2014-11-14T13:16:03-06:00 2013-12-31 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2013-01-01 131739922 BLYTHEDALE CHILDREN'S HOSPITAL BLYT 9145927555 95 BRADHURST AVE VALHALLA NY 10595 JOHN CANNING CFO 9145927555 2014-11-11 1 P00743140 5169187000 2014-11-12 2013 2015-11-30 17:44:51Z JOHN CANNING 95 BRADHURST AVE VALHALLA NY 10595 72697098 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. 34 34 509 285 0 0 2881226 2723973 59912842 52677604 6919891 11579787 4953924 5486314 74667883 72467678 0 0 0 0 43408667 42111943 0 0 583854 21506607 21348720 64915274 63460663 9752609 9007015 205551901 215148530 57656214 49125540 147895687 166022990 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 34552032 0 41129049 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 2013. THE HOSPITAL HAD 594 TOTAL DISCHARGES. OVER 71% OF OUR INPATIENT ADMISSIONS WERE REIMBURSED THROUGH THE MEDICAID PROGRAM (FFS & MANAGED) IN 2013. WHILE 100% OF THE HOSPITALS INPATIENT POPULATION IS REFERRED IN FROM OTHER ACUTE CARE HOSPITALS IN THE REGION, OVER >62% COME DIRECTLY FROM INTENSIVE CARE UNITS (ICU'S). THIS SPEAKS TO THE HIGH ACUITY OF THE PATIENT POPULATION BEING MANAGED AT BLYTHEDALE. IN 2013 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. 7777368 10004456 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 2013, 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 2013, THE PROGRAM SERVED ON AVERAGE OF 84 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 19,752 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 2013, THE PROGRAM SERVED ON AVERAGE OF 16 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 3,433 VISITS. EVALUATION AND TREATMENT PLANNING ARE PERFORMED BY A MULTIDISCIPLINARY TEAM THAT MAY CONSIST OF THERAPISTS, SPECIAL EDUCATION TEACHERS, AUDIOLOGISTS, PHYSIATRISTS (REHABILITATION DOCTORS), NEUROLOGISTS, PSYCHIATRISTS, PSYCHOLOGISTS, SOCIAL WORKERS, NURSES, NUTRITIONISTS, AND OTHER SPECIALTY CONSULTANTS. AT BLYTHEDALE, WE PROVIDE INDIVIDUALIZED RELATED SERVICES TO ELIGIBLE CHILDREN AGES THREE TO FIVE THROUGH OUR OUTPATIENT DEPARTMENT. WE SERVE CHILDREN WITH A WIDE RANGE OF NEEDS INCLUDING DIFFICULTIES THAT MAY INTERFERE WITH THEIR LEARNING AND FUNCTIONING IN PRESCHOOL. CHILDREN WITH THE FOLLOWING DIFFICULTIES ARE MOST COMMON IN THE PROGRAM:- DELAYS OR LAGS IN COGNITIVE, LANGUAGE, MOTOR OR SOCIAL EMOTIONAL DEVELOPMENT- CONGENITAL OR ACQUIRED ABNORMALITIES- DIAGNOSED MEDICAL CONDITIONS SUCH AS CEREBRAL PALSY, NEUROMUSCULAR OR OTHER NEUROLOGICAL DISORDERS 3340715 1544099 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 2012, THE PROGRAM SERVED ON AVERAGE OF 24 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 6,115 VISITS. THE HOSPITAL ALSO PROVIDED 3,106 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 2013 THE HOSPITAL PROVIDED OVER 4,252 ENCOUNTERS TO CHILDREN REQUIRING THESE SERVICES (THESE SERVICES INCLUDE AUDIOLOGY, NEUROLOGY, ORTHOPEDICS, SPINA BIFIDA CLINIC, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, BRACE AND EQUIPMENT MODIFICATION AND FITTING). 