2013-11-15T09:04:21-06:00 2012-12-31 363168081 SIKICH LLP 13400 BISHOPS LANE SUITE 300 BROOKFIELD WI 53005 990 2012-01-01 390812532 CHILDREN'S HOSPITAL OF WISCONSIN INC CHIL 4142665420 9000 W WISCONSIN AVE PO BOX 1997 NO MS 900 MILWAUKEE WI 53201 WELDON GAGE 4142665420 2013-11-10 1 BRYAN L PAUTSCH CPA P00034913 2627549400 2013-11-10 2012 2016-03-07 17:11:31Z CINDY CHRISTENSEN 9000 W WISCONSIN AVE PO BOX 1997 NO MS 90 MILWAUKEE WI 53201 696544670 0 X WWW.CHW.ORG X 1894 WI PEDIATRIC HEALTH CARE SERVICES 25 17 3666 338 138182 -71361 22263687 15053773 537023949 533784943 10609400 8239508 8803401 9031363 578700437 566109587 14355877 12557033 0 0 205262259 213111810 0 0 0 293217191 309688106 512835327 535356949 65865110 30752638 1217648841 1270795904 467244057 456687546 750404784 814108358 X THE MISSION OF CHILDREN'S HOSPITAL OF WISCONSIN, INC. IS TO PROVIDE A COMPREHENSIVE AND INTEGRATED PEDIATRIC HEALTH CARE MODEL THAT DELIVERS SUPERIOR QUALITY AND VALUE BY OFFERING THE BEST SOLUTION FOR THE TOTAL HEALTH CARE NEEDS OF CHILDREN WITHIN OUR COMMUNITY, STATE AND REGION.AS A PREMIER AND STANDARD-SETTING LEADER IN DELIVERY OF PEDIATRIC CLINICAL SERVICE, EDUCATION AND RESEARCH, CHILDREN'S HOSPITAL ADVOCATES FOR CHILDREN AND BRINGS A COMMITMENT TO EXCELLENCE TO OUR PATIENTS AND FAMILIES, MEDICAL STAFF, EMPLOYEES AND COMMUNITIES IN ADDRESSING THE HEALTH AND WELL-BEING OF CHILDREN.OUR MISSION IS OUR CHILDREN (AND IT SPELLS "CARE"):CAREGIVING - OFFERING HIGH QUALITY, COMPREHENSIVE MEDICAL CAREADVOCACY - SPEAKING UP AND PROTECTING CHILDRENRESEARCH - FINDING CURES TO THE ILLNESSES THAT AFFECT CHILDRENEDUCATION - SHARE WHAT WE LEARN AND TEACHING OTHERS TO CARE FOR KIDS 0 0 421201663 12557033 533922902 INPATIENT SERVICES:CHILDREN'S HOSPITAL OF WISCONSIN, INC. ("CHW" OR "THE HOSPITAL") OPERATES A 296-BED HOSPITAL AT ITS MILWAUKEE CAMPUS, WHICH INCLUDES AN EMERGENCY ROOM OPEN ON A 24/7 BASIS. IT IS A FREESTANDING WISCONSIN HOSPITAL DEDICATED SOLELY TO THE CARE AND TREATMENT OF CHILDREN AND IS ONE OF THE LEADING CENTERS FOR PEDIATRIC HEALTH CARE IN THE U.S. THE HOSPITAL SERVES CHILDREN WITH ALL TYPES OF ILLNESSES, INJURIES, BIRTH DEFECTS AND OTHER DISORDERS. THE HOSPITAL PROVIDES ACUTE LEVEL SERVICES, AS WELL AS EMERGENCY AND SPECIALTY CARE, TO CHILDREN FROM WISCONSIN, THE UPPER PENINSULA OF MICHIGAN, NORTHERN ILLINOIS AND BEYOND. IN 2012, 24,085 CHILDREN WERE ADMITTED TO THE MILWAUKEE HOSPITAL, WHICH INCLUDES A NEONATAL INTENSIVE CARE UNIT (NICU), PEDIATRIC INTENSIVE CARE UNIT (PICU), A CANCER AND BLOOD DISORDERS CENTER, MEDICAL/SURGICAL UNITS AND A DAY SURGERY SHORT STAY UNIT. THE HOSPITAL ALSO OPERATES A SEPARATELY-LICENSED 42-BED PEDIATRIC HOSPITAL, WHICH INCLUDES A NICU AND A PEDIATRIC MEDICAL/SURGICAL UNIT, LOCATED AT THEDA CLARK MEDICAL CENTER IN NEENAH, WIS., THROUGH WHICH IT PROVIDES PEDIATRIC EXPERTISE TO THE GREATER FOX VALLEY AND GREEN BAY AREAS. IN 2012, 1,284 CHILDREN WERE ADMITTED TO THE FOX VALLEY CAMPUS.OUTPATIENT AND AMBULATORY SERVICES:THE HOSPITAL PROVIDES A FULL ARRAY OF OUTPATIENT AMBULATORY, DIAGNOSTIC, TREATMENT AND SURGICAL SERVICES. PROVIDERS AT MORE THAN 70 SUBSPECIALTY CLINICS DIAGNOSE AND TREAT A WIDE VARIETY OF PEDIATRIC DISORDERS. THE HOSPITAL IS A CERTIFIED LEVEL 1 PEDIATRIC TRAUMA CENTER, AND HANDLED 61,732 VISITS TO THE EMERGENCY DEPARTMENT IN 2012. OUTPATIENT SERVICES ARE OFFERED AT ACCESSIBLE LOCATIONS THROUGHOUT SOUTHEASTERN WISCONSIN AND NORTHERN ILLINOIS, AND IN THE FOX VALLEY AND GREEN BAY MARKETS. THE HOSPITAL'S NATIONALLY KNOWN AND RECOGNIZED SPECIALTY PROGRAMS INCLUDE THOSE FOR TREATING CHILDREN WITH AIRWAY, DIGESTIVE AND VOICE CONDITIONS; BURNS; CANCER AND BLOOD DISORDERS; CONGENITAL AND ACQUIRED HEART DEFECTS AND DISEASES; CRANIOFACIAL DISORDERS; DERMATOLOGY, BIRTHMARKS AND VASCULAR ANOMALIES; DIABETES; GASTROINTESTINAL PROBLEMS; GENETIC DISORDERS; HIV; NEUROLOGICAL DISORDERS; ORTHOPEDIC CONDITIONS (INCLUDING SPINE, SPORTS MEDICINE, CONCUSSION); IMMUNODEFICIENCIES AND IMMUNE DYSREGULATION SYNDROMES; PSYCHIATRY; SLEEP DISORDERS; SOLID ORGAN TRANSPLANTATION; SPEECH AND HEARING DISORDERS; AND SPASTICITY AND OTHER TONE AND MOBILITY CONDITIONS. THE HOSPITAL PROVIDES PRIMARY CARE, DENTAL CARE AND CHILD PROTECTIVE SERVICES TO UNDERSERVED CHILDREN AT CLINICS IN CENTRAL CITY MILWAUKEE NEIGHBORHOODS. THE HOSPITAL ALSO OFFERS CASE MANAGEMENT SERVICES AND A FULL RANGE OF MEDICAL, PSYCHOLOGICAL, NURSING AND SOCIAL SERVICES FOR CHILDREN WITH DEVELOPMENTAL, BEHAVIORAL AND LEARNING PROBLEMS. IN 2012, THERE WERE A TOTAL OF 322,716 OUTPATIENT VISITS.RESEARCH, EDUCATION AND COMMUNITY OUTREACH:THE HOSPITAL IS INVOLVED IN EXTENSIVE RESEARCH, EDUCATION AND COMMUNITY OUTREACH PROGRAMS.RESEARCH: THE HOSPITAL AND ITS CHILDREN'S RESEARCH INSTITUTE PARTICIPATE IN AN ARRAY OF RESEARCH INITIATIVES SEEKING TO IMPROVE THE DIAGNOSIS AND TREATMENT OF CONGENITAL AND ACQUIRED PEDIATRIC HEALTH CONDITIONS. THESE RESEARCH INITIATIVES INCLUDE BEHAVIORAL HEALTH, EPILEPSY AND OTHER NEUROLOGICAL CONDITIONS; ORGAN