2013-01-31T13:14:58-06:00 2011-12-31 131517563 LOEB & TROPER LLP 655 THIRD AVENUE 12TH FLOOR NEW YORK NY 10017 990 2011-01-01 111679599 ST MARY'S HOSPITAL FOR CHILDREN INC STMA 7182818835 29-01 216TH STREET BAYSIDE NY 11360 JEFFREY K FRERICHS 7182818835 2013-01-30 1 FREDERICK H ROTHMAN P01275277 2128674000 2011 2016-02-25 16:41:14Z JEFFREY K FRERICHS 29-01 216TH STREET BAYSIDE NY 11360 123930434 0 X WWW.STMARYSKIDS.ORG X 1888 NY TO PROVIDE HIGHLY SPECIALIZED SUB-ACUTE INPATIENT CARE AND OTHER SERVICES TO CHILDREN AND YOUNG ADULTS WITH MEDICALLY COMPLEX SPECIAL NEEDS. KEY STAFF FROM ST. MARY'S PARTICIPATE IN NUMEROUS PROFESSIONAL ORGANIZATIONS AND POLICY-MAKING WORKGROUPS, AND ARE WIDELY ACKNOWLEDGED AS EXPERTS IN THE PROVISION OF LIFE-ALTERING CLINICAL AND THERAPEUTIC CARE TO CHILDREN WITH COMPLEX SPECIAL NEEDS. 6 3 861 74 0 0 5339114 5666862 85139124 71182817 1662769 4136428 858918 540487 92999925 81526594 0 0 0 0 48931491 39766905 0 0 0 39806324 44362141 88737815 84129046 4262110 -2602452 176019528 161100302 130528072 130186344 45491456 30913958 X ST. MARY'S HOSPITAL FOR CHILDREN ("SMH"), THE FLAGSHIP FACILITY OF ST. MARY'S HEALTHCARE SYSTEM FOR CHILDREN, IS COMMITTED TO IMPROVING THE HEALTH AND QUALITY OF LIFE FOR CHILDREN AND YOUNG ADULTS WITH SPECIAL NEEDS. A NATIONALLY RECOGNIZED PROVIDER OF SPECIALIZED SERVICES FOR CHILDREN WITH COMPLEX HEALTH CARE NEEDS REQUIRING MEDICAL, REHABILITATION, PSYCHOLOGICAL AND DEVELOPMENTAL INTERVENTION, SMH PROVIDES BOTH SUB-ACUTE AND LONG-TERM CARE SERVICES, AS WELL AS A NUMBER OF HIGHLY SPECIALIZED, TECHNOLOGICALLY SOPHISTICATED HOME- AND COMMUNITY-BASED AND EARLY INTERVENTION SERVICES. SMH MAKES REFERRALS TO AND, WHEN APPROPRIATE, ACCEPTS ADMISSIONS FROM, ST. MARY'S HOME CARE (A CERTIFIED HOME HEALTH AGENCY FOCUSED ON THE PROVISION OF SERVICES TO CHILDREN AND YOUNG ADULTS WITH SPECIAL NEEDS) AND ST. MARY'S CCP (A LICENSED HOME CARE SERVICES AGENCY PROVIDING PARAPROFESSIONAL AND OTHER SERVICES), AS WELL AS FROM HOSPITALS AND OTHER PROVIDERS THROUGHOUT THE NEW YORK METROPOLITAN AREA. 0 0 25988682 30516526 INPATIENT SERVICES AND FACILITY-BASED PROGRAMS - SEE SCHEDULE O INPATIENT SERVICES AND FACILITY-BASED PROGRAMS - FOLLOWING HOSPITALIZATIONS FOR SERIOUS ILLNESS OR INJURY OR WHEN SPECIALIZED CARE IS NEEDED, CHILDREN AND THEIR FAMILIES COME TO ST. MARY'S HOSPITAL FOR CHILDREN TO RECEIVE EXCEPTIONAL CARE, TO HEAL, AND TO THRIVE.CHILDREN WITH SPECIAL HEALTHCARE NEEDS FROM BIRTH TO AGE EIGHTEEN RECEIVE COMPLEX INPATIENT MEDICAL CARE AND INTENSIVE REHABILITATION AT ST. MARY'S 97-BED FACILITY. ST. MARY'S BROAD ARRAY OF INPATIENT PROGRAMS AND SERVICES ARE DESIGNED TO PROVIDE GOAL-ORIENTED MEDICAL CARE THAT ADDRESSES ALL ASPECTS OF THE HEALING PROCESS, WHILE ENCOURAGING GROWTH