3377974 5599534 OTHER PROGRAM SERVICE REVENUE INCLUDE HI TECH, SCHOOL CONTRACTS AND OFF-SITE THERAPIES. 3377974 5599534 49048089 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 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 X 187 0 1 509 1 0 1 BD VI CJ 0 0 0 1 1 0 0 0 0 0 X 34 34 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 JEANNE SAVITT SECRETARY 1.00 X 0 0 0 TIM EVNIN TREASURER 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 HOWARD ADLER TRUSTEE 1.00 X 0 0 0 JOHN BARKER TRUSTEE 1.00 X 0 0 0 THOMAS BROCK TRUSTEE 1.00 X 0 0 0 JON BURNHAM TRUSTEE 1.00 X 0 0 0 WILLIAM CAHN TRUSTEE 1.00 X 0 0 0 LAURENCE COHEN TRUSTEE 1.00 X 0 0 0 EDWARD DAVIDOWITZ TRUSTEE 1.00 X 0 0 0 PEGGY EPSTEIN TANNER TRUSTEE 1.00 X 0 0 0 DARREN FOGEL TRUSTEE 1.00 X 0 0 0 JOHN FURTH TRUSTEE 1.00 X 0 0 0 ALAN GERSTEIN TRUSTEE 1.00 X 0 0 0 JUDITH GOODHUE TRUSTEE 1.00 X 0 0 0 MERWIN HASKEL TRUSTEE 1.00 X 0 0 0 TERRI HERENSTEIN TRUSTEE 1.00 X 0 0 0 JORDANA HOLOVACH TRUSTEE 1.00 X 0 0 0 PHYLLIS LASHINS TRUSTEE 1.00 X 0 0 0 SCOTT R LEVY TRUSTEE 1.00 X 0 0 0 WILLIAM LEVY TRUSTEE 1.00 X 0 0 0 MICHAEL MARGULIES TRUSTEE 1.00 X 0 0 0 ANDREW MORRISON TRUSTEE 1.00 X 0 0 0 ABBEY POPPER TRUSTEE 1.00 X 0 0 0 LUCY SCHMOLKA TRUSTEE 1.00 X 0 0 0 HEIDI SCHWARTZ TRUSTEE 1.00 X 0 0 0 STEVEN SOLOMON TRUSTEE 1.00 X 0 0 0 PATRICIA STANLEY TRUSTEE 1.00 X 0 0 0 FARREL STARKER TRUSTEE 1.00 X 0 0 0 FRANK STERN TRUSTEE 1.00 X 0 0 0 LANCE R WACHENHEIM TRUSTEE 1.00 X 0 0 0 LESLIE WEISSMAN TRUSTEE 1.00 X 0 0 0 LAWRENCE LEVINE CEO 37.50 X 559289 0 158917 JOHN CANNING CFO 37.50 X 328070 0 72642 LOIS ALLEN CQO 37.50 X 180611 0 3308 RONI AMIEL CIO 37.50 X 168328 0 38969 ELIZABETH BOWMAN CHIEF MARKETING OFC (THRU 9/13/13) 37.50 X 353496 0 22833 MAUREEN DESIMONE COO 37.50 X 266650 0 88213 RONALD GALLO CHIEF HR OFFICER 37.50 X 201866 0 65901 REGINA KELLY CHIEF COMPLIANCE & PLANNING OFFICER 37.50 X 157304 0 76577 SCOTT KLEIN CHIEF MEDICAL OFFICER 37.50 X 236128 0 17313 JANE MACDONALD CHIEF DEVELOPMENT OFFICER 37.50 X 201522 0 36135 JOELLE MAST CHIEF SCIENTIFIC OFFICER 37.50 X 279684 0 71636 JILL WEGENER CHIEF NURSING OFFICER 37.50 X 106567 0 3082 MILICENT MITCHELL MD CHIEF OF PULMONOLOGY 37.50 X 236600 0 73151 JAY SELMAN MD CHIEF NEUROLOGY 37.60 X 172584 0 37394 BYRON FERNANDEZ MD PEDIATRICIAN 37.50 X 232720 0 37864 KATHY SILVERMAN MD PEDIATRICIAN 37.50 X 174507 0 30871 MARY DIDIE MD PEDIATRICIAN 37.50 X 168362 0 70186 4024288 0 904992 64 0 1 0 BOVIS LEND LEASE 200 PARK AVE NEW YORK NY 10166 CONSTRUCTION 8086067 SODEXO INC & AFFILIATES