TRANSPLANTATION; BIRTH DEFECTS AND FETAL ANOMALIES; IMMUNOLOGICAL CONDITIONS, BLOOD DISORDERS AND VARIOUS CHILDHOOD CANCERS; AND ENVIRONMENTAL HEALTH CONDITIONS. ADDITIONAL RESEARCH IS CONDUCTED IN COLLABORATION WITH ACADEMIC INVESTIGATORS AT THE MEDICAL COLLEGE OF WISCONSIN, MARQUETTE UNIVERSITY, UNIVERSITY OF WISCONSIN-MADISON AND OTHER INSTITUTIONS. NURSING RESEARCH INCLUDES STUDIES REGARDING PAIN MANAGEMENT, QUALITY OF LIFE, COPING SKILLS, FAMILY READINESS AND SEDATION PROTOCOLS.EDUCATION: THE HOSPITAL IS A MAJOR TEACHING AFFILIATE OF THE MEDICAL COLLEGE OF WISCONSIN, WITH THIRD- AND FOURTH-YEAR MEDICAL STUDENTS ROTATING THROUGH THE HOSPITAL FOR REQUIRED AND ELECTIVE ROTATIONS. THE HOSPITAL ALSO MAINTAINS A THREE-YEAR PEDIATRIC RESIDENCY PROGRAM, A TWO-YEAR DENTAL TRAINING PROGRAM AND ACADEMIC FELLOWSHIP PROGRAMS IN AN ARRAY OF SPECIALTIES. THE HOSPITAL HAS RELATIONSHIPS WITH MORE THAN TWO DOZEN UNIVERSITIES FOR THE CLINICAL EDUCATION OF PEDIATRIC NURSES AND OTHER HEALTH CARE PROFESSIONAL STUDENTS, AS WELL AS HEALTH CARE ADMINISTRATION AND VARIOUS OTHER DISCIPLINES. THE HOSPITAL'S PEDIATRIC SPECIALISTS ALSO PROVIDE EDUCATION AND TRAINING TO HEALTH CARE PROFESSIONALS AT COMMUNITY HOSPITALS, PRIMARY CARE CLINICS AND SCHOOLS THROUGHOUT WISCONSIN IN CONNECTION WITH THE IDENTIFICATION, DIAGNOSIS AND TREATMENT OF PEDIATRIC HEALTH AND WELFARE CONDITIONS. COMMUNITY OUTREACH: THE HOSPITAL OFFERS A WIDE VARIETY OF COMMUNITY EDUCATION, OUTREACH AND CHILD HEALTH ADVOCACY PROGRAMS. THROUGH COMMUNITY EDUCATION PROGRAMS ON TOPICS SUCH AS CHILD HEALTH, INJURY PREVENTION, PARENTING, MANAGEMENT OF CHRONIC DISEASES, AND PREVENTIVE HEALTH, THE HOSPITAL REACHES THOUSANDS OF FAMILIES. ALONG WITH THE MEDICAL COLLEGE, THE HOSPITAL SPONSORS THE CENTER FOR THE ADVANCEMENT OF UNDERSERVED CHILDREN, WHICH SEEKS TO IMPROVE THE HEALTH AND WELL-BEING OF UNDERSERVED CHILDREN. THE HOSPITAL PARTICIPATES IN AND STAFFS THE CHILDREN'S HEALTH ALLIANCE OF WISCONSIN, THROUGH WHICH PROVIDERS AROUND THE STATE WORK COLLABORATIVELY TO RAISE AWARENESS OF CHILDREN'S HEALTH ISSUES, INCREASE ACCESS TO PEDIATRIC CARE, AND PROMOTE BEST PRACTICES. OTHER COMMUNITY OUTREACH AND ADVOCACY INITIATIVES INCLUDE, FOR EXAMPLE, CAR SEAT CLINICS, THE DANIEL M. SOREF FAMILY RESOURCE CENTER AND PROJECT ADAM (EDUCATION AND PREVENTION INITIATIVES IN THE AREA OF PEDIATRIC SUDDEN CARDIAC DEATH). 