AND INDEPENDENCE. MULTIDISCIPLINARY TEAMS OF PEDIATRIC SPECIALISTS IN MEDICINE, NURSING, REHABILITATION, PSYCHOLOGY, SOCIAL WORK, AND CHILD DEVELOPMENT PARTICIPATE IN THE CREATION OF INDIVIDUALIZED CARE PLANS TO ENSURE OPTIMAL OUTCOMES FOR EACH CHILD.ST. MARY'S STRIVES TO HELP KIDS BE KIDS. IN ADDITION TO RECEIVING MEDICAL CARE AND REHABILITATION THERAPIES WHILE AT OUR FACILITY, CHILDREN ATTEND SCHOOL, PARTICIPATE IN ONSITE AND OFF-CAMPUS RECREATIONAL ACTIVITIES, AND ARE ENCOURAGED TO SOCIALIZE, PLAY, AND REGAIN THEIR INDEPENDENCE. SERVICES INCLUDE: REHABILITATION THERAPIES (PT, OT, SPEECH); COMPREHENSIVE PEDIATRIC/ADOLESCENT MEDICAL CARE; SPECIALIZED SKILLED NURSING; NUTRITIONAL/FEEDING THERAPY; PSYCHOLOGICAL SERVICES; NEUROPSYCHOLOGY; INFANT STIMULATION; SOCIAL WORK; EARLY EDUCATION (INCLUDING PS 23 ON-SITE PUBLIC SCHOOL AND SERVICES OFFERED THROUGH THE COMMITTEE ON PRE-SCHOOL EDUCATION); PARENT/FAMILY TRAINING PROGRAMS; HEALING ARTS AND THERAPEUTIC ACTIVITIES; PASTORAL CARE; PALLIATIVE CARE; RESPITE CARE; COMPLEMENTARY CARE AND WOUND CARE.ST. MARY'S HOSPITAL FOR CHILDREN ALSO OPERATES AN ON-SITE EARLY EDUCATION PROGRAM AND A PEDIATRIC DAY HEALTH CARE (PDHC) PROGRAM. ST. MARY'S EARLY EDUCATION PROGRAM IS FOCUSED ON AND DEDICATED TO PROVIDING CHILDREN WITH THE OPPORTUNITY TO INTERACT, SHARE IDEAS, AND LEARN. A WIDE RANGE OF EDUCATIONAL PROGRAMS AND OPPORTUNITIES, FROM BIRTH TO HIGH SCHOOL, HELPS CHILDREN WITH SPECIAL NEEDS MAXIMIZE THEIR POTENTIAL BY PROMOTING GROWTH, CONFIDENCE, AND INDEPENDENCE. ST. MARY'S OFFERS AN ON-CAMPUS PUBLIC SCHOOL FOR INPATIENTS, ALLOWING THEM TO HAVE A CONTINUITY OF EDUCATION DURING THEIR STAY AT THE HOSPITAL. FOR YOUNGER CHILDREN, ST. MARY'S OFFERS AN INCLUSIVE EARLY EDUCATION/PRESCHOOL PROGRAM FOR COMMUNITY CHILDREN WITH SPECIAL NEEDS. ST. MARY'S COMMITMENT TO EDUCATIONAL GOALS ALLOWS CHILDREN TO MAKE INCREDIBLE GAINS AND REACH ASPIRING MILESTONES, WHILE FOSTERING DEVELOPMENT.ST. MARY'S PEDIATRIC DAY HEALTHCARE PROGRAM IS A MEDICAL PROGRAM THAT OFFERS THERAPEUTIC AND MEDICAL AFTER-SCHOOL, WEEKEND, AND SUMMER CAMP PROGRAMS FOR CHILDREN 5-18 YEARS OF AGE AND YOUNG ADULTS FROM 18-25 YEARS OF AGE WHO HAVE COGNITIVE AND PHYSICAL DISABILITIES. USING THERAPEUTIC, REHABILITATIVE, AND RECREATIONAL ACTIVITIES, ST. MARY'S PDHC STAFF HELP EACH CHILD WITH SPECIAL HEALTHCARE NEEDS DEVELOP EVERY CAPABILITY TO HIS OR HER FULLEST. CHILDREN AND YOUNG ADULTS WHO ATTEND THE PDHC PROGRAM PARTICIPATE IN INDOOR AND OUTDOOR ACTIVITIES, RECEIVE A HOT MEAL, ARE PROVIDED WITH ROUND-TRIP TRANSPORTATION, AND ALSO HAVE THE OPPORTUNITY TO INTERACT WITH OTHER CHILDREN WITH SPECIAL NEEDS. EDUCATIONAL ACTIVITIES ARE LED BY A LICENSED SPECIAL EDUCATION TEACHER. CAREGIVERS WORK WITH PARTICIPANTS TO PROMOTE SKILLS, CONFIDENCE, AND INDEPENDENCE IN A NURTURING AND FUN ENVIRONMENT. FAMILY MEMBERS ARE ALSO EDUCATED ON THE CRITICAL ROLES THEY PLAY IN THE CHILD'S SUCCESS. 26638399 32775673 LONG TERM HOME HEALTH CARE AND CARE COORDINATION PROGRAMS - SEE SCHEDULE O LONG TERM HOME HEALTH CARE AND CARE COORDINATION PROGRAMS - ST. MARY'S HEALTHCARE SYSTEM FOR CHILDREN OFFERS A WIDE RANGE OF HOME AND COMMUNITY BASED SERVICES, ALL ORGANIZED AROUND THE BELIEF THAT THE HOME IS THE MOST APPROPRIATE CARE DELIVERY SETTING FOR CHILDREN TO HEAL AND THRIVE. ST. MARY'S PIONEERED THE FIRST HOME CARE PROGRAM FOR CHILDREN IN NEW YORK OVER 25 YEARS AGO, AND THE SYSTEM REMAINS THE LARGEST AND MOST COMPREHENSIVE PROVIDER OF SERVICES TO CHILDREN WITH SPECIAL HEALTHCARE NEEDS. THE LARGEST OF THE COMMUNITY-BASED PROGRAMS OFFERED BY ST. MARY'S HOSPITAL FOR CHILDREN, INC. IS THE LONG TERM HOME HEALTH CARE PROGRAM (LTHHCP).THE CHILDREN SERVED THROUGH THE ST. MARY'S LTHHCP ARE TYPICALLY MEDICALLY FRAGILE, AND THEY WOULD, ABSENT THIS PROGRAM, REQUIRE HOSPITALIZATION OR OTHER INSTITUTIONAL CARE. THEIR DIAGNOSES RUN THE GAMUT OF CHILDHOOD SEVERE ILLNESSES INCLUDING COMPLICATIONS OF PREMATURITY, GENETIC DISORDERS, NEURO-DEVELOPMENTAL DISORDERS, NEURO-MUSCULAR DISORDERS, TRAUMATIC BRAIN INJURY, AIDS, CANCER, RESPIRATORY DISORDERS, AND VENTILATOR DEPENDENCE. THE SERVICES PROVIDED BY ST. MARY'S INCLUDE COMBINATIONS OF PROFESSIONAL HEALTHCARE SERVICES AND LIFE ASSISTANCE SERVICES THAT ARE TAILORED TO MEET THE NEEDS OF EACH CHILD AND HIS/HER FAMILY. SERVICES MAY INCLUDE MEDICAL CARE, NURSING CARE, REHABILITATION THERAPIES, PERSONAL CARE ASSISTANCE, HOME HEALTH AIDE CARE, WOUND CARE, MEDICATION MANAGEMENT, PAIN MANAGEMENT, DISEASE EDUCATION AND MANAGEMENT, COMPLEMENTARY CARE, ASSISTIVE TECHNOLOGY AND OTHER AUGMENTIVE COMMUNICATIONS SUPPORT, EQUIPMENT, HOME MODIFICATIONS, AND ASSISTANCE WITH THE COORDINATION OF CARE. ST. MARY'S HOSPITAL FOR CHILDREN, INC. ALSO SPONSORS BOTH A CARE AT HOME PROGRAM (WITH AN AVERAGE CENSUS OF ABOUT 300 CHILDREN) AND A MEDICAID SERVICES COORDINATION PROGRAM (SERVING AN AVERAGE CENSUS OF ABOUT 75 CHILDREN AT A GIVEN TIME). EACH OF THESE PROGRAMS HAS AS ITS FOCUS THE COORDINATION OF SERVICES TO OPTIMIZE EACH PATIENT'S QUALITY OF LIFE, WITHOUT COMPROMISING CLINICAL/MEDICAL PROGRESS, ENABLING EACH CHILD TO REMAIN IN THE LEAST RESTRICTIVE ENVIRONMENT POSSIBLE AND REMAIN INTEGRATED WITHIN HIS OR HER COMMUNITY. ANOTHER KEY GOAL OF THESE PROGRAMS IS TO ENSURE THAT THROUGH COORDINATION, CAREGIVERS AND FAMILIES ARE ABLE TO MAKE THE MOST EFFICIENT AND EFFECTIVE USE OF RESOURCES AVAILABLE. 