PO BOX 81049 WOBURN MA 018131049 PURCHASED SERVICES 2995485 FOJP SERVICES CORP 28 E 28TH ST NEW YORK NY 100167946 INSURANCE 621699 HOSPITALS INSURANCE COMPANY 50 MAIN ST WHITE PLAINS NY 10606 INSURANCE 380916 SSC INC PO BOX 13 BRATTLEBORO VT 053020135 SECURITY 322519 40 954455 1769518 130372 2723973 INPATIENT 900099 41129049 41129049 DAY HOSPITAL 900099 10004456 10004456 EARLY INT / OPD 900099 1544099 1544099 52677604 497590 497590 11082197 0 11082197 11082197 11082197 116200 954455 229420 -113220 -113220 SCHOOL CONTRACT 900099 1117006 1117006 OFFSITE THERAPIES 900099 722840 722840 HI TECH REVENUE 900099 367644 367644 3392044 3392044 5599534 72467678 58277138 0 11466567 3695041 714410 2742974 237657 28733107 25329677 3288938 114492 3911462 3546787 341945 22730 3494324 3263829 204223 26272 2278009 1897487 359289 21233 2394462 1206337 1148914 39211 309461 83571 225890 306646 283993 22653 99489 99489 79880 53328 13790 12762 105200 46277 56210 2713 681684 391395 287152 3137 4840566 3546310 1289187 5069 37035 28449 8715 -129 151604 85962 65642 -3631 -3631 6288206 3609465 2648796 29945 1069536 651712 406327 11497 CONTRACTED LABOR 2869574 2741424 109606 18544 UTILITIES 944955 760253 171057 13645 TAXES & OTHER ASSESSMEN 691721 609084 80214 2423 DEBT FINANCE FEES 482332 482332 0 0 63460663 49048089 13828720 583854 20063359 11841484 5591416 2014427 975644 564511 10139574 8761567 269748 178702 513735 819465 104887226 27306755 73362513 77580471 35177227 55113919 58170392 57367685 1288293 906299 205551901 215148530 4636299 4854752 26405000 25300000 19744 13034 26595171 18957754 57656214 49125540 X 137764695 154957839 6150300 6991514 3980692 4073637 147895687 166022990 205551901 215148530 X 9007015 1756530 7363758 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 73876 0 1 25613 99489 0 PART II-B, LINE 1: BLYTHEDALE CHILDREN'S HOSPITAL, AS A MEMBER OF STATE-WIDE HOSPITAL ORGANIZATIONS, HAS A PORTION OF ITS DUES USED FOR LOBBYING. IN ADDITION, BLYTHEDALE HAS ENGAGED AN OUTSIDE LOBBYIST TO LOBBY ON ITS BEHALF ON ISSUES RELATING TO THE STATE BUDGET. 10130991 926397 1758628 1750866 11065150 9207439 1230427 923951 1230826 10130991 14508992 911024 -687562 5525015 9207439 20617212 430633 1098917 7637770 14508992 19230372 1619160 372366 604686 20617212 0.90000 0.04000 0.06000 0 0 1383879 1383879 46094110 9500474 36593636 42180161 15659544 26520617 15229076 2146737 13082339 77580471 LIMITED LIABILITY PARTNERSHIP (HEDGE FUNDS) 57367685 C 57367685 ACCRUED PENSION LIABILITY 15836216 DUE TO THIRD PARTIES 2146040 ASSET RETIREMENT OBLIGATIONS 68498 MALPRACTICE LIABILITIES 907000 18957754 X 73519472 1750866 1750866 71768606 699072 699072 72467678 63690086 229423 229423 63460663 0 63460663 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, 2013 AND 2012, ARE AVAILABLE