2017-11-08T01:43:02-06:00 2016-12-31 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2016-01-01 131739922 BLYTHEDALE CHILDREN'S HOSPITAL BLYT 9145927555 95 BRADHURST AVE VALHALLA NY 10595 JOHN CANNING CFO 9145927555 2017-11-07 1 CHRISTINE KAWECKI P00743140 5169187000 2017-11-06 167.219.88.214 2017-11-07 15:51:17 ES P D73626A0C70306D8F9DF5AF9012356B9233F38BE D73626A0C70306D8F9DF5AF9012356B9233F38BE 2016 2018-03-14 21:41:22Z JOHN CANNING 95 BRADHURST AVE VALHALLA NY 10595 84956961 0 X WWW.BLYTHEDALE.ORG X 1891 NY BLYTHEDALE CHILDREN'S HOSPITAL IS DEDICATED TO IMPROVING THE HEALTH & WELL-BEING OF CHILDREN. 29 29 571 274 0 0 11361061 3428187 61164787 62952704 6052589 -3111474 3788721 3963671 82367158 67233088 0 0 0 0 42609552 45348987 0 0 1203076 21696322 22890818 64305874 68239805 18061284 -1006717 217643442 221883829 54472346 53958433 163171096 167925396 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. 1 0 40143051 48432073 SEE SCHEDULE O. 8026021 10689208 SEE SCHEDULE O. 2480866 1077802 SEE SCHEDULE O. 3280865 6613934 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 2016, THE PROGRAM SERVED ON AVERAGE OF 16 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 4,054 VISITS. THE HOSPITAL ALSO PROVIDED 777 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 2016 THE HOSPITAL PROVIDED OVER 2,192 ENCOUNTERS TO CHILDREN REQUIRING THESE SERVICES (THESE SERVICES INCLUDE AUDIOLOGY, NEUROLOGY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, BRACE AND EQUIPMENT MODIFICATION AND FITTING).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. 3280865 6613934 53930803 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 1 150 0 1 571 1 0 1 LU 0 0 0 1 1 0 0 0 0 X 29 29 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 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 J BARKER 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 LANCE WACHENHIEM TRUSTEE 1.00 X 0 0 0 LARRY W COHEN TRUSTEE 1.00 X 0 0 0 LESLIE WEISSMAN TRUSTEE 1.00 X 0 0 0 MICHAEL MARGULIES TRUSTEE 1.00 X 0 0 0 NANCY R BLAINE TRUSTEE 1.00 X 0 0 0 OWEN GUTFREUND TRUSTEE 1.00 X 0 0 0 PATRICIA B STANLEY TRUSTEE 1.00 X 0 0 0 STEVEN SOLOMON TRUSTEE 1.00 X 0 0 0 TERRI HERENSTEIN TRUSTEE 1.00 X 0 0 0 VIRGINIA FURTH WEISMAN TRUSTEE (AS OF 05/16) 1.00 X 0 0 0 WILLIAM ANDY CAHN 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 996321 0 85982 JOHN CANNING CHIEF FINANCIAL OFFICER 37.50 X 416291 0 115986 SCOTT KLEIN CHIEF MEDICAL OFFICER 37.50 X 465759 0 63309 JILL WEGENER CHIEF NURSING OFFICER 37.50 X 214972 0 13404 JANE MACDONALD CHIEF DEVELOPMENT OFFICER 37.50 X 234315 0 54205 RONALD GALLO CHIEF HUMAN RESOURCES OFFICER 37.50 X 229271 0 74904 MAUREEN DESIMONE CHIEF OPERATING OFFICER 37.50 X 322933 0 63521 SUSAN GOODBODY MURRAY CHIEF ENGAGEMENT OFFICER 37.50 X 197376 0 27740 BYRON FERNANDEZ UNIT CHIEF PEDIATRICS 37.50 X 292979 0 52775 JAY SELMAN CHIEF NEUROLOGY 22.50 X 201892 0 126 KATHY SILVERMAN UNIT CHIEF PEDIATRICS 37.50 X 222741 0 56251 MILICENT MITCHELL CHIEF PULONOLOGY 37.50 X 258358 0 12184 XIAOFANG WEI ATTENDING PSYCHIATRIST 37.50 X 178756 0 58530 REGINA KELLY FORMER CHIEF PLANNING OFFICER 0.00 X 119051 0 0 4351015 0 678917 95 1 1 0 BOVIS LEND LEASE 200 PARK AVENUE 9TH FLOOR NEW YORK NY 10166 CONSTRUCTION 5370193 SODEXO INC & AFFILIATES PO BOX 81049 WOBURN MA 01813 DIETARY, FACILITIES,HOUSEKEEPING 3218946 PRESIDIO NETWORKED SOLUTIONS 12120 SUNSET HILLS ROAD RESTON VA 20190 IT INFRASTRUCTURE 1995022 BURKE MEDICAL RESEARCH INSTITUTE 785 MAMARONECK AVENUE WHITE PLAINS NY 10605 MEDICAL RESEARCH 466512 DELOITTE TAX LLP PO BOX 7247-6446 PHILADELPHIA PA 191706446 ACCOUNTING 294492 55 1288125 2140062 169913 3428187 INPATIENT 622110 48432073 48432073 DAY HOSPITAL 622110 10689208 10689208 OUTPATIENT / EARLY INT 621400 1102416 1102416 LONG TERM CARE 622110 1077802 1077802 BUFSD SCHOOL 611710 944646 944646 706559 706559 62952704 658102 658102 13648683 17418259 -3769576 -3769576 -3769576 216976 1288125 305614 -88638 -88638 SPENDING POLICY 900099 3586023 3586023 CAFETERIA 722514 191996 191996 MEDICAL RECORDS 900099 55837 55837 218453 218453 4052309 67233088 66813017 0 -3008116 4910781 2317152 2196879 396750 29054081 25903750 2810935 339396 4568233 3963562 523779 80892 4480598 3855276 529620 95702 2335294 1943070 334144 58080 2473814 1984551 420601 68662 388085 388085 308477 308477 22813 22813 460150 460150 90672 27950 62722 103050 47259 53303 2488 1263424 1257121 6303 5650681 5291406 293428 65847 38672 26342 11960 370 139309 72117 67192 81640 81640 6167363 4709307 1438393 19663 815077 663742 116537 34798 CONTRACTED LABOR 2789672 2359740 406975 22957 TAXES FEES ASSESSMENTS 856376 92747 758969 4660 UTILITIES 792773 672832 113433 6508 DEBT SERVICE FEES 448770 448770 68239805 53930803 13105926 1203076 12606698 7794272 6386155 4278854 7667235 10369642 4412697 5435792 353602 382663 400214 568738 121411284 43737879 75354417 77673405 63525063 61438217 46082313 53071466 855048 870780 217643442 221883829 3741481 3098523 22441481 21800557 2551791 2537230 25737593 26522123 54472346 53958433 X 145086231 152263235 14055979 11713215 4028886 3948946 163171096 167925396 217643442 221883829 X -1006717 5591090 169927 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 22813 22813 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. 18084864 2554980 874730 5852414 15662160 11559343 9177628 -154788 2497319 18084864 11065150 1908465 609854 2024123 11559346 10130991 926397 1758628 1750866 11065150 9207439 1230427 923951 1230826 10130991 0.25200 0.74800 0 0 1383879 1383879 55998367 15021774 40976593 61258512 27283125 33975387 2770526 1432980 1337546 77673405 LIMITED LIABILITY PARTNERSHIP (HEDGE FUNDS) 53071466 C 53071466 ASSET RETIREMENT 133940 ACCRUED PENSION LIABILITY 25291183 EST MALPRACTICE LIABILITIES 1097000 26522123 72158689 4719490 3153679 7873169 64285520 460150 2487418 2947568 67233088 68085370 305615 305615 67779755 460050 460050 68239805 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 TRUSTEES 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, 2016 AND 2015, ARE AVAILABLE FOR THE FOLLOWING PURPOSES: 2016 2015 PLANT REPLACEMENT $4,278,854 $6,501,832 TEMPORARILY RESTRICTED $5,115,360 $4,582,599 MEDICAL EQUIPMENT $19,091 $15,873 OTHER $2,299,910 $2,955,675 TOTALS $11,713,215 $14,055,979 PERMANENTLY RESTRICTED NET ASSETS AS OF DECEMBER 31, 2016 AND 2015, ARE RESTRICTED TO THE FOLLOWING: 2016 2015 INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES $3,948,946 $4,028,886 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 3,153,679. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED INVESTMENT INCOME 3,130. FUNDRAISING EXPENSE RECLASS -305,615. RESTRICTED CONTRIBUTIONS 2,789,892. ROUNDING 11. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSE RECLASS 305,615. CENTRAL AMERICA & THE CARIBBEAN 0 0 INVESTMENTS 27333530 EUROPE (INCLUDING ICELAND AND GREENLAND) 0 0 INVESTMENTS 5677483 0 0 0 0 0 0 33011013 0 33011013 1 0 1 1 0 0 SPRING GALA 786123 679113 107010 1837 107010 2500 39371 GOLF EVENT 398664 319409 79255 79255 7280 4 320314 289603 30711 40810 584 15000 11967 1505101 1288125 216976 1837 120065 107594 17500 58618 305614 -88638 1 1 1 X 400.000000000000 1 X 1 1 1 0 0 517728 517728 0.00770 665847 579391 86456 0.00130 1183575 579391 604184 0.00900 169322 38528 130794 0.00190 279627 199604 80023 0.00120 495368 117745 377623 0.00560 423279 347337 75942 0.00110 191061 181677 9384 0.00010 1558657 884891 673766 0.00990 2742232 1464282 1277950 0.01890 2353070 1053825 1299245 0.01930 2353070 1053825 1299245 0.01930 1 970396 0 0 0 X 1 1 1 1 BLYTHEDALE CHILDREN'S HOSPITAL 95 BRADHURST AVE VALHALLA NY 10595 WWW.BLYTHEDALE.ORG 5957000H X X BLYTHEDALE CHILDREN'S HOSPITAL 1 0 0 1 X X X X X 16 1 0 1 1 X WWW.BLYTHEDALE.ORG 1 14 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 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 HOSPITALS' 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 METINGS 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 ASSOC.POW'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. PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY USED THE PUBLISHED MEDICAID RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. 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 $ 970,396. 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 IN STEP 1. 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, 2016 AND 2015, WERE APPROXIMATELY $517,728 AND $343,417 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 2016. THE HOSPITAL MAINTAINED AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IN 2016 AND 2015 IN THE AMOUNTS OF APPROXIMATELY $961,000 AND $892,000, RESPECTIVELY. THESE AMOUNTS REPRESENT 1.6% AND 1.5% OF NET PATIENT SERVICE REVENUE RESPECTIVELY. PART III, LINE 8: BLYTHEDALE, AS A CHILDREN'S HOSPITAL RECEIVED IMMATERIAL AMOUNTS OF MEDICARE REIMBURSEMENT. IN 2016, 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, HOWEVER, IN ADDITION TO ITS REFERRAL HOSPITALS, BLYTHEDALE ALSO WORKS 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 (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 110,000 STUDENTS, AS WELL AS OVER 5,500 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. THIS PAST YEAR THE PROGRAM WAS PROVIDED IN 23 SCHOOLS (OFTEN MORE THAN ONE VISIT) AND 16 SCHOOL DISTRICTS, TO 17,763 K-8 STUDENTS AND 1,057 ADULTS. 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 1 1 0 0 0 0 0 1 0 LAWRENCE LEVINE CHIEF EXECUTIVE OFFICER 603840 0 123600 0 268881 0 41748 0 44234 0 1082303 0 0 0 JOHN CANNING CHIEF FINANCIAL OFFICER 347352 0 57680 0 11259 0 69238 0 46748 0 532277 0 0 0 SCOTT KLEIN CHIEF MEDICAL OFFICER 406051 0 58898 0 810 0 13530 0 49779 0 529068 0 0 0 JILL WEGENER CHIEF NURSING OFFICER 199950 0 14063 0 959 0 10400 0 3004 0 228376 0 0 0 JANE MACDONALD CHIEF DEVELOPMENT OFFICER 210153 0 21390 0 2772 0 37089 0 17116 0 288520 0 0 0 RONALD GALLO CHIEF HUMAN RESOURCES OFFICER 205099 0 21400 0 2772 0 41337 0 33567 0 304175 0 0 0 MAUREEN DESIMONE CHIEF OPERATING OFFICER 266294 0 43968 0 12671 0 30853 0 32668 0 386454 0 0 0 SUSAN GOODBODY MURRAY CHIEF ENGAGEMENT OFFICER 178792 0 18030 0 554 0 25408 0 2332 0 225116 0 0 0 BYRON FERNANDEZ UNIT CHIEF PEDIATRICS 