLASSIFIED AS TRUE CHARITY CARE RELATIVE TO FULL SERVICE ACUTE CARE HOSPITALS. 14163885 13794938 THE STEVEN AND ALEXANDRA COHEN PEDIATRIC LONG TERM CARE PAVILION, WHICH OPENED IN FALL 2016, IS A UNIQUE 24-BED FACILITY DEDICATED TO THE HIGHLY SPECIALIZED NEEDS OF INFANTS AND CHILDREN WHO REQUIRE EXTENDED MEDICAL CARE AND REHABILITATION. IN 2020, THE HOSPITAL CARED FOR 26 CHILDREN AND RAN AN AVERAGE OCCUPANCY OF 99%. 41% OF THE CHILDREN WERE UNDER THE AGE OF 6 AND 100% REQUIRED VENTILATOR-RESPIRATORY SUPPORT. THE PAVILION SERVES CHILDREN WITH COMPLEX MEDICAL NEEDS, INCLUDING THOSE WHO REQUIRE A LONGER PERIOD OF TIME TO BE WEANED FROM THE VENTILATOR, AND PREMATURE INFANTS WITH FEEDING DIFFICULTIES, CONGENITAL CONDITIONS OR NEUROLOGICAL DISORDERS. THE PAVILION IS STAFFED BY A FULL-TIME PEDIATRICIAN WHO WORKS IN CONSULTATION WITH A VARIETY OF PEDIATRIC SUBSPECIALISTS INCLUDING PEDIATRIC PULMONOLOGY, PEDIATRIC PHYSICAL MEDICINE AND REHABILITATION, AND PEDIATRIC NEUROLOGY. THE COMPREHENSIVE TEAM ALSO INCLUDE REGISTERED NURSES, CERTIFIED RESPIRATORY THERAPISTS, PHYSICAL/OCCUPATIONAL/SPEECH THERAPISTS, RECREATIONAL THERAPISTS, CHILD PSYCHOLOGISTS, CHILD LIFE SPECIALISTS AND A DEDICATED SOCIAL WORKER. FEATURES OF THE PAVILION INCLUDE 11 DOUBLE-BEDDED ROOMS AND TWO PRIVATE ROOMS, ALL WITH PIPED-IN OXYGEN, A SPACIOUS DINING AND RECREATION AREA, DEDICATED THERAPY SPACE, AN INFANT PLAY ROOM AND TEEN LOUNGE. AN ATTRACTIVE COURTYARD INCLUDES PLAY AREAS, WALKING PATHS AND SITTING AREAS FOR RESIDENTS AND THEIR FAMILIES. CHILDREN IN THE PEDIATRIC LONG TERM CARE UNIT HAVE ACCESS TO EDUCATION THROUGH THE ON-SITE MT. PLEASANT-BLYTHEDALE SCHOOL AND EARLY CHILDHOOD CENTER, AND RECREATIONAL PROGRAMMING ON EVENINGS, WEEKENDS AND HOLIDAYS. FAMILY INVOLVEMENT IS A KEY COMPONENT OF CARE AT BLYTHEDALE, AND PROGRESS TOWARD GOALS (ESTABLISHED UPON ADMISSION) WILL BE REVIEWED DURING PERIODIC FAMILY CONFERENCES. AN INTERDISCIPLINARY APPROACH TO TREATMENT IS A HALLMARK OF BLYTHEDALE, AND EACH PATIENT'S CLINICAL CARE TEAM WILL MEET EVERY TWO WEEKS TO DISCUSS THE INDIVIDUALIZED PLAN FROM EVERY PERSPECTIVE: MEDICAL, SOCIAL, PSYCHOLOGICAL AND EDUCATIONAL. 7168906 5903829 DAY HOSPITAL & CPSE PROGRAMS - BLYTHEDALE OFFERS A DAY HOSPITAL PROGRAM FOR THOSE CHILDREN WHO ARE ABLE TO LIVE AT HOME, BUT STILL REQUIRE A LEVEL OF MEDICAL AND REHABILITATIVE CARE THAT CANNOT BE MET BY THEIR SCHOOL OR OUTPATIENT PROGRAM. IN 2020, BLYTHEDALE TREATED 213 CHILDREN IN THE PROGRAM, EVEN WITH THE PROGRAM BEING CLOSED FOR 3 MONTHS DURING THE EARLY STAGES OF THE COVID 19 PANDEMIC. ROUGHLY 30 % OF THE PROGRAM COMES DIRECTLY FROM BLYTHEDALE'S INPATIENT SETTING, WHILE THE BALANCE COME DIRECTLY FROM REFERRALS IN THE COMMUNITY AND THROUGH THE EARLY INTERVENTION/CPSE PROGRAMS THROUGHOUT THE REGION. IN 2020, THE DAY HOSPITAL SERVED ON AVERAGE OF 181 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 11,559 VISITS. OVER 80+% OF THESE PATIENTS WERE REIMBURSED BY THE MEDICAID PROGRAM. THE DAY HOSPITAL PROGRAM PROVIDES A NURTURING ENVIRONMENT WHERE CHILDREN WITH VARIOUS SPECIAL MEDICAL NEEDS CAN RECEIVE DAILY MEDICAL SUPERVISION, NURSING CARE, AND HAVE THEIR NEEDS FOR PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES MET, ALL WHILE RETURNING HOME AT THE END OF THE DAY. EACH CHILD'S PROGRAM IS INDIVIDUALIZED TO ADDRESS THEIR UNIQUE MEDICAL, PSYCHOLOGICAL AND THERAPEUTIC NEEDS. IN ADDITION, EVERY CHILD IS ASSIGNED A SOCIAL WORKER TO PROVIDE FAMILY SUPPORT AND CASE MANAGEMENT. AS NECESSARY, ONGOING PSYCHOSOCIAL SUPPORT AND COUNSELING, AND CASE MANAGEMENT ARE PROVIDED. SERVICES FOR SCHOOL-AGE CHILDREN ARE PROVIDED IN CONJUNCTION WITH A FULL ACADEMIC PROGRAM UNDER THE AUSPICES OF THE MOUNT PLEASANT-BLYTHEDALE UNION FREE SCHOOL DISTRICT.COMMITTEE ON PRESCHOOL SPECIAL EDUCATION (CPSE PROGRAM): BLYTHEDALE CHILDREN'S HOSPITAL PROVIDES EVALUATION AND TREATMENT SERVICES FOR YOUNG CHILDREN BETWEEN THE AGES OF 3 TO 5 YEARS WHO ARE REFERRED THROUGH THEIR LOCAL COMMITTEE ON PRESCHOOL SPECIAL EDUCATION (CPSE). THESE PATIENTS ARE ELIGIBLE FOR ASSESSMENT AT NO COST TO THEIR FAMILIES. THE NEW YORK STATE EDUCATION DEPARTMENT OVERSEES A STATEWIDE PRESCHOOL SPECIAL EDUCATION PROGRAM WITH SCHOOL DISTRICTS, MUNICIPALITIES, APPROVED PROVIDERS, AND PARENTS. EVALUATIONS AND SERVICES ARE PROVIDED TO ELIGIBLE CHILDREN WHO HAVE A DISABILITY THAT AFFECTS THEIR LEARNING. FUNDING FOR EVALUATIONS AND SERVICES IS PROVIDED BY MUNICIPALITIES AND THE STATE. IN 2020, THE PROGRAM SERVED 32 PATIENTS FOR A TOTAL OF 2,127 VISITS. EVALUATION AND TREATMENT PLANNING ARE PERFORMED BY A MULTIDISCIPLINARY TEAM THAT MAY CONSIST OF THERAPISTS, SPECIAL EDUCATION TEACHERS, AUDIOLOGISTS, PHYSIATRISTS (REHABILITATION DOCTORS), NEUROLOGISTS, PSYCHIATRISTS, PSYCHOLOGISTS, SOCIAL WORKERS, NURSES, NUTRITIONISTS, AND OTHER SPECIALTY CONSULTANTS. 1229476 2728540 IN 2020, THE HOSPITAL PROVIDED 5,297 OUTPATIENT THERAPY, TELETHERAPY, AND SPECIALTY CLINIC VISITS TO PATIENTS IN THE REGION. BLYTHEDALE CHILDREN'S HOSPITAL IS WELL SUITED TO PROVIDE EVALUATION AND TREATMENT SERVICES FOR YOUNG CHILDREN. AS THE REGION'S PREMIERE HOSPITAL OFFERING REHABILITATIVE SERVICES TO CHILDREN, WE HAVE THE LARGEST DEPARTMENTS OF SPEECH THERAPY, OCCUPATIONAL THERAPY AND PHYSICAL THERAPY. THE EXPERTISE OF OUR HIGHLY SKILLED, MULTIDISCIPLINARY STAFF ENABLES US TO PROVIDE COORDINATED, COMPREHENSIVE, INDIVIDUALIZED PROGRAMS FOR THE CHILDREN AND FAMILIES WE SERVE. PARENTS AND STAFF WORK CLOSELY TOGETHER TO DEVELOP GOALS. EVALUATION AND TREATMENT PLANNING ARE PERFORMED BY A MULTI-DISCIPLINARY TEAM THAT MAY CONSIST OF THERAPISTS, PHYSIATRISTS (REHABILITATION DOCTORS), NEUROLOGISTS, PSYCHIATRISTS, PSYCHOLOGISTS, SPECIAL EDUCATION, TEACHERS, AUDIOLOGISTS, SOCIAL WORKERS, NURSES, NUTRITIONISTS, AND OTHER SPECIALTY CONSULTANTS. WHILE NOT LIMITED TO THE FOLLOWING, THE PROGRAM TREATS A WIDE ARRAY OF ISSUES AND DIAGNOSES INCLUDING; DELAYS OR LAGS IN REACHING THEIR DEVELOPMENTAL MILESTONES, CONGENITAL OR ACQUIRED ABNORMALITIES SUCH AS VISION OR HEARING IMPAIRMENTS, DIAGNOSED MEDICAL CONDITIONS SUCH AS CEREBRAL PALSY, NEUROMUSCULAR OR OTHER NEUROLOGICAL DISORDERSBLYTHEDALE CHILDREN'S HOSPITAL IS A PARTICIPATING PEDIATRIC HEALTH HOME PROVIDER OF CARE, AND A LEAD CARE COORDINATION AGENCY FOR MEDICALLY FRAGILE CHILDREN. OUR PROACTIVE CARE COORDINATION MODEL PROVIDES THE FAMILIES OF MEDICALLY FRAGILE CHILDREN WITH THE SUPPORT THEY NEED, LEADING TO MORE CONSISTENT MEDICAL CARE ON A REGULAR BASIS. THIS IS A PRIMARY GOAL OF THE HEALTH HOME PROJECT. A MAJOR GOAL OF BLYTHEDALE'S SYSTEM OF CARE COORDINATION IS TO ALLOW THE FAMILIES OF MEDICALLY FRAGILE CHILDREN TO LIVE THEIR LIVES AND THRIVE, RATHER THAN SIMPLY SURVIVE. HELPING FAMILIES NAVIGATE THE COMPLEX MAZE OF HEALTHCARE FOR MEDICALLY FRAGILE CHILDREN WHILE ASSISTING WITH SOCIAL ISSUES THAT IMPACT THEIR ABILITY TO CARE FOR THE CHILD IS A COMBINATION THAT WILL RESULT IN MORE EFFICIENT AND APPROPRIATE USE OF THE HEALTHCARE SYSTEM, WITH THE "RIGHT CARE" BEING PROVIDED AT THE "RIGHT TIME" IN THE "RIGHT PLACE." BLYTHEDALE'S MODEL INCLUDES IN-HOME VISITS WITH THE CHILD AND FAMILY, CARE PLANNING MEETINGS WITH THE FAMILY AND RELEVANT PROVIDERS, AND TOOLS TO ENSURE 24 HOUR/SEVEN DAYS A WEEK ACCESS TO CARE MANAGEMENT SUPPORT. 