2014-03-25T11:24:18-05:00 2013-06-30 560747981 DIXON HUGHES GOODMAN LLP 4510 COX ROAD SUITE 200 GLEN ALLEN VA 230603394 990 2012-07-01 540506309 CRIPPLED CHILDREN'S HOSPITAL CRIP 8042285874 2924 BROOK ROAD RICHMOND VA 232201298 LINDA E PEARSON 8042285874 2014-03-11 1 DALE P BURGESS CPA P01232881 8042827636 2012 2015-11-30 17:44:51Z CHILDREN'S HOSPITAL OF RICHMOND OF THE VCU HEALTH SYSTEM LINDA E PEARSON 2924 BROOK ROAD RICHMOND VA 232201298 35994670 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 3 422 260 0 0 587018 6706388 25797231 29018240 13602 5645 77326 248482 26475177 35978755 0 0 0 0 21743558 23394989 0 0 0 7620891 7686737 29364449 31081726 -2889272 4897029 18736549 17683722 13581019 9027143 5155530 8656579 X CH 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 0 9539894 11962080 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 40 IN FISCAL YEAR 2013, AN INCREASE OF 3 PATIENTS FROM THE AVERAGE OF 37 IN FISCAL YEAR 2012. 100% OF THE REVENUE IN THIS PROGRAM COMES FROM VIRGINIA MEDICAID. 8466873 11235852 THE HOSPITAL IS THE PREMIER PROVIDER OF OUTPATIENT PEDIATRIC PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES IN CENTRAL VIRGINIA. OUTPATIENT THERAPY VISITS TOTALED 75,104 IN FISCAL YEAR 2013 WHICH IS AN INCREASE OF 2,080 VISITS FROM THE PRIOR YEAR. THERAPY SERVICES ARE OFFERED AT THE MAIN HOSPITAL IN THE CITY OF RICHMOND AND AT FOUR COMMUNITY THERAPY CENTERS LOCATED IN GLEN ALLEN, BON AIR, FREDERICKSBURG, AND PETERSBURG. 2526797 3634260 DENTAL PROGRAM SERVICES ARE PROVIDED FOR THE TYPICAL WELL-CHILD AND FOR CHILDREN WITH SPECIAL NEEDS. IN FISCAL YEAR 2013, THE DENTAL PROGRAM COMPLETED OVER 600 SURGERIES AND 4,500 CLINIC VISITS. THE MAJORITY OF THE DENTAL PROGRAM PATIENTS ARE FUNDED BY VIRGINIA MEDICAID. IN FISCAL YEAR 2013, THE HOSPITAL CONTINUED WITH THE DENTAL OUTREACH PROGRAM THAT TAKES IMPORTANT DENTAL EDUCATION AND MATERIALS TO AREA ELEMENTARY SCHOOLS. 3264807 2195643 PHYSICIAN SPECIALTY SERVICES - PEDIATRIC PHYSICIAN SPECIALIST, NURSE PRACTITIONERS AND THERAPIST PROVIDE EVALUATION, DIAGNOSIS AND TREATMENT OF A WIDE VARIETY OF MEDICAL CONDITIONS IN OUR OUTPATIENT CENTER. CLINICS INCLUDE: PHYSICAL MEDICINE AND REHABILITATION; CEREBRAL PALSY; MUSCULAR DYSTROPHY; SPASTICITY AND SPINA BIFIDA. 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. 3264807 2195643 23798371 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 34 0 1 422 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 1 1 1 1 1 1 1 1 0 VA X JAMES A DEYARMIN 8042285874 2924 BROOK ROAD RICHMOND VA 232201298 THOMAS S CAIN 1.00 X X 0 0 0 PONJOLA CONEY MD 1.00 X X 0 59227 7777 LINDA E PEARSON 1.00 X X 0 397405 48969 JOHN F DUVAL 1.00 X 0 599242 84965 SHELDON M RETCHIN MD 1.00 X 0 398910 30758 BRUCE K RUBIN MD 1.00 X 0 329025 58701 ANN E HONEYCUTT 1.00 X 0 0 0 HENRY L VALENTINE III 1.00 X 0 0 0 JOHN D WARD MD 1.00 X 0 450582 55750 LESLIE G WYATT 45.00 X 278731 0 39307 SHARON W DARBY 45.00 X 175976 0 28406 JOANNA CASTALDI 45.00 X 101630 0 18635 SALLIE C TIDMAN 45.00 X 102685 0 26409 PATRICIA P ANDERSON 45.00 X 107152 0 19186 JAMES A DEYARMIN 45.00 X 131176 0 19886 GREGORY FRIEDMAN 45.00 X 104789 0 26350 KAREN A BENNETT 45.00 X 143028 0 23424 1145167 2234391 488523 8 1 1 0 MCV PHYSICIANS PO BOX 79203 BALTIMORE MD 212790203 CONTRACT PHYSICIANS 1089445 ARKANSAS COUNTRY ANESTHESIA 48180 KIPPER DRIVE MOSELEY VA 23120 CONTRACT PHYSICIANS 320250 SHELTERING ARMS HOSPITAL 8254 ATLEE ROAD MECHANICSVILLE VA 23116 OFFICE SPACE LEASE 110615 MEDSITES LLC 1005 SOPHIA STREET FREDERICKSBURG VA 22401 OFFICE SPACE LEASE 104528 4 6200919 505469 6706388 PATIENT SERVICES 623000 28999740 28999740 INFANT SERVICES 621610 