2017-05-15T15:52:20-05:00 2016-06-30 560747981 DIXON HUGHES GOODMAN LLP 901 EAST CARY STREET SUITE 1000 RICHMOND VA 23219 990 2015-07-01 540506309 CRIPPLED CHILDREN'S HOSPITAL CRIP 8042285874 2924 BROOK ROAD RICHMOND VA 232201298 JAMES A DEYARMIN DIRECTOR OF FINANCE 8042285874 2017-05-12 1 CHRISTOPHER T BENNETT P01232201 8042827636 2015 2021-01-29 14:40:06Z CHILDREN'S HOSPITAL OF RICHMOND OF THE VCU HEALTH SYSTEM SHARON W DARBY 2924 BROOK ROAD RICHMOND VA 232201298 32362083 0 X WWW.CHRICHMOND.ORG X 1920 VA CRIPPLED CHILDREN'S HOSPITAL IS A RESOURCE AND PROVIDER OF SPECIALIZED MEDICAL AND THERAPEUTIC SERVICES CUSTOMIZED TO MEET THE SPECIFIC NEEDS OF CHILDREN AND THEIR FAMILIES. OVER 9,000 CHILDREN WERE SERVED THIS PAST YEAR. WE CONTINUE TO FOCUS ON EXPANDING OUR CAPACITY TO SERVE. 9 3 459 200 0 0 634113 587961 29293812 31718261 7305 3868 103778 41394 30039008 32351484 0 0 0 0 26321438 27367227 0 0 0 8357780 7937636 34679218 35304863 -4640210 -2953379 19266850 23960648 14769890 24159904 4496960 -199256 X CRIPPLED CHILDREN'S HOSPITAL IS A RESOURCE AND PROVIDER OF SPECIALIZED MEDICAL AND THERAPEUTIC SERVICES CUSTOMIZED TO MEET THE SPECIFIC NEEDS OF CHILDREN AND THEIR FAMILIES. OVER 9,000 CHILDREN WERE SERVED THIS PAST YEAR. WE CONTINUE TO FOCUS ON EXPANDING OUR CAPACITY TO SERVE MORE CHILDREN. 0 1 10299525 11696850 THE TRANSITIONAL CARE UNIT IS THE HOSPITAL'S ONLY INPATIENT UNIT. IT HAS 47 BEDS AND PROVIDES LONG TERM CARE FOR CHILDREN UP TO THE AGE OF 21 WHO REQUIRE SPECIALIZED, AROUND THE CLOCK, NURSING CARE. THE UNIT HAD AN AVERAGE DAILY CENSUS OF 39.2 IN FISCAL YEAR 2016, AN INCREASE FROM 38.4 IN FISCAL YEAR 2015. THE UNIT IS CERTIFIED BY THE VIRGINIA DEPARTMENT OF MEDICAL ASSISTANCE SERVICES AND 100% OF THE REVENUE IN THIS PROGRAM COMES FROM VIRGINIA MEDICAID. 9983906 12693417 THE HOSPITAL IS THE PREMIER PROVIDER OF OUTPATIENT PEDIATRIC PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY SERVICES IN CENTRAL VIRGINIA. OUTPATIENT THERAPY VISITS TOTALED 84,844 IN FISCAL YEAR 2016. THERAPY SERVICES ARE PROVIDED AT THE MAIN HOSPITAL IN THE CITY OF RICHMOND AND AT FIVE COMMUNITY THERAPY CENTERS LOCATED IN GLEN ALLEN, BON AIR, FREDERICKSBURG, PETERSBURG, AND STAFFORD. APPROXIMATELY 50% OF THE THERAPY VISITS ARE FUNDED BY VIRGINIA MEDICAID AND MEDICAID MANAGED CARE ORGANIZATIONS. 2303551 3160072 DENTAL PROGRAM SERVICES ARE PROVIDED FOR THE TYPICAL WELL-CHILD AND FOR CHILDREN WITH SPECIAL NEEDS. IN FISCAL YEAR 2016, THE DENTAL PROGRAM COMPLETED 631 SURGERIES AND 6,387 CLINIC VISITS. THE MAJORITY OF THE DENTAL PROGRAM PATIENTS ARE FUNDED BY VIRGINIA MEDICAID AND MEDICAID MANAGED CARE ORGANIZATIONS. 3330076 4167922 CHILDREN'S FEEDING PROGRAM - THE CHILDREN'S FEEDING PROGRAM IS DESIGNED TO HELP CHILDREN WHO HAVE A MEDICAL CONDITION THAT HAS AFFECTED THEIR FEEDING AND GROWTH. THE CHILD IS INITIALLY SEEN IN THE FEEDING CLINIC BY A TEAM OF SPECIALISTS WHO EVALUATE THE CHILD'S NEEDS AND MAKE RECOMMENDATIONS FOR TREATMENT AND/OR PROVIDES TIPS FOR THE FAMILY. TREATMENT PROGRAMS, EITHER OUTPATIENT OR DAY PATIENT, FOCUS ON ESTABLISHING APPROPRIATE FEEDING AND NUTRITIONAL HABITS. 3330076 4167922 25917058 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 40 0 1 459 1 0 0 0 0 0 0 0 0 0 0 X 9 3 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 VA X JAMES A DEYARMIN 8042285874 2924 BROOK ROAD RICHMOND VA 232201298 THOMAS S CAIN CHAIRMAN 1.00 X X 0 0 0 PONJOLA CONEY MD SECRETARY 1.00 X X 0 57895 7417 LINDA E PEARSON VICE CHAIR AND TREASURER 1.00 X X 0 453035 62123 JOHN F DUVAL DIRECTOR - EX-OFFICIO 1.00 X 0 1303463 109778 BRUCE K RUBIN MD DIRECTOR - EX-OFFICIO 1.00 X 0 412975 38439 ANN E HONEYCUTT DIRECTOR 1.00 X 0 0 0 JOHN D WARD MD DIRECTOR - EX-OFFICIO 1.00 X 0 581177 37055 FRANCES LW KAY DIRECTOR 1.00 X 0 0 0 MARSHA D RAPPLEY MD DIRECTOR 1.00 X 0 140904 12109 LESLIE G WYATT EXECUTIVE DIRECTOR 45.00 X 0 312234 48715 SHARON W DARBY VP OF CLINICAL OPERATIONS 45.00 X 214076 0 37607 JAMES A DEYARMIN DIRECTOR OF FINANCE 45.00 X 156031 0 26849 SALLIE C TIDMAN DIRECTOR OF THERAPY SERVICES 45.00 X 118946 0 32991 MARY S TOGNARELLI DIRECTOR OF OUTPATIENT SERVICES 45.00 X 113512 0 19095 PATRICIA P ANDERSON DIRECTOR OF INPATIENT SERVICES 45.00 X 123219 0 22360 CYNTHIA J BILHEIMER ASSISTANT DIRECTOR OF INPATIENT SERVICES 45.00 X 115354 0 30838 TIMOTHY M GIBBS DIRECTOR OF INFORMATION TECHNOLOGY 45.00 X 128562 0 11794 JEROME F STRAUSS III MD FORMER DIRECTOR 1.00 X 0 764011 11089 969700 4025694 508259 16 1 1 0 MCV ASSOCIATED PHYSICIANS DBA MCV PHYS PO BOX 79203 BALTIMORE MD 212790203 CONTRACT PHYSICIANS 816800 VCU DENTISTRY 521 NORTH 11TH STREET RICHMOND VA 23298 CONTRACT DENTISTS 576282 HURON CONSULTING SERVICES LLC 1620 L STREET NW SUITE 600 WASHINGTON DC 20036 I.T. CONSULTANTS 393864 ARKANSAS COUNTY ANESTHESIA 48180 KIPPER DRIVE MOSELEY VA 23120 CONTRACT PHYSICIANS 292750 FIRST CHOICE NURSES INC 5310 MARKEL ROAD SUITE 105A RICHMOND VA 23230 CONTRACT NURSES 215700 5 587961 587961 PATIENT SERVICES 623000 31707878 31707878 PHYSICAL THERAPY CONTRACT SERVICE 623000 11883 11883 INFANT SERVICES 621610 -1500 -1500 31718261 3668 3668 150 0 150 150 150 200 0 200 200 200 17463 10599 6864 6864 MED RECORDS FEE 623000 12903 12903 MISC REVENUE 900099 11493 11493 HOSP INSURANCE CLAIMS INTEREST 623000 8312 8312 1672 1672 34380 32351484 31718261 0 45262 429559 322169 107390 18630484 14416505 4213979 1039179 744831 294348 5902125 4358493 1543632 1365880 1060825 305055 284950 284950 11027 11027 29100 29100 2052105 1616015 436090 2524 2395 129 1266290 223787 1042503 31865 23017 8848 960697 486433 474264 56833 34937 21896 66825 49532 17293 932693 699520 233173 166202 121678 44524 RESIDENT CARE 1977462 1746865 230597 DUES & LICENSES 91630 6682 84948 MISCELLANEOUS 7433 3374 4059 35304863 25917058 9387805 0 814016 3197311 3773 1679 3422751 3544616 163487 175061 92373 128166 40014123 31950493 8410904 8063630 6359546 8850185 19266850 23960648 3424372 3607779 11345518 20552125 14769890 24159904 X 809052 -3772242 1235304 1090382 2452604 2482604 4496960 -199256 19266850 23960648 X -2953379 -1742837 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3687908 3058 -30019 87961 3572986 3602326 120007 99688 134113 3687908 3339987 47440 475729 260830 3602326 2870417 205967 353072 89469 3339987 2996275 563458 -102298 587018 2870417 0.00000 0.69480 0.30520 1 0 54914 54914 17713784 11889762 5824022 583826 376988 206838 21263931 19286075 1977856 397668 397668 0 8063630 OTHER CURRENT ASSETS 2906 EQUITY INTEREST IN FOUNDATION NET ASSETS 3572986 DEPOSITS 24836 SETTLEMENTS DUE FROM THIRD PARTY PAYORS 5249457 8850185 PENSION LIABILITY 9142773 DUE TO AFFILIATES 11095337 OTHER LIABILITIES 91364 PATIENT CREDIT BALANCES 216490 PATIENT ACCOUNT REFUNDS 1649 UNCLAIMED CHECKS 4512 20552125 X PART V, LINE 4: THE HOSPITAL HAS RECORDED ITS BENEFICIAL INTEREST IN CERTAIN TEMPORARILY AND PERMANENTLY RESTRICTED NET ASSETS OF THE FOUNDATION THAT ARE TO BENEFIT THE HOSPITAL. TEMPORARILY RESTRICTED NET ASSETS IN THE FOUNDATION OF $1,090,382 AND $1,235,304 AT JUNE 30, 2016 AND 2015, RESPECTIVELY, ARE AVAILABLE FOR THE PURCHASE OF CAPITAL ASSETS AND TO SUPPORT THE OPERATIONS OF THE HOSPITAL. PERMANENTLY RESTRICTED NET ASSETS IN THE FOUNDATION OF $2,482,604 AND $2,452,604 AT JUNE 30, 2016 AND 2015, RESPECTIVELY, ARE INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT PROGRAMS AT THE HOSPITAL. THE HOSPITAL RECEIVED FROM THE FOUNDATION $87,961 AND $134,113 IN 2016 AND 2015, RESPECTIVELY, TO SUPPORT OPERATIONS OF THE HOSPITAL AND FOR THE PURCHASE OF CAPITAL ASSETS. PART X, LINE 2: CHILDREN'S HOSPITAL IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF THE AUTHORITY: THE AUTHORITY RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. AT JUNE 30, 2016 AND 2015, THE AUHTORITY HAS NO INCOME TAX POSITIONS THAT ARE NOT CONSIDERED GREATER THAN 50% LIKELY OF BEING REALIZED. 1 1 1 X 1 X 1 1 0 1 1 1 8 25930 25930 0.00070 1 3660 24692307 19861772 4830535 0.13680 2 3668 24718237 19861772 4856465 0.13750 2 3668 24718237 19861772 4856465 0.13750 1 242816 17016 17016 X 1 1 1 1 CRIPPLED CHILDREN'S HOSPITAL 2924 BROOK ROAD RICHMOND VA 23220 WWW.CHRICHMOND.ORG H1842 X X X PEDIATRIC LONG TERM CARE CRIPPLED CHILDREN'S HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X WWW.CHRICHMOND.ORG X 1 15 1 WWW.CHRICHMOND.ORG 0 0 1 X 100.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X WWW.CHRICHMOND.ORG X WWW.CHRICHMOND.ORG X WWW.CHRICHMOND.ORG X X X X X 1 X 0 X X X X 0 X X 0 0 CRIPPLED CHILDREN'S HOSPITAL PART V, SECTION B, LINE 5: THE HOSPITAL USED A WRITTEN SURVEY TO OBTAIN INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. THE SURVEY RESPONDENTS REPRESENTED SOME OF THE FOLLOWING ORGANIZATIONS: VIRGINIA DEPARTMENT OF HEALTH, VIRGINIA DEPARTMENT OF EDUCATION, RICHMOND CITY HEALTH DISTRICT, CARE CONNECTION FOR CHILDREN, MARCH OF DIMES FOUNDATION, AND GREATER RICHMOND FIT4KIDS. CRIPPLED CHILDREN'S HOSPITAL PART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY TAKING THE FOLLOWING ACTIONS:1. ADOPTION OF AN IMPLEMENTATION STRATEGY THAT ADDRESSES THE MAJORITY OF THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA2. EXECUTION OF THE IMPLEMENTATION STRATEGY3. INCLUSION OF A COMMUNITY BENEFIT SECTION IN OPERATIONAL PLANS4. ADOPTION OF A BUDGET FOR PROVISION OF SERVICES THAT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA5. PRIORITIZATION OF SERVICES THAT THE HOSPITAL WILL UNDERTAKE TO MEET HEALTH NEEDS IN ITS COMMUNITYEACH OF THE HEALTH NEEDS IDENTIFIED IN THE CHNA IS IMPORTANT AND MANY ARE BEING ADDRESSED BY NUMEROUS PROGRAM AND INITIATIVES THROUGHOUT VCUHS. THE HOSPITAL CANNOT DIRECTLY ADDRESS CERTAIN COMMUNITY HEALTH NEEDS THAT DO NOT RELATE TO ITS MISSION. THESE MAY BE NEEDS THAT GOVERNMENTAL OR OTHER NON-PROFIT AGENCIES HAVE THE MORE APPROPRIATE EXPERTISE AND RESOURCES NECESSARY TO ADDRESS. ALTHOUGH THE HOSPITAL CANNOT ADDRESS THESE NEEDS DIRECTLY, IT CAN AND DOES SUPPORT THE EFFORTS OF GOVERNMENTAL AND OTHER AGENCIES TO HELP WITH THESE NEEDS. CRIPPLED CHILDREN'S HOSPITAL PART V, SECTION B, LINE 22D: THE HOSPITAL OFFERS A SELF PAY DISCOUNT TO UNINSURED PATIENTS IN ADDITION TO THOSE WHO QUALIFY FOR FINANCIAL ASSISTANCE. AS A CHILDREN'S HOSPITAL WITH LOW MEDICARE UTILIZATION, THE HOSPITAL USED THE MEDICAID PAYMENT RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. THE PROSPECTIVE METHOD WAS USED. PART I, LINE 6A: THE HOSPITAL REPORTS COMMUNITY BENEFIT DATA TO THE VA HOSPITAL AND HEALTHCARE ASSOCIATION (VHHA). PART I, LINE 7: COMMUNITY BENEFIT COST FOR EACH CATEGORY IS DETERMINED BY USING EITHER A COST TO CHARGE RATIO OR A COST ACCOUNTING METHODOLOGY. THE SCHEDULE H WORKSHEETS ARE USED TO COMPUTE THE CORRESPONDING LINE. PART III, LINE 2: CHARGED AMOUNTS NOT EXPECTED TO BE PAID ARE RESERVED AND EXPENSED TO BAD DEBT. A COST TO CHARGE RATIO IS APPLIED TO DETERMINE THE COST OF THE BAD DEBT. PART III, LINE 3: NO ATTEMPT HAS BEEN MADE TO DETERMINE THE AMOUNT IN BAD DEBT THAT COULD HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE. PART III, LINE 4: SEE PAGE 24 OF THE AUDITED FINANCIAL STATEMENTS FOR THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE. PART III, LINE 8: MEDICARE ALLOWABLE COST IS FROM THE LOW UTILIZATION MEDICARE COST REPORT. PART III, LINE 9B: A FINANCIAL COUNSELOR ASSISTS PATIENTS IN UNDERSTANDING THE AVAILABILITY OF COMMUNITY OR GOVERNMENTAL ASSISTANCE PROGRAMS, AS WELL AS, THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. NEW PATIENTS RECEIVE NOTIFICATION THROUGH THE PATIENT BOOKLET. THE HOSPITAL PROVIDES A BILLING STATEMENT TO THE FAP INDIVIDUAL THAT SHOWS THE AMOUNTS GENERALLY BILLED FOR THE CARE AND HOW THE HOSPITAL DETERMINED THE AMOUNT THE INDIVIDUAL OWES. THE HOSPITAL WILL ALSO REFUND ANY EXCESS PAYMENTS MADE AND TAKE MEASURES TO REVERSE ANY EXTRAORDINARY COLLECTION ACTION TAKEN. PART VI, LINE 3: SEE PART V, LINE 16 ANSWERS. PART VI, LINE 4: THE HOSPITAL SERVICE AREA CONSISTS OF MORE THAN FIFTY ZIP CODES ADJACENT TO ITS SIX LOCATIONS. MOST OF THE ZIP CODES ARE IN THE RICHMOND METROPOLITAN AREA AND EXTEND SOUTH TO PETERSBURG AND NORTH TO STAFFORD. AS A CHILDREN'S HOSPITAL, THE SERVICE POPULATION IS AGED 0-21 YEARS AND AS OF 2011, THE SERVICE AREA INCLUDED MORE THAN 400,000 PERSONS AGED 0-21. PART VI, LINE 5: THE HOSPITAL IS ULTIMATELY CONTROLLED BY IT'S CORPORATE MEMBER, VCU HEALTH SYSTEM AUTHORITY. THE MAJORITY OF THAT GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF.THE HOSPITAL EXTENDS MEDICAL STAFF PRIVEILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALITIES.THE HOSPITAL USES SURPLUS FUNDS TO FURTHER ITS EXEMPT PURPOSE. MEDICAL EDUCATION AND RESEARCH TAKES PLACE ON THE MCV CAMPUS, WHICH IS AN ACADEMIC MEDICAL CENTER. PART VI, LINE 6: THE HOSPITAL IS AN AFFILIATE OF THE VCU HEALTH SYSTEM AUTHORITY.THE HOSPITAL PROVIDES PEDIATRIC SPECIALTY CARE TO BOTH INPATIENTS AND OUTPATIENTS.VCU HEALTH SYSTEM AUTHORITY ALSO HAS THE FOLLOWING ADDITIONAL AFFILIATES:THE MEDICAL COLLEGE OF VIRGINIA HOSPITALS IS AN APPROXIMATELY 800-BED TEACHING HOSPITAL THAT PROVIDES INPATIENT AND OUTPATIENT SERVICES PRIMARILY TO PATIENTS IN THE COMMONWEALTH OF VIRGINIA.MCV ASSOCIATED PHYSICIANS FUNCTIONS AS THE GROUP PRACTICE PLAN FOR THOSE PHYSICIANS AND HEALTH CARE PROFESSIONALS WHO HAVE FACULTY APPOINTMENTS IN THE VCU SCHOOL OF MEDICINE.UNIVERSITY HEALTH SERVICES SUPPORTS THE EDUCATIONAL, SCIENTIFIC, AND CHARITABLE PURPOSE AND ACTIVITIES OF VCU AND, IN PARTICULAR, THE ACTIVITIES OF THE SCHOOL OF MEDICINE AND THE MEDICAL COLLEGE OF VIRGINIA HOSPITALS.VA PREMIER IS A MEDICAID HEALTH MAINTENANCE ORGANIZATION WHOSE PRIMARY PURPOSE IS TO PROVIDE QUALITY HEALTH CARE WITHIN A MANAGED CARE FRAMEWORK. X X X X 0 0 0 0 0 0 0 0 0 LINDA E PEARSON VICE CHAIR AND TREASURER 0 408314 0 38490 0 6231 0 48109 0 14014 0 515158 0 0 JOHN F DUVAL DIRECTOR - EX-OFFICIO 0 776048 0 340973 0 186442 0 92432 0 17346 0 1413241 0 0 BRUCE K RUBIN MD DIRECTOR - EX-OFFICIO 0 325702 0 81881 0 5392 0 35912 0 2527 0 451414 0 0 JOHN D WARD MD DIRECTOR - EX-OFFICIO 0 427665 0 54248 0 99264 0 34659 0 2396 0 618232 0 0 MARSHA D RAPPLEY MD DIRECTOR 0 138462 0 0 0 2442 0 11077 0 1032 0 153013 0 0 LESLIE G WYATT EXECUTIVE DIRECTOR 0 284857 0 27377 0 0 0 34297 0 14418 0 360949 0 0 SHARON W DARBY VP OF CLINICAL OPERATIONS 214076 0 0 0 0 0 24892 0 12715 0 251683 0 0 0 JAMES A DEYARMIN DIRECTOR OF FINANCE 156031 0 0 0 0 0 18743 0 8106 0 182880 0 0 0 SALLIE C TIDMAN DIRECTOR OF THERAPY SERVICES 118946 0 0 0 0 0 11746 0 21245 0 151937 0 0 0 JEROME F STRAUSS III MD FORMER DIRECTOR 0 387778 0 192705 0 183528 0 8334 0 2755 0 775100 0 0 PART I, LINE 3 COMPENSATION OF THE EXECUTIVE DIRECTOR IS DETERMINED BY THE LEADERSHIP OF VCUHS. FORM 990, PART III, LINE 3 IN MARCH 2016, THE HOSPITAL DISCONTINUED THEIR PHYSICIAN SPECIALTY CLINICS FOR PHYSICAL MEDICINE & REHAB, CEREBRAL PALSY, MUSCULAR DYSTROPHY, SPASTICITY, SPINA BIFIDA, AND FEEDING DISORDERS. THESE CLINICS WILL NOW BE OPERATED BY THE MCV HOSPITAL IN THE NEW CHILDREN'S HOSPITAL PAVILION ON THE MCV CAMPUS. FORM 990, PART VI, SECTION A, LINE 6 ALSO LINES 7A AND 7B - THE SOLE MEMBER OF THE CORPORATION IS VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY (VCUHS), A STATUTORY AUTHORITY CREATED UNDER THE CODE OF VIRGINIA. VCUHS HAS THE EXCLUSIVE RIGHT AND POWER TO ELECT, APPOINT, OR REMOVE THE MEMBERS OF THE CORPORATION'S BOARD OF DIRECTORS AS PROVIDED IN THE BYLAWS. THE BOARD OF DIRECTORS OF VCUHS SHALL ACT ON VCUHS'S BEHALF IN EXERCISING VCUHS'S RESERVED POWERS OVER THE CORPORATION. CERTAIN COMMITTEES OF THE BOARD OF DIRECTORS OF VCUHS SHALL OVERSEE THE ACTIVITIES OF THE CORPORATION. LISTED BELOW ARE VCUHS'S RESERVED POWERS: (A) APPROVAL OF AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS; (B) APPROVAL OF THE CORPORATION'S CAPITAL AND OPERATING BUDGETS; (C) ELECTION AND REMOVAL OF AN ELECTED DIRECTOR (AS HEREINAFTER DEFINED); (D) APPROVAL OF THE INCURRENCE OF DEBT OR THE ISSUANCE OF GUARANTEES BY THE CORPORATION IN EXCESS OF $500,000 FOR A SINGLE EXPENDITURE; (E) APPROVAL OF ANY NON-BUDGETED CAPITAL EXPENDITURE IN EXCESS OF $500,000 FOR A SINGLE CAPITAL EXPENDITURE OR $1 MILLION FOR ALL SUCH CAPITAL EXPENDITURES ON AN AGGREGATE BASIS IN ANY TWELVE (12) MONTH PERIOD; (F) ANY PROPOSED EXPENDITURE IN EXCESS OF $500,000 FROM FUNDED DEPRECIATION MAINTAINED BY OR ON BEHALF OF THE CORPORATION FOR THE RENOVATION AND REPLACEMENT OF THE CORPORATION'S CAPITAL ASSETS; (G) AUTHORIZATION OF ANY ACTION THAT COULD CAUSE THE CORPORATION TO OPERATE IN A MANNER INCONSISTENT WITH THE COMMUNITY BENEFIT STANDARD ARTICULATED BY THE INTERNAL REVENUE SERVICE, OR OTHERWISE CAUSE THE CORPORATION TO ACT IN POTENTIAL DEROGATION OF ITS FEDERAL, STATE, OR LOCAL TAX-EXEMPTION AND/OR CHARITABLE PURPOSE; (H) SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (I) MERGER, CONSOLIDATION, DISSOLUTION, OR DIVISION OF THE CORPORATION; (J) ASSIGNMENT OF PROPERTY OR OTHER ASSETS OF THE CORPORATION IN TRUST FOR CREDITORS OR ON THE ASSIGNEE'S PROMISE TO PAY THE DEBTS OF THE CORPORATION; (K) DECLARATION OF BANKRUPTCY BY THE CORPORATION; (L) AUTHORIZATION OF ANY ACTION THAT COULD HAVE A MATERIAL ADVERSE IMPACT ON ANY LICENSURE, ACCREDITATION, OR CERTIFICATION HELD OR DESIRED TO BE HELD BY THE CORPORATION, INCLUDING, WITHOUT LIMITATION, STATE LICENSURE, MEDICARE OR MEDICAID CERTIFICATION, THE JOINT COMMISSION OR OTHER FACILITY ACCREDITATION, MEDICAL RESIDENCY PROGRAM ACCREDITATION, OR CLINICAL DESIGNATION OR CERTIFICATION; (M) ANY SIGNIFICANT PROPOSED AFFILIATIONS WITH OTHER HEALTH CARE PROVIDERS OR ACADEMIC INSTITUTIONS, INCLUDING, WITHOUT LIMITATION, ACQUISITION, MERGER, JOINT OPERATION, MANAGEMENT, STAFFING, CLINICAL COORDINATION, OR "CO-BRANDING; (N) ANY ACTION INVOLVING USE OF THE CORPORATION'S LOGO, SERVICE MARK, TRADE OR OTHER DRESS, OTHER THAN FOR THE DIRECT BENEFIT OF THE CORPORATION OR THE DEPARTMENT OF PEDIATRICS OF THE MEMBER; AND (O) HIRING OR TERMINATION OF THE CORPORATION'S CHIEF EXECUTIVE OFFICER (IRRESPECTIVE OF TITLE). FORM 990, PART VI, SECTION A, LINE 7A SEE RESPONSE TO FORM 990, PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION A, LINE 7B SEE RESPONSE TO FORM 990, PART VI, SECTION A, LINE 6 FORM 990, PART VI, SECTION B, LINE 11 A PDF COPY OF THE 990 IS SENT TO ALL THE BOARD MEMBERS FOR REVIEW. COMPENSATION INFORMATION IS REDACTED FROM THE COPY OF THE 990 PROVIDED. THIS BOARD REVIEW PROCESS TAKES PLACE PRIOR TO FILING AND A PERIOD OF TIME IS ALLOTTED FOR REVIEW COMMENTS BY THE BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, TRUSTEES AND KEY EMPLOYEES SHALL DISCLOSE A POTENTIAL CONFLICT TO THE CHAIRMAN OF THE BOARD OR COMPLIANCE OFFICER FOR INVESTIGATION AND RESOLUTION. UPON APPOINTMENT TO THE BOARD OR EMPLOYMENT AND ANNUALLY THEREAFTER, OFFICERS, TRUSTEES AND KEY EMPLOYEES SHALL COMPLETE AN AFFIRMATION STATEMENT AND DISCLOSURE FORM FOR REVIEW BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 15 AN OUTSIDE CONSULTANT IS USED TO COMPLETE A REVIEW AND ESTABLISH RANGES TO BE USED BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THESE RANGES MEET THE 4958 SAFE HARBOR REQUIREMENTS. FORM 990, PART VI, SECTION C, LINE 19 THE PUBLIC VIEWING DOCUMENT IS AVAILABLE FOR INSPECTION AT THE MAIN HOSPITAL LOCATION UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN PLAN ASSETS AND BENEFIT OBLIGATION OF PENSION PLAN -1,627,915. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENTS -114,922. FORM 990, PART XII, LINE 2C: THE BOARD HAS NOT CHANGED THE OVERSIGHT OF ITS PROCESS FOR THE ORGANIZATION'S AUDIT OR SELECTION OF THE INDEPENDENT ACCOUNTANT. FORM 990, PART IX, LINE 25D FUNDRAISING EXPENSES: THE HOSPITAL DOES NOT PERFORM FUNDRAISING FUNCTIONS. THE CHILDREN'S HOSPITAL FOUNDATION RAISES FUNDS FOR CHILDREN'S SERVICES IN THE RICHMOND AREA AND DONATES TO THE HOSPITAL EACH YEAR. WEBSITE EXPLANATION CHILDREN'S HOSPITAL OF RICHMOND AT VCU (WEBSITE WWW.CHRICHMOND.ORG) IS A SHARED WEBSITE FOR THE PEDIATRIC SERVICES WITHIN VCUHS AND THE SERVICES AT CCH. THE CCH SERVICES AND DOCUMENTS ARE REFERENCED ON THE WEBSITE AS THE BROOK ROAD CAMPUS. THE CHNA AND IMPLEMENTATION PLAN COMPLETED IN 2016 ARE LOCATED UNDER THE BROOK ROAD CAMPUS LINK AT THE BOTTOM OF THE PAGE. VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY (VCUHS) PO BOX 980152 RICHMOND VA 23298 541848065 PARENT - ACADEMIC MEDICAL CTR - MCV HOSPITALS VA 501(C)(1) N/A 0 MCV ASSOCIATED PHYSICIANS DBA MCV PHYSICIANS PO BOX 980620 RICHMOND VA 232980510 541581185 GROUP PRACTICE OF PROFESSIONALS SUPPORTING MEDICAL TEACHING VA 501(C)(3) LINE 11A, I VCUHS 1 UNIVERSITY HEALTH SERVICES INC (UHS) PO BOX 980152 RICHMOND VA 23298 541790550 SUPPORT EDUCATIONAL & SCIENTIFIC ACTIVITIES OF VCU. VA 501(C)(3) LINE 11A, I VCUHS 1 UHS MANAGED CARE INC PO BOX 980152 RICHMOND VA 23298 541790554 PROVIDE HEALTHCARE VA 501(C)(3) LINE 9 UHS 1 COMMUNITY MEMORIAL HOSPITAL 125 BUENA VISTA CIRCLE SOUTH HILL VA 23970 540221711 HOSPITAL VA 501(C)(3) LINE 3 VCUHS 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 1 0 0 MCV ASSOCIATED PHYSICIANS DBA MCV PHYSICIANS M 816800 CASH