FOR THE FOLLOWING PURPOSES: 2013 2012 PLANT REPLACEMENT $465,000 $1,147,607 TEMPORARILY RECTRICTED PORTION OF ENDOWMENT FUND _$4,651,447___________ 3,185,006 MEDICAL EQUIPMENT _$14,088___________ 87,366 OTHER _$1,860,980__________ 1,7030,321 TOTALS __$6,991,514__________ $6,150,300 PERMANENTLY RESTRICTED NET ASSETS AS OF DECEMBER 31, 2013 AND 2012 ARE RESTRICTED TO THE FOLLOWING: 2013 2012 INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES _$4,073,637___________ $3,980,629 BLYTHEDALE CHILDREN'S HOSPITAL HAS A CHARITABLE REMAINDER TRUST HELD BY TRUSTEES CITIBANK, CALLED THE HENRY STERN TRUST. THE PRINCIPLE IS PERMANENTLY RESTRICTED. PART X, LINE 2: IN JUNE 2006, THE FINANCIAL ACCOUNTING STANDARDS BOARD ("FASB") ISSUED ASC 740-10-65, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, WHICH CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTERPRISE'S FINANCIAL STATEMENTS IN ACCORDANCE WITH ASC 740, ACCOUNTING FOR INCOME TAXES. THIS INTERPRETATION PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THIS INTERPRETATION ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE, AND TRANSITION. THE HOSPITAL ADOPTED THE PROVISIONS OF ASC 740-10-65 ON JANUARY 1, 2009. THE ADOPTION HAD NO IMPACT UPON THE FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTION 1,750,866. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES RECLASS TO REVENUE -229,420. TEMPORARILY RESTRICTED CONTRIBUTIONS 913,557. PERMANENTLY RESTRICTED CONTRIBUTIONS 12,840. TEMPORARILY RESTRICTED GAIN ON INVESTMENTS 2,098. ROUNDING -3. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES RECLASS TO REVENUE 229,420. ROUNDING 3. CENTRAL AMERICA & THE CARIBBEAN 0 0 INVESTMENTS 43477705 0 0 0 0 0 0 43477705 0 43477705 1 0 1 1 0 0 SPRING EVENT 655619 589219 66400 68030 31676 GOLF EVENT 272550 222750 49800 69752 8868 1 142486 142486 1100 49995 1070655 954455 116200 138882 90539 229421 -113221 1 1 1 X 400.000000000000 1 X 1 1 0 1 1 58886 58886 0.00090 39843932 36430486 3413446 0.05380 609084 407166 201918 0.00320 40511902 36837652 3674250 0.05790 570077 398587 171490 0.00270 548618 372235 176383 0.00280 398360 193930 204430 0.00320 379009 183568 195441 0.00310 1896064 1148320 747744 0.01180 42407966 37985972 4421994 0.06970 2491878 883461 1608417 0.02530 2491878 883461 1608417 0.02530 1 476303 0 0 0 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 1 X X X X X X X X 13 1 1 1 X WWW.BLYTHEDALE.ORG X X X X X X 0 0 1 1 400.000000000000 1 400.000000000000 1 X 1 1 X X X X 1 0 X 0 X X 0 0 BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 3: IN JANUARY 2013, 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 ON AUGUST 10, 2013 TO GATHER ADDITIONAL 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 4: BURKE REHABILITATION CENTERHUDSON VALLEY HOSPITAL CENTERLAWRENCE HOSPITAL CENTERMOUNT VERNON NEIGHBORHOOD CENTERNORTHERN WESTCHESTER HOSPITALOPEN DOOR FAMILY MEDICAL CENTERPHELPS MEMORIAL HOSPITAL CENTER SAINT 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 7: 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 18E: NEITHER THE HOSPITAL NOR ANY AUTHORIZED THIRD PARTY TOOK ANY OF THE ACTIONS LISTED IN FORM 990, SCHEDULE H, PART V, SECTION B, QUESTION 16 OR 17. BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 20D: THE HOSPITAL FACILITY USED THE PUBLISHED MEDICAID RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. PART I, LINE 7: 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 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: $250,000 LESS CONTRACTUAL ALLOWANCES: -$150,000 NET REVENUE: $100,000 ACTUAL PAYMENTS: -$75,000 ACCOUNT 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, 2013 AND 2012, WERE APPROXIMATELY $58,886 AND $18,627, 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 2013. THE HOSPITAL MAINTAINED AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IN 2013 AND 2012 IN THE AMOUNTS OF APPROXIMATELY $828,000 AND $892,000, RESPECTIVELY. THESE AMOUNTS REPRESENT 1.6% AND 1.4% OF NET PATIENT SERVICE REVENUE RESPECTIVELY. PART III, LINE 8: BLYTHEDALE, AS A CHILDREN'S HOSPITAL RECEIVED IMMATERIAL AMOUNTS OF MEDICARE REIMBURSEMENT. IN 2013 THE HOSPITAL FILED A LOW/NO COST UTLIZATION REPORT WITH CMS. PART III, LINE 9B: COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS.ALL PATIENTS HAVING DIFFICULTY PAYING THEIR BILLS ARE DIRECTED TO HOSPITAL STAFF WHO ASSIST THE FAMILY IN COMPLETING A FINANCIAL ASSESSMENT AND TRY TO QUALIFY THE PATIENT FOR ASSISTANCE. ONCE A LEVEL OF FINANCIAL ASSISTANCE IS DETERMINED, THE ACCOUNT BALANCE IS PRORATED FOR CONTRACTUAL ADJUSTMENTS AND THEN PRO-RATED TO COST. FROM COSTS, THE LEVEL OF FINANCIAL ASSISTANCE IS THEN APPLIED, ANY REMAINING BALANCE IS COLLECTABLE AS PATIENT RESPONSIBILITY.PATIENTS ARE SCREENED FOR ELIGIBILTY FOR FINANCIAL ASSISTANCE BEFORE COLLECTION PROCEDURE BEGIN. IF AT ANY POINT IN THE COLLECTION PROCESS, DOCUMENTATION IS RECEIVED THAT INDICATES THAT THE PATIENT IS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, THE ACCOUNT IS REFERRED BACK FOR A FINANCIAL ASSISTANCE REVIEW. BLYTHEDALE DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR CHARITY CARE.IF A PATIENT HAS REQUESTED AND/OR FILLED OUT A FINANCIAL ASSISTANCE APPLICATION, ALL DEBT COLLECTION ACTIVITIES STOP UNTIL ELIGIBILTY FOR FINANCIAL ASSISTANCE CAN BE DETERMINED. BLYTHEDALE'S POLICY PROVIDES THAT WE WILL NOT REFER ANY ACCOUNTS FOR COLLECTION UNTIL IT IS DETERMINED WHETHER THE INDIVIDUAL IS INSURED AND NOT ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: SINCE THE VAST MAJORITY OF ADMISSIONS TO BLYTHEDALE COME BY REFERRAL FROM OTHER