18000 18000 RESEARCH REVENUE 541700 500 500 29018240 5554 5554 12450 0 12450 12450 12450 1360 1269 91 91 91 23387 14646 8741 8741 MISCELLANEOUS 900099 202605 202605 MED RECORDS FEE 623000 12487 12487 PHYS THERAPY CONTRACT SERVICE 624310 10004 10004 2195 2195 227291 35978755 29027835 0 244532 545151 408863 136288 17120159 13932375 3187784 1104834 829055 275779 3385282 2705860 679422 1239563 1011553 228010 281029 281029 2267 2267 1939940 1526568 413372 2972 2367 605 1076918 249087 827831 49169 30967 18202 881191 366675 514516 40591 31836 8755 83812 47915 35897 971427 728570 242857 150011 150011 RESIDENT CARE 2173094 1917848 255246 DUES & LICENSES 29872 7580 22292 MISCELLANEOUS 4444 1252 3192 31081726 23798371 7283355 0 2309118 1421545 4421 4029 3061679 2879635 169591 167516 89817 154124 38530486 29127128 10193929 9403358 2907994 3653515 18736549 17683722 2549038 2736444 11031981 6290699 13581019 9027143 X 2285113 5316592 542895 947383 2327522 2392604 5155530 8656579 18736549 17683722 X 4897029 -1395981 X X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2870417 205967 353072 89469 3339987 2996275 563458 -102298 587018 2870417 2609947 541132 605099 759903 2996275 2563739 597294 41040 592126 2609947 3089602 1034025 82059 1641947 2563739 0.00000 0.71600 0.28400 1 0 54914 54914 17574281 10592478 6981803 477715 208600 269115 20025908 17932157 2093751 397668 393893 3775 9403358 OTHER CURRENT ASSETS 302132 EQUITY INTEREST IN FOUNDATION NET ASSETS 3339987 DEPOSITS 11396 3653515 SETTLEMENTS DUE TO THIRD-PARTY PAYORS 81068 PENSION LIABILITY 5985167 DUE TO AFFILIATES 23912 OTHER LIABILITES 92791 PATIENT CREDIT BALANCES 81534 PATIENT ACCOUNT REFUNDS 23599 UNCLAIMED CHECKS 2628 6290699 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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 $947,383 AND $542,895 AT JUNE 30, 2013 AND 2012, 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 $2,392,604 AND $2,327,522 AT JUNE 30, 2013 AND 2012, 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 $89,469 AND $587,018 IN 2013 AND 2012, RESPECTIVELY, TO SUPPORT OPERATIONS OF THE HOSPITAL AND FOR THE PURCHASE OF CAPITAL ASSETS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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, 2013 AND 2012, 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 6509 0 6509 0.00020 1 1180 14798404 13272565 1525839 0.04910 2 1188 14804913 13272565 1532348 0.04930 78 28866 207636 0 207636 0.00670 14 2219 129965 0 129965 0.00420 1 252 350733 25186 325547 0.01050 93 31337 688334 25186 663148 0.02140 95 32525 15493247 13297751 2195496 0.07070 1 23907 35766 35766 X 1 1 1 1 CRIPPLED CHILDREN'S HOSPITAL

2924 BROOK ROAD RICHMOND VA 23220

X X X PEDIATRIC LONG TERM CARE CRIPPLED CHILDREN'S HOSPITAL 1 1 X X X X X X X X X 07 1 0 1 X X X X X X X 1 0 1 1 100.000000000000 1 250.000000000000 1 X X X X X X X 1 1 X 1 0 0 X X 0 0 PART I, LINE 6A: THE HOSPITAL AND CHILDREN'S HOSPITAL FOUNDATION REPORTS THROUGH ITS MANY PUBLICATIONS AND WEB SITES THE ACTIVITIES THAT SUPPORT THE COMMUNITY. THE FOUNDATION INCLUDES INFORMATION IN AN ANNUAL REPORT THAT IS DISTRIBUTED THROUGHOUT THE COMMUNITY. PART I, LINE 7: COST IS USED TO DETERMINE THE AMOUNT OF COMMUNITY BENEFIT FOR EACH CATEGORY. COST IS DETERMINED BY USING EITHER A COST ACCOUNTING METHODOLOGY OR A COST TO CHARGE RATIO. PART I, LINE 7G: THE COST OF THE INFANT SERVICE PROGRAM THAT MET THE DEFINITION OF A SUBSIDIZED HEALTHCARE SERVICE IS INCLUDED IN SUBSIDIZED HEALTHCARE SERVICES. DIRECT COST FOR THE INFANT SERVICE PROGRAM WAS $350,733. PART III, LINE 4: REVENUE FROM THE MEDICAID PROGRAM ACCOUNTED FOR APPROXIMATELY 70% OF THE HOSPITAL'S