1229476 2728540 72902907 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 1 0 0 0 1 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 135 0 1 586 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 21 21 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X JOHN CANNING 9145927555 95 BRADHURST AVE VALHALLA NY 10595 ABBY POPPER TRUSTEE 1.00 0.00 X 0 0 0 ALAN GERSTEIN TRUSTEE 1.00 0.00 X 0 0 0 CINDY MUSOFF TRUSTEE 1.00 0.00 X 0 0 0 DAVID R PEDOWITZ TRUSTEE 1.00 0.00 X 0 0 0 DEAN CURNUTT TRUSTEE 1.00 0.00 X 0 0 0 FARREL STARKER TRUSTEE 1.00 0.00 X 0 0 0 HOWARD ADLER TRUSTEE 1.00 0.00 X 0 0 0 JOHN L FURTH TRUSTEE 1.00 0.00 X 0 0 0 JUDITH R WIENER GOODHUE TRUSTEE 1.00 0.00 X 0 0 0 KIM MOTOLA TRUSTEE 1.00 0.00 X 0 0 0 LANCE WACHENHEIM TRUSTEE 1.00 0.00 X 0 0 0 LARRY W COHEN TRUSTEE 1.00 0.00 X 0 0 0 OWEN GUTFREUND TRUSTEE 1.00 0.00 X 0 0 0 PERRY C HOFFMEISTER TRUSTEE 1.00 0.00 X 0 0 0 SCOTT COUGHLIN TRUSTEE 1.00 0.00 X 0 0 0 VIRGINIA FURTH WEISMAN TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM G LEVY TRUSTEE 1.00 0.00 X 0 0 0 LUCY SCHMOLKA SECRETARY 1.00 0.00 X X 0 0 0 PETER D RITTMASTER VICE CHAIR 1.00 0.00 X X 0 0 0 SCOTT R LEVY CHAIR 1.00 0.00 X X 0 0 0 TIM EVNIN TREASURER 1.00 0.00 X X 0 0 0 LAWRENCE LEVINE PRESIDENT AND CEO 40.00 0.00 X 704076 0 195386 SCOTT M KLEIN CHIEF MEDICAL OFFICER 40.00 0.00 X 470850 0 134687 JOHN E CANNING CHIEF FINANCIAL OFFICER 40.00 0.00 X 412210 0 127026 JILL M WEGENER CHIEF NURSING OFFICER 40.00 0.00 X 267744 0 28906 JOHN J FLANAGAN VICE PRESIDENT OF OPERATIONS 40.00 0.00 X 256058 0 31710 LISA KOCH-CAPOBIANCO VICE PRESIDENT OF DEVELOPMENT 40.00 0.00 X 199307 0 54470 ADAM S HERBST CHIEF LEGAL,GOV'T RELATIONS,ST 40.00 0.00 X 223600 0 24177 SUSAN GOODBODY-MURRAY CHIEF ENGAGEMENT & EXPERIENCE 40.00 0.00 X 201220 0 43628 CONSTANCE T CORNELL VICE PRESIDENT OF STRATEGIC CO 40.00 0.00 X 159477 0 52605 BYRON FERNANDEZ CLINICAL/UNIT CHIEF 40.00 0.00 X 331589 0 69082 KATHY SILVERMAN CLINICAL/UNIT CHIEF 40.00 0.00 X 270646 0 86515 MARY M DIDIE CLINICAL/UNIT CHIEF 40.00 0.00 X 216783 0 133736 RUTH E ALEJANDRO ATTENDING PHYSIATRIST 40.00 0.00 X 216483 0 52284 TRACY LYNN LAWRENCE-BLACK LTC MEDICAL DIRECTOR 40.00 0.00 X 210653 0 47193 MAUREEN DESIMONE CHIEF OPERATING OFFICER 40.00 0.00 X 309278 0 42767 ROBERT R LANE CHIEF DEVELOPMENT OFFICER 40.00 0.00 X 241456 0 55371 4691430 0 1179543 156 1 1 0 LEND LEASE 9TH FLOOR 200 PARK AVE NEW YORK NY 10166 CONSTRUCTION MANAGEMENT 3779589 SODEXO INC 500 ROSS ST PITTSBURGH PA 156200001 FACILITY SUPPORT SERVICES 3547812 SSC INC 25 CONTROLS DR SHELTON CT 06484 PHYSICAL SECURITY 766530 E4H ENVIRONMENTS 15 W 37TH ST NEW YORK NY 10018 ARCHITECTURE 479550 D&J SERVICE INC 1200 ZEREGA AVENUE BRONX NY 10462 TRANSPORTATION SERVICES 371525 11 1138860 6116751 4219947 219164 11475558 INPATIENT SERVICES 622110 50427693 50427693 RHCF LONG TERM CARE 622110 13794938 13794938 DAY HOSPITAL 622110 5903829 5903829 SCHOOL PROGRAM 611710 1051340 1051340 OUTPATIENT 621400 905802 905802 72083602 2802509 -516 2803025 118414520 118703194 -288674 -288674 -288674 117030 1138860 177456 -60426 -60426 SPENDING POLICY 900099 3618924 3618924 CAFETERIA 722514 206859 206859 MEDICAL RECORDS 900099 15066 15066 756332 756332 4597181 90609750 72855000 -516 6279708 3310409 1563634 1418155 328620 37928906 33062798 4799652 66456 5228877 4343105 796881 88891 7392777 6228210 1096284 68283 2917865 2423578 444683 49604 4193335 4037730 126819 28786 468650 416370 38520 13760 180002 162196 14533 3273 124191 71153 51602 1436 560337 560337 19115 16595 1447 1073 99650 91031 3647 4972 1463435 1240326 193237 29872 8268746 8130936 137073 737 9636 8996 314 326 37717 35868 972 877 215489 215489 6512575 5265417 1215898 31260 651223 599158 52065 CONTRACTED LABOR 3457377 2824208 629586 3583 TAXES/FEES/ASSESSMENTS 1171936 1073659 93886 4391 UTILITIES 779207 716911 62296 DEBT FEES 408172 375539 32633 85399627 72902907 11770520 726200 23551583 25260729 44000 1483450 10233989 9483024 2872158 4027661 456005 672452 903927 939376 130953350 68642655 63170253 62310695 86564068 87294842 56388901 62605458 1012559 1129519 245197443 255207206 5131027 4301014 580856 19771923 18944939 3865594 3479278 19866902 20555106 48635446 47861193 X 181598345 188884189 14963652 18461824 196561997 207346013 245197443 255207206 X 5210123 6440922 -867029 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 112081 0 1 12110 124191 0 PART II-B, LINE 1: BLYTHEDALE CHILDREN'S HOSPITAL, AS A MEMBER OF STATE-WIDE HOSPITAL ORGANIZATIONS, HAS A PORTION OF ITS DUES FOR LOBBYING. IN ADDITION, BLYTHEDALE HAS ENGAGED AN OUTSIDE LOBBYIST TO LOBBY ON ITS BEHALF ON ISSUES RELATING TO THE STATE BUDGET MEDICAID. 14963763 5079552 1756082 3337573 18461824 13082617 2957030 3042821 4118705 14963763 15056311 4270912 -659699 0 5584906 13082618 15662160 2796440 2173245 5575534 15056311 18084864 2554980 874730 5852414 15662160 0.00000 0.93300 0.06700 0 0 1383879 1383879 56378489 23607690 32770799 2808364 2808364 64717170 43066619 21650551 5665448 1968346 3697102 62310695 INVESTMENTS- OTHER SECURITIES 62605458 C 62605458 ACCRUED PENSION 18205189 EST. INSURANCE RECOVERIES 2254000 OTHER ASSET 17716 ASSET RETIREMENT OBLIGATION 78201 20555106 X 91319147 6440922 3398911 9839833 81479314 560337 8570099 9130436 90609750 83282281 0 83282281 560337 1557009 2117346 85399627 PART V, LINE 4: BLYTHEDALE MAINTAINS A VARIETY OF DONOR FUNDS RESTRICTED BY PURPOSE THAT COVER A VARIETY OF PROGRAM ACTIVITIES INCLUDING THE PROVISION OF TRANSPORTATION TO PARENT FAMILIES, SUPPORT FOR ASSISTIVE TECHNOLOGY, AND FUNDS THAT SUPPORT THE SALARIES OF THERAPISTS AMONG OTHERS. IN ADDITION, BLYTHEDALE MAINTAINS A NUMBER OF PERMANENT ENDOWMENTS, THE INCOME FROM WHICH IS PRIMARILY USED TO SUPPORT GENERAL OPERATIONS. THE HOSPITAL'S ENDOWMENT CONSISTS OF BOTH DONOR-RESTRICTED AND BOARD-DESIGNATED FUNDS. NET ASSETS ASSOCIATED WITH THE ENDOWMENT FUNDS ARE CLASSIFIED AND REPORTED BASED UPON THE EXISTENCE OR ABSENCE OF DONOR-IMPOSED RESTRICTIONS. NET ASSETS WITH DONOR RESTRICTIONS CONSIST OF ASSETS WHOSE USE IS LIMITED BY DONOR IMPOSED, TIME AND/OR PURPOSE RESTRICTIONS. THE HOSPITAL REPORTS GIFTS OF CASH AND OTHER ASSETS AS REVENUE WITH DONOR