HOSPITALS, PARTICULARLY THE LARGE MEDICAL CENTERS IN THE METROPOLITAN NEW YORK AND HUDSON VALLEY AREA, BLYTHEDALE'S SENSE OF NEED FOR CLINICAL SERVICES LARGELY EMANATES FROM REFERRING HOSPITALS AND THEIR PHYSICIANS. BLYTHEDALE CONTINUOUSLY REVIEWS WITH REFERRING HOSPITALS AND PHYSICIANS THEIR NEEDS FOR SERVICES.HOWEVER, IN ADDITION TO ITS REFERRAL HOSPITALS, BLYTHEDALE ALSO WORKS CLOSELY WITH A VARIETY OF LOCAL AGENCIES, NOTABLY THE WESTCHESTER, ROCKLAND AND PUTNAM COUNTY DEPARTMENTS OF HEALTH, THE WESTCHESTER CHILD HEALTH ADVOCACY NETWORK AND THE WESTCHESTER SAFE KIDS COALITION, 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, AND INJURY AND DISEASE PREVENTION 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 2012 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: 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 THROUGH WESTCHESTER COUNTY 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 26 SCHOOLS (OFTEN MORE THAN ONE VISIT) AND 15 SCHOOL DISTRICTS, TO 18,528 K-8 STUDENTS AND 980 ADULTS.INJURY PREVENTION: BLYTHEDALE HAS FOR MANY YEARS COORDINATED THE WESTCHESTER SAFE KIDS COALITION, THE LOCAL AFFILIATE OF THE NATIONAL SAFE KIDS CAMPAIGN. BLYTHEDALE HAS SPONSORED FITTING AND INSTALLATION CHECKS FOR BOTH REGULAR AND SPECIAL-NEED CAR SEATS ON SITE AT THE HOSPITAL. IN THE MOST RECENT SCHOOL YEAR, BLYTHEDALE DID BIKE HELMET SAFETY, WATER AND FIRE SAFETY EDUCATION FOR 3,000 CHILDREN AND 300 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 4,549 INDIVIDUALS TRAINED IN 2013 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 CEO 521345 0 26666 0 11278 0 125387 0 33530 0 718206 0 0 0 JOHN CANNING CFO 303578 0 16000 0 8492 0 38726 0 33916 0 400712 0 0 0 LOIS ALLEN CQO 172126 0 4000 0 4485 0 0 0 3308 0 183919 0 0 0 RONI AMIEL CIO 161983 0 6000 0 345 0 8008 0 30961 0 207297 0 0 0 ELIZABETH BOWMAN CHIEF MARKETING OFC (THRU 9/13/13) 156791 0 0 0 196705 0 20035 0 2798 0 376329 0 0 0 MAUREEN DESIMONE COO 244048 0 12000 0 10602 0 63823 0 24390 0 354863 0 0 0 RONALD GALLO CHIEF HR OFFICER 193170 0 6000 0 2696 0 41672 0 24229 0 267767 0 0 0 REGINA KELLY CHIEF COMPLIANCE & PLANNING OFFICER 155069 0 0 0 2235 0 40856 0 35721 0 233881 0 0 0 SCOTT KLEIN CHIEF MEDICAL OFFICER 225899 0 10000 0 229 0 2569 0 14744 0 253441 0 0 0 JANE MACDONALD CHIEF DEVELOPMENT OFFICER 192832 0 6000 0 2690 0 22877 0 13258 0 237657 0 0 0 JOELLE MAST CHIEF SCIENTIFIC OFFICER 276912 0 0 0 2772 0 35606 0 36030 0 351320 0 0 0 MILICENT MITCHELL MD CHIEF OF PULMONOLOGY 235808 0 0 0 792 0 54406 0 18745 0 309751 0 0 0 JAY SELMAN MD CHIEF NEUROLOGY 171060 0 0 0 1524 0 26872 0 10522 0 209978 0 0 0 BYRON FERNANDEZ MD PEDIATRICIAN 232540 0 0 0 180 0 10577 0 27287 0 270584 0 0 0 KATHY SILVERMAN MD PEDIATRICIAN 173991 0 0 0 516 0 21135 0 9736 0 205378 0 0 0 MARY DIDIE MD PEDIATRICIAN 166838 0 0 0 1524 0 42432 0 27754 0 238548 0 0 0 PART I, LINES 4A-B LINE 4A: BETSY BOWMAN WAS EMPLOYEED BY BLYTHEDALE CHILDREN'S HOSPITAL UNTIL SEPTEMBER 13, 2013. SHE BECAME ELIGIBLE FOR SEVERENCE PAYMENTS OF $156,791 ON LEAVING BLYTHDALE CHILDREN'S HOSPITAL. 