12344624 7890618 EARLY INTERVENTION PROGRAM SERVICES - SEE SCHEDULE O EARLY INTERVENTION PROGRAM SERVICES - ST. MARY'S HOSPITAL FOR CHILDREN IS ONE OF THE LARGEST EARLY INTERVENTION (EI) PROVIDERS IN NEW YORK CITY, WITH MANY YEARS OF EXPERIENCE PROVIDING EI SERVICES IN NEW YORK CITY, AND TO CHILDREN IN NASSAU, SUFFOLK AND WESTCHESTER COUNTIES. ST. MARY'S EVALUATES MORE THAN 1,800 CHILDREN AGES THREE AND UNDER EACH YEAR. ST. MARY'S MULTIDISCIPLINARY TREATMENT TEAMS PROVIDE NUTRITION SERVICES, OCCUPATIONAL AND PHYSICAL THERAPY, SPECIAL INSTRUCTION, SPEECH AND LANGUAGE PATHOLOGY, AND VISION THERAPY TO AN AVERAGE CENSUS OF 1,300 ELIGIBLE CHILDREN. ST. MARY'S PROFESSIONALS WORK WITH ELIGIBLE CHILDREN TO MAXIMIZE THEIR POTENTIAL, ADDRESSING THEIR PHYSICAL, COGNITIVE, COMMUNICATION, SOCIAL/EMOTIONAL AND ADAPTIVE NEEDS, INCLUDING HELPING FAMILIES LEARN THE BEST WAYS TO SUPPORT THEIR CHILDREN. THE ST. MARY'S TEAM CREATES SPECIFIC CARE PLANS FOCUSED ON EACH CHILD'S NEEDS, TO FOSTER IMPROVED FAMILY AND CHILD FUNCTIONING. OUR SCOPE OF SERVICES INCLUDES HOME/COMMUNITY BASED, FACILITY-BASED, GROUP DEVELOPMENTAL INTERVENTION, PARENT-CHILD GROUP AND FAMILY/CAREGIVER SUPPORT GROUP. SERVICES PROVIDED INCLUDE: PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, SPECIAL EDUCATION, SOCIAL WORK, NUTRITIONAL SERVICES, CORE AND SUPPLEMENTAL EVALUATIONS, GROUP SUPPORT (PARENT AND CHILD), SERVICE COORDINATION, ASSISTIVE TECHNOLOGY, AND AUGMENTATIVE COMMUNICATION EVALUATIONS. 64971705 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 0 1 X 550 0 861 1 0 1 BD CJ VI 0 0 0 0 0 0 0 0 X 6 3 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 NY X X MICHAEL G SKLAR 7182818835 5 DAKOTA DRIVE SUITE 200 NEW HYDE NY 11042 X JEFFREY K FRERICHS 1.00 X X 0 469567 18133 EDWIN SIMPSER 1.00 X X 0 461206 34057 PINCUS D ZAGELBAUM 1.00 X X 0 276001 32543 STEPHEN BRENT WELLS 1.50 X X 0 0 0 BERNARD HABER 1.00 X 0 0 0 CINDY JOHNSON 1.00 X 0 0 0 EILEEN CHISARI 1.00 X 0 325426 21269 HOPE M ILICETO 1.00 X 0 368880 17883 KATHRYN A LANG 37.50 X 167578 0 2965 AUDREY B BERMAN-DAVIDOWITZ 37.50 X 155226 0 35030 LINDA MEGALLY 37.50 X 140591 0 26546 MOSHE YADOO 37.50 X 141952 0 24264 MARY LOU HIRE 37.50 X 144613 0 16530 749960 1901080 229220 31 0 1 0 TURNER CONSTRUCTION COMPANY 375 HUDSON STREET NEW YORK NY 10014 CONSTRUCTION 18796283 D&J SERVICE INC 1200 ZAREGA AVENUE BRONX NY 10462 TRANSPORTATION 1686599 ST MARY'S COMMUNITY CARE PROFESSIONAL 5 DAKOTA DRIVE SUITE 308 NEW HYDE PARK NY 11042 HOME CARE AIDES 1308601 HABERLE STEEL INC 1946 EAST CHERRY LANE SOUDERTON PA 18964 CONSTRUCTION 400000 STANTEC ARCHITECTURE INC 13980 COLLECTIONS CENTER DRIVE CHICAGE IL 60693 ARCHITECTURE 348500 11 5084178 582684 5666862 HOME AND COMMUNITY BAS 623000 32775673 32775673 INPATIENT SERVICES 623000 30516526 30516526 EARLY INTERVENTION 623000 7890618 7890618 71182817 482640 482640 93507 93507 0 0 45964121 42310333 3653788 3653788 