RESTRICTIONS IF THEY ARE RECEIVED WITH DONOR STIPULATIONS THAT LIMIT THE USE OF THE DONATED ASSETS. WHEN A DONOR RESTRICTION EXPIRES, THAT IS, WHEN A STIPULATED TIME RESTRICTION ENDS OR PURPOSE RESTRICTION IS ACCOMPLISHED, THE NET ASSETS WITH DONOR RESTRICTION ARE RECLASSIFIED TO NET ASSETS WITHOUT DONOR RESTRICTION AND REPORTED IN THE STATEMENTS OF OPERATIONS AND CHANGES IN NET ASSETS AS NET ASSETS RELEASED FROM RESTRICTIONS. AT DECEMBER 31, 2020 THE HOSPITAL HAD ENDOWMENTS INCLUDED IN NET ASSETS WITH DONOR RESTRICTIONS PLEDGE RECEIVABLES : $ 1,483,450 BENEFICIAL INTEREST IN TRUST : $1,129,519 DONOR RESTRICTED INVESTMENTS : $15,848,855 BLYTHEDALE CHILDREN'S HOSPITAL HAS A CHARITABLE REMAINDER TRUST HELD BY TRUSTEES CITIBANK, CALLED THE HENRY STERN TRUST. THE PRINCIPLE IS PERMANENTLY RESTRICTED. PART X, LINE 2: THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY WHEN THE TAX POSITIONS ARE MORE LIKELY THAN NOT TO BE SUSTAINED. MANAGEMENT HAS DETERMINED THAT THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS THAT WOULD REQUIRE FINANCIAL STATEMENT RECOGNITION OR DISCLOSURE. THE HOSPITAL IS NO LONGER SUBJECT TO EXAMINATIONS BY THE APPLICABLE TAXING JURISDICTIONS FOR PERIODS PRIOR TO 2017. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS 3,221,455. SCHEDULE G FUNDRAISING EXPENSE 177,456. PART XI, LINE 4B - OTHER ADJUSTMENTS: PENSION NPBC TRANSFER FROM NON OP 1,734,465. RESTRICTED CONTRIBUTIONS 6,835,634. PART XII, LINE 4B - OTHER ADJUSTMENTS: SCHEDULE G FUNDRAISING EXPENSES -177,456. PENSION NPBC TRANSFER FROM NON OP 1,734,465. CENTRAL AMERICA AND THE CARIBBEAN INVESTMENTS 28877289 EUROPE (INCLUDING ICELAND & GREENLAND) INVESTMENTS 2112032 0 0 0 0 0 0 30989321 0 30989321 1 0 1 1 1 0 PART III ACCOUNTING METHOD: STUART DIX GOLF EVENT 479890 412690 67200 49700 12927 FALL GALA 437632 437632 0 40640 4 338368 288538 49830 44592 29597 1255890 1138860 117030 94292 83164 177456 -60426 1 1 X 1 X 400.000000000000 1 X 1 1 0 1 1 131669 0 131669 0.00150 61187827 53627592 7560235 0.08850 61319496 53627592 7691904 0.09000 149390 22385 127005 0.00150 507135 87152 419983 0.00490 825952 392643 433309 0.00510 526489 11600 514889 0.00600 2008966 513780 1495186 0.01750 63328462 54141372 9187090 0.10750 677186 355044 322142 0.00380 677186 355044 322142 0.00380 1 0 0 0 0 X 1 1 1 1 BLYTHEDALE CHILDREN'S HOSPITAL 95 BRADHURST AVE VALHALLA NY 10595 WWW.BLYTHEDALE.ORG 5957000H X X THE STEVEN & ALEXANDRA COHEN PEDIATRIC LONG TERM CARE FACILITY BLYTHEDALE CHILDREN'S HOSPITAL 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X WWW.BLYTHEDALE.ORG X 1 19 1 WWW.BLYTHEDALE.ORG 0 1 X 400.000000000000 400.000000000000 1 1 X X X X 1 X WWW.BLYTHEDALE.ORG X WWW.BLYTHEDALE.ORG X WWW.BLYTHEDALE.ORG X X X X X X X 1 X 0 X X X X 0 X X X 0 0 BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 5: THE WESTCHESTER COUNTY DOH CONVENED A WORKGROUP OF LOCAL HOSPITALS TO SELECT PRIORITIES FROM THE STATE'S PREVENTION AGENDA AND COLLABORATIVELY DEVELOP PLANS TO ADDRESS THESE PRIORITIES AS PART OF WESTCHESTER COUNTY DOH'S COMMUNITY HEALTH ASSESSMENT. THE WESTCHESTER COUNTY WORKGROUP DISTRIBUTED COMMUNITY AND PROVIDER SURVEYS TO COLLECT EXTENSIVE DATA ABOUT THE PARAMOUNT HEALTH CARE NEEDS WITHIN THE COMMUNITY AND COMPARED THAT DATE WITH THE CURRENT STATE OF AFFAIRS WITHIN THE COUNTY TO DESIGNATE SPECIFIC AGENDA ITEMS. IN ADDITION TO ITS REFERRING HOSPITALS, BLYTHEDALE WORKS CLOSELY WITH THE WESTCHESTER COUNTY DEPARTMENT OF HEALTH (DOH) TO IDENTIFY COMMUNITY HEALTH PRIORITIES RELEVANT TO BLYTHEDALE'S MISSION AND SERVICES.THE PURPOSE OF THIS COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY SERVICE PLAN IS THREEFOLD:1. ASSIST IN IDENTIFYING PRIORITY HEALTH NEEDS OF THE AREA SERVED BY BLYTHEDALE CHILDREN'S HOSPITAL;2. COMPLY WITH THE REQUIREMENTS AND GUIDELINES OF THE NYS DEPARTMENT OF HEALTH FOR A COMMUNITY SERVICE PLAN; AND3. COMPLY WITH THE REQUIREMENTS PROMULGATED BY THE INTERNAL REVENUE SERVICE (IRS) BASED ON THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT ENACTED MARCH 23, 2010 THAT ALL 501(C)(3) HOSPITAL ORGANIZATIONS CONDUCT A "COMMUNITY HEALTH NEEDS ASSESSMENT AND PREPARE A CORRESPONDING IMPLEMENTATION STRATEGY ONCE EVERY THREE TAXABLE YEARS."AS DIRECTED BY THE STATE HEALTH DEPARTMENT, BLYTHEDALE'S 2019-2021 COMMUNITY SERVICE PLAN ADDRESSES HEALTH IMPROVEMENT PRIORITIES FROM THE STATE'S PREVENTION AGENDA, INCLUDING THOSE SELECTED BY A COALITION OF LOCAL COMMUNITY HOSPITALS AND OTHER COMMUNITY REPRESENTATIVES CONVENED BY THE WESTCHESTER COUNTY DEPARTMENT OF HEALTH. AS A SPECIALTY HOSPITAL SERVING ONLY CHILDREN AND ADOLESCENTS, BLYTHEDALE HAS SELECTED PRIORITIES FROM THE STATE'S PREVENTION AGENDA WHICH ADDRESS ISSUES OF CONCERN TO BLYTHEDALE'S LOCAL COMMUNITY AND ITS COMMUNITY OF REFERRING HOSPITALS IN THE NEW YORK CITY METROPOLITAN AREA. IT ALSO IDENTIFIED TARGET OBJECTIVES FOR MEASURING FUTURE ACHIEVEMENTS MADE IN ADDRESSING THE SELECTED PRIORITIES. BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 6B: WESTCHESTER COUNTY DEPARTMENT OF HEALTHREGIONAL BEHAVIORAL HEALTH WORKGROUPA LARGE COLLECTION OF AGENCIES AND HOSPITALS FROM ACROSS THE MID-HUDSON REGION HAVE JOINED TOGETHER TO CREATE A MONTHLY BEHAVIORAL HEALTH WORKGROUP THAT EVALUATES THE MENTAL AND BEHAVIORAL HEALTH NEEDS OF THE COMMUNITY. COMMUNITY PARTNERS OF OSSINING, CENTERS FOR DISEASE CONTROL/NHSN, AND WESTCHESTER MEDICAL CENTER BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 11: BLYTHEDALE'S COMMUNITY SERVICE PLAN FOR 2019-2021 IDENTIFIED A NUMBER OF HEALTH INDICATORS AS A BASIS FOR SELECTING PRIORITIES. AS NOTED ABOVE, IN ADDITION TO PUBLIC INPUT, A VARIETY OF DATA FROM THE NYS DEPARTMENT OF HEALTH, WESTCHESTER COUNTY COMMUNITY HEALTH ASSESSMENTS, AND OTHER SOURCES WERE USED TO IDENTIFY THE HEALTH PRIORITIES. THE FOLLOWING GOALS WERE SELECTED AS STATE AND COUNTY-WIDE PRIORITIES: PREVENT COMMUNICABLE DISEASES PREVENT CHRONIC DISEASES PROMOTE A HEALTHY AND SAFE ENVIRONMENT PROMOTE ACCESS FOR PHYSICAL ACTIVITY PROMOTE HEALTHY WOMEN, INFANTS AND CHILDREN PROMOTE WELL-BEING AND PREVENT MENTAL AND SUBSTANCE ABUSE DISORDERSAS NOTED ABOVE, SEVERAL OF PRIORITY INITIATIVES IDENTIFIED BY THE COUNTY WERE NOT WITHIN BLYTHEDALE'S SCOPE OF PRACTICE. THEREFORE, IT HAD FOCUSED ON THOSE PRIORITIES THAT FELL WITHIN THE HOSPITAL'S MISSION.THE PURPOSE OF BLYTHEDALE'S ANTIMICROBIAL STEWARDSHIP PROGRAM (ASP) IS TO ADVANCE THE HOSPITAL'S ANTIMICROBIAL PRESCRIBING PRACTICES THAT ASSIST IN REDUCING THE RISK OF ANTIMICROBIAL RESISTANCE IN THE COMMUNITY ONCE A PATIENT IS DISCHARGED.BY 2021, BLYTHEDALE WILL MEET THE FOLLOWING OBJECTIVES:1. REDUCE THE STANDARDIZED ANTIMICROBIAL ADMINISTRATION RATIO (SAAR) BY 5%. THE SAAR YEAR TO DATE FOR 2019 IS 0.415. AN