2018-11-12T16:01:38-06:00 2017-12-31 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2017-01-01 131739922 BLYTHEDALE CHILDREN'S HOSPITAL BLYT 9145927555 95 BRADHURST AVE VALHALLA NY 10595 JOHN CANNING CFO 9145927555 2018-11-12 1 CHRISTINE KAWECKI P00743140 5169187000 2018-11-12 167.219.88.212 2018-11-12 16:00:34 ES P 4A2558486EEC6DB97E73B1E5FE2049900CCE7E47 FB03248700C55E7316312EA5AE12D7916242AABD 2017 2019-02-21 02:37:17Z JOHN CANNING 95 BRADHURST AVE VALHALLA NY 10595 342693775 0 X WWW.BLYTHEDALE.ORG X 1891 NY BLYTHEDALE CHILDREN'S HOSPITAL IS DEDICATED TO IMPROVING THE HEALTH & WELL-BEING OF CHILDREN. 27 27 597 267 -445 -445 3428187 3716462 62952704 72362491 -3111474 7453734 3963671 3879114 67233088 87411801 0 0 0 0 45348987 50018723 0 0 1074458 22890818 25785943 68239805 75804666 -1006717 11607135 221883829 234170708 53958433 48147819 167925396 186022889 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, THE MAJORITY OF WHICH ARE COVERED BY THE MEDICAID PROGRAM. 0 0 41010505 49586194 INPATIENT SERVICES, SEE SCHEDULE O FOR MORE DETAILS. 8946963 10301657 DAY HOSPITAL, SEE SCHEDULE O FOR MORE DETAILS. 11275805 10388249 LONG TERM CARE, SEE SCHEDULE O FOR MORE DETAILS. 3966403 5924825 EARLY INTERVENTION - THE EARLY INTERVENTION PROGRAM IS A STATEWIDE PROGRAM THAT PROVIDES MANY DIFFERENT TYPES OF EARLY INTERVENTION SERVICES TO CHILDREN BETWEEN THE AGES OF BIRTH TO THREE YEARS WITH DEVELOPMENT DELAY OR DIAGNOSED DISABILITIES AND TO THEIR FAMILIES. IN NEW YORK STATE, THE DEPARTMENT OF HEALTH IS THE LEAD STATE AGENCY RESPONSIBLE FOR THE EARLY INTERVENTION PROGRAM. IN 2017, THE PROGRAM SERVED ON AVERAGE OF 16 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 3,280 VISITS. THE HOSPITAL ALSO PROVIDED 1,002 OUTPATIENT THERAPY AND CLINIC VISITS TO PATIENTS IN THE PROGRAM. 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 AND IMPATIENT PLANS. 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:- DELAYS OR LAGS IN REACHING THEIR DEVELOPMENTAL MILESTONES- CONGENITAL OR ACQUIRED ABNORMALITIES SUCH AS VISION OR HEARINGIMPAIRMENTS- DIAGNOSED MEDICAL CONDITIONS SUCH AS CEREBRAL PALSY, NEUROMUSCULAR OROTHER NEUROLOGICAL DISORDERSBLYTHEDALE CHILDREN'S HOSPITAL OFFERS VARIOUS OUTPATIENT THERAPY AND SUB SPECIALTY MEDICAL CLINICS TO SPECIAL NEEDS CHILDREN THROUGHOUT THE REGION. IN 2017, THE HOSPITAL PROVIDED OVER 1,150 ENCOUNTERS TO CHILDREN REQUIRING THESE SERVICES (THESE SERVICES INCLUDE AUDIOLOGY, NEUROLOGY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, BRACE AND EQUIPMENT MODIFICATION AND FITTING).BLYTHEDALE IS INVOLVED IN THE NEW YORK STATE DEPARTMENT OF HEALTH INITIATIVE DESIGNED TO IMPROVE CARE COORDINATION FOR CHILDREN COVERED BY MEDICAID. AS A PART OF THE HEALTH HOME SERVING CHILDREN PROGRAM, BLYTHEDALE CARE MANAGEMENT SENDS SOCIAL WORKERS INTO THE BRONX AND WESTCHESTER TO WORK WITH MEDICALLY FRAGILE CHILDREN AND THEIR FAMILIES. AS OF LATE 2017, WE WERE ACTIVELY SERVING 12 CHILDREN AND THEIR FAMILIES AND HAD WORKED WITH NEARLY 20 THROUGHOUT THE COURSE OF 2017. THE CARE MANAGER WORKS WITH FAMILIES TO DEVELOP A CUSTOMIZED PLAN OF CARE THAT ADDRESSES BOTH THE CHILD'S MEDICAL NEEDS AND THE SOCIAL DETERMINANTS OF HEALTH WITH A GOAL OF HELPING EACH CHILD REACH HIS OR HER MAXIMUM POTENTIAL.