3653788 MEDICAL STAFF SERVICES 900099 292125 292125 MEAL INCOME 900099 158408 158408 MEDICAL RECORDS 900099 35480 35480 54474 54474 540487 81526594 71182817 0 4676915 31080267 29913637 1166630 971960 243182 728778 4929147 4865265 63882 2785531 2234893 550638 7596630 7596630 417716 417716 191161 191161 150589 150589 104603 104603 21348218 17170848 4177370 144107 144107 4549000 3715437 833563 34183 34183 2091669 2091669 335862 335862 48019 28620 19399 473470 473470 2032908 2032908 1452293 1452293 NYS ASSESSMENT EXPENSE 2741709 2741709 BAD DEBT EXPENSE 650004 650004 84129046 64971705 19157341 0 1856400 84768 94953130 58778356 11904186 8794829 18650640 11374863 430760 426893 82704224 27851177 25552853 54853047 17352557 17840116 5319002 4505962 4441468 176019528 161100302 10029714 14293424 249697 105970 102200000 102200000 15232252 11127165 2816409 2459785 130528072 130186344 X 41128644 29514081 4362812 1399877 45491456 30913958 176019528 161100302 X -2602452 -11975046 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 150589 0 1 4799 155388 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: ST. MARY'S HOSPITAL FOR CHILDREN, INC. ENGAGED A LAW FIRM TO LOBBY ON THEIR BEHALF REGARDING BUDGET, REGULATORY AND LEGISLATIVE ISSUES. ADDITIONALLY, THE LOBBYING PORTION OF ASSOCIATION DUES, INCLUDING CONTINUING CARE LEADERSHIP COUNCIL (CCLC) AND THE HEALTH CARE ASSOCIATION OF NYS INC (HCA) ARE INCLUDED AS OTHER ACTIVITIES. 730256 730256 15523303 14462387 1060916 19082724 13388790 5693934 47367941 47367941 54853047 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 2169785 ACCRUED ASSET RETIREMENT OBLIGATION 290000 2459785 81526594 84129046 -2602452 -4864391 -7110655 -11975046 -14577498 76651107 -4864391 93507 -4770884 81421991 104603 104603 81526594 91228605 7204162 7204162 84024443 104603 104603 84129046 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: SMH HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. PERIODS ENDING DECEMBER 31, 2008 AND SUBSEQUENT REMAIN SUBJECT TO EXAMINATION BY APPLICABLE TAXING AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: RESERVE ON AMOUNTS DUE FROM RELATED ORGANIZATIONS -7,110,655. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 93,507. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 93,507. RESERVE ON AMOUNTS DUE FROM RELATED ORGANIZATIONS 7,110,655. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 2658546 EUROPE 0 0 INVESTMENTS 1287760 0 0 0 0 0 0 3946306 0 3946306 0 0 0 0 0 0 X X X X X 1 1 0 0 0 0 0 0 0 JEFFREY K FRERICHS 0 450000 0 0 0 19567 0 0 0 18133 0 487700 0 0 EDWIN SIMPSER 0 400000 0 0 0 61206 0 15925 0 18132 0 495263 0 0 PINCUS D ZAGELBAUM 0 262650 0 0 0 13351 0 11555 0 20988 0 308544 0 0 EILEEN CHISARI 0 256367 0 0 0 69059 0 14310 0 6959 0 346695 0 0 HOPE M ILICETO 0 340000 0 0 0 28880 0 0 0 17883 0 386763 0 0 KATHRYN A LANG 112494 0 0 0 55084 0 0 0 2965 0 170543 0 0 0 AUDREY B BERMAN-DAVIDOWITZ 160742 0 0 0 -5516 0 10448 0 24582 0 190256 0 0 0 LINDA MEGALLY 144888 0 0 0 -4297 0 8903 0 17643 0 167137 0 0 0 MOSHE YADOO 140000 0 0 0 1952 0 6677 0 17587 0 166216 0 0 0 MARY LOU HIRE 140000 0 0 0 4613 0 0 0 16530 0 161143 0 0 0 PART I, LINES 4A-B PART I, LINES 4A-B: SERP: EDWIN SIMPSER - $45,272 SEVERANCE: EILEEN CHISARI - $69,231 KATHRYN A. LANG - $54,727 DORMITORY AUTHORITY STATE OF NY 146000293 649905ZMI 2010-07-14 102200000 CONSTRUCTION 0 0 0 102200000 4500000 13999771 851329 47367941 2012 0 0 0 1 0 0 0 0 0.00000 0.00000 0.00000 1 1 0 0 0 0 0 EDWIN SIMPSER EVP/COO/CMO 418872 SMH PROVIDES STAFFING FOR EXTRAORDINARY PEDIATRICS PC, A PROFESSIONAL PRACTICE (MEDICAL AND REHABILITATION) AND SHARES OFFICE SPACE IN ROSLYN. SMH'S CHIEF MEDICAL OFFICER IS THE SOLE SHAREHOLDER OF EXTRAORDINARY PEDIATRICS PC. 0 FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT DUTIES ARE HANDLED BY ADMINISTRATIVE PERSONNEL WHO EMPLOYED BY A RELATED ENTITY, SMH ADMINISTRATIVE SERVICES, INC.; COSTS INCURRED BY SMH ADMINISTRATIVE SERVICES, INC. ARE ALLOCATED TO INDIVIDUAL ST. MARY'S ENTITIES IN ACCORDANCE WITH EXPENSE-BASED METHODOLOGY THAT IS REVIEWED ANNUALLY. FORM 990, PART VI, SECTION A, LINE 6 ST. MARY'S HEALTHCARE SYSTEM FOR CHILDREN, INC. (SMHSC) IS THE SOLE CORPORATE MEMBER OF ST. MARY'S HOSPITAL FOR CHILDREN, INC. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBER (SMHSC) HAS THE EXCLUSIVE POWER AND AUTHORITY TO ELECT AND REMOVE DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER (SMHSC) HAS THE EXCLUSIVE POWER AND AUTHORITY TO APPROVE THE FOLLOWING: MERGERS, SALES OR DISSOLUTIONS; AMENDMENTS TO THE CERTIFICATE OF INCORPORATION AND/OR BYLAWS; OPERATING AND CAPITAL BUDGETS; UNBUDGETED BORROWINGS IN EXCESS OF $1,000,000; UNBUDGETED CAPITAL EXPENDITURES IN EXCESS OF $500,000; A STRATEGIC PLAN; AND HIRING AND FIRING OF THE CEO. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE COMPLETED FORM 990 IS REVIEWED BY THE AUDIT & COMPLIANCE COMMITTEE. COMMENTS FROM THIS REVIEW ARE DISCUSSED AND CHANGES MADE AS NECESSARY. A FINAL DRAFT IS THEN POSTED TO THE BOARD WEBSITE WHERE IT IS MADE AVAILABLE TO ALL BOARD MEMBERS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ONCE A YEAR, EACH BOARD MEMBER, OFFICER OR KEY EMPLOYEE OF THE ORGANIZATION COMPLETES A CONFLICT OF INTEREST QUESTIONNAIRE, STATEMENT AND ACKNOWLEDGEMENT WHICH ACKNOWLEDGES THAT EACH INDIVIDUAL HAS DISCLOSED ANY POTENTIAL CONFLICT OF INTEREST; HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; HAS READ AND UNDERSTANDS THE POLICY; AND AGREES TO COMPLY WITH THE CONFLICT OF INTEREST