SAAR OF LESS THAN ONE IS CONSIDERED TO BE OPTIMUM.2. MONITOR ANTIMICROBIAL PRESCRIBING PRACTICES IN THE HOSPITAL AND REPORT TO THE PRESCRIBERS AND THE CHIEF MEDICAL OFFICER.3. MONITOR CHANGING PATTERNS OF ANTIMICROBIAL RESISTANCE BASED ON THE HOSPITALS ANTIBIOGRAM AND REPORT TREATMENT RECOMMENDATIONS TO THE PRESCRIBERS.BY AUGUST 2021, BLYTHEDALE WILL INCREASE THE PERCENTAGE OF SCHOOL STAFF MEMBERS EDUCATED ON TRAUMA-INFORMED, RESILIENCE FOCUSED PRACTICES TO ADDRESS ACES. THE WELLNESS PROGRAM WILL ALSO IMPLEMENT SCHOOL-BASED PROGRAMS, PARTICIPATE IN COMMUNITY EVENTS AND FORM COMMUNITY PARTNERSHIPS AIMED TO IMPROVE CHILDREN'S MENTAL HEALTH.INTERVENTIONS AND ACTIVITIES1. INFORM AND IMPROVE SCHOOL WELLNESS PROGRAMS & PROTOCOLS:SCHOOLS ARE IN A UNIQUE POSITION TO IMPROVE BOTH THE DETRIMENTAL IMPACTS OF ADVERSE CHILDHOOD EXPERIENCES (ACES) AND THE HEALTH STATUS OF YOUNG PEOPLE ACROSS THE NATION. WE WILL SUPPORT SCHOOLS IN CUSTOMIZING AN APPROACH TO HEALTH BASED ON A MULTIDIMENSIONAL- MODEL WELLNESS PROGRAM, THE FOCUS OF WHICH WOULD BE COORDINATING POLICY, STRATEGIES AND CURRICULUM RELATED TO SIX KEY COMPONENTS (NUTRITION AND HEALTHY EATING, PHYSICAL EDUCATION AND PHYSICAL ACTIVITY, HEALTH EDUCATION, HEALTH SERVICES, PSYCHOLOGICAL AND SOCIAL SERVICES, AND EMPLOYEE WELLNESS). THESE COMPONENTS SERVE THE DIRECT HEALTH NEEDS OF THE STUDENTS AND STAFF, WHICH RESULTS IN IMPROVED HEALTH OUTCOMES AND LEARNING. OUR MISSION IS TO INSPIRE AND GUIDE SCHOOLS TO EVALUATE THEIR CURRENT STATUS, OFFER EDUCATION TO THE KEY STAKEHOLDERS, ENCOURAGE SHORT AND LONG-TERM GOAL-SETTING, INFORM ON ENDORSED POLICY AND STRATEGIES; AND SERVE AS A RESOURCE FOR EVIDENCE-BASED HEALTH EDUCATION AND PREVENTION-BASED PROGRAMS.BLYTHEDALE HAS PROVIDED A SIGNIFICANT AMOUNT OF COMMUNITY BENEFIT PROGRAMS, AS EVIDENCED THROUGH A VARIETY OF PROGRAMS AND SERVICES, INCLUDING:CARE MANAGEMENT: BLYTHEDALE BEGAN WORKING WITH HUDSON RIVER HEALTHCARE'S COMMUNITY CARE COLLABORATIVE HEALTH HOME SERVING CHILDREN PROGRAM AS A CMA (CARE MANAGEMENT AGENCY) FOR MEDICALLY FRAGILE CHILDREN. OUR CARE MANAGER SERVES AN AVERAGE OF 15 MEDICALLY FRAGILE CHILDREN AND THEIR FAMILIES IN WESTCHESTER COUNTY THROUGH THIS IMPORTANT NYSDOH INITIATIVE.CPR TRAINING CENTER: BLYTHEDALE HAS BEEN A COMMUNITY TRAINING CENTER FOR THE AMERICAN HEART ASSOCIATION, PROVIDING TRAINING IN HEARTSAVER CPR (CARDIO-PULMONARY RESUSCITATION), HEARTSAVER AED (AUTOMATED EXTERNAL DEFIBRILLATOR) AND HEARTSAVER FIRST AID. IN ADDITION TO BLYTHEDALE STAFF, THOSE TRAINED INCLUDE HEALTH CARE PROFESSIONALS, MEMBERS OF LOCAL POLICE AND FIRE DEPARTMENTS, STUDENTS AT AREA SCHOOLS AND STAFF FROM VARIOUS COMMUNITY AGENCIES. BLYTHEDALE HAS ALSO OFFERED PEDIATRIC CPR TRAINING FOR THE COMMUNITY AND HEALTH CARE PROFESSIONALS, AND IS A CERTIFIED PEDIATRIC ADVANCED LIFE SUPPORT (PALS) TRAINING CENTER.FIRST RESPONDER TRAINING PROGRAM: BLYTHEDALE, IN COORDINATION WITH THE WESTCHESTER REGIONAL EMS OFFICE, WESTCHESTER COUNTY DEPARTMENT OF ENVIRONMENTAL SERVICES, AND THE NYS EMS FOR CHILDREN PROGRAM, HAS DEVELOPED A SPECIAL PEDIATRIC CONTINUING MEDICAL EDUCATION SERIES FOR FIRST RESPONDERS OF THE WESTCHESTER EMS REGION. THE SERIES COVERS SUBJECTS VITAL TO FIRST RESPONDERS, INCLUDING TRAUMATIC BRAIN INJURY, AUTISM, TECHNOLOGY AND CARE OF THE INFANT OR CHILD, CHILD ABUSE/NEGLECT AND CHILD/INFANT SAFETY DURING TRANSFER. THE COURSES ARE PRESENTED BY BLYTHEDALE CLINICAL EXPERTS, INCLUDING PHYSICIANS, NURSES, AND THERAPISTS. BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 16J: BLYTHEDALE CHILDREN'S HOSPITAL IS A LONG-TERM, REFERRAL-BASED, CHILDREN'S HOSPITAL. ALL PATIENTS ARE PROVIDED INFORMATION REGARDING BLYTHEDALE'S POLICIES UPON THEIR REFERRAL TO THE HOSPITAL. BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 21D: HOSPITAL IS A REGIONAL SPECIALTY CHILDREN'S HOSPITAL, AND DOES NOT HAVE AN EMERGENCY ROOM. PART I, LINE 3C: NA PART I, LINE 7: EXPLANATION: BLYTHEDALE DETERMINES A PATIENT'S COST USING AVAILABLE COST DATA AND RATIOS FROM THE MOST RECENTLY FILED NYS ICR. A PROSPECTIVE PATIENT'S GROSS CHARGES ARE ESTIMATED FOR EACH OF THE SERVICES AND ALLOWANCED DOWN TO COST BASED UPON THE RATIO OF COST TO CHARGES. WE THEN DISCOUNT THE COST DOWN ON A SLIDING % BASIS IN THE FAP SCHEDULE USING A PATIENT'S ADJUSTED GROSS INCOME (AGI) FROM THEIR MOST RECENT TAX RETURN AND TAKING INTO ACCOUNT THEIR NUMBER OF DEPENDENTS / FAMILY SIZE REPORTED. PART II, COMMUNITY BUILDING ACTIVITIES: AS A RESULT OF THE COVID-19 PANDEMIC IN 2020, THE ORGANIZATION'S ABILITY TO PHYSICALLY INTERACT WITH MANY COMPONENTS OF THE COMMUNITY AT PREVIOUS REPORTED SERVICE LEVELS WAS HAMPERED. BLYTHEDALE STILL PROVIDED A SIGNIFICANT AMOUNT OF COMMUNITY BENEFIT PROGRAMS, AS EVIDENCED THROUGH A VARIETY OF PROGRAMS AND SERVICES, INCLUDING:CARE MANAGEMENT: BLYTHEDALE BEGAN WORKING WITH HUDSON RIVER HEALTHCARE'S COMMUNITY CARE COLLABORATIVE HEALTH HOME SERVING CHILDREN PROGRAM AS A CMA (CARE MANAGEMENT AGENCY) FOR MEDICALLY FRAGILE CHILDREN. OUR CARE MANAGER SERVES AN AVERAGE OF 15 MEDICALLY FRAGILE CHILDREN AND THEIR FAMILIES IN WESTCHESTER COUNTY THROUGH THIS IMPORTANT NYSDOH INITIATIVE.CPR TRAINING CENTER: BLYTHEDALE HAS BEEN A COMMUNITY TRAINING CENTER FOR THE AMERICAN HEART ASSOCIATION, PROVIDING TRAINING IN HEARTSAVER CPR (CARDIO-PULMONARY RESUSCITATION), HEARTSAVER AED (AUTOMATED EXTERNAL DEFIBRILLATOR) AND HEARTSAVER FIRST AID. IN ADDITION TO BLYTHEDALE STAFF, THOSE TRAINED INCLUDE HEALTH CARE PROFESSIONALS, MEMBERS OF LOCAL POLICE AND FIRE DEPARTMENTS, STUDENTS AT AREA SCHOOLS AND STAFF FROM VARIOUS COMMUNITY AGENCIES. BLYTHEDALE HAS ALSO OFFERED PEDIATRIC CPR TRAINING FOR THE COMMUNITY AND HEALTH CARE PROFESSIONALS, AND IS A CERTIFIED PEDIATRIC ADVANCED LIFE SUPPORT (PALS) TRAINING CENTER.FIRST RESPONDER TRAINING PROGRAM: BLYTHEDALE, IN COORDINATION WITH THE WESTCHESTER REGIONAL EMS OFFICE, WESTCHESTER COUNTY DEPARTMENT OF ENVIRONMENTAL SERVICES, AND THE NYS EMS FOR CHILDREN PROGRAM, HAS DEVELOPED A SPECIAL PEDIATRIC CONTINUING MEDICAL EDUCATION SERIES FOR FIRST RESPONDERS OF THE WESTCHESTER EMS REGION. THE SERIES COVERS SUBJECTS VITAL TO FIRST RESPONDERS, INCLUDING TRAUMATIC BRAIN INJURY, AUTISM, TECHNOLOGY AND CARE OF THE INFANT OR CHILD, CHILD ABUSE/NEGLECT AND CHILD/INFANT SAFETY DURING TRANSFER. THE COURSES ARE PRESENTED BY BLYTHEDALE CLINICAL EXPERTS, INCLUDING PHYSICIANS, NURSES, AND THERAPISTS. PART III, LINE 2: IN 2020 THE HOSPITAL RECORDED $0 IN THE BAD DEBT EXPENSE ON THE IRS 990. THIS WAS A RESULT OF THE HOSPITAL ADOPTING NEW ACCOUNTING STANDARD ASU 2014-09 WHICH ESSENTIALLY NEGATES THE WAY BAD DEBT WAS DISCLOSED IN PRIOR YEARS. THE HOSPITAL DID RECOGNIZED $1,211,456 OF IMPLICIT PRICE CONCESSIONS IN 2020 RELATED TO DENIED REIMBURSEMENT FROM THIRD PARTY INSURERS WHERE CARE WAS PROVIDED. PART III, LINE 3: AS A RESULT OF IMPLEMENTING ASU 2014-09, CERTAIN PATIENT ACTIVITY WHERE COLLECTION IS UNCERTAIN PREVIOUSLY REPORTED AS NET PATIENT SERVICE REVENUE AND BAD DEBT EXPENSE IN THE HOSPITAL'S CONSOLIDATED STATEMENTS OF OPERATIONS NO LONGER MEETS THE CRITERIA FOR REVENUE RECOGNITION AND, ACCORDINGLY, BAD DEBT EXPENSE AFTER THE ADOPTION DATE IS SIGNIFICANTLY REDUCED WITH A CORRESPONDING REDUCTION TO NET PATIENT SERVICE REVENUE. FOR THE YEAR ENDED DECEMBER 31, 2020, THE HOSPITAL RECORDED APPROXIMATELY $1.2 MILLION OF IMPLICIT PRICE CONCESSIONS AS A DIRECT REDUCTION TO NET PATIENT SERVICE REVENUE THAT WOULD HAVE BEEN RECORDED AS BAD DEBT EXPENSE PRIOR TO THE ADOPTION OF ASU 2014-09. ADDITIONALLY, BAD DEBT EXPENSE AFTER DECEMBER 31, 2019 IS NOW PRESENTED AS AN EXPENSE ITEM (INCLUDED AS A COMPONENT OF SUPPLIES AND OTHER EXPENSES) RATHER THAN A REDUCTION TO NET PATIENT SERVICE REVENUE.THE HOSPITAL ALSO PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE THE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE IS NOT PURSUED, THEY ARE NOT REPORTED AS REVENUE. THE AMOUNT OF IDENTIFIED CHARITY CARE PROVIDED AT COSTNET OF ANY REIMBURSEMENTS DURING THE YEARS ENDED DECEMBER 31, 2020 AND 2019, WAS $131,669 AND $54,724, RESPECTIVELY. THE ESTIMATED COST OF THESE CHARITY CARE SERVICES WAS DETERMINED USING A RATIO OF COST TO GROSS CHARGES AND APPLYING THAT RATIO TO THE GROSS CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS FOR THE PERIOD. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR SERVICES TO PATIENTS AND PATIENT SERVICE REVENUEACCOUNTS RECEIVABLE ARE STATED AT ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS, AND OTHER INSURERS TO WHICH THE HOSPITAL EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE. MANAGEMENT PERIODICALLY REVIEWS THE ADEQUACY OF THE IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL EXPERIENCE, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS.SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE (DETERMINED ON A PORTFOLIO BASIS WHEN APPLICABLE) ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. FOR THE YEAR ENDED DECEMBER 31, 2020, CHANGES IN THE HOSPITAL'S ESTIMATES OF EXPECTED PAYMENTS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR YEARS WERE NOT SIGNIFICANT. PORTFOLIO COLLECTION ESTIMATES ARE UPDATED BASED ON COLLECTION TRENDS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY (DETERMINED ON A PORTFOLIO BASIS WHEN APPLICABLE) ARE RECORDED AS BAD DEBT EXPENSE. BAD DEBT EXPENSE FOR THE YEAR ENDED DECEMBER 31, 2020, WAS NOT SIGNIFICANT. PART III, LINE 8: BLYTHEDALE IS A CHILDREN'S HOSPITAL AND SERVES A PEDIATRIC POPULATION TYPICALLY NOT ELIGIBLE FOR THE MEDICARE PROGRAM.BLYTHEDALE, AS A CHILDREN'S HOSPITAL RECEIVED IMMATERIAL AMOUNTS OF MEDICARE REIMBURSEMENT. IN 2020 THE HOSPITAL FILED A LOW/NO COST UTILIZATION REPORT WITH CMS. PART III, LINE 9B: 1. BCH WILL SEEK PAYMENT ON ACCOUNTS WITH BALANCES IN SELF-PAY (I.E., PATIENT LIABILITY). BCH DOES NOT TAKE PART IN EXTRAORDINARY COLLECTION ACTIONS (ECA) BEFORE MAKING REASONABLE EFFORTS TO DECIDE WHETHER FINANCIAL ASSISTANCE IS AVAILABLE AND/OR COLLECTION EFFORTS HAVE BEEN PURSUED. ANY ITEMIZED STATEMENT REQUESTED BY A GUARANTOR WILL BE GIVEN WITHIN TEN (10) DAYS OF SUCH REQUEST, IN COMPLIANCE WITH NEW YORK LAW.2. BCH WILL MAKE REASONABLE EFFORTS TO NOTIFY PATIENTS AND FAMILIES ABOUT THE FAP THROUGH THE FOLLOWING METHODS:A. ORALLY NOTIFY INDIVIDUALS ABOUT THE FAP AND HOW TO OBTAIN ASSISTANCE WITH THE APPLICATION PROCESS.B. BCH WILL REFRAIN FROM INITIATING ECAS UNLESS AUTHORIZED BY THE CFO.C. BCH WILL SEND AT LEAST THREE MONTHLY BILLING NOTICES IN A THIRTY (30) DAY PERIOD, FOR AT LEAST 3 MONTHS OR CYCLES, TO THE GUARANTOR OF AN ACCOUNT INFORMING OF A BALANCE DUE.1) FIRST NOTICE INFORMS THE GUARANTOR THAT THERE IS AN UNPAID BALANCE DUE ON AN ACCOUNT;2) SECOND NOTICE REMINDS THE GUARANTOR OF CONTINUED UNPAID BALANCE;3) FINAL NOTICE OF THE PAST DUE ACCOUNT NOTIFIES THE GUARANTOR THAT HE/SHE HAS THIRTY (30) DAYS TO RESOLVE THE DEBT, OR ECAS MAY BE TAKEN ON THE DEBT AND WILL SPECIFY THE ECAS THAT BCH INTENDS TO TAKE AND INCLUDE A COPY OF THE PLAIN LANGUAGE SUMMARY.NOTE: THE ACCOUNT CAN EITHER BE PAID IN FULL, SET UP ON A PAYMENT PLAN, REFERRED TO FINANCIAL COUNSELING, OR MORE INSURANCE INFORMATION OBTAINED DURING THIS TIMELINE. A PLAIN LANGUAGE NOTICE OF BCH'S FAP IS PROVIDED IN BOTH ENGLISH AND SPANISH ON EVERY BILLING STATEMENT.D. AFTER THREE (3) BILLING NOTICES HAVE BEEN SENT AND NO PAYMENT HAS BEEN RECEIVED WITHIN SIXTY (60) DAYS OF THE FINAL NOTICE, THE ACCOUNT MAY BE CONSIDERED TO BAD DEBT AND ECAS MAY BE TAKEN.1) ACCOUNTS QUALIFY FOR BAD DEBT WHEN PATIENT BALANCES (I.E., SELF-PAY) HAVE NOT BEEN PAID AND THE HOSPITAL HAS MADE REASONABLE EFFORTS, THAT INCLUDE BUT ARE NOT LIMITED TO PHONE CALLS, STATEMENTS OR LETTERS, TO DECIDE WHETHER THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE.2) THE BAD DEBT AGENCY WILL REPORT TO THE CREDIT BUREAU SIXTY (60) DAYS AFTER AN ACCOUNT IS PLACED WITH SUCH BAD DEBT AGENCY IF NO ACTION IS TAKEN BY THE GUARANTOR TO RESOLVE THE BALANCE EITHER BY MAKING A PAYMENT OR BY SUBMITTING ADDITIONAL DISPUTE INFORMATION.3) IF ALL OTHER OPTIONS TO COLLECT PAYMENT HAVE BEEN TAKEN AND AN ACCOUNT IN BAD DEBT HAS AGED MORE THAN SIXTY (60) DAYS WITHOUT CONTACT FROM THE GUARANTOR OR THE GUARANTOR REFUSES TO RESOLVE THE BALANCE, LEGAL ACTION MAY BE TAKEN.E. INITIATION OF A FINANCIAL ASSISTANCE APPLICATION1) THE APPLICATION PERIOD FOR FINANCIAL ASSISTANCE WILL END NO EARLIER THAN 240 DAYS FROM THE FIRST POST-VISIT BILL.F. ALL PARTIES ENGAGED IN COLLECTION ACTIONS FOR BCH WILL FOLLOW TO THIS POLICY. PART VI, LINE 2: SINCE THE VAST MAJORITY OF ADMISSIONS TO BLYTHEDALE COME BY REFERRAL FROM OTHER HOSPITALS, PARTICULARLY THE LARGE MEDICAL CENTERS IN THE METROPOLITAN NEW YORK AND HUDSON VALLEY AREA, BLYTHEDALE'S SENSE OF NEED FOR CLINICAL SERVICES LARGELY EMANATES FROM REFERRING HOSPITALS AND THEIR PHYSICIANS. BLYTHEDALE CONTINUOUSLY REVIEWS WITH REFERRING HOSPITALS AND PHYSICIANS THEIR NEEDS FOR SERVICES.HOWEVER, IN ADDITION TO ITS REFERRAL HOSPITALS, BLYTHEDALE ALSO WORKS CLOSELY WITH A VARIETY OF LOCAL AGENCIES, NOTABLY THE WESTCHESTER, ROCKLAND AND PUTNAM COUNTY DEPARTMENTS OF HEALTH TO IDENTIFY COMMUNITY HEALTH PRIORITIES THAT ARE RELEVANT TO BLYTHEDALE'S MISSION AND SERVICES. PARTICIPANTS IN THESE COALITIONS INCLUDE THE MAJOR CHILD AND ADOLESCENT HEALTH-FOCUSED COMMUNITY-BASED ORGANIZATIONS IN WESTCHESTER. BLYTHEDALE ALSO HAS CLOSE WORKING RELATIONSHIPS WITH MANY OF THE SCHOOL DISTRICTS IN WESTCHESTER COUNTY, THROUGH ITS NUTRITION EDUCATION ACTIVITIES, AND THROUGH ARRANGEMENTS WHEREBY BLYTHEDALE STAFF ARE CONTRACTED TO PROVIDE PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES TO CHILDREN IN THE SCHOOLS. PART VI, LINE 3: CONSISTENT WITH ITS MISSION AND STATE REQUIREMENTS (NEW YORK STATE PUBLICHEALTH LAW 2807(K) (9-A), BLYTHEDALE HAS DEVELOPED GUIDELINES THAT DELINEATE THE CIRCUMSTANCES AND PROCEDURES UNDER WHICH FREE OR REDUCED COST CARE IS AVAILABLE. THESE GUIDELINES ARE MADE AVAILABLE TO ALL FAMILIES UPON REGISTRATION, AND HOSPITAL STAFF PROVIDE COUNSELING AS NECESSARY. INTERPRETATION SERVICES ARE AVAILABLE FOR PATIENTS NEEDING INFORMATION IN LANGUAGES OTHER THAN ENGLISH. PATIENTS ARE ALSO NOTIFIED OF BLYTHEDALE'S CHARITY CARE FINANCIAL ASSISTANCE POLICIES THROUGH NOTICES IN ENGLISH AND SPANISH POSTED IN THE HOSPITAL'S LOBBY AND IN PATIENT REGISTRATION AND WAITING AREAS. IN ADDITION, BLYTHEDALE'S PATIENT ASSISTANCE FUNDS HELPS PROVIDE CHILDREN WITH VARIOUS ITEMS (I.E., EQUIPMENT, CLOTHING, ETC.) WHERE FAMILY RESOURCES ARE LIMITED AND INSURANCE DOES NOT COVER. PART VI, LINE 4: AS A SPECIALTY CHILDREN'S HOSPITAL SERVING CHILDREN WITH A BROAD RANGE OF DIAGNOSES, BLYTHEDALE'S SERVICE AREA IS WIDESPREAD, WITH PATIENTS COMING FROM THE ENTIRE SOUTHERN PORTION OF NEW YORK STATE AS WELL AS ADJACENT AREAS OF NEW JERSEY AND CONNECTICUT: NEW YORK CITY (56%), HUDSON VALLEY (26%), LONG ISLAND (7%), OUT OF STATE (8%). THE HOSPITAL IS LOCATED IN A SUBURBAN COUNTY (WESTCHESTER) THAT IS PART OF THE GREATER NEW YORK METROPOLITAN AREA. BLYTHEDALE'S PATIENT POPULATION REFLECTS THE ETHNIC AND RACIAL DIVERSITY OF ITS LARGE SERVICE AREA, AS ILLUSTRATED BY BOTH ITS INPATIENT POPULATION: ASIAN (4%); BLACK OR AFRICAN-AMERICAN (33%); HISPANIC OR LATINO (32%); WHITE (24%); OTHER (7%), AND OUTPATIENT POPULATION: ASIAN (2%); BLACK OR AFRICAN-AMERICAN (18%); HISPANIC OR LATINO (33%); WHITE (39%); OTHER (8%). TO ADDRESS THIS DIVERSITY, THE HOSPITAL PROVIDES STAFF TRAINING IN CULTURAL DIVERSITY, INTERPRETER SERVICES, DIETARY VARIETY AND OTHER ACCOMMODATIONS TO SUPPORT FAMILIES FROM DIFFERENT CULTURAL BACKGROUNDS WHILE THEIR CHILDREN ARE PATIENTS AT BLYTHEDALE. PART VI, LINE 5: THE GLOBAL VIRAL OUTBREAK CAUSED BY CORONAVIRUS DISEASE 2019 ("COVID-19") HAS RESULTED IN A NATIONAL PUBLIC HEALTH EMERGENCY DURING 2020, WHICH IS CONTINUING INTO 2021. THERE HAVE BEEN RESULTING EFFECTS IN THE ECONOMY GENERALLY AND TO THE HEALTH CARE INDUSTRY SPECIFICALLY THAT HAVE AND WILL CONTINUE TO IMPACT THE HOSPITAL'S FINANCIAL CONDITION, INCLUDING SIGNIFICANT CAPITAL MARKET VOLATILITY, VARIOUS TEMPORARY CLOSURES AND CANCELLATIONS, AND OTHER EFFECTS THAT HAVE AND WILL LIKELY CONTINUE TO RESULT IN SUPPLY DISRUPTIONS AND DECISIONS TO DEFER MEDICAL TREATMENT AT THE HOSPITAL. AS A RESULT, MANY OF THE COMMUNITY BASED SERVICES THAT HAVE BEEN PROVIDED BY BLYTHEDALE IN PAST YEARS WERE IMPACTED IN 2020. LIKE MANY AGENCIES ACROSS THE COUNTRY, BLYTHEDALE HAS FOCUSED ON ISSUES OF DIVERSITY, EQUITY, AND INCLUSION (DEI) AS THEY AFFECT BOTH OUR PATIENT POPULATION AND OUR EMPLOYEES. WE CREATED AN EMPLOYEE-DRIVEN TASK FORCE DURING THE SUMMER OF 2020 TO BETTER UNDERSTAND AND ANALYZE ISSUES RELATED TO DEI AND OUR HIRING AND RECRUITMENT PROCESSES, THE CULTURAL COMPETENCY OF OUR STAFF, AND OUR POLICIES AND PROCEDURES. THE TASK FORCE GOAL IS FOR THE DIVERSITY OF OUR STAFF TO BE COMPARABLE TO THE VAST DIVERSITY OF OUR PATIENT POPULATION.BLYTHEDALE CHILDREN'S HOSPITAL HAS A CARE MANAGEMENT DIVISION THAT PROVIDES COMMUNITY SUPPORT TO MEDICALLY FRAGILE CHILDREN AND FAMILIES IN THE BRONX AND WESTCHESTER COUNTIES THROUGH THE NEW YORK STATE DEPARTMENT OF HEALTH HEALTH HOME SERVING CHILDREN PROGRAM. OUR PROACTIVE CARE COORDINATION MODEL PROVIDES THE FAMILIES OF MEDICALLY FRAGILE CHILDREN WITH THE SUPPORT THEY NEED, LEADING TO MORE CONSISTENT MEDICAL CARE ON A REGULAR BASIS. DURING THE COIVD-19 PANDEMIC, THIS PROGRAM BECAME A CRITICAL LIFELINE FOR FAMILIES ALREADY LIVING ON THE EDGE OF POVERTY. THE TEAM WAS ABLE TO PROVIDE SIDEWALK DROP-OFFS OF FOOD, DIAPERS, AND OTHER HYGIENE SUPPLIES ON A REGULAR BASIS, WORKED WITH FAMILIES TO NAVIGATE THE NEW WORLD OF TELEHEALTH MEDICAL APPOINTMENTS AND REMOTE EDUCATION, AND CONNECTED MANY CHILDREN AND FAMILIES WITH MENTAL HEALTH SUPPORTS DURING A TIME OF GREAT STRESS.IN EARLY 2020, BLYTHEDALE COLLABORATED WITH NYLAG (NEW YORK LEGAL ASSISTANCE GROUP) THROUGH THE LEGAL HEALTH DIVISION TO LAUNCH A LEGAL CLINIC AVAILABLE TO BLYTHEDALE PATIENTS AND FAMILIES. THE CLINIC ATTORNEY IS ABLE TO MEET WITH FAMILIES VIRTUALLY TO PROVIDE SUPPORT, GUIDANCE, AND LEGAL SUPPORT FOR ISSUES INCLUDING ENTITLEMENTS, IMMIGRATION, HOUSING, AND LEGAL GUARDIANSHIP OF CHILDREN WITH MEDICAL AND INTELLECTUAL DISABILITIES. ISSUES LIKE THESE SOCIAL DETERMINANTS OF HEALTH CAN HAVE A GREAT IMPACT ON A CHILD'S MEDICAL CARE AND SUCCESSFUL DISCHARGE HOME, SO PROACTIVELY ADDRESSING THEM DURING THE CHILD'S ADMISSION IS THE BEST WAY TO ENSURE A SUCCESSFUL RETURN TO THE COMMUNITY.BLYTHEDALE OFFERS A NUMBER OF COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND SPECIAL PROGRAMS FOR DEVELOPMENT OF THE PEDIATRIC PROFESSIONAL COMMUNITY: NUTRITION EDUCATION: IN A MAJOR INITIATIVE TO HELP REDUCE THE PREVALENCE OF CHILDHOOD OBESITY AND PREVENT ITS LONG TERM NEGATIVE HEALTH EFFECTS, BLYTHEDALE IS REACHING OUT TO SCHOOL DISTRICTS THROUGHOUT WESTCHESTER AND SURROUNDING COUNTIES WITH ITS EAT WELL BE WELL SCHOOL BASED NUTRITION EDUCATION PROGRAM. THE EAT WELL, BE WELL PROGRAM, WITH SUPPORT FROM KOHLS DEPARTMENT STORES, IS DESIGNED TO PROVIDE SCHOOL STAFF AND STUDENTS WITH THE TOOLS NECESSARY TO HELP CHILDREN DEVELOP HEALTHY EATING HABITS THROUGH A COMPREHENSIVE CURRICULUM DEVELOPED BY BLYTHEDALE'S REGISTERED DIETICIANS. AS OF 2020, THIS PROGRAM HAS REACHED MORE THAN 125,000 STUDENTS, AS WELL AS OVER 6,000 PARENTS AND SCHOOL STAFF IN SCHOOLS THROUGHOUT WESTCHESTER, ROCKLAND AND PUTNAM COUNTIES, WITH INFORMATION ON HOW TO MAKE FOOD AND LIFESTYLE CHOICES THAT WILL PROMOTE HEALTHY LIVING FOR A LIFETIME. THE PROGRAM FOCUSED ON AT-RISK SCHOOL DISTRICTS IN WESTCHESTER COUNTY, INCLUDING OSSINING AND YONKERS. A COLLABORATION WITH FEEDING WESTCHESTER ENABLED US TO REACH FAMILIES WITH DIETARY INFORMATION TRANSLATED IN SPANISH, RELATED TO FOOD PANTRY OFFERINGS. IN 2020, THE COVID-19 PANDEMIC SIGNIFICANTLY IMPACTED OUR KOHL'S FUNDED EAT WELL, BE WELL PROGRAM ACTIVITIES IN THE COMMUNITY. WITH ALL SCHOOL-BASED PROGRAMMING, AND COMMUNITY WORKSHOPS AND EVENTS CANCELED; WE PIVOTED TO FOCUS OUR EFFORTS ON OUR WORK GROUP COLLABORATION WITH WESTCHESTER COUNTY TO IDENTIFY AND ADDRESS ACES (ADVERSE CHILDHOOD EXPERIENCES), MORE RELEVANT THAN EVER, GIVEN THE IMPACT OF THE PANDEMIC ON VULNERABLE CHILDREN AND FAMILIES AND THE CLEAR RECOGNITION OF JUST HOW INEXTRICABLE MENTAL HEALTH IS FROM PHYSICAL HEALTH.WITHIN WESTCHESTER COUNTY, THE CITIES WITH THE HIGHEST NUMBER OF CONFIRMED CASES AND DEATHS WERE ALSO THE ONES WITH THE LOWEST SOCIOECONOMIC STATUS. THESE DISTRICTS (YONKERS, OSSINING, NEW ROCHELLE, MOUNT VERNON, AND WHITE PLAINS) WERE ALSO THE NAMED AREAS OF FOCUS FOR OUR GRANT-RELATED OBJECTIVES AND ACTIVITIES IN 2020. WE WORKED CLOSELY WITH THESE SCHOOL DISTRICTS AND COMMUNITIES TO ASSESS NEEDS AND PROVIDE VIRTUAL SUPPORT, REACHING MORE THAN 7,000 STUDENTS AND 250 STAFF. THIS OUTREACH INCLUDED REVAMPING CURRICULA INTO VIRTUAL WORKSHOPS FOR FAMILIES AND STAFF; CREATING AND DISSEMINATING A SAFETY TIPS VIDEO; PRODUCING AND DISSEMINATING CONTENT RELATIVE TO SAFETY AND WELLBEING DURING THE PANDEMIC AND CONDUCTING A SURVEY FOR A SCHOOL STAFF WELLNESS/DEVELOPMENT SERIES. WE ALSO INCREASED OUR MEDIA OUTPUT, WITH USEFUL PRACTICAL TIPS AND GUIDANCE FOR FAMILIES. OUR PAID MEDIA SOCIAL MEDIA CAMPAIGN RECEIVED MORE THAN 500,000 ENGAGEMENTS, AND A RADIO CAMPAIGN ON WCBS FM RADIO RECORDED 27 MILLION IMPRESSIONS. THE RELATED HEALTH AND WELLNESS CONTENT ON OUR WEBSITE GENERATED MORE THAN 27,000 PAGE VIEWS. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X X X 1 1 0 0 0 0 0 0 0 LAWRENCE LEVINE PRESIDENT AND CEO 684823 0 0 0 19253 0 147585 0 47801 0 899462 0 0 0 SCOTT M KLEIN CHIEF MEDICAL OFFICER 470850 0 0 0 0 0 84470 0 50217 0 605537 0 0 0 JOHN E CANNING CHIEF FINANCIAL OFFICER 403473 0 0 0 8737 0 77084 0 49942 0 539236 0 0 0 BYRON FERNANDEZ CLINICAL/UNIT CHIEF 331589 0 0 0 0 0 23840 0 45242 0 400671 0 0 0 KATHY SILVERMAN CLINICAL/UNIT CHIEF 270646 0 0 0 0 0 61863 0 24652 0 357161 0 0 0 MAUREEN DESIMONE CHIEF OPERATING OFFICER 0 0 0 0 309278 0 30 0 42737 0 352045 0 0 0 MARY M DIDIE CLINICAL/UNIT CHIEF 216783 0 0 0 0 0 98711 0 35025 0 350519 0 0 0 ROBERT R LANE CHIEF DEVELOPMENT OFFICER 0 0 0 0 241456 0 7634 0 47737 0 296827 0 0 0 JILL M WEGENER CHIEF NURSING OFFICER 267744 0 0 0 0 0 13842 0 15064 0 296650 0 0 0 JOHN J FLANAGAN VICE PRESIDENT OF OPERATIONS 256058 0 0 0 0 0 5121 0 26589 0 287768 0 0 0 RUTH E ALEJANDRO ATTENDING PHYSIATRIST 216483 0 0 0 0 0 9787 0 42497 0 268767 0 0 0 TRACY LYNN LAWRENCE-BLACK LTC MEDICAL DIRECTOR 210653 0 0 0 0 0 12048 0 35145 0 257846 0 0 0 LISA KOCH-CAPOBIANCO VICE PRESIDENT OF DEVELOPMENT 199307 0 0 0 0 0 8797 0 45673 0 253777 0 0 0 ADAM S HERBST CHIEF LEGAL,GOV'T RELATIONS,ST 118027 0 0 0 105573 0 8436 0 15741 0 247777 0 0 0 SUSAN GOODBODY-MURRAY CHIEF ENGAGEMENT & EXPERIENCE 201220 0 0 0 0 0 27617 0 16011 0 244848 0 0 0 CONSTANCE T CORNELL VICE PRESIDENT OF STRATEGIC CO 159477 0 0 0 0 0 6204 0 46401 0 212082 0 0 0 PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE OF THE FOLLOWING DURING 2020: -MAUREEN DESIMONE $352,015 (BASE $309,278, FRINGE $29,715 & TAXES $13,022) -ROBERT LANE $296,827 (BASE $241,456, FRINGE $35,698 & TAXES $12,039) -ADAM HERBST $105,573 (BASE $105,573) THE HOSPITAL PROVIDES NON-QUALIFIED DEFERRED COMPENSATION IN THE FORM OF A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO MEMBERS OF A SELECT GROUP OF MANAGEMENT THAT INCLUDES LAWRENCE LEVINE-CEO, SCOTT KLEIN-CMO, AND JOHN CANNING-CFO. THE PLANS ARE UNFUNDED DEFINED CONTRIBUTION PLANS THAT ARE AT-RISK OF SIGNIFICANT FORFEITURE AND HAVE VESTING PERIODS RANGING FROM 5 TO 12 YEARS. FOR EACH PLAN YEAR THE HOSPITAL MAKES QUARTERLY CONTRIBUTIONS ON BEHALF OF THE PARTICIPANTS IN AN AMOUNT EQUAL TO TWENTY (20%), AND FIFTEEN PERCENT (15%) RESEPECTIVELY FOR THE CEO, COO, AND CFO. IN 2020, THE HOSPITAL CONTRIBUTED THE FOLLOWING AMOUNTS LARRY LEVINE - CEO $147,585 SCOTT KLEIN - CMO $70,628 JOHN CANNING - CFO $60,522 A DORMITORY AUTHORITY OF NY (DASNY) 146000293 649905DG8 2009-06-19 27000000 CONSTRUCTION 0 0 0 A 6965000 26748127 113445 540000 820868 25387259 2011 1 0 1 1 A 0 0 1 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 1 0 0 1 0 A 0 PART I, COLUMN (E) & PART II, LINE 3: THE DIFFERENCE BETWEEN THE ISSUE PRICE (PART I, COLUMN (E)) AND TOTAL PROCEEDS (PART II, LINE 3) IS DUE TO (A) AN INCREASE FOR INVESTMENT EARNINGS OF $227,835, AND (B) A DECREASE DUE TO SALE PROCEEDS OF $479,707 THAT WERE USED TO CALL AND RETIRE OUTSTANDING BONDS. PART II, LINE 4: THE AMOUNT ENTERED HERE IS A DEBT SERVICE FUND BALANCE. PART IV, LINE 2C: THE DATE OF THE COMPUTATION IS NOT KNOWN BY BLYTHEDALE CHILDREN'S HOSPITAL. ARBITRAGE REPORTING IS HANDLED BY THE ACTUAL ISSUER OF THE BONDS, AND BLYTHEDALE CHILDREN'S HOSPITAL DOES NOT HAVE A COPY OF THE ACTUAL REBATE REPORT. PART IV, LINE 6: SUCH AMOUNTS WERE APPROPRIATELY YIELD RESTRICTED. X 16 219164 COST OR SELLING PRICE 0 0 1 0 PART I, COLUMN (B): THE VALUES REPRESENT THE NUMBER OF CONTRIBUTION TRANSACTIONS RECEIVED. FORM 990, PART VI, SECTION A, LINE 2 JOHN FURTH AND OWEN GUTFREUND (BOARD MEMBERS) HAVE A FAMILY RELATIONSHIP. DAVID PEDOWITZ HAS A BUSINESS RELATIONSHIP WITH PATRICIA STANLEY (BOARD MEMBERS, AND FORMER BOARD MEMBER, RESPECTIVELY), LARRY COHEN, AND PEGGY TANNER (BOARD MEMBERS, AND FORMER BOARD MEMBER, RESPECTIVELY). FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE BLYTHEDALE CHILDREN'S HOSPITAL'S BOARD OF TRUSTEES PRIOR TO ITS FILING WITH THE INTERNAL REVENUE SERVICE. THE FORM 990 IS REVIEWED BY THE BLYTHEDALE FINANCE DEPARTMENT AS WELL AS BY DELOITTE TAX, LLP, BEFORE IT IS PRESENTED TO THE BOARD'S AUDIT & COMPLIANCE COMMITTEE. THE COMMITTEE THEN PROVIDES AN OVERVIEW OF THE FORM 990 TO THE FULL BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, SENIOR MANAGEMENT AND KEY EMPLOYEES OF BLYTHEDALE CHILDREN'S HOSPITAL MUST COMPLETE A STATEMENT ANNUALLY AND WHENEVER NEW INFORMATION ARISES, WHICH DISCLOSES ANY POTENTIAL CONFLICT OF INTEREST, AS REQUIRED BY THE HOSPITAL'S CONFLICT OF INTEREST POLICY. THESE STATEMENTS ARE REVIEWED BY THE HOSPITAL'S COMPLIANCE OFFICER WHO PREPARES A REPORT ON DISCLOSURES FOR THE BOARD'S AUDIT & COMPLIANCE COMMITTEE. HOSPITAL BOARD MEMBERS AND STAFF ARE TRAINED AND EDUCATED ON THEIR OBLIGATIONS UNDER THIS POLICY, INCLUDING ITS GIFT AND GRATUITIES PROVISIONS. ONCE A YEAR, THE HOSPITAL DISTRIBUTES A CERTIFICATION AND DISCLOSURE FORM TO ITS OFFICERS, DIRECTORS AND KEY EMPLOYEES, IN WHICH EACH RESPONDENT CERTIFIES THAT HE OR SHE: (I) HAS RECEIVED A COPY OF THE CONFLICT OF-INTEREST POLICY; (II) HAS READ AND UNDERSTANDS THE POLICY; (III) HAS AGREED TO COMPLY WITH THE POLICY; AND (IV) UNDERSTANDS THAT THE HOSPITAL IS CHARITABLE AND THAT IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES THAT ACCOMPLISH ONE OR MORE OF ITS EXEMPT PURPOSES AND NOT ENGAGE IN ACTIVITIES AND TRANSACTIONS THAT PROVIDE IMPERMISSIBLE BENEFITS TO INDIVIDUALS OR ENTITIES. IN ADDITION, THE CERTIFICATION AND DISCLOSURE FORM ALSO REQUIRE EACH PERSON TO EITHER: (I) CERTIFY THAT HE OR SHE HAS NO