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, 2013 AND 2012, THE PROJECTED BENEFIT OBLIGATION WAS $1,354,809 AND $1,245,926, RESPECTIVELY AND IS INCLUDED IN ACCRUED PENSION LIABILITY IN THE STATEMENTS OF FINANCIAL POSITION. IN 2013 THE HOSPITAL CONTRIBUTED $46,000 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 2013 THE HOSPITAL CONTRIBUTED $31,276 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 27228543 60956 540000 820868 25806719 2011 0 0 0 1 A 0 0 1 0 0 0 0 1 A 0 0 0 0 1 0 0 0 0 X 16 130372 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 16 STOCK CONTRIBUTIONS IN 2013. FORM 990, PART VI, SECTION A, LINE 2 JOHN FURTH AND OWEN GUTFREUND (BOARD MEMBERS) HAVE A FAMILY RELATIONSHIP. DAVID PEDOWITZ HAS BUSINESS RELATIONSHIPS WITH PEGGY EPSTEIN TANNER, PATRICIA STANLEY AND LARRY COHEN (BOARD MEMBERS). ANDREW HERENSTEIN (SPOUSE OF BOARD MEMBER TERRI HERENSTEIN) HAS BUSINESS RELATIONSHIPS WITH DAVID TANNER (SPOUSE OF BOARD MEMBER PEGGY EPSTEIN TANNER) AND LARRY COHEN. FRANK STERN AND JOHN BARKER (BOARD MEMBERS) HAVE A BUSINESS RELATIONSHIP. JOHN BARKER, DAVID PEDOWITZ AND DARREN FOGEL ARE EMPLOYEES OF NEUBERGER BERMAN, WHICH MANAGES SOME ASSET AND PENSION PORTFOLIOS FOR THE HOSPITAL. THESE MEMBERS RECUSE THEMSELVES FROM ALL ISSUES RELATED TO THESE INVESTMENTS. 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. SULLIVAN, COTTER AND ASSOCIATES IS A WELL REGARDED COMPENSATION CONSULTING FIRM WITH REGIONAL AND NATIONAL EXPERTISE. THE FIRM COMPARED BLYTHEDALE'S EXECUTIVE COMPENSATION TO REGIONAL CHILDREN'S AND REHABILITATION NOT-FOR-PROFIT HOSPITALS THAT BLYTHEDALE IDENTIFIED AS ITS PRIMARY COMPARATORS; NOT-FOR-PROFIT HOSPITALS IN THE METROPOLITAN NEW YORK AREA; AND NOT-FOR-PROFIT HOSPITALS IN THE HUDSON VALLEY REGION. SULLIVAN, COTTER AND ASSOCIATES PROVIDED 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. 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. 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 DETERMINED THAT IT WAS PROVIDING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" THAT THE COMPENSATION PROVIDED TO BLYTHEDALE EXECUTIVES WAS REASONABLE AND CONSISTENT WITH MARKET PRACTICES. IN DECEMBER 2012, WITHOUT INPUT OR VOTING PARTICIPATION BY THE INDIVIVDUALS WHOSE COMPENSATION WAS APPROVED, THE COMPENSATION COMMITTEE APPROVED INCENTIVE COMPENSATION AWARDS FOR THE EXECUTIVE MANAGEMENT TEAM AND APPROVED THE PROPOSED 2013 EXECUTIVE BASE COMPENSATION. THE FINAL DETEMINATION 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 7,363,758.