292703 0 0 0 276 0 16928 0 35847 0 345754 0 0 0 JAY SELMAN CHIEF NEUROLOGY 193587 0 5833 0 2472 0 0 0 126 0 202018 0 0 0 KATHY SILVERMAN UNIT CHIEF PEDIATRICS 216024 0 5803 0 914 0 41887 0 14364 0 278992 0 0 0 MILICENT MITCHELL CHIEF PULONOLOGY 256717 0 0 0 1641 0 0 0 12184 0 270542 0 0 0 XIAOFANG WEI ATTENDING PSYCHIATRIST 178480 0 0 0 276 0 15002 0 43528 0 237286 0 0 0 REGINA KELLY FORMER CHIEF PLANNING OFFICER 0 0 0 0 119051 0 0 0 0 0 119051 0 0 0 PART I, LINES 4A-B LINE 4A - DURING 2016, REGINA KELLY WAS PAID SEVERANCE IN THE AMOUNT OF $119,051 AFTER TERMINATING EMPLOYMENT ON MUTUALLY AGREED TERMS IN NOVEMBER OF 2015. 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 $256,383 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. BOTH PLANS ARE MAINTAINED TO PROVIDE DEFERRED COMPENSATION TO A MEMBER OF A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES. IN 2016, THE HOSPITAL CONTRIBUTED $58,833 TO A SERP ON BEHALF OF JOHN CANNING. 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. PART I, LINE 7 BLYTHEDALE ENGAGED SULLIVAN COTTER IN 2016 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 3755000 26748127 83885 540000 820868 25387259 2011 0 0 1 1 A 0 0 1 0 0 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 5370193 PROFESSIONAL SERVICES 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 3218946 PROFESSIONAL SERVICES 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 460000 PROFESSIONAL SERVICES 0 SUBSTANTIAL CONTRIBUTOR SUBSTANTIAL CONTRIBUTOR 325514 PROFESSIONAL SERVICES 0 X 14 169613 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 2 BLYTHEDALE OPENED UP THE 24 BED STEVEN AND ALEXANDRA COHEN PEDIATRIC LONG TERM CARE UNIT IN SEPTEMBER OF 2016. FORM 990, PART III, LINE 4A 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. THE HOSPITAL OPERATES 86 LICENSED ACUTE BEDS AND PROVIDED CARE TO OVER 75 INPATIENTS PER DAY ON AVERAGE IN 2016. THE HOSPITAL RECEIVED OVER 850 REGIONAL REFERRALS IN THE YEAR AND ADMITTED 628 KIDS. OVER 71% OF OUR INPATIENT ADMISSIONS WERE REIMBURSED THROUGH THE MEDICAID PROGRAM (FFS & MANAGED) IN 2016. WHILE 100% OF THE HOSPITALS INPATIENT POPULATION IS REFERRED IN FROM OTHER ACUTE CARE HOSPITALS IN THE REGION, OVER >45% COME DIRECTLY FROM INTENSIVE CARE UNITS (ICU'S). THIS SPEAKS TO THE HIGH ACUITY OF THE PATIENT POPULATION BEING MANAGED AT BLYTHEDALE. IN 2016 ALMOST 60% OF PATIENTS TREATED WERE BELOW THE AGE OF 4 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 2016, BLYTHEDALE ADMITTED 136 CHILDREN TO THE PROGRAM. 60 % 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 2016, THE PROGRAM SERVED ON AVERAGE OF 92 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 20,060 VISITS. OVER 82% 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 2016, THE PROGRAM SERVED ON AVERAGE OF 20 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 3,972 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 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. 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. 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. 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 2016, 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 2016, 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 2017 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: CHANGE IN PENSION LIABILITY 404,950. WRITE OFF OF PLEDGES -234,912. ROUNDING -111.