421201663 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 525 0 3666 1 1 1 0 0 0 0 0 0 0 0 0 X 25 17 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X MS SARAH KAFKA 4142661854 9000 W WISCONSIN AVE MILWAUKEE WI 53201 WILLIAM J ABRAHAM JR 1.00 1.00 X 0 0 0 MICHAEL W ALTSCHAEFL 1.00 1.00 X 0 0 0 THOMAS M BOLGER 1.00 1.00 X 0 0 0 ELIZABETH BRENNER 1.00 1.00 X 0 0 0 CURT S CULVER 1.00 1.00 X 0 0 0 BETH DALEY-ULLEM 1.00 1.00 X 0 0 0 DAVID J DRURY 1.00 1.00 X X 0 0 0 DAVID H GILBERT 1.00 1.00 X 0 0 0 SUSAN HERMA 1.00 1.00 X 0 0 0 MARK R HOGAN 1.00 1.00 X 0 0 0 PAUL W JONES 1.00 1.00 X 0 0 0 JOSEPH KERSCHNER MD 1.00 1.00 X 0 0 0 KEVIN MANSELL 1.00 1.00 X 0 0 0 LINDA T MELLOWES 1.00 1.00 X 0 0 0 C DAVID MYERS 1.00 1.00 X 0 0 0 ALBERT S ORR III 1.00 1.00 X 0 0 0 MICHAEL T PEPKE 1.00 1.00 X 0 0 0 J JOEL QUADRACCI 1.00 1.00 X 0 0 0 LARRY A RAMBO 1.00 1.00 X 0 0 0 JAY O ROTHMAN 1.00 1.00 X 0 0 0 JOHN E SCHLIFSKE 1.00 1.00 X 0 0 0 PETER M SOMMERHAUSER 1.00 1.00 X X 0 0 0 PAUL W SWEENEY 1.00 1.00 X 0 0 0 OWEN J SULLIVAN 1.00 1.00 X 0 0 0 PHOEBE W WILLIAMS 1.00 1.00 X 0 0 0 MARK C WITT 1.00 1.00 X 0 0 0 MARGARET TROY 0.00 40.00 X X 0 1263624 291068 ELIZABETH BEDWELL 0.00 40.00 X 0 105027 14638 MARC CADIEUX 0.00 40.00 X 0 238911 22520 CINTHIA S CHRISTENSEN 40.00 0.00 X 679101 0 92874 WELDON GAGE 0.00 40.00 X 0 362086 70172 MICHAEL GUTZEIT MD 40.00 0.00 X 475486 0 80218 BARBARA JOERS 40.00 0.00 X 277373 0 29006 JULIET KERSTEN 40.00 0.00 X 294203 0 39843 NANCY KOROM 40.00 0.00 X 431059 0 72919 SHEILA REYNOLDS 0.00 40.00 X 0 389028 76385 MARK SHIP 7.00 33.00 X 33039 285169 37576 DONNA JAMIESON 40.00 0.00 X 172874 0 48318 TOM LAUSTEN 40.00 0.00 X 166320 0 36299 ERIN YALE 40.00 0.00 X 167934 0 29870 SUZAN BUCHAKLIAN 40.00 0.00 X 152325 0 27352 LORI BARBEAU DDS 40.00 0.00 X 268617 0 44296 ANDREW SCHMITT MD 40.00 0.00 X 250508 0 32646 MARYLYN RANTA MD 40.00 0.00 X 238618 0 48532 SHANE FISHER DDS 40.00 0.00 X 233483 0 27144 A CHARLES POST DDS 40.00 0.00 X 235099 0 28346 TIMOTHY L BIRKENSTOCK 0.00 0.00 X 0 232256 1866 RAMESH SACHDEVA MD 0.00 40.00 X 0 274351 10232 4076039 3150452 1162120 125 1 1 0 MEDICAL COLLEGE OF WISCONSIN INC 8701 WATERTOWN PLANK RD MILWAUKEE WI 53226 HEALTHCARE PROF/ ACADEMIC/ADMIN 32065910 MEDICAL COLLEGE OF WI AFFILATED 8701 WATERTOWN PLANK RD MILWAUKEE WI 53226 RESIDENT SERVICES 10841018 BLOOD CENTER OF WISCONSIN INC 638 N 18TH ST MILWAUKEE WI 532332121 BLOOD PRODUCTS/LAB SERVICES 9918394 DELOITTE CONSULTING LLP PO BOX 7247-6447 PHILADELPHIA PA 191706447 CONSULTING 9873089 PARAGON DEV SYS INC 1823 EXECUTIVE DRIVE OCONOMOWOC WI 53066 IT HARDWARE AND CONSULTING 6929537 35 69120 