POLICY. DURING THE COURSE OF THE YEAR, EACH BOARD MEMBER, OFFICER, AND KEY EMPLOYEE IS REQUIRED TO PROMPTLY ADVISE THE CHIEF EXECUTIVE OFFICER OR HIS/HER DESIGNEE, OF ANY CHANGES TO THE INFORMATION PROVIDED IN THAT INDIVIDUAL'S LAST COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE. THE CHIEF EXECUTIVE OFFICER, OR HIS/HER DESIGNEE, REVIEWS ALL COMPLETED QUESTIONNAIRES AND ALL SUBSEQUENT ADVICE OF CHANGES, TAKING SUCH ACTION AS IS DEEMED APPROPRIATE TO ELIMINATE POTENTIAL CONFLICTS OF INTEREST, INCLUDING SUCH STEPS AS REASSIGNMENT OF RESPONSIBILITIES. ALL DISCLOSURES OF INTERESTS IN COMPLETED QUESTIONNAIRES OR SUBSEQUENT ADVICE, UNLESS CLEARLY IRRELEVANT OR IMMATERIAL, SHALL BE COMPILED AND REPORTED BY MANAGEMENT TO THE GOVERNANCE COMMITTEE OF THE BOARD, TOGETHER, IN EACH CASE, WITH THE RESPONSE OR RECOMMENDATION OF MANAGEMENT. THE GOVERNANCE COMMITTEE SHALL DETERMINE WHETHER THE REPORTED RESOLUTION OF ISSUES RAISED BY THE DISCLOSURES IS SATISFACTORY AND, IF NOT, SHALL TAKE SUCH FURTHER ACTION AS IT DEEMS APPROPRIATE. EACH BOARD MEMBER, AND ANY OFFICER OR KEY EMPLOYEE PRESENTING A PROPOSED TRANSACTION OR OTHER MATTER TO THE BOARD SHALL DISCLOSE PROMPTLY AND IN GOOD FAITH TO THE BOARD SUCH INDIVIDUAL'S INTEREST IN A PROPOSED TRANSACTION OR OTHER MATTER TO BE CONSIDERED BY THE BOARD. THE INDIVIDUAL MAY NOT PARTICIPATE IN ANY WAY IN THE BOARD'S DELIBERATIONS CONCERNING MATTERS IN WHICH HE/SHE HAS DISCLOSED AN INTEREST. FOLLOWING ANY SUCH DISCLOSURE, AND AFTER SUCH DUE DILIGENCE AND SUCH DEVELOPMENT AND CONSIDERATION OF OTHER ALTERNATIVES, IF ANY, AS THE BOARD SHALL DEEM APPROPRIATE, THE BOARD MAY, IN ITS DISCRETION, AUTHORIZE OR APPROVE THE PROPOSED TRANSACTION OR ACTIONS AS AT LEAST AS FAIR AND REASONABLE TO THE ORGANIZATION AS WOULD OTHERWISE BE OBTAINABLE BY THE ORGANIZATION. SUCH ACTIONS SHALL BE BY A VOTE SUFFICIENT FOR SUCH PURPOSE WITHOUT COUNTING THE VOTE OR VOTES OF SUCH INTERESTED PERSON OR PERSONS AND SUCH PERSON OR PERSONS MAY NOT PARTICIPATE IN, DETERMINING THE PRESENCE OF A QUORUM AT THE MEETING. ANY DISCLOSURE, NON-PARTICIPATION, AND BOARD ACTION TAKEN IN ACCORDANCE WITH THIS POLICY SHALL BE CLEARLY RECORDED IN THE MINUTES OF THE MEETING. UPON REASONABLE BELIEF THAT A BOARD MEMBER, OFFICER OR KEY EMPLOYEE FAILED TO COMPLY WITH THE POLICIES AND DIRECTIVES SET FORTH IN ITS DISCLOSURE POLICY, THE BOARD OR THE GOVERNANCE COMMITTEE SHALL INFORM THE INDIVIDUAL OF THE BASIS OF THE BELIEF AND PROVIDE AN OPPORTUNITY TO EXPLAIN THE NONCOMPLIANCE. IF AFTER HEARING THE INDIVIDUAL'S RESPONSE AND MAKING FURTHER APPROPRIATE INVESTIGATIONS, THE BOARD OR GOVERNANCE COMMITTEE DETERMINES THAT THE INDIVIDUAL HAS, IN FACT, FAILED TO COMPLY WITH SUCH POLICIES AND DIRECTIVES, IT SHALL TAKE OR RECOMMEND APPROPRIATE CORRECTIVE ACTION. FORM 990, PART VI, SECTION B, LINE 15 ADMINISTRATIVE SALARIES ARE PAID OUT OF A RELATED ADMINISTRATIVE CORPORATION. THE POLICIES FOR DETERMINING COMPENSATION ARE AS FOLLOWS: THE BOARD OF ST. MARYS HEALTHCARE SYSTEM FOR CHILDREN, THE SOLE MEMBER OF THE ORGANIZATION, RETAINS THE SERVICES OF A MAJOR EXECUTIVE COMPENSATION FIRM TO REVIEW MARKET PAY PRACTICES FOR SENIOR EXECUTIVES IN ORGANIZATIONS OF COMPARABLE SIZE AND TYPE. THIS MARKET ANALYSIS IS THEN REVIEWED BY THE EXECUTIVE REVIEW/COMPENSATION COMMITTEE AND USED AS A FACTOR IN DETERMINING SALARY ADJUSTMENTS RELATIVE TO MARKET COMPETIVENESS AND JOB PERFORMANCE. COMPENSATION FOR OTHER EXECUTIVES IS MANAGED IN A SIMILAR MANNER, WITH THE HUMAN RESOURCES DEPARTMENT IN CONSULTATION WITH THE CEO, USING LOCAL PERIODIC SURVEYS OF THE MARKET TO ENSURE THAT ST. MARY'S COMPENSATION IS COMPETITIVE. THIS PROCESS WAS LAST DONE IN 2010. FORM 990, PART VI, SECTION C, LINE 18 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 14: ST. MARY'S HOSPITAL FOR CHILDREN, INC. HAS A DOCUMENT RETENTION POLICY, BUT NOT A DOCUMENT DESTRUCTION POLICY. THE DOCUMENT DESTRUCTION POLICY IS UNDER DEVELOPMENT, AND WILL BE COMPLETED IN 2013. HOURS WORKED FOR RELATED ORGANIZATIONS: FORM 990, PART VII: JEFFREY K. FRERICHS - 42.5 EDWIN SIMPSER - 39.5 PINCUS ZAGELBAUM - 42.5 EILEEN CHISARI - 38.5 HOPE M. ILICETO - 40.5 STEPHEN BRENT WELLS - 9 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -4,864,391. RESERVE ON AMOUNTS DUE FROM RELATED ORGANIZATIONS -7,110,655. TOTAL TO FORM 990, PART XI, LINE 5: -11,975,046. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. ST MARY'S FOUNDATION FOR CHILDREN INC 29-01 216TH STREET BAYSIDE NY 11360 112728736 FUNDRAISING NY 501(C)(3) LINE 7 ST MARY'S HEALTHCARE SYSTEM FOR CHILDREN INC 0 ST MARY'S COMMUNITY CARE PROFESSIONALS INC 29-01 216TH STREET BAYSIDE NY 11360 113360276 HEALTH CARE NY 501(C)(3) LINE 9 ST MARY'S HEALTHCARE SYSTEM FOR CHILDREN INC 0 ST MARY'S REHABILITATION CENTER FOR CHILDREN 29-01 216TH STREET BAYSIDE NY 11360 136163550 HEALTH CARE NY 501(C)(3) LINE 9 ST MARY'S HEALTHCARE SYSTEM FOR CHILDREN INC 0 ST MARY'S HEALTHCARE SYSTEM FOR CHILDREN INC 29-01 216TH STREET BAYSIDE NY 11360 113574493 HEALTH CARE NY 501(C)(3) LINE 11A, I N/A 0 SMH ADMINISTRATIVE SERVICES INC 29-01 216TH STREET BAYSIDE NY 11360 271529374 MANAGEMENT AND SUPPORTING SERVICES NY 501(C)(3) LINE 11B, II ST MARY'S HEALTHCARE SYSTEM FOR CHILDREN INC 0 EXTRAORDINARY HOME CARE 29-01 216TH STREET BAYSIDE NY 11360 272021133 HEALTH CARE NY 501(C)(3) LINE 9 ST MARY'S HEALTHCARE SYSTEM FOR CHILDREN INC 0 KIDSNEEDSCOM INC 29-01 216TH STREET BAYSIDE NY 11360 113539055 INTERNET SERVICE NY ST MARY'S HOSPITAL FOR CHILDREN INC C 1.00000 0 0 1 1 1 0 0 0 0 0 0 1 1 1 1 1 0 0