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 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. 3966403 5924825 65199676 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 0 1 1 0 0 0 0 0 0 0 0 1 155 0 1 597 1 0 1 LU 0 0 0 1 1 0 0 0 0 X 27 27 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 DAVID R PEDOWITZ CHAIR 1.00 X 0 0 0 PETER D RITTMASTER VICE CHAIR 1.00 X 0 0 0 SCOTT R LEVY VICE CHAIR 1.00 X 0 0 0 TIM EVNIN TREASURER 1.00 X 0 0 0 LUCY SCHMOLKA SECRETARY 1.00 X 0 0 0 ABBY POPPER TRUSTEE 1.00 X 0 0 0 ADAM GALEON TRUSTEE 1.00 X 0 0 0 ALAN GERSTEIN TRUSTEE 1.00 X 0 0 0 DARREN M FOGEL TRUSTEE 1.00 X 0 0 0 DEAN CURNUTT TRUSTEE (AS OF 03/17) 1.00 X 0 0 0 FARREL STARKER TRUSTEE 1.00 X 0 0 0 FRANK A STERN TRUSTEE 1.00 X 0 0 0 HOWARD ADLER TRUSTEE 1.00 X 0 0 0 JOHN L FURTH TRUSTEE 1.00 X 0 0 0 JON M BURNHAM TRUSTEE 1.00 X 0 0 0 JORDANA HOLOVACH TRUSTEE 1.00 X 0 0 0 JUDITH R GOODHUE TRUSTEE 1.00 X 0 0 0 KIM MOTOLA TRUSTEE (AS OF 01/17) 1.00 X 0 0 0 LANCE WACHENHIEM TRUSTEE 1.00 X 0 0 0 LARRY W COHEN TRUSTEE 1.00 X 0 0 0 LAUREN BUMBY MD TRUSTEE (AS OF 03/17) 1.00 X 0 0 0 MICHAEL MARGULIES TRUSTEE 1.00 X 0 0 0 NANCY R BLAINE TRUSTEE (THRU 9/17) 1.00 X 0 0 0 OWEN GUTFREUND TRUSTEE 1.00 X 0 0 0 PERRY C HOFFMEISTER TRUSTEE (AS OF 11/17) 1.00 X 0 0 0 STEVEN SOLOMON TRUSTEE 1.00 X 0 0 0 VIRGINIA FURTH WEISMAN TRUSTEE 1.00 X 0 0 0 WILLIAM G LEVY TRUSTEE 1.00 X 0 0 0 LAWRENCE LEVINE CHIEF EXECUTIVE OFFICER 37.50 X 1028669 0 81431 JOHN CANNING CHIEF FINANCIAL OFFICER 37.50 X 494545 0 62955 SCOTT KLEIN CHIEF MEDICAL OFFICER 37.50 X 496703 0 67499 JILL WEGENER CHIEF NURSING OFFICER 37.50 X 231508 0 24159 JANE MACDONALD CHIEF DEVELOPMENT OFFICER 37.50 X 253676 0 63753 RONALD GALLO CHIEF HUMAN RESOURCES OFFI 37.50 X 253295 0 80593 MAUREEN DESIMONE CHIEF ADMINISTRATIVE OFFICER 37.50 X 312677 0 70616 SUSAN GOODBODY MURRAY CHIEF ENGAGEMENT OFFICER 37.50 X 203756 0 39903 ADAM HERBST CHIEF LEGAL & COMPLIANCE 37.50 X 136504 0 18013 BYRON FERNANDEZ UNIT CHIEF PEDIATRICS 37.50 X 302063 0 62258 JAY SELMAN CHIEF NEUROLOGY 22.50 X 200217 0 10793 KATHY SILVERMAN UNIT CHIEF PEDIATRICS 37.50 X 245886 0 67425 RUTH ALEJANDRO PHYSICIAN 37.50 X 198291 0 56233 MARY DIDIE CLINICAL CHIEF 37.50 X 198283 0 115838 4556073 0 821469 110 0 1 0 SODEXO INC & AFFILIATES 9801 WASHINGTONIAN BLVD GATHERSBURG MD 20878 DIETARY, FACILITIES, HOUSEKEEPING 3158730 PRESIDIO NETWORKED SOLUTIONS 12120 SUNSET HILLS ROAD SUITE 202 RESTON VA 20190 IT INFRASTRUCTURE 1079982 LENDLEASE 200 PARK AVE 9TH FLOOR NEW YORK NY 10166 CONSTRUCTION 565202 BOSTON CHILDREN'S HEALTH PHYSICIANS 40 SUNSHINE COTTAGE ROAD STE 1N-C2 VALHALLA NY 10595 MEDICAL SERVICES 532917 DELL MARKETING LP ONE DELL WAY RR 8 ROUND ROCK TX 78682 COMPUTER & IT SERVICES 502078 13 1369973 2346489 210721 3716462 INPATIENT 622110 49586194 49586194 LONG TERM CARE 622110 10388249 10388249 DAY HOSPITAL 622110 10301657 10301657 BUFSD SCHOOL 611710 939500 939500 OUTPATIENT / EARLY INT 621400 687924 687924 458967 458967 72362491 711318 -445 711763 261720305 254977889 6742416 6742416 6742416 152460 1369973 304085 -151625 -151625 SPENDING POLICY 900099 3565008 3565008 CAFETERIA 722514 192305 192305 MEDICAL RECORDS 900099 41906 41906 231520 231520 4030739 87411801 76200925 -445 7494859 4225354 2379075 1596300 249979 32870618 31970722 512663 387233 4340059 3390888 881466 67705 6005038 4691736 1219845 93457 2577654 2013921 523522 40211 3205515 2781601 368688 55226 437679 330332 85685 21662 323963 244300 75516 4147 20607 0 20607 0 489679 489679 119588 90335 27730 1523 112628 95369 14415 2844 1271609 958920 280357 32332 6605523 6161691 437592 6240 37406 34351 2564 491 189829 187462 1171 1196 252835 190663 58936 3236 6651817 5053385 1550539 47893 644433 485967 150217 8249 CONTRACTED LABOR 3061996 2355322 686402 20272 TAXES FEES ASSESSMENTS 1094756 828886 251514 14356 UTILITIES 824790 621974 192259 10557 DEBT SERVICE FEES 441290 332776 102865 5649 75804666 65199676 9530532 1074458 7794272 14762282 4278854 2195905 10369642 10672859 5435792 5015049 382663 364251 568738 694066 122666162 49912107 77673405 72754055 61438217 83061809 53071466 43658330 870780 992102 221883829 234170708 3098523 3462375 21800557 21124630 2537230 3800229 26522123 19760585 53958433 48147819 X 152263235 170966577 11713215 10983043 3948946 4073269 167925396 186022889 221883829 234170708 X 11607135 5220694 1269664 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 20607 20607 0 PART II-B, LINE 1, LOBBYING ACTIVITIES: 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. 15662160 2796440 2173245 5575534 15056311 18084864 2554980 874730 5852414 15662160 11559343 9177628 -154788 2497319 18084864 11065150 1908465 609854 2024123 11559346 10130991 926397 1758628 1750866 11065150 0.27050 0.72950 0 0 1383879 1383879 55998368 17268957 38729411 62196085 31078079 31118006 3087830 1565071 1522759 72754055 ALTERNATIVE INVESTMENTS 43658330 C 43658330 ASSET RETIREMENT 177334 ACCRUED PENSION LIABILITY 18057251 EST MALPRACTICE LIABILITIES 1526000 19760585 90717667 3049544 2723463 5773007 84944660 2467141 2467141 87411801 75646490 304085 304085 75342405 489679 -27418 462261 75804666 PART V, LINE 4: TEMPORARILY RESTRICTED NET ASSETS ARE THOSE WHOSE USE BY BLYTHEDALE CHILDREN'S HOSPITAL (THE "HOSPITAL") HAS BEEN LIMITED BY DONORS TO A SPECIFIC PERIOD OR PURPOSE. PERMANENTLY RESTRICTED NET ASSETS HAVE BEEN RESTRICTED BY DONORS TO BE MAINTAINED BY THE HOSPITAL IN PERPETUITY. THE HOSPITAL'S ENDOWMENT CONSISTS OF APPROXIMATELY 20 INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. THE HOSPITAL BECAME SUBJECT TO NYPMIFA (THE NEW YORK PRUDENT MANAGEMENT OF INSTITUTIONAL FUNDS ACT) WHICH WAS ENACTED IN SEPTEMBER 2010. THE BOARD OF DIRECTORS INTERPRETED NYPMIFA AS (A) REQUIRING THE PRESERVATION OF THE ORIGINAL GIFT AS OF THE GIFT DATE OF THE DONOR-RESTRICTED ENDOWMENT FUNDS ABSENT EXPLICIT DONOR STIPULATIONS TO THE CONTRARY. AS A RESULT OF THIS INTERPRETATION, THE HOSPITAL CLASSIFIES AS PERMANENTLY RESTRICTED NET ASSETS: (A) THE ORIGINAL VALUE OF GIFTS DONATED TO THE PERMANENT ENDOWMENT, (B) THE ORIGINAL VALUE OF SUBSEQUENT GIFTS TO THE PERMANENT ENDOWMENT, AND (C) ACCUMULATIONS OF INCOME ARE ADDED TO THE FUND IN ACCORDANCE WITH THE DIRECTION OF THE APPLICABLE DONOR GIFT INSTRUMENT AT THE TIME THE ACCUMULATION IS ADDED TO THE FUND. THE REMAINING PORTION OF THE DONOR-RESTRICTED ENDOWMENT FUND THAT IS NOT CLASSIFIED IN PERMANENTLY RESTRICTED NET ASSETS IS CLASSIFIED AS TEMPORARILY RESTRICTED UNTIL THOSE AMOUNTS ARE APPROPRIATED FOR EXPENDITURE BY THE ORGANIZATION. IN ACCORDANCE WITH NYPMIFA, THE ORGANIZATION CONSIDERS THE FOLLOWING FACTORS IN MAKING A DETERMINATION TO APPROPRIATE OR ACCUMULATE DONOR-RESTRICTED ENDOWMENT FUNDS: (A) THE DURATION AND PRESERVATION OF THE FUND (B) THE PURPOSES OF THE ORGANIZATION AND THE DONOR-RESTRICTED ENDOWMENT FUND (C) GENERAL ECONOMIC CONDITIONS (D) THE POSSIBLE EFFECT OF INFLATION AND DEFLATION (E) THE EXPECTED TOTAL RETURN FROM INCOME AND THE APPRECIATION OF INVESTMENTS (F) OTHER RESOURCES OF THE ORGANIZATION (G) THE INVESTMENT POLICIES OF THE ORGANIZATION TEMPORARILY RESTRICTED NET ASSETS AS OF DECEMBER 31, 2017 AND 2016, ARE AVAILABLE FOR THE FOLLOWING PURPOSES: 2017 2016 PLANT REPLACEMENT $2,195,905 AND $4,278,854 TEMPORARILY RESTRICTED $6,827,158 AND $5,115,360 MEDICAL EQUIPMENT $0 AND $19,091 OTHER 1,959,980 AND $2,299,910 TOTALS $10,983,043 AND $11,713,215 PERMANENTLY RESTRICTED NET ASSETS AS OF DECEMBER 31, 2017 AND 2016, ARE RESTRICTED TO THE FOLLOWING: 2017 2016 INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES $4,073,269 AND $3,948,946 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 3,213,142. INVESTMENT EXPENSE RECLASS -489,679. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED INVESTMENT INCOME 2,095. FUNDRAISING EXPENSE RECLASS -304,085. RESTRICTED CONTRIBUTIONS 2,796,440. EXPENSE RECLASS TO REVENUE -27,418. NET 965 INCOME 109. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSE RECLASS 304,085. PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSE RECLASS TO REVENUE -27,418. CENTRAL AMERICA & THE CARIBBEAN 0 0 INVESTMENTS 15181151 EUROPE (INCLUDING ICELAND AND GREENLAND) 0 0 INVESTMENTS 232151 0 0 0 0 0 0 15413302 0 15413302 1 0 1 1 1 0 SPRING EVENT 680223 645078 35145 528 24228 53198 2500 24686 STUART DIX GOLF 461215 392640 68575 0 90814 0 0 4836 6 380995 332255 48740 12763 62562 1014 0 26956 1522433 1369973 152460 13291 177604 54212 2500 56478 304085 -151625 1 1 1 X 400.000000000000 1 X 1 1 1 0 0 165105 61638 103467 0.00140 54512264 53504216 1008048 0.01340 54677369 53565854 1111515 0.01480 272049 88930 183119 0.00240 220075 179746 40329 0.00050 574982 439854 135128 0.00180 491111 29100 462011 0.00620 1558217 737630 820587 0.01090 56235586 54303484 1932102 0.02570 1393521 603562 789959 0.01050 1393521 603562 789959 0.01050 1 744342 0 0 0 X 1 1 1 1 BLYTHEDALE CHILDREN'S HOSPITAL 95 BRADHURST AVE VALHALLA NY 10595 WWW.BLYTHEDALE.ORG 5957000H X X 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 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 21D: HOSPITAL IS A REGIONAL SPECIALTY CHILDREN'S HOSPITAL, AND DOES NOT HAVE AN EMERGENCY ROOM.BLYTHEDALE CHILDREN'S HOSPITAL:PART V, SECTION B, LINE 22D:THE HOSPITAL FACILITY USED THE PUBLISHED MEDICAID RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. PART V, SECTION B, LINE 16H: 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. 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 I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 744,342. PART II, COMMUNITY BUILDING ACTIVITIES: BLYTHEDALE IS INVOLVED IN NUMEROUS COMMUNITY BUILDING ACTIVITIES 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: REVENUE IS RECOGNIZED WHEN THE CLAIM HAS (1) PERVASIVE EVIDENCE OF A PAYMENT AGREEMENT / AUTHORIZATION, RATE SHEET OR CONTRACT (2) SERVICES HAVE BEEN RENDERED (3) PRICE IS FIXED AND DETERMINABLE (4) COLLECTABILITY IS REASONABLE ASSURED. BAD DEBT IS RECOGNIZED IF MANAGEMENT IS UNABLE TO COLLECT THE DEBT AFTER THESE CRITERIA HAVE BEEN MET.BAD DEBTS DO NOT INCLUDE CHARITY CARE, COURTESY DISCOUNTS, SELF PAY ALLOWANCES, OR ALLOWANCES FOR OUTPATIENT SERVICES PROVIDED THAT ARE NOT AUTHORIZED.BAD DEBTS WILL BE RECORDED AND RECOGNIZED IN THE PERIOD IN WHICH IT IS DETERMINED THE DEBT IS UNCOLLECTIBLE. BAD DEBT IS RECOGNIZED AS THE AMOUNT CONTRACTUALLY OBLIGATED AND RECOGNIZED AS REVENUE FOR WHICH ALL AVENUES OF COLLECTION HAVE BEEN EXHAUSTED. ALL WRITE OFFS IN EXCESS OF $10,000 REQUIRE APPROVAL FROM THE CFO PRIOR TO RECORDING ENTRY IN MEDITECH SYSTEM. ALL BAD DEBT ALLOWANCE ENTRIES ARE TO BE CODED USING "XFR PROCEDURE IN MEDITECH.THE FOLLOWING EXAMPLE WILL DEMONSTRATE THE COMPONENTS OF BAD DEBT TO BE RECORDED.TOTAL PATIENT CHARGES: $250,000LESS CONTRACTUAL ALLOWANCES: -$150,000NET REVENUE: $100,000ACTUAL PAYMENTS: -$75,000ACCOUNT BALANCE UNCOLLECTED: $25,000 <==BAD DEBT VALUE AFTER ALL EFFORTS TO COLLECT ARE EXHAUSTEDCOMPONENTS OF BAD DEBT REPORTING:THE RESERVE BALANCE SHOULD REFLECT 9.0% OF THE GROSS AR AS RECORDED IN1. THE VARIANCE FROM THE 12/31 RESERVE BALANCE IS RECORDED ON A MONTHLY BASIS. THE NET OF THE ACTUAL BAD DEBTS + CHANGE IN RESERVE BALANCE FROM 12/31 IS RECORDED AS BAD DEBT EXPENSE IN THE FINANCIAL STATEMENTS. PART III, LINE 4: CHARITY CARE - THE HOSPITAL 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 COST, NET OF ANY REIMBURSEMENTS DURING THE YEARS ENDED DECEMBER 31, 2017 AND 2016, WERE APPROXIMATELY $103,737 AND $517,728 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.PROVISION AND ALLOWANCE FOR DOUBTFUL ACCOUNTS - TO PROVIDE FOR ACCOUNTS RECEIVABLE THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE, THE HOSPITAL ESTABLISHES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR DOUBTFUL ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR DOUBTFUL ACCOUNTS FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE EXHAUSTED THIRD PARTY BENEFITS RELATIVE TO SERVICES PROVIDED AT THE HOSPITAL AND HAVE NO SECONDARY SOURCE OF COVERAGE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL DID NOT CHANGE ITS CHARITY CARE OR UNINSURED DISCOUNT POLICIES DURING FISCAL YEAR 2017. THE HOSPITAL MAINTAINED AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IN 2017 AND 2016 IN THE AMOUNTS OF APPROXIMATELY $992,000 AND $961,000, RESPECTIVELY. THESE AMOUNTS REPRESENT 1.4% AND 1.6% OF NET PATIENT SERVICE REVENUE RESPECTIVELY. PART III, LINE 8: BLYTHEDALE, AS A CHILDREN'S HOSPITAL RECEIVED IMMATERIAL AMOUNTS OF MEDICARE REIMBURSEMENT. IN 2017, THE HOSPITAL FILED A LOW/NO COST UTILIZATION REPORT WITH CMS. PART III, LINE 9B: COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. ALL PATIENTS HAVING DIFFICULTY PAYING THEIR BILLS ARE DIRECTED TO HOSPITAL STAFF WHO ASSIST THE FAMILY IN COMPLETING A FINANCIAL ASSESSMENT AND TRY TO QUALIFY THE PATIENT FOR ASSISTANCE. ONCE A LEVEL OF FINANCIAL ASSISTANCE IS DETERMINED, THE ACCOUNT BALANCE IS PRORATED FOR CONTRACTUAL ADJUSTMENTS AND THEN PRO-RATED TO COST. FROM COSTS, THE LEVEL OF FINANCIAL ASSISTANCE IS THEN APPLIED, ANY REMAINING BALANCE IS COLLECTABLE AS PATIENT RESPONSIBILITY.PATIENTS ARE SCREENED FOR ELIGIBILTY FOR FINANCIAL ASSISTANCE BEFORE COLLECTION PROCEDURE BEGIN. IF AT ANY POINT IN THE COLLECTION PROCESS, DOCUMENTATION IS RECEIVED THAT INDICATES THAT THE PATIENT IS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, THE ACCOUNT IS REFERRED BACK FOR A FINANCIAL ASSISTANCE REVIEW. BLYTHEDALE DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR CHARITY CARE.IF A PATIENT HAS REQUESTED AND/OR FILLED OUT A FINANCIAL ASSISTANCE APPLICATION, ALL DEBT COLLECTION ACTIVITIES STOP UNTIL ELIGIBILTY FOR FINANCIAL ASSISTANCE CAN BE DETERMINED. BLYTHEDALE'S POLICY PROVIDES THAT WE WILL NOT REFER ANY ACCOUNTS FOR COLLECTION UNTIL IT IS DETERMINED WHETHER THE INDIVIDUAL IS INSURED AND NOT ELIGIBLE FOR FINANCIAL ASSISTANCE. 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 PUBLIC HEALTH 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 (54%), HUDSON VALLEY (33%), LONG ISLAND (6%), OUT OF STATE (7%).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 (27%); HISPANIC OR LATINO (30%); WHITE (26%); OTHER (12%). 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 CHRONIC DISEASE - AND THROUGH THE GENEROSITY OF KOHL'S CARES - BLYTHEDALE'S EAT WELL, BE WELL NUTRITION PROGRAM EDUCATES CHILDREN AND LOW-INCOME INDIVIDUALS IN WESTCHESTER COUNTY THROUGH CLASSROOM INSTRUCTION, COMMUNITY EVENTS AND COLLABORATIVE ENDEAVORS WITH FOOD PANTRIES. REGISTERED DIETITIANS PROMOTE HEALTHY EATING HABITS TO CHILDREN BY PROVIDING CURRICULUM AND NUTRITION GUIDELINES, AND TRAINING AND EDUCATIONAL TOOLS TO SCHOOL DISTRICTS THROUGHOUT THE AREA. SINCE ITS INCEPTION IN 2006, THE PROGRAM HAS REACHED MORE THAN 115,000 STUDENTS IN THE GREATER METROPOLITAN REGION. OUR PROMOTION OF NATIONAL NUTRITION MONTH IN MARCH REACHED 36,000 STUDENTS AND 1,900 STAFF MEMBERS. OUR NEWEST INITIATIVES TO PROMOTE HEALTHY LIFESTYLE CHOICES AND FOOD SECURITY LOW-INCOME FAMILIES THROUGH OUR FOOD PANTRY COLLABORATION HAS REACHED MORE THAN 50,000 PEOPLE IN 2017.FIRST RESPONDER TRAINING PROGRAM: BLYTHEDALE, IN COORDINATION WITH THEWESTCHESTER REGIONAL EMS OFFICE, WESTCHESTER COUNTY DEPARTMENT OFENVIRONMENTAL SERVICES, AND THE NYS EMS FOR CHILDREN PROGRAM, HASDEVELOPED A SPECIAL PEDIATRIC CME SERIES FOR FIRST RESPONDERS OF THEWESTCHESTER EMS REGION. THE SERIES COVERS SUBJECTS VITAL TO FIRSTRESPONDERS, INCLUDING TRAUMATIC BRAIN INJURY, AUTISM, TECHNOLOGY AND CAREOF THE INFANT OR CHILD, CHILD ABUSE/NEGLECT AND CHILD/INFANT SAFETY DURINGTRANSFER. THE COURSES WERE PRESENTED BY BLYTHEDALE CLINICAL EXPERTS,INCLUDING PHYSICIANS, NURSES, THERAPISTS AND OTHER CLINICAL EXPERTS.CPR TRAINING CENTER: BLYTHEDALE IS A COMMUNITY TRAINING CENTER FOR THEAMERICAN HEART ASSOCIATION, PROVIDING TRAINING IN HEARTSAVER CPR,HEARTSAVER AED, HEARTSAVER FIRST AID, BASIC LIFE SUPPORT AND PEDIATRICADVANCED LIFE SUPPORT AND RELATED PROGRAMS. THOSE 3,861 INDIVIDUALS TRAINED IN 2017 INCLUDED HEALTH CARE PROFESSIONALS, MEMBER OF LOCAL POLICEAND FIRE DEPARTMENTS, STUDENTS AT AREA SCHOOLS AND STAFF FROM VARIOUSCOMMUNITY AGENCIES.SERVICES TO THE PROFESSIONAL COMMUNITY: BLYTHEDALE ALSO PROVIDES CLINICALTRAINING 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 ALSOSPONSORS 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 LAWRENCE LEVINE CHIEF EXECUTIVE OFFICER 632975 0 127300 0 268394 0 35834 0 45597 0 1110100 0 0 0 JOHN CANNING CHIEF FINANCIAL OFFICER 369235 0 60000 0 65310 0 10405 0 52550 0 557500 0 0 0 SCOTT KLEIN CHIEF MEDICAL OFFICER 430893 0 65000 0 810 0 13656 0 53843 0 564202 0 0 0 JILL WEGENER CHIEF NURSING OFFICER 205717 0 24825 0 966 0 9869 0 14290 0 255667 0 0 0 JANE MACDONALD CHIEF DEVELOPMENT OFFICER 219129 0 30850 0 3697 0 37089 0 26664 0 317429 0 0 0 RONALD GALLO CHIEF HUMAN RESOURCES OFFI 219603 0 30920 0 2772 0 41748 0 38845 0 333888 0 0 0 MAUREEN DESIMONE CHIEF ADMINISTRATIVE OFFICER 281482 0 20000 0 11195 0 30853 0 39763 0 383293 0 0 0 SUSAN GOODBODY MURRAY CHIEF ENGAGEMENT OFFICER 184618 0 18565 0 573 0 25408 0 14495 0 243659 0 0 0 ADAM HERBST CHIEF LEGAL & COMPLIANCE 125231 0 11100 0 173 0 5141 0 12872 0 154517 0 0 0 BYRON FERNANDEZ UNIT CHIEF PEDIATRICS 301787 0 0 0 276 0 17436 0 44822 0 364321 0 0 0 JAY SELMAN CHIEF NEUROLOGY 199171 0 0 0 1046 0 0 0 10793 0 211010 0 0 0 KATHY SILVERMAN UNIT CHIEF PEDIATRICS 244516 0 0 0 1370 0 43144 0 24281 0 313311 0 0 0 RUTH ALEJANDRO PHYSICIAN 198111 0 0 0 180 0 10934 0 45299 0 254524 0 0 0 MARY DIDIE CLINICAL CHIEF 196758 0 0 0 1525 0 69890 0 45948 0 314121 0 0 0 PART I, LINE 4B SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN - EFFECTIVE AS OF JANUARY 1, 2008, THE HOSPITAL IMPLEMENTED THE BLYTHEDALE CHILDREN'S HOSPITAL SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO PROVIDE PENSION BENEFITS FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES. THIS PLAN IS UNFUNDED AND A TARGET DEFINED BENEFIT PLAN. LAWRENCE LEVINE RECEIVED PAYMENTS FROM A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN DURING THE YEAR IN THE AMOUNT OF $251,927 UNDER THE TERMS OF THE BLYTHEDALE CHILDREN'S HOSPITAL SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN FOR LAWRENCE LEVINE. EFFECTIVE AS OF JANUARY 1, 2012 THE HOSPITAL IMPLEMENTED AN ADDITIONAL SERP. THIS PLAN IS UNFUNDED AND A DEFINED CONTRIBUTION PLAN. FOR EACH PLAN YEAR THE HOSPITAL WILL MAKE 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. BOTH PLANS ARE MAINTAINED TO PROVIDE DEFERRED COMPENSATION TO A MEMBER OF A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES. IN 2017, THE HOSPITAL CONTRIBUTED $55,697 TO A SERP ON BEHALF OF JOHN CANNING. PART I, LINE 7 BLYTHEDALE ENGAGED SULLIVAN, COTTER AND ASSOCIATES IN 2017 TO DEVELOP AND PROVIDE RECOMMENDATIONS TO THE COMENSATION 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 DIRECTORS 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 DIRECTORS 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 4505000 26748127 100737 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 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 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 