2015-11-12T15:09:16-06:00 2014-12-31 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2014-01-01 131739922 BLYTHEDALE CHILDREN'S HOSPITAL BLYT 9145927555 95 BRADHURST AVE VALHALLA NY 10595 JOHN CANNING CFO 9145927555 2015-11-12 1 P00743140 5169187000 2014 2016-02-25 16:41:14Z JOHN CANNING 95 BRADHURST AVE VALHALLA NY 10595 94314615 0 X WWW.BLYTHEDALE.ORG X 1891 NY 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. 29 29 499 276 0 0 2723973 2755397 52677604 56650005 11579787 1053100 5486314 3595194 72467678 64053696 0 0 0 0 42111943 41062490 0 0 852514 21348720 20761082 63460663 61823572 9007015 2230124 215148530 215375612 49125540 55552944 166022990 159822668 X BLYTHEDALE CHILDREN'S HOSPITAL IS DEDICATED TO IMPROVING THE HEALTH & WELL-BEING OF CHILDREN. BLYTHEDALE IS A LEADER IN THE DIAGNOSIS & TREATMENT OF CHILDREN WITH DISABLING AND COMPLEX MEDICAL CONDITIONS. 0 0 36178828 47128570 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 BEDS AND PROVIDED CARE TO OVER 68 INPATIENTS PER DAY ON AVERAGE IN 2014. THE HOSPITAL HAD 594 TOTAL DISCHARGES. OVER 72.5% OF OUR INPATIENT ADMISSIONS WERE REIMBURSED THROUGH THE MEDICAID PROGRAM (FFS & MANAGED) IN 2014. WHILE 100% OF THE HOSPITALS INPATIENT POPULATION IS REFERRED IN FROM OTHER ACUTE CARE HOSPITALS IN THE REGION, OVER >58% COME DIRECTLY FROM INTENSIVE CARE UNITS (ICU'S). THIS SPEAKS TO THE HIGH ACUITY OF THE PATIENT POPULATION BEING MANAGED AT BLYTHEDALE. IN 2014 OVER 49% 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. 8726481 10516120 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 2014, 65 % OF THE PROGRAM CAME DIRECTLY FROM THE INPATIENT SETTING, 25 % CAME DIRECTLY FROM REFERRALS IN THE COMMUNITY AND 10% THROUGH THE EARLY INTERVENTION/CPSE PROGRAMS. IN 2014, THE PROGRAM SERVED ON AVERAGE OF 77 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 17,934 VISITS. OVER 85% 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 2014, THE PROGRAM SERVED ON AVERAGE OF 19 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 3,970 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 2239372 2668919 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 2014, THE PROGRAM SERVED ON AVERAGE OF 25 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 6,288 VISITS. THE HOSPITAL ALSO PROVIDED 2,991 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 HEARING IMPAIRMENTS - DIAGNOSED MEDICAL CONDITIONS SUCH AS CEREBRAL PALSY, NEUROMUSCULAR OR OTHER NEUROLOGICAL DISORDERS BLYTHEDALE CHILDREN'S HOSPITAL OFFERS VARIOUS OUTPATIENT THERAPY AND SUB SPECIALTY MEDICAL CLINICS TO SPECIAL NEEDS CHILDREN THROUGHOUT THE REGION. IN 2014 THE HOSPITAL PROVIDED OVER 3,860 ENCOUNTERS TO CHILDREN REQUIRING THESE SERVICES (THESE SERVICES INCLUDE AUDIOLOGY, NEUROLOGY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, BRACE AND EQUIPMENT MODIFICATION AND FITTING). 47144681 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 0 1 0 0 0 0 0 0 0 0 1 139 0 1 499 1 0 1 CJ 0 0 0 1 1 0 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 OWEN GUTFREUND CHAIR OF THE BOARD 1.00 X 0 0 0 DAVID PEDOWITZ VICE CHAIRMAN 1.00 X 0 0 0 PETER RITTMASTER VICE CHAIRMAN 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 ALAN GERSTEIN TRUSTEE 1.00 X 0 0 0 ANDREW MORRISON TRUSTEE 1.00 X 0 0 0 DARREN FOGEL TRUSTEE 1.00 X 0 0 0 EDWARD DAVIDOWITZ TRUSTEE (THRU 10/10/14) 1.00 X 0 0 0 FARREL STARKER TRUSTEE 1.00 X 0 0 0 FRANK STERN TRUSTEE 1.00 X 0 0 0 HEIDI SCHWARTZ TRUSTEE 1.00 X 0 0 0 HOWARD ADLER TRUSTEE 1.00 X 0 0 0 JEANNE SAVITT TRUSTEE (THRU 6/2/14) 1.00 X 0 0 0 JOHN BARKER TRUSTEE 1.00 X 0 0 0 JOHN FURTH TRUSTEE 1.00 X 0 0 0 JON BURNHAM TRUSTEE 1.00 X 0 0 0 JORDANA HOLOVACH TRUSTEE 1.00 X 0 0 0 JUDITH GOODHUE TRUSTEE 1.00 X 0 0 0 LANCE R WACHENHEIM TRUSTEE 1.00 X 0 0 0 LAURENCE COHEN TRUSTEE 1.00 X 0 0 0 LESLIE WEISSMAN TRUSTEE 1.00 X 0 0 0 MERWIN HASKEL TRUSTEE (THRU 3/4/14) 1.00 X 0 0 0 MICHAEL MARGULIES TRUSTEE 1.00 X 0 0 0 NANCY BLAINE TRUSTEE 1.00 X 0 0 0 PATRICIA STANLEY TRUSTEE 1.00 X 0 0 0 PEGGY EPSTEIN TANNER TRUSTEE (THRU 9/1/14) 1.00 X 0 0 0 PHYLLIS LASHINS TRUSTEE (THRU 6/2/14) 1.00 X 0 0 0 SCOTT R LEVY 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 THOMAS BROCK TRUSTEE (THRU 6/2/14) 1.00 X 0 0 0 WILLIAM CAHN TRUSTEE 1.00 X 0 0 0 WILLIAM LEVY TRUSTEE 1.00 X 0 0 0 LAWRENCE LEVINE CHIEF EXECUTIVE OFFICER 37.50 X 1636037 0 65434 JOHN CANNING CHIEF FINANCIAL OFFICER 37.50 X 369854 0 74052 MAUREEN DESIMONE CHIEF OPERATIONS OFFICER 37.50 X 273908 0 73667 REGINA KELLY CHIEF COMPLIANCE & PLANING OFFICER 37.50 X 167162 0 76210 SCOTT KLEIN CHIEF MEDICAL OFFICER 37.50 X 424973 0 50413 RONALD GALLO CHIEF HUMAN RESOURCES OFFICER 37.50 X 207679 0 66085 JANE MACDONALD CHIEF DEVELOPMENT OFFICER 37.50 X 212084 0 35565 RONI AMIEL CHIEF INFORMATION OFFICER 37.50 X 189309 0 40371 JILL WEGENER CHIEF NURSING OFFICER 37.50 X 191628 0 6559 LOIS ALLEN CHIEF QUALITY OFFICER 37.50 X 189849 0 390 JOELLE MAST THRU 11114 CHIEF SCIENTIFIC OFFICER 37.50 X 285114 0 70654 MILICENT MITCHELL CHIEF PULMONOLOGY 37.50 X 247031 0 12159 BYRON FERNANDEZ CHIEF TODDLER UNIT 37.50 X 257458 0 45184 JAY SELMAN CHIEF NEUROLOGY 37.50 X 183793 0 252 MARY DIDIE CHIEF DAY HOSPITAL 37.50 X 173278 0 33871 KATHY SLIVERMAN CHIEF ADOLESCENT UNIT 37.50 X 185641 0 33235 5194798 0 684101 71 0 1 0 SODEXO INC & AFFILIATES PO BOX 81049 WOBURN MA 018131049 FACILITIES, DEITARY, MAINTENANCE 3248190 BOVIS LEND LEASE 200 PARK AVENUE 9TH FLOOR NEW YORK NY 10166 CONSTRUCTION 1431446 NEW PROVIDENCE ASSET MANAGEMENT 570 LEXINGTON AVE 1900 NEW YORK NY 10022 INVESTMENT MANAGEMENT 503346 MANATT PHELPS AND PHILLIPS LLP 7 TIMES SQUARE NEW YORK NY 10036 LEGAL 315824 SSC INC PO BOX 13 BRATTLEBORO VT 053020135 SECURITY 293092 41 1010575 1744822 131560 2755397 INPATIENT 622310 43464966 43464966 DAY HOSPITAL 621400 9564825 9564825 EARLY INT / OPD 621110 1766018 1766018 SCHOOL CONTRACT 611710 951295 951295 OFF-SITE THERAPY 621110 902901 902901 56650005 692690 692690 30367739 30007329 360410 360410 360410 185180 1010575 253590 -68410 -68410 SPENDING RATE POLICY 900099 3358894 3358894 CAFETERIA 722514 182570 182570 MEDICAL RECORDS 900099 86904 86904 35236 35236 3663604 64053696 60313609 0 984690 3691997 2036453 1407895 247649 28162081 23885149 3875429 401503 3052246 2442318 516061 93867 3862408 3210345 643564 8499 2293758 1677350 583977 32431 2210500 1790611 404999 14890 338116 338116 250573 250573 71357 71357 66090 66090 104964 55997 46885 2082 892512 881702 10810 4785645 4065650 719256 739 42256 34398 7644 214 152308 73367 78941 16113 16113 5964949 4712341 1236373 16235 757652 757652 CONTRACTED LABOR 2948962 2397951 527416 23595 UTILITIES 966266 762751 203515 0 TAXES & OTHER ASSESSMEN 722865 0 722865 0 DEBT FINANCE FEES 469954 0 469954 0 61823572 47144681 13826377 852514 11841484 12572143 2014427 2418076 564511 341825 8761567 7894467 178702 122942 819465 903851 106199944 32255757 77580471 73944187 55113919 62269523 57367685 53998328 906299 910270 215148530 215375612 4854752 3950162 25300000 24645000 13034 6262 18957754 26951520 49125540 55552944 X 154957839 148263324 6991514 7478736 4073637 4080608 166022990 159822668 215148530 215375612 X 2230124 608161 -9038607 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 71357 71357 0 PART II-B, LINE 1: BLYTHEDALE CHILDREN'S HOSPITAL, AS A MEMBER OF STATE-WIDE HOSPITAL ORGANIZATIONS, HAS A PORTION OF ITS DUES FOR LOBBYING. IN ADDITION, BLYTHEDALE HAS ENGAGED AN OUTSIDE LOBBYIST TO LOBBY ON ITS BEHALF ON ISSUES RELATING TO THE STATE BUDGET. 11065150 1908465 609854 2024123 11559346 10130991 926397 1758628 1750866 11065150 9207439 1230427 923951 1230826 10130991 14508992 911024 -687562 5525015 9207439 20617212 430633 1098917 7637770 14508992 0.90000 0.04000 0.06000 0 0 1383879 1383879 50699007 21803335 28895672 49777745 9424319 40353426 4339313 1028103 3311210 73944187 LIMITED LIABILITY PARTNERSHIP (HEDGE FUNDS) 53998328 C 53998328 ACCRUED PENSION LIABILITY 23530755 ASSET RETIREMENT OBLIGATIONS 462230 MALPRACTICE LIABILITIES 1010000 DUE TO THIRD PARTY PAYORS 1948535 26951520 64421253 1954832 1954832 62466421 1587275 1587275 64053696 62077161 253589 253589 61823572 0 61823572 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 ENDOWMENTFUND (C) GENERAL ECONOMIC CONDITIONS (D) THE POSSIBLE EFFECT OF INFLATION AND DEFLATION (E) THE EXPECTED TOTAL RETURN FROM INCOME AND THE APPRECIATION OFINVESTMENTS (F) OTHER RESOURCES OF THE ORGANIZATION (G) THE INVESTMENT POLICIES OF THE ORGANIZATION TEMPORARILY RESTRICTED NET ASSETS AS OF DECEMBER 31, 2014 AND 2013, ARE AVAILABLE FOR THE FOLLOWING PURPOSES: 2014 2013 PLANT REPLACEMENT $242,466 $465,000 TEMPORARILY RECTRICTED PORTION OF ENDOWMENT FUND $4,974,609 $4,651,447 MEDICAL EQUIPMENT $0 $14,088 OTHER $2,261,661 $1,860,980 TOTALS $7,478,736 $6,991,514 PERMANENTLY RESTRICTED NET ASSETS AS OF DECEMBER 31, 2014 AND 2013 ARE RESTRICTED TO THE FOLLOWING: 2014 2013 INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES $4,080,608 $4,073,637 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 1,954,832. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES RECLASS TO REVENUE -253,589. RESTRICTED CONTRIBUTIONS 1,839,171. RESTRICTED GAINS ON INVESTMENTS 1,693. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES RECLASS TO REVENUE 253,589. CENTRAL AMERICA & THE CARIBBEAN 0 0 INVESTMENTS 32787430 0 0 0 0 0 0 32787430 0 32787430 1 0 1 1 0 0 SPRING EVENT 599908 542108 57800 11930 65796 18392 FALL GOLF EVENT 236088 182006 54082 11725 40377 1980 12348 4 359759 286462 73297 7650 68006 1581 3330 10474 1195755 1010576 185179 19375 120313 69357 3330 41214 253589 -68410 1 1 1 X 400.000000000000 1 X 1 1 0 0 547645 0 547645 0.00890 39396994 37516032 1880962 0.03040 647414 267027 380387 0.00620 40592053 37783059 2808994 0.04550 100047 31270 68777 0.00110 284704 284704 0.00000 370461 150000 220461 0.00360 350109 286311 63798 0.00100 273019 236237 36782 0.00060 1378340 988522 389818 0.00630 41970393 38771581 3198812 0.05180 2770297 1298327 1471970 0.02380 2770297 1298327 1471970 0.02380 1 701893 0 197610 0 197610 X 1 1 1 1 BLYTHEDALE CHILDREN'S HOSPITAL 95 BRADHURST AVE VALHALLA NY 10595 WWW.BLYTHEDALE.ORG NYS LIC# 595700H X X BLYTHEDALE CHILDREN'S HOSPITAL 1 0 0 1 X X X X X X 13 1 0 1 1 X WWW.BLYTHEDALE.ORG 1 14 1 WWW.BLYTHEDALE.ORG 0 0 1 X 400.000000000000 400.000000000000 1 1 X X X 1 X X X X 1 X 0 X X X 0 X X 0 0 BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 5: IN JANUARY 2013, THE WESTCHESTER COUNTYDEPARTMENT OF HEALTH CONVENED A WORKGROUP OF LOCAL HOSPITALS TO SELECT TWOPRIORITIES FROM THE STATE'S PREVENTION AGENDA AND COLLABORATIVELY DEVELOPPLANS TO ADDRESS THESE PRIORITIES AS PART OF THE COUNTY HEALTHDEPARTMENT'S COMMUNITY HEALTH ASSESSMENT AND THE HOSPITALS' COMMUNITYSERVICE PLANS. IN ADDITION TO WORKGROUP MEETINGS, THE COUNTY HEALTHDEPARTMENT ALSO HELD A HEALTH CARE SUMMIT ON AUGUST 10, 2013 TO GATHERADDITIONAL COMMUNITY INPUT. 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 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). 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 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: WWW.BLYTHEDALE.ORG BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: WWW.BLYTHEDALE.ORG PART I, LINE 7: EXPLANATION: BLYTHEDALE DETERMINES A PATIENT'S COST USING AVAILABLE COSTDATA AND RATIOS FROM THE MOST RECENTLY FILED NYS ICR. A PROSPECTIVEPATIENT'S GROSS CHARGES ARE ESTIMATED FOR EACH OF THE SERVICES ANDALLOWANCED DOWN TO COST BASED UPON THE RATIO OF COST TO CHARGES. WE THENDISCOUNT THE COST DOWN ON A SLIDING % BASIS IN THE FAP SCHEDULE USING APATIENT'S ADJUSTED GROSS INCOME (AGI) FROM THEIR MOST RECENT TAX RETURNAND TAKING INTO ACCOUNT THEIR NUMBER OF DEPENDENTS / FAMILY SIZE REPORTED. PART II, COMMUNITY BUILDING ACTIVITIES: EXPLANATION: BLYTHEDALE IS INVOLVED IN NUMEROUS COMMUNITY BUILDINGACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. NUMEROUSCOMMUNITY CONCERNS ARE ADDRESSED, INCLUDING HEALTH IMPROVEMENT (SEEDETAILS UNDER LINE 6 BELOW) AND ACCESS TO CARE. BLYTHEDALE ACTIVELYPARTICIPATES IN THE WESTCHESTER CHILDREN'S ASSOCIATION'S CHILD HEALTH TASKFORCE, WHOSE PRINCIPAL GOAL IS TO MAXIMIZE ENROLLMENT OF ELIGIBLE CHILDRENIN 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 CARINGFOR MEDICALLY FRAGILE CHILDREN AT HOME. PART III, LINE 2: EXPLANATION: 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 IFMANAGEMENT IS UNABLE TO COLLECT THE DEBT AFTER THESE CRITERIA HAVE BEENMET.BAD DEBTS DO NOT INCLUDE CHARITY CARE, COURTESY DISCOUNTS, SELF PAYALLOWANCES, OR ALLOWANCES FOR OUTPATIENT SERVICES PROVIDED THAT ARE NOTAUTHORIZED.BAD DEBTS WILL BE RECORDED AND RECOGNIZED IN THE PERIOD IN WHICH IT ISDETERMINED THE DEBT IS UNCOLLECTIBLE. BAD DEBT IS RECOGNIZED AS THE AMOUNTCONTRACTUALLY OBLIGATED AND RECOGNIZED AS REVENUE FOR WHICH ALL AVENUES OFCOLLECTION HAVE BEEN EXHAUSTED. ALL WRITE OFFS IN EXCESS OF $10,000REQUIRE APPROVAL FROM THE CFO PRIOR TO RECORDING ENTRY IN MEDITECH SYSTEM.ALL BAD DEBT ALLOWANCE ENTRIES ARE TO BE CODED USING "XFR" PROCEDURE INMEDITECH.THE FOLLOWING EXAMPLE WILL DEMONSTRATE THE COMPONENTS OF BAD DEBT TO BERECORDED.TOTAL PATIENT CHARGES: $250,000LESS CONTRACTUAL ALLOWANCES: -$150,000NET REVENUE: $100,000ACTUAL PAYMENTS: -$75,000ACCOUNT BALANCE UNCOLLECTED: $25,000 <==BAD DEBT VALUE AFTER ALLEFFORTS TO COLLECT ARE EXHAUSTEDCOMPONENTS OF BAD DEBT REPORTING:THE RESERVE BALANCE SHOULD REFLECT 9.0% OF THE GROSS AR AS RECORDED INSTEP 1. THE VARIANCE FROM THE 12/31 RESERVE BALANCE IS RECORDED ON AMONTHLY BASIS.THE NET OF THE ACTUAL BAD DEBTS + CHANGE IN RESERVE BALANCE FROM 12/31 ISRECORDED 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, 2014 AND 2013, WERE APPROXIMATELY $547,645 AND $58,886, 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 2014. THE HOSPITAL MAINTAINED AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IN 2014 AND 2013 IN THE AMOUNTS OF APPROXIMATELY $865,000 AND $828,000, RESPECTIVELY. THESE AMOUNTS REPRESENT 1.58% AND 1.6% OF NET PATIENT SERVICE REVENUE RESPECTIVELY. PART III, LINE 8: EXPLANATION: BLYTHEDALE, AS A CHILDREN'S HOSPITAL RECEIVED IMMATERIALAMOUNTS OF MEDICARE REIMBURSEMENT. IN 2014, THE HOSPITAL FILED A LOW/NO COST UTILIZATION REPORT WITH CMS. PART III, LINE 9B: EXPLANATION: 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 TRYTO QUALIFY THE PATIENT FOR ASSISTANCE. ONCE A LEVEL OF FINANCIALASSISTANCE IS DETERMINED, THE ACCOUNT BALANCE IS PRORATED FOR CONTRACTUALADJUSTMENTS AND THEN PRO-RATED TO COST. FROM COSTS, THE LEVEL OF FINANCIALASSISTANCE IS THEN APPLIED, ANY REMAINING BALANCE IS COLLECTABLE ASPATIENT RESPONSIBILITY.PATIENTS ARE SCREENED FOR ELIGIBILTY FOR FINANCIAL ASSISTANCE BEFORECOLLECTION PROCEDURE BEGIN. IF AT ANY POINT IN THE COLLECTION PROCESS,DOCUMENTATION IS RECEIVED THAT INDICATES THAT THE PATIENT IS POTENTIALLYELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, THE ACCOUNTIS REFERRED BACK FOR A FINANCIAL ASSISTANCE REVIEW. BLYTHEDALE DOES NOTPURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FORCHARITY CARE.IF A PATIENT HAS REQUESTED AND/OR FILLED OUT A FINANCIAL ASSISTANCEAPPLICATION, ALL DEBT COLLECTION ACTIVITIES STOP UNTIL ELIGIBILTY FORFINANCIAL ASSISTANCE CAN BE DETERMINED. BLYTHEDALE'S POLICY PROVIDES THATWE WILL NOT REFER ANY ACCOUNTS FOR COLLECTION UNTIL IT IS DETERMINEDWHETHER THE INDIVIDUAL IS INSURED AND NOT ELIGIBLE FOR FINANCIALASSISTANCE. 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 (60%), HUDSON VALLEY (28%), LONG ISLAND (8%), OUT OF STATE (4%). 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 (40%); WHITE (20%); OTHER (8%). TO ADDRESS THIS DIVERSITY, THE HOSPITAL PROVIDES STAFF TRAINING IN CULTURAL DIVERSITY, INTERPRETER SERVICES, DIETARY VARIETY AND OTHER ACCOMMODATIONS TO SUPPORT FAMILIES FROM DIFFERENT CULTURAL BACKGROUNDS WHILE THEIR CHILDREN ARE PATIENTS AT BLYTHEDALE. PART VI, LINE 5: EXPLANATION: BLYTHEDALE OFFERS A NUMBER OF COMMUNITY HEALTH IMPROVEMENTPROGRAMS AND SPECIAL PROGRAMS FOR DEVELOPMENT OF THE PEDIATRICPROFESSIONAL COMMUNITY:NUTRITION EDUCATION: IN A MAJOR INITIATIVE TO HELP REDUCE THE PREVALENCEOF 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 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 ANDREACHED 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 2014 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 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 1 1 0 0 0 0 0 1 0 LAWRENCE LEVINE CHIEF EXECUTIVE OFFICER 536232 0 75000 0 1024805 0 31348 0 34086 0 1701471 0 510014 0 JOHN CANNING CHIEF FINANCIAL OFFICER 312450 0 50000 0 7404 0 39593 0 34459 0 443906 0 0 0 MAUREEN DESIMONE CHIEF OPERATIONS OFFICER 251546 0 13000 0 9362 0 50088 0 23579 0 347575 0 0 0 REGINA KELLY CHIEF COMPLIANCE & PLANING OFFICER 154834 0 8000 0 4328 0 40359 0 35851 0 243372 0 0 0 SCOTT KLEIN CHIEF MEDICAL OFFICER 384163 0 40000 0 810 0 16003 0 34410 0 475386 0 0 0 RONALD GALLO CHIEF HUMAN RESOURCES OFFICER 193919 0 11000 0 2760 0 41666 0 24419 0 273764 0 0 0 JANE MACDONALD CHIEF DEVELOPMENT OFFICER 198325 0 11000 0 2759 0 23986 0 11579 0 247649 0 0 0 RONI AMIEL CHIEF INFORMATION OFFICER 170942 0 18000 0 367 0 8646 0 31725 0 229680 0 0 0 JILL WEGENER CHIEF NURSING OFFICER 178077 0 13000 0 551 0 5953 0 606 0 198187 0 0 0 LOIS ALLEN CHIEF QUALITY OFFICER 177209 0 8000 0 4640 0 0 0 390 0 190239 0 0 0 JOELLE MAST THRU 11114 CHIEF SCIENTIFIC OFFICER 270953 0 0 0 14161 0 33912 0 36742 0 355768 0 0 0 MILICENT MITCHELL CHIEF PULMONOLOGY 245507 0 0 0 1524 0 0 0 12159 0 259190 0 0 0 BYRON FERNANDEZ CHIEF TODDLER UNIT 257278 0 0 0 180 0 12008 0 33176 0 302642 0 0 0 JAY SELMAN CHIEF NEUROLOGY 182269 0 0 0 