NET PATIENT SERVICE REVENUE FOR THE YEAR ENDED JUNE 30, 2013. AMOUNTS NOT EXPECTED TO BE PAID ARE RESERVED AND CHARGED TO BAD DEBT EXPENSE. THE AMOUNT REPORTED AS BAD DEBT EXPENSE IS AT COST AND IS BASED ON A COST TO CHARGE RATIO. NO ATTEMPT HAS BEEN MADE TO DETERMINE THE AMOUNT IN BAD DEBT EXPENSE THAT COULD HAVE BEEN ELIGIBLE FOR CHARITY CARE. THE HOSPITAL WILL REFER TO A CONTRACTED COLLECTION AGENCY ACCOUNTS WHERE THE RESPONSIBLE PARTY HAS NOT ATTEMPTED TO RESOLVE THE BALANCE DUE AND THE RESPONSIBLE PARTY IS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE. PART III, LINE 8: THE BAD DEBT EXPENSE IS BASED UPON THE COST TO CHARGE RATIO. MEDICARE ALLOWABLE COST IS FROM THE LOW UTILIZATION MEDICARE COST REPORT. PART III, LINE 9B: A FINANCIAL COUNSELOR ASSISTS PATIENTS IN UNDERSTANDING AVAILABILITY OF COMMUNITY OR GOVERNMENTAL ASSISTANCE PROGRAMS, AS WELL AS THE HOSPITAL'S CHARITY CARE POLICY. PATIENT FAMILIES RECEIVE NOTIFICATION THROUGH THE PATIENT BOOKLET AS A NEW PATIENT. CRIPPLED CHILDREN'S HOSPITAL PART V, SECTION B, LINE 3: 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 20D: THE HOSPITAL OFFERS A SELF-PAY DISCOUNT (APPROXIMATELY 60% OF CHARGES), BASED ON THE MEDICAID RATE, TO UNINUSURED PATIENTS BEYOND THOSE WHO QUALIFY FOR CHARITY CARE. PATIENTS CAN ALSO MAKE MONTHLY PAYMENTS, INTEREST FREE, FOR 18 MONTHS. PART VI, LINE 3: SEE PART III, LINE 9B EXPLANATION. PART VI, LINE 4: SEE PART V EXPLANATION. PART VI, LINE 5: SEE PART V EXPLANATION. X X 0 0 0 0 0 0 0 0 0 LINDA E PEARSON 0 334841 0 50388 0 12176 0 40372 0 8597 0 446374 0 0 JOHN F DUVAL 0 588072 0 0 0 11170 0 71281 0 13684 0 684207 0 0 SHELDON M RETCHIN MD 0 394577 0 0 0 4333 0 27229 0 3529 0 429668 0 0 BRUCE K RUBIN MD 0 301300 0 25000 0 2725 0 56609 0 2092 0 387726 0 0 JOHN D WARD MD 0 375650 0 65734 0 9198 0 52724 0 3026 0 506332 0 0 LESLIE G WYATT 242663 0 30064 0 6004 0 27588 0 11719 0 318038 0 0 0 SHARON W DARBY 172639 0 0 0 3337 0 17671 0 10735 0 204382 0 0 0 JAMES A DEYARMIN 128512 0 0 0 2664 0 13008 0 6878 0 151062 0 0 0 KAREN A BENNETT 137228 0 0 0 5800 0 16565 0 6859 0 166452 0 0 0 PART I, LINE 3 COMPENSATION OF THE EXECUTIVE DIRECTOR IS DETERMINED BY THE LEADERSHIP OF VCUHS. 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. FORM 990, PART VI, SECTION A, LINE 7A SEE RESPONSE TO PAGE 6, PART VI, LINE 6 FORM 990, PART VI, SECTION A, LINE 7B SEE RESPONSE TO PAGE 6, PART VI, 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 AND A PERIOD OF TIME IS ALLOTTED FOR REIVEW 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. FORM 990, PART VI, SECTION C, LINE 19 THE PUBLIC VIEWING DOCUMENT IS AVAILABLE FOR INSPECTION AT THE MAIN HOSPITAL LOCATION UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN PLAN ASSETS AND BENEFIT OBLIGATION OF PENSION PLAN -1,865,551. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENTS 469,570. 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. FUNDRAISING EXPENSES FORM 990, PART IX, LINE 25D 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 ON JUNE 30, 2010, CRIPPLED CHILDRENS HOSPITAL (CCH) AFFILIATED WITH THE VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM (VCUHS). CHILDRENS 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 THIS YEAR 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 0 UNIVERSITY HEALTH SERVICES INC (UHS) PO BOX 980152 RICHMOND VA 23298 541790550 SUPPORT EDUCATIONAL & SCIENTIFIC ACTIVITIES OF VIRGINIA COMMONWEALTH UNIV. VA 501(C)(3) LINE 11A, I VCUHS 0 UHS MANAGED CARE INC PO BOX 980152 RICHMOND VA 23298 541790554 PROVIDE HEALTHCARE VA 501(C)(3) LINE 9 UHS 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY C 6200919 CASH TRANSFER