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. SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 565202 CONSTRUCTION 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 353124 LEGAL SERVICES 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 3158730 FOOD SERVICES 0 X 17 210721 COST/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 III, LINE 4A, DESCRIPTION OF PROGRAM SERVICE: 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 2017, 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 22 LONG TERM CARE PATIENTS PER DAY IN 2017. THE HOSPITAL RECEIVED OVER 880 REGIONAL REFERRALS IN THE YEAR AND ADMITTED 643 KIDS. OVER 72% OF OUR INPATIENT ADMISSIONS WERE REIMBURSED THROUGH THE MEDICAID PROGRAM (FFS & MANAGED) IN 2017. WHILE 100% OF THE HOSPITAL'S INPATIENT POPULATION IS REFERRED IN FROM OTHER ACUTE CARE HOSPITALS IN THE REGION, OVER >56% COME DIRECTLY FROM INTENSIVE CARE UNITS (ICU'S). THIS SPEAKS TO THE HIGH ACUITY OF THE PATIENT POPULATION BEING MANAGED AT BLYTHEDALE. IN 2017, ALMOST 67% OF PATIENTS TREATED WERE BELOW THE AGE OF 5 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. FORM 990, PART III, LINE 4B, DESCRIPTION OF PROGRAM SERVICE: 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 2017, BLYTHEDALE ADMITTED 141 CHILDREN TO THE PROGRAM. 65% 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 2017, THE PROGRAM SERVED ON AVERAGE OF 90 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 19,404 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 2017, THE PROGRAM SERVED ON AVERAGE OF 21 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 3,979 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 AGES 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 EMOTIONAL DEVELOPMENT - CONGENITAL OR ACQUIRED ABNORMALITIES - DIAGNOSED MEDICAL CONDITIONS SUCH AS CEREBRAL PALSY, NEUROMUSCULAR OR OTHER NEUROLOGICAL DISORDERS FORM 990, PART III, LINE 4C, DESCRIPTION OF PROGRAM SERVICE: 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 2017, THE HOSPITAL ADMITTED 36 CHILDREN TO THE UNIT AND RAN AN AVERAGE DAILY CENSUS OF 21.6. 73% OF THE CHILDREN WERE UNDER THE AGE OF 5 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 INCLUDES 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. 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 (BOARD MEMBERS). 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 DIRECTORS 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 DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C 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) IF 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 2017, 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 AND ASSOCIATES ASSISTED THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS 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 DIRECTORS 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 2017, 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 2018 EXECUTIVE BASE COMPENSATION. THE FINAL DETERMINATION OF THE COMMITTEE WAS DOCUMENTED AND AN OVERVIEW WAS PROVIDED TO THE FULL BOARD OF DIRECTORS 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 1,269,773. NET 965 INCOME -109.