ACTUAL OR POSSIBLE CONFLICT OF INTEREST TO REPORT, OR (II) DESCRIBE ANY RELATIONSHIPS, TRANSACTIONS, OR OTHER CIRCUMSTANCES, INCLUDING THOSE OF AN IMMEDIATE FAMILY MEMBER, THAT COULD RESULT IN A CONFLICT BETWEEN THE HOSPITAL'S INTERESTS AND HIS OR HER PERSONAL, FINANCIAL OR OTHER INTERESTS. AS PART OF THE ANNUAL PROCESS, THE HOSPITAL PROVIDES EACH PERSON COVERED BY THE CONFLICT-OF-INTEREST POLICY WITH A COPY OF THE POLICY AND OFFERS INDIVIDUALS THE OPPORTUNITY TO ASK QUESTIONS ABOUT THE POLICY. THE COVERED PERSONS SHOULD THEN BE REQUIRED TO COMPLETE AND SIGN THE CERTIFICATION AND DISCLOSURE FORM, WHICH SHOULD BE RETAINED IN THE HOSPITAL'S FILES. TO PROPERLY MONITOR AND ENFORCE A CONFLICT-OF-INTEREST POLICY, THE HOSPITAL IS DILIGENT IN REVIEWING THE ANNUAL DISCLOSURE FORMS SUBMITTED BY COVERED PERSONS, AND IN COMPILING AND MAINTAINING A LIST OF POTENTIALLY CONFLICTED ENTITIES AND INDIVIDUALS. PROPOSED TRANSACTIONS CAN THEN BE MATCHED AGAINST THE LIST AS A MEANS OF IDENTIFYING POSSIBLE CONFLICTS. THE HOSPITAL HAS IDENTIFIED THE CHIEF COMPLIANCE OFFICER AS THE PERSON ULTIMATELY RESPONSIBLE FOR MAINTAINING THE LIST AND SCREENING FOR POSSIBLE CONFLICTS OF INTEREST. WHEN DEALING WITH MAJOR VENDORS AND SERVICE PROVIDERS, THE HOSPITAL ASKS THE VENDOR OR SERVICE PROVIDER TO DISCLOSE ANY RELATIONSHIP - PERSONAL, FINANCIAL, OR OTHERWISE - THAT THE VENDOR OR SERVICE PROVIDER HAS WITH ANY OF THE HOSPITAL'S DIRECTORS, OFFICERS, EMPLOYEES OR VOLUNTEERS. IN ADDITION, THE HOSPITAL UNDERTAKES PERIODIC REVIEWS OF TRANSACTIONS INVOLVING ANY SIGNIFICANT EXPENDITURE OF ORGANIZATIONAL FUNDS TO ENSURE ANY COMPENSATION PAID CONTINUES TO BE REASONABLE. IF A POSSIBLE CONFLICT IS IDENTIFIED WITH RESPECT TO A PROPOSED TRANSACTION, THE HOSPITAL IS COMMITTED TO FOLLOWING THE PROCEDURES SET OUT IN ITS CONFLICT-OF INTEREST POLICY FOR DETERMINING WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS, AND THE PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST. AMONG THE STEPS THE HOSPITAL TAKES ARE THE FOLLOWING: (I) THE PERSON WITH THE POTENTIAL CONFLICT WITH RESPECT TO A TRANSACTION SHOULD DISCLOSE SUCH CONFLICT (II) THE PERSON DOES NOT PARTICIPATE OR BE PRESENT AT ANY MEETING DURING WHICH THE DISCUSSION OF THE POSSIBLE CONFLICT OF INTEREST TAKES PLACE (III) THE CHAIR OF THE BOARD, IF APPROPRIATE, APPOINT A COMMITTEE OF THE BOARD MADE UP OF DISINTERESTED DIRECTORS TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION (IV) F A MORE ADVANTAGEOUS TRANSACTION IS NOT REASONABLY AVAILABLE, THE GOVERNING BOARD OR COMMITTEE DETERMINES WHETHER THE TRANSACTION IS IN THE ORGANIZATION'S BEST INTEREST AND IS FAIR AND REASONABLE. FORM 990, PART VI, SECTION B, LINE 15 BLYTHEDALE CHILDREN'S HOSPITAL MAINTAINS A DILIGENT, THOROUGH AND TRANSPARENT PROCESS TO EVALUATE EXECUTIVE COMPENSATION. ON AN ANNUAL BASIS, BLYTHEDALE FORMALLY ENGAGES SULLIVAN, COTTER AND ASSOCIATES TO PROVIDE THE COMPENSATION COMMITTEE WITH A COMPLETE TOTAL COMPENSATION STUDY OF ALL ELEMENTS OF EXECUTIVE COMPENSATION. THIS IS DONE TO ENSURE THE OVERALL REASONABLENESS OF THE TOTAL COMPENSATION PROVIDED TO ITS CHIEF EXECUTIVE OFFICER AND ALL OTHER CHIEF OFFICERS. IN ADDITION, BLYTHEDALE ALSO ENGAGES SULLIVAN, COTTER AND ASSOCIATES TO REVIEW BOTH THE NATIONAL AND REGIONAL HEALTHCARE MARKETPLACE TO DETERMINE ANNUAL BASE PAY INCREASE PROJECTIONS FOR ALL MAIN EMPLOYEE CATEGORIES INCLUDING EXECUTIVES. SULLIVAN, COTTER AND ASSOCIATES IS A WELL REGARDED COMPENSATION CONSULTING FIRM WITH REGIONAL AND NATIONAL EXPERTISE. THE FIRM COMPARES BLYTHEDALE'S EXECUTIVE COMPENSATION TO A PRIMARY COMPARATOR MARKET OF SIMILARLY SITUATED ORGANIZATIONS THAT INCLUDES REGIONAL CHILDREN'S AND REHABILITATION NOT-FOR-PROFIT HOSPITALS; NOT-FOR-PROFIT HOSPITALS IN THE METROPOLITAN NEW YORK AREA; AND NOT-FOR-PROFIT HOSPITALS IN THE HUDSON VALLEY REGION. THE PRIMARY COMPARATOR MARKET REFLECTS THE ORGANIZATION'S EXECUTIVE RECRUITMENT AND RETENTION MARKET AND COMPLIES WITH THE DEFINITION OF "COMPARABLE ORGANIZATIONS AS SET FORTH IN THE IRS INTERMEDIATE SANCTIONS REGULATIONS. IN NOVEMBER 2019, SULLIVAN, COTTER AND ASSOCIATES PROVIDED TO THE BOARD'S COMPENSATION COMMITTEE AN ASSESSMENT OF THE COMPETITIVENESS OF THE TOTAL COMPENSATION PROVIDED TO BLYTHEDALE'S EXECUTIVES RELATIVE TO PREVALENT AND COMPARABLE MARKETPLACE PRACTICES. FURTHERMORE, SULLIVAN COTTER ASSISTED THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES IN REVIEWING BLYTHEDALE'S EXECUTIVE COMPENSATION PHILOSOPHY STATEMENT AND REVIEWED THE RANGES FOR INCENTIVE COMPENSATION AWARDS FOR THE CEO AND OTHER EXECUTIVES. IN ADDITION TO ANALYZING THE DATA PROVIDED BY SULLIVAN, COTTER AND ASSOCIATES, THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES CONSIDERS A NUMBER OF FACTORS WHEN REVIEWING AND ESTABLISHING COMPENSATION FOR THE CEO AND ALL OTHER CHIEF OFFICERS INCLUDING BUT NOT LIMITED TO THE FOLLOWING: DEVELOPMENT OF NEW PROGRAMS; MOBILIZING THE HOSPITAL TO STRIVE FOR EXCELLENT RESULTS IN PATIENT CARE; MANAGEMENT PERFORMANCE AND COMPLIANCE WITH ALL PROFESSIONAL AND REGULATORY STANDARDS; AND INITIATIVES AND FACILITIES TO SUPPORT AND ADVANCE BLYTHEDALE'S MISSION WHILE EFFECTIVELY ALLOCATING AND MANAGING THE HOSPITAL'S RESOURCES. BY REVIEWING THE COMPENSATION DATA FROM INDEPENDENT SOURCES FOR FUNCTIONALLY COMPARABLE POSITIONS IN ORGANIZATIONS COMPARABLE TO BLYTHEDALE AND BY ANALYZING THE INTERNAL PERFORMANCE DATA, THE COMPENSATION COMMITTEE DETERMINES THAT IT PROVIDES A "REBUTTABLE PRESUMPTION OF REASONABLENESS" THAT THE TOTAL COMPENSATION PROVIDED TO BLYTHEDALE EXECUTIVES IS REASONABLE AND CONSISTENT WITH MARKET PRACTICES. IN JUNE 2020 AS A RESULT OF THE FINANCIAL UNCERTAINTY CREATED BY THE COVID 19 PANDEMIC, SENIOR MANAGEMENT PRESENTED TO THE BOARD OF TRUSTEES A PLAN OF ACTION THAT INCLUDED REDUCTIONS IN EXPENSES REQUIRED TO STABILIZE THE FINANCIAL OPERATIONS OF THE HOSPITAL DURING THE ECONOMIC SHUT DOWN. INCENTIVE COMPENSATION AWARDS FOR THE CEO AND EXECUTIVE MANAGEMENT WERE DETERMINED TO BE INCONSISTENT WITH THE ONGOING FINANCIAL ENVIRONMENT AND WERE ELIMINATED IN CALENDAR YEAR 2020 AS A RESULT. THE FINAL DETERMINATION OF THE COMMITTEE WAS DOCUMENTED AND AN OVERVIEW WAS PROVIDED TO THE FULL BOARD OF TRUSTEES TO ENSURE FULL DISCLOSURE AND TRANSPARENCY OF EXECUTIVE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 BLYTHEDALE CHILDREN'S HOSPITAL MAKES ITS FORM 990 AND FORM 1023 AVAILABLE TO THE PUBLIC BY RETAINING A COPY OF EACH AT THE ADDRESS LISTED ON PAGE 1 OF THIS RETURN. THE ORGANIZATION' S FORM 990 IS ALSO AVAILABLE FOR PUBLIC INSPECTION ON WWW.GUIDESTAR.ORG. THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND AT MANAGEMENT'S DISCRETION. FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY -867,029.