4221133 9822280 941240 15053773 NET PATIENT SVC REV 621990 527284154 527284154 RENTAL INCOME 531120 5364790 1098186 4266604 SHARED SERVICES 541900 1135999 1135999 533784943 11706332 11706332 126943789 24470 127819015 2616068 -875226 -2591598 -3466824 -3466824 CAFETERIA 722210 2456543 2456543 PHARMACY SALES TO EMPLOYEES 446110 1422442 1422442 REBATES AND DISCOUNTS 900099 1221697 1221697 3930681 3182866 138182 609633 9031363 566109587 533922902 138182 16994730 12557033 12557033 4717251 4717251 162099688 139232112 22867576 10127165 8147662 1979503 24045788 22654255 1391533 12121918 10206708 1915210 71036370 89213 70947157 464061 464061 26964902 26964902 12696 12696 300753 284105 16648 132675 101873 30802 19743712 16191751 3551961 664878 351461 313417 14334869 14334869 40952888 40952888 2075021 18341 2056680 MEDICAL SUPPLIES 59058650 59028413 30237 PURCHASED SERVICES 41747699 41747699 HOSPITAL ASSESSMENT TAX 12435088 12435088 RESIDENT STIPENDS AND B 5779677 5779677 13984167 10110917 3873250 535356949 421201663 114155286 0 25844365 20934534 2723265 1890349 72520526 78401999 10000 542960 511460 3821990 4089825 5146262 5162899 706488873 261932253 416857607 444556620 302582557 298749648 387609309 416488570 1217648841 1270795904 68674395 73260669 749791 1157530 272942555 269599134 124877316 112670213 467244057 456687546 X 603203769 649591292 31037095 36839166 116163920 127677900 750404784 814108358 1217648841 1270795904 X 30752638 3115865 29835071 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 364237 133078 117515 379800 0 320201015 12951629 13134597 7676552 1093625 337517064 319718349 8809809 501862 7914215 914790 320201015 301025999 13508585 13344633 7310168 850700 319718349 246110966 12400322 48806039 6291328 301025999 294258148 20363545 -54457713 14053014 246110966 0.51300 0.37800 0.10900 0 1 1 478859224 179172635 299686589 7313370 3045685 4267685 205782378 77831368 127951010 14533901 1882565 12651336 444556620 DUE FROM AFFILIATES 32756014 BENEFICIAL INTEREST IN NET ASSETS OF CHILDREN'S HOSPITAL OF WISCONSIN FOUND. 383017854 457 PLAN ASSETS 714702 416488570 RESERVE FOR MEDICAL EDUCATION GRANT SETTLEMENTS 3269016 CAPITAL AND OTHER LEASE OBLIGATIONS 1951126 FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS 39133337 457 PLAN LIABILITY 714702 ACCRUED PENSION 64920143 ESTIMATED THIRD PARTY PAYER SETTLEMENTS 2681889 112670213 X PART IV, LINE 1B: CERTAIN EMPLOYEES OF THE ORGANIZATION HAVE SIGNING AUTHORITY FOR THE CHILDREN'S HOSPITAL OF WISCONSIN MEDICAL STