2019-11-13T10:58:14-06:00 2018-12-31 861065772 DELOITTE TAX LLP 30 ROCKEFELLER PLAZA NEW YORK NY 10112 990 2018-01-01 131739922 BLYTHEDALE CHILDREN'S HOSPITAL BLYT 9145927555 95 BRADHURST AVE VALHALLA NY 10595 JOHN CANNING CFO 9145927555 2019-11-12 1 JEANNE FAHRENBACH P01365953 2124924000 2019-11-13 167.219.172.209 2019-11-13 08:47:43 ES P 943C2B779621AE68CF3E0BED5C235FDF89DF7949 C9ED19D146748CAC02A1A8999E376782BC08CAB7 2018 2020-04-17 16:48:07Z JOHN CANNING 95 BRADHURST AVE VALHALLA NY 10595 148993768 0 X WWW.BLYTHEDALE.ORG X 1891 NY BLYTHEDALE CHILDREN'S HOSPITAL IS DEDICATED TO IMPROVING THE HEALTH & WELL-BEING OF CHILDREN. 23 22 627 281 -309 -309 3716462 4273387 72362491 76504576 7453734 2916695 3879114 3854412 87411801 87549070 0 0 0 0 50018723 53228831 0 0 874804 25785943 27043198 75804666 80272029 11607135 7277041 234170708 227423108 48147819 41548022 186022889 185875086 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 43959616 53079616 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 2018, 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 78 INPATIENTS, AND 24 LONG TERM CARE PATIENTS PER DAY IN 2018. THE HOSPITAL RECEIVED OVER 850 REGIONAL REFERRALS IN THE YEAR AND ADMITTED 520 KIDS. OVER 75% OF OUR INPATIENT ADMISSIONS WERE REIMBURSED THROUGH THE MEDICAID PROGRAM (FFS & MANAGED) IN 2018. WHILE 100% OF THE HOSPITALS INPATIENT POPULATION IS REFERRED IN FROM OTHER ACUTE CARE HOSPITALS IN THE REGION, OVER >65% COME DIRECTLY FROM INTENSIVE CARE UNITS (ICU'S). THIS SPEAKS TO THE HIGH ACUITY OF THE PATIENT POPULATION BEING MANAGED AT BLYTHEDALE. IN 2018 ALMOST 80% 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. 10591928 9308685 DAY HOSPITAL PROGRAM - 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 2018, BLYTHEDALE ADMITTED 128 CHILDREN TO THE PROGRAM. 35 % 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 2018, THE PROGRAM SERVED ON AVERAGE OF 100 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 17,925 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 2018, THE PROGRAM SERVED 40 PATIENTS FOR A TOTAL OF 3,621 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. AT BLYTHEDALE, WE PROVIDE INDIVIDUALIZED RELATED SERVICES TO ELIGIBLE CHILDREN AGE'S THREE TO FIVE THROUGH OUR OUTPATIENT DEPARTMENT. WE SERVE CHILDREN WITH A WIDE RANGE OF NEEDS INCLUDING DIFFICULTIES THAT MAY INTERFERE WITH THEIR LEARNING AND FUNCTIONING IN PRESCHOOL. CHILDREN WITH THE FOLLOWING DIFFICULTIES ARE MOST COMMON IN THE PROGRAM:- DELAYS OR LAGS IN COGNITIVE, LANGUAGE, MOTOR OR SOCIAL EMOTIONALDEVELOPMENT- CONGENITAL OR ACQUIRED ABNORMALITIES- DIAGNOSED MEDICAL CONDITIONS SUCH AS CEREBRAL PALSY, NEUROMUSCULAR OROTHER NEUROLOGICAL DISORDERS 13176829 12361874 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 2018, THE HOSPITAL CARED FOR 32 CHILDREN AND RAN AN AVERAGE OCCUPANCY OF 98.1%. 73% OF THE CHILDREN WERE UNDER THE AGE OF 6 ON ADMISSION 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 NEW 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. 2091928 IN 2018, THE HOSPITAL PROVIDED 2,713 OUTPATIENT THERAPY 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 DISORDERS BLYTHEDALE 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 TIME" IN THE "RIGHT CARE" BEING PROVIDED AT THE "RIGHT 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 2091928 67728373 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 1 0 0 0 1 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 149 0 1 627 1 0 0 0 0 0 1 1 0 0 0 0 0 0 0 X 23 22 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 0.00 0.00 X 0 0 0 ADAM GALEON TRUSTEE 0.00 0.00 X 0 0 0 ALAN GERSTEIN TRUSTEE 0.00 0.00 X 0 0 0 DAVID R PEDOWITZ CHAIRMAN 0.00 0.00 X X 0 0 0 DEAN CURNUTT TRUSTEE 0.00 0.00 X 0 0 0 FARREL STARKER TRUSTEE 0.00 0.00 X 0 0 0 FRANK A STERN RESIGNED 6418 TRUSTEE 0.00 0.00 X 0 0 0 HOWARD ADLER TRUSTEE 0.00 0.00 X 0 0 0 JOHN L FURTH TRUSTEE 0.00 0.00 X 0 0 0 JON M BURNHAM RESIGNED 6418 TRUSTEE 0.00 0.00 X 0 0 0 JORDANA HOLOVACH TRUSTEE 0.00 0.00 X 0 0 0 JUDITH R WIENER GOODHUE TRUSTEE 0.00 0.00 X 0 0 0 KIM MOTOLA TRUSTEE 0.00 0.00 X 0 0 0 LANCE WACHENHEIM TRUSTEE 0.00 0.00 X 0 0 0 LARRY W COHEN TRUSTEE 0.00 0.00 X 0 0 0 LAUREN BUMBY MD TRUSTEE 0.00 0.00 X 0 0 0 LUCY SCHMOLKA SECRETARY 0.00 0.00 X X 0 0 0 MICHAEL MARGULIES TRUSTEE 0.00 0.00 X 0 0 0 OWEN GUTFREUND TRUSTEE 0.00 0.00 X 0 0 0 PERRY C HOFFMEISTER TRUSTEE 0.00 0.00 X 0 0 0 PETER D RITTMASTER VICE CHAIR 0.00 0.00 X X 0 0 0 SCOTT R LEVY VICE CHAIR 0.00 0.00 X X 0 0 0 STEVEN SOLOMON RESIGNED 6418 TRUSTEE 0.00 0.00 X 0 0 0 TIM EVNIN TREASURER 0.00 0.00 X X 0 0 0 VIRGINIA FURTH WEISMAN TRUSTEE 0.00 0.00 X 0 0 0 WILLIAM G LEVY TRUSTEE 0.00 0.00 X 0 0 0 ADAM HERBST CHIEF LEGAL & COMPLIANCE 40.00 0.00 X 215554 0 22393 JILL WEGENER CNO 40.00 0.00 X 260973 0 26097 JOHN CANNING CFO 40.00 0.00 X 450307 0 121301 LARRY LEVINE CEO 40.00 0.00 X 794224 0 165481 MAUREEN DESIMONE CAO 40.00 0.00 X 317967 0 42989 ROBERT LANE CHIEF DEVELOPMENT 40.00 0.00 X 276351 0 64080 RON GALLO CHR 40.00 0.00 X 76589 0 14830 SCOTT KLEIN CMO 40.00 0.00 X 515232 0 112007 SUSAN GOODBODY-MURRAY CXO 40.00 0.00 X 201017 0 46406 BYRON FERNANDEZ MD 40.00 0.00 X 322128 0 59892 KATHY SILVERMAN MD 40.00 0.00 X 294286 0 69198 MARY DIDIE MD 40.00 0.00 X 203683 0 105386 RUTH ALEJANDRO MD 40.00 0.00 X 204055 0 53176 TRACY LAWRENCE-BLACK MD 40.00 0.00 X 248611 0 44519 4380977 0 947755 131 0 1 0 SODEXO INC & AFFILIATES 9801 WASHINGTONIAN BLVD GATHERSBURG MD 20878 CONTRACTED SERVICES 3718953 CARDINAL HEALTH-411 5303 COLLECTION CENTER DRIVE CHICAGO IL 60693 MED SURG SUPPLIES 2083293 ALLEGIANCE CORP DBA CARDINAL HEALTH 11 7000 CARDINAL PLACE DUBLIN OH 43017 MED SURG SUPPLIES 1212801 DELL MARKETING LP PO BOX 149256 AUSTIN TX 78714 DISTRIBUTORS 775979 BURKE MEDICAL RESEARCH INSTITUTE 785 MAMARONECK AVE WHITE PLAINS NY 10605 HOSPITAL 664488 9 1466326 2807061 1064815 4273387 INPATIENT 622110 53079616 53079616 LONG TERM CARE 622110 12361874 12361874 DAY HOSPITAL 622110 9308685 9308685 BUFSD SCHOOL 611710 1006842 1006842 OUTPATIENT/EARLY INT 621400 488127 488127 259432 259432 76504576 1391577 -309 1391886 62605716 61080598 1525118 1525118 1525118 165075 1466326 364100 -199025 -199025 SPENDING POLICY 900099 3495898 3495898 CAFETERIA 722514 220012 220012 MEDICAL RECORDS 900099 30337 30337 307190 307190 4053437 87549070 76842103 -309 6433889 3108214 1295189 1536674 276351 36715863 31977317 4567404 171142 4360204 3657517 671088 31599 6251291 5243982 961888 45421 2793259 2320081 425693 47485 3338214 3081136 239278 17800 402671 333331 58951 10389 304992 252472 44651 7869 76025 76025 529000 529000 94911 78675 13803 2433 215655 193907 18490 3258 1379912 1142291 202019 35602 7420149 7167280 214114 38755 41188 38067 2653 468 115735 113425 1964 346 392948 392948 6586852 5325470 1229765 31617 656486 543439 96110 16937 CONTRACTED LABOR 3262122 2728883 453346 79893 TAXES/FEES/ASSESSMENTS 1044386 864543 152898 26945 UTILITIES 772616 639572 113111 19933 DEBT FEES 409336 338848 59927 10561 80272029 67728373 11668852 874804 14762282 17375291 2195905 85158 10672859 10652848 5015049 5032653 364251 390564 694066 846225 123807267 56073377 72754055 67733890 83061809 91958575 43658330 32480500 992102 867404 234170708 227423108 3462375 4069515 21124630 20439782 3800229 3137412 19760585 13901313 48147819 41548022 X 170966577 172792467 10983043 8133409 4073269 4949210 186022889 185875086 234170708 227423108 X 7277041 -10884961 3460117 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 19796 19796 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. 15056311 4270912 -659699 0 5584906 13082618 15662160 2796440 2173245 5575534 15056311 18084864 2554980 874730 5852414 15662160 11559343 9177628 -154788 2497319 18084864 11065150 1908465 609854 2024123 11559346 0.83000 0.17000 0 0 1383879 1383879 56129571 19455996 36673575 62987288 34919037 28068251 3306529 1698344 1608185 67733890 INVESTMENTS- OTHER SECURITIES 32480500 C 32480500 ASSET RETIREMENT 178584 ACCRUED PENSION LIABILITY 11844449 CAPITAL LEASE OBLIGATION 12280 EST MALPRACTICE LIABILITIES 1866000 13901313 76361807 -10223257 2944811 -7278446 83640253 3908817 3908817 87549070 80107128 364100 364100 79743028 529001 529001 80272029 PART V, LINE 4: NET ASSETS WITH DONOR RESTRICTIONS- NET ASSETS WITH DONOR RESTRICTIONS ARE THOSE WHOSE USE HAS BEEN LIMITED BY DONORS TO A SPECIFIC TIME FRAME OR PURPOSE OR HAVE BEEN RESTRICTED BY THE DONORS TO BE MAINTAINED BY THE HOSPITAL IN PERPETUITY. THE HOSPITAL RECORDS DONOR RESTRICTED CONTRIBUTIONS IF THEY ARE RECEIVED WITH DONOR STIPULATIONS THAT LIMIT THEIR USE EITHER THROUGH PURPOSE OR TIME RESTRICTIONS. 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. NET ASSETS WITH DONOR RESTRICTIONS AS OF DECEMBER 31, 2018 AND 2017, ARE AVAILABLE FOR THE FOLLOWING PURPOSES: 2018 PLANT REPLACEMENT: 85,158 ENDOWMENT FUNDS WITH PERMANENTLY RESTRICTED CORPUS: 9,995,909 OTHER: 2,134,149 TOTAL: 13,082,619 2017 PLANT REPLACEMENT: 2,195,905 ENDOWMENT FUNDS WITH PERMANENTLY RESTRICTED CORPUS: 9,908,325 OTHER: 1,959,980 TOTAL: 15,056,312 BLYTHEDALE CHILDREN'S HOSPITAL HAS A CHARITABLE REMAINDER TRUST HELD BY TRUSTEES CITIBANK, CALLED THE HENRY STERN TRUST. THE PRINCIPLE IS PERMANENTLY RESTRICTED. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 3,473,812. INVESTMENT EXPENSE RECLASS -529,001. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED INVESTMENT INCOME 2,005. FUNDRAISING EXPENSE RECLASS -364,100. RESTRICTED CONTRIBUTIONS 4,270,912. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSE RECLASS 364,100. CENTRAL AMERICA & THE CARIBBEAN 0 0 INVESTMENTS 15735882 EUROPE (INCLUDING ICELAND AND GREENLAND) 0 0 INVESTMENTS 1045075 0 0 0 0 0 0 16780957 0 16780957 1 0 1 1 1 0 SPRING EVENT 789930 753135 36795 0 1131 22701 49500 6049 14895 STUART DIX GOLF 460750 381220 79530 91678 4751 5 380721 331971 48750 1870 83003 2886 85636 1631401 1466326 165075 3001 197382 52386 6049 105282 364100 -199025 1 1 1 X 400.000000000000 1 X 1 1 0 0 11973 11973 0.00010 59151508 57842729 1308779 0.01630 59163481 57842729 1320752 0.01640 396983 155430 241553 0.00300 283661 207443 76218 0.00090 595953 346368 249585 0.00310 549604 62660 486944 0.00610 1826201 771901 1054300 0.01310 60989682 58614630 2375052 0.02950 910787 512765 398022 0.00500 910787 512765 398022 0.00500 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 16 1 0 1 1 X WWW.BLYTHEDALE.ORG X 1 16 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: IN JANUARY 2016, THE WESTCHESTER COUNTY DEPARTMENT OF HEALTH CONVENED A WORKGROUP OF LOCAL HOSPITALS TO SELECT TWO PRIORITIES FROM THE STATE'S PREVENTION AGENDA AND COLLABORATIVELY DEVELOP PLANS TO ADDRESS THESE PRIORITIES AS PART OF THE COUNTY HEALTH DEPARTMENT'S COMMUNITY HEALTH ASSESSMENT AND THE HOSPITAL'S COMMUNITY SERVICE PLANS. IN ADDITION TO WORKGROUP MEETINGS, THE COUNTY HEALTH DEPARTMENT ALSO HELD A HEALTH CARE SUMMIT IN AUGUST 2016 TO GATHER ADDITIONAL COMMUNITY INPUT. THE COUNTY HAS RECONVENED MEETINGS WITH THE GROUP PERIODICALLY TO REASSESS COMMUNITY NEEDS & SELECT PRIORITIES FOR THE 2016-2018 PLAN.THE FOLLOWING COMMUNITY ORGANIZATIONS PARTICIPATED IN THE SUMMIT:AFFINITY HEALTH PLANAMERICAN DIABETES ASSOCIATIONAMERICAN HEART ASSOCIATIONAMERICAN LUNG ASSOCIATIONPOW'R TOBACCO CESSATION CENTERHAGAN SCHOOL OF BUSINESS, IONA COLLEGEHUDSON HEALTH PLANLOWER HUDSON VALLEY PERINATAL NETWORKCHILDREN'S HEALTH AND RESEARCH FOUNDATION, INC.MARCH OF DIMESNEW YORK MEDICAL COLLEGESCHOOL OF HEALTH SCIENCES AND PRACTICEPACE UNIVERSITYPLANNED PARENTHOOD HUDSON PECONIC, INC.POW'R AGAINST TOBACCORYE YMCAST. FRANCES AFRICAN METHODIST EPISCOPAL ZION CHURCHTHINCUNITED WAY OF WESTCHESTER AND PUTNAMWESTCHESTER COUNTY DEPARTMENT OF SOCIAL SERVICESWESTCHESTER COUNTY OFFICE OF WOMENWESTCHESTER COUNTY DEPT. OF SENIOR PROGRAMS & SERVICESYONKERS PUBLIC SCHOOLS BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 6B: BURKE REHABILITATION CENTERHUDSON VALLEY HOSPITAL CENTERLAWRENCE HOSPITAL CENTERMOUNT VERNON NEIGHBORHOOD CENTERNORTHERN WESTCHESTER HOSPITALOPEN DOOR FAMILY MEDICAL CENTERPHELPS MEMORIAL HOSPITAL CENTERSAINT JOSEPH'S HOSPITALSOUND SHORE MEDICAL CENTERST. JOHN'S RIVERSIDE HOSPITALST. VINCENT'S HOSPITAL WESTCHESTERSTELLARIS HEALTH NETWORKWESTCHESTER MEDICAL CENTERWHITE PLAINS HOSPITALWESTCHESTER COUNTY DEPARTMENT OF HEALTH BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 11: ONE OF THE PRIORITY INITIATIVES IDENTIFIED BY THE COALITION ASSEMBLED BY THE WESTCHESTER COUNTY DEPARTMENT OF HEALTH RELATED TO CHRONIC DISEASE IN THE ADULT POPULATION AND THUS IS NOT WITHIN BLYTHEDALE'S MISSION AND SCOPE. THUS BLYTHEDALE HAS SELECTED ANOTHER PRIORITY FROM THE STATE'S PREVENTION AGENDA WHICH ADDRESSES AN ISSUE OF CONCERN TO BLYTHEDALE'S COMMUNITY OF REFERRING HOSPITALS: PREVENT HOSPITAL ACQUIRED INFECTIONS, SPECIFICALLY REDUCING INFECTIONS CAUSED BY MULTIDRUG-RESISTANT ORGANISMS (MDROS). PRIORITY INITIATIVES SELECTED FOR THE 2016-2018 PLAN RELATED TO CHRONIC DISEASE, SPECIFICALLY PREVENTION OF OBESITY IN ADULTS & CHILDREN.THE SECOND PRIORITY RELATED TO PROMOTING MENTAL HEALTH & PREVENTING SUBSTANCE ABUSE. THIS SECOND PRIORITY IS NOT WITHIN BLYTHEDALE CHILDREN'S HOSPTAL'S MISSION AND SCOPE. THUS, BLYTHEDALE CHILDREN'S HOSPITAL HAS SELECTED THE PREVENTION AGENDA GOAL OF PREVENT HEALTHCARE-ASSOCIATED INFECTIONS AND ACTIVITIES BY SECTOR. 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: BLYTHEDALE IS INVOLVED IN NUMEROUS COMMUNITY BUILDINGACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. NUMEROUS COMMUNITY CONCERNS ARE ADDRESSED, INCLUDING HEALTH IMPROVEMENT (SEE DETAILS UNDER LINE 6 BELOW) AND ACCESS TO CARE. BLYTHEDALE ACTIVELY PARTICIPATES IN THE WESTCHESTER CHILDREN'S ASSOCIATION'S CHILD HEALTH TASK FORCE, WHOSE PRINCIPAL GOAL IS TO MAXIMIZE ENROLLMENT OF ELIGIBLE CHILDREN IN NEW YORK STATE'S MEDICAID AND CHILD HEALTH PLUS PROGRAMS. ADDITIONALLY, THROUGH THE NEW YORK STATE WORKGROUP ON MEDICALLY FRAGILE CHILDREN, BLYTHEDALE HAS WORKED TO ADVOCATE FOR SERVICES TO SUPPORT FAMILIES CARING FOR MEDICALLY FRAGILE CHILDREN AT HOME. PART III, LINE 2: IN 2018 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 DISCLOSED THAT IT RECOGNIZED $1,600,000 OF IMPLICIT PRICE CONCESSIONS IN 2018 RELATED TO CASES WHERE THIRD PARTY PAYORS DENIED REIMBURSEMENT FOR CARE 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, 2018, THE HOSPITAL RECORDED APPROXIMATELY $1.6 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 FOR THE YEAR ENDED DECEMBER 31, 2018 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. PART III, LINE 4: ACCOUNTS RECEIVABLE FOR SERVICES TO PATIENTS AND PATIENT SERVICE REVENUE - ACCOUNTS 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 (DURING 2018) OR THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS (DURING 2017) 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, 2018, 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, 2018, 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 2018 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 (53%), HUDSON VALLEY (29%), LONG ISLAND (6%), OUT OF STATE (12%). 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 ITS INPATIENT POPULATION: ASIAN (5%); BLACK OR AFRICAN-AMERICAN (28%); HISPANIC OR LATINO (34%); WHITE (24%); OTHER (14%). 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: 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. TO DATE, 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. IN 2018, THE PROGRAM FOCUSED ON AT-RISK SCHOOL DISTRICTS IN WESTCHESTER COUNTY, INCLUDING OSSINING AND YONKERS, REACHING MORE THAN 5,000 STUDENTS AND 200 STAFF MEMBERS. A COLLABORATION WITH FEEDING WESTCHESTER ENABLED US TO REACH 275 FAMILIES WITH DIETARY INFORMATION TRANSLATED IN SPANISH, RELATED TO FOOD PANTRY OFFERINGS. OUR PROMOTION OF NATIONAL NUTRITION MONTH REACHED 70 SCHOOLS, 36K STUDENTS AND 1,900 STAFF. ADDITIONALLY, WE PARTICIPATED IN THREE COMMUNITY EVENTS, SHARING MATERIALS AND NUTRITION GUIDANCE. IN ADDITION TO OUR OFF-SITE PROGRAMMING, WE HAVE AN EXTENSIVE PAID SOCIAL MEDIA CAMPAIGN PROMOTING OUR EAT WELL, BE WELL PROGRAM THAT REACHES 750,000 USERS ANNUALLY, AND A RADIO CAMPAIGN ON WCBS AM THAT RECORDS 29M IMPRESSIONS PER YEAR. TO DATE, 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. IN 2018, THE PROGRAM FOCUSED ON AT-RISK SCHOOL DISTRICTS IN WESTCHESTER COUNTY, INCLUDING OSSINING AND YONKERS, REACHING MORE THAN 5,000 STUDENTS AND 200 STAFF MEMBERS. A COLLABORATION WITH FEEDING WESTCHESTER ENABLED US TO REACH 275 FAMILIES WITH DIETARY INFORMATION TRANSLATED IN SPANISH, RELATED TO FOOD PANTRY OFFERINGS. OUR PROMOTION OF NATIONAL NUTRITION MONTH REACHED 70 SCHOOLS, 36K STUDENTS AND 1,900 STAFF. ADDITIONALLY, WE PARTICIPATED IN THREE COMMUNITY EVENTS, SHARING MATERIALS AND NUTRITION GUIDANCE. IN ADDITION TO OUR OFF-SITE PROGRAMMING, WE HAVE AN EXTENSIVE PAID SOCIAL MEDIA CAMPAIGN PROMOTING OUR EAT WELL, BE WELL PROGRAM THAT REACHES 750,000 USERS ANNUALLY, AND A RADIO CAMPAIGN ON WCBS AM THAT RECORDS 29M IMPRESSIONS PER YEAR.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 CME 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 WERE PRESENTED BY BLYTHEDALE CLINICAL EXPERTS, INCLUDING PHYSICIANS, NURSES, THERAPISTS AND OTHER CLINICAL EXPERTS AND REACHED OVER 230 FIRST RESPONDERS.CPR TRAINING CENTER: BLYTHEDALE IS A COMMUNITY TRAINING CENTER FOR THE AMERICAN HEART ASSOCIATION, PROVIDING TRAINING IN HEARTSAVER CPR, HEARTSAVER AED, HEARTSAVER FIRST AID, BASIC LIFE SUPPORT AND PEDIATRIC ADVANCED LIFE SUPPORT AND RELATED PROGRAMS. THOSE 3,836 INDIVIDUALS TRAINED IN 2016 INCLUDED HEALTH CARE PROFESSIONALS, MEMBER OF LOCAL POLICE AND FIRE DEPARTMENTS, STUDENTS AT AREA SCHOOLS AND STAFF FROM VARIOUS COMMUNITY AGENCIES.SERVICES TO THE PROFESSIONAL COMMUNITY: BLYTHEDALE ALSO PROVIDES CLINICAL TRAINING FOR SCORES OF PROFESSIONAL STUDENTS IN A WIDE RANGE OF FIELDS, INCLUDING MEDICINE, NURSING, RESPIRATORY THERAPY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY AND SOCIAL WORK. BLYTHEDALE ALSO SPONSORS SPECIALIZED COURSES ON PEDIATRIC ISSUES FOR AREA PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X X X 0 1 0 0 0 0 0 1 0 ADAM HERBST CHIEF LEGAL & COMPLIANCE 190783 0 24771 0 0 0 8200 0 14193 0 237947 0 0 0 JILL WEGENER CNO 228342 0 32631 0 0 0 10400 0 15697 0 287070 0 0 0 JOHN CANNING CFO 380312 0 61192 0 8803 0 68459 0 52842 0 571608 0 0 0 LARRY LEVINE CEO 651964 0 131127 0 11133 0 114735 0 50746 0 959705 0 0 0 MAUREEN DESIMONE CAO 289927 0 20409 0 7631 0 0 0 42989 0 360956 0 0 0 ROBERT LANE CHIEF DEVELOPMENT 257801 0 18550 0 0 0 10918 0 53162 0 340431 0 0 0 SCOTT KLEIN CMO 443821 0 71411 0 0 0 58834 0 53173 0 627239 0 0 0 SUSAN GOODBODY-MURRAY CXO 191456 0 9561 0 0 0 32023 0 14383 0 247423 0 0 0 BYRON FERNANDEZ MD 322128 0 0 0 0 0 17959 0 41933 0 382020 0 0 0 KATHY SILVERMAN MD 294286 0 0 0 0 0 44459 0 24739 0 363484 0 0 0 MARY DIDIE MD 203683 0 0 0 0 0 70957 0 34429 0 309069 0 0 0 RUTH ALEJANDRO MD 204055 0 0 0 0 0 11262 0 41914 0 257231 0 0 0 TRACY LAWRENCE-BLACK MD 248611 0 0 0 0 0 9944 0 34575 0 293130 0 0 0 PART I, LINE 4B 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. THESE PLANS ARE AT-RISK OF SIGNIFICANT FORFEITURE AND HAVE VESTING PERIODS RANGING FROM 5 TO 7 YEARS. EFFECTIVE AS OF JANUARY 1, 2018 THE HOSPITAL IMPLEMENTED TWO ADDITIONAL SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERPS) FOR LAWRENCE LEVINE, CEO AND SCOTT KLEIN, CMO. THE PLANS ARE UNFUNDED AND A DEFINED CONTRIBUTION PLAN. FOR EACH PLAN YEAR THE HOSPITAL WILL MAKE A CONTRIBUTION ON BEHALF OF THE PARTICIPANTS IN AN AMOUNT EQUAL TO SEVENTEEN AND ONE HALF (17.5%) AND TEN PERCENT (10%) RESEPECTIVELY OF THE PARTICIPANT'S BASE COMPENSATION. EFFECTIVE AS OF JANUARY 1, 2012 THE HOSPITAL IMPLEMENTED A SERP. THIS PLAN IS UNFUNDED AND A DEFINED CONTRIBUTION PLAN. THE HOSPITAL MADE A CONTRIBUTION ON BEHALF OF THE PARTICIPANT IN AN AMOUNT EQUAL TO TEN PERCENT (10%) OF THE PARTICIPANT'S BASE COMPENSATION. IN 2016, THE ANNUAL CONTRIBUTION RATE OF THE ADDITIONAL DEFINED CONTRIBUTION SERP PLAN WAS AMENDED TO FIFTEEN PERCENT (15%) OF THE PARTICIPANT'S BASE COMPENSATION. IN 2018, THE HOSPITAL CONTRIBUTED THE FOLLOWING AMOUNTS LARRY LEVINE - CEO $114.735 SCOTT KLEIN - CMO $44,632 JOHN CANNING - CFO $57,638 PART I, LINE 7 BLYTHEDALE ENGAGED SULLIVAN COTTER IN 2018 TO DEVELOP AND PROVIDE RECOMMENDATIONS TO THE COMPENSATION COMMITTEE OF THE BOARD REGARDING PAYMENT OF AN ANNUAL PERFORMANCE INCENTIVE PLAN FOR EMPLOYEES WITH MANAGEMENT RESPONSIBILITIES. THIS INCENTIVE PLAN CONDITIONS PAYMENTS BASED UPON THE ACHIEVEMENT OF MULTIPLE INDIVIDUAL AND ORGANIZATIONAL MEASURES. FUNDING FOR THE PLAN IS DEPENDENT UPON ANNUAL BOARD OF TRUSTEES APPROVAL. BASED UPON THE FINANCIAL CONDITIONS TOWARD THE END OF EACH FISCAL YEAR, THE BOARD WILL EVALUATE THE APPROPRIATENESS OF ESTABLISHING A LUMP SUM POOLED AMOUNT. EVEN IF ALL RELEVANT PERFORMANCE MEASURES ARE ACHIEVED, THE BOARD OF TRUSTEES RETAINS FULL DISCRETION TO MAKE, NOT MAKE OR REDUCE THE AMOUNT OF ANY INCENTIVE AWARDS. A DORMITORY AUTHORITY OF NY (DASNY) 146000293 649905DG8 2009-06-19 27000000 CONSTRUCTION 0 0 0 A 5290000 26748127 119718 540000 820868 25387259 2011 0 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 II, LINE 3 BOND: DORMITORY AUTHORITY OF NY (DASNY) - 06/19/2009 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 WAS 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 HANDED BY THE ACTUAL ISSUER OF THE BONDS, AND BLYTHEDALE CHILDREN'S HOSPITAL DOES NOT HAVE A COPY OF THE ACTUAL REBATE RERPORT. PART IV, LINE 6 SUCH AMOUNTS WERE APPROPRIATELY YIELD RESTRICTED DAVID PEDOWITZ FAMILY MEMBER COMPENSATION 31922 COMPENSATION 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 3718953 FOOD SERVICE 0 X 11 1064815 COST OR SELLING PRICE 0 0 1 0 PART I, COLUMN (B): THE AMOUNT REPORTED IN COLUMN (B) REFERS TO THE NUMBER OF CONTRIBUTIONS 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, LARRY COHEN, AND PEGGY TANNER (BOARD MEMBERS, AND FORMER BOARD MEMBER, RESPECTIVELY). FRANK STERN HAS A BUSINESS RELATIONSHIP WITH BOTH DAVID PEDOWITZ AND JOHN BARKER (BOARD MEMBERS). 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 EXECUTIVE COMMITTEE. THE EXECUTIVE 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 EXECUTIVE 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 2018, 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 DECEMBER 2018, WITHOUT INPUT OR VOTING PARTICIPATION BY THE INDIVIDUALS WHOSE COMPENSATION WAS APPROVED, THE COMPENSATION COMMITTEE APPROVED INCENTIVE COMPENSATION AWARDS FOR THE CEO AND EXECUTIVE MANAGEMENT TEAM AND APPROVED THE PROPOSED 2019 EXECUTIVE BASE COMPENSATION. 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: NET ASSETS RELEASED FROM RESTRICTION- OPERATIONS 0. CHANGE IN PENSION LIABILITY 3,460,117. NET ASSETS RELEASED FROM RESTRICTION- CAPITAL 0. NET 965 INCOME