1524 0 0 0 252 0 184045 0 0 0 MARY DIDIE CHIEF DAY HOSPITAL 171754 0 0 0 1524 0 0 0 33871 0 207149 0 0 0 KATHY SLIVERMAN CHIEF ADOLESCENT UNIT 185125 0 0 0 516 0 22076 0 11159 0 218876 0 0 0 PART I, LINES 4A-B JOELLE MAST RECEIVED $11,389 AS SEVERANCE AND WILL RECEIVE 80% OF FULL SALARY IN 2015. PART I, LINES 4A-B 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. AS OF DECEMBER 31, 2014 AND 2013, THE PROJECTED BENEFIT OBLIGATION WAS $573,160 AND $1,354,809, RESPECTIVELY AND IS INCLUDED IN ACCRUED PENSION LIABILITY IN THE STATEMENTS OF FINANCIAL POSITION. IN 2014 THE HOSPITAL CONTRIBUTED $48,200 IN CASH CONTRIBUTIONS, ACCRUALS OF $282,351, AND PAYMENTS OF $1,014,917 TO A SERP ON BEHALF OF LARRY 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 2014 THE HOSPITAL CONTRIBUTED $32,200 TO A SERP ON BEHALF OF JOHN CANNING. PART I, LINE 7 BLYTHEDALE ENGAGED SULLIVAN COTTER IN 2011 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 THE STATE OF NEW YORK 146000293 649905DG8 2009-06-19 27000000 CONSTRUCTION 0 0 0 A 2355000 26748128 65475 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 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 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 II, LINE 4 THE AMOUNT ENTERED HERE IS A DEBT SERVICE FUND BALANCE. PART IV, LINE 6 SUCH AMOUNTS WERE APPROPRIATELY YIELD RESTRICTED. X 9 131560 COST OR SELLING PRICE 0 1 0 PART I, COLUMN (B): THE AMOUNT REPORTED IN COLUMN (B) REFERS TO THE NUMBER OF CONTRIBUTORS; THERE WERE 11 STOCK CONTRIBUTIONS IN 2014. FORM 990, PART VI, SECTION A, LINE 2 JOHN FURTH AND OWEN GUTFREUND (BOARD MEMBERS) HAVE A FAMILY RELATIONSHIP. DAVID PEDOWITZ HAS A BUSINESS RELATIONSHIP WITH PATRICIA STANLEY (BOARD MEMBER). FRANK STERN AND JOHN BARKER (BOARD MEMBERS) HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 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 RIGOROUS APPROACH AND A THOROUGH AND TRANSPARENT PROCESS TO EVALUATE EXECUTIVE COMPENSATION. EVERY 2 YEARS, BLYTHEDALE FORMALLY ENGAGES SULLIVAN, COTTER AND ASSOCIATES TO PROVIDE THE COMPENSATION COMMITTEE WITH A THOROUGH REVIEW AND ASSESSMENT 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 AND KEY EMPLOYEES. MOREOVER, ON AN ANNUAL BASIS BLYTHEDALE ENGAGES SULLIVAN, COTTER AND ASSOCIATES TO REVIEW BOTH THE NATIONAL AND REGIONAL HEALTHCARE MARKETPLACE TO DETERMINE 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 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. IN OCTOBER 2013, SULLIVAN, COTTER AND ASSOCIATES, INC. 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. ADDITIONALLY, SULLIVAN, COTTER AND ASSOCIATES ASSISTED THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES IN REVIEWING BLYTHEDALE'S EXECUTIVE COMPENSATION PHILOSOPHY STATEMENT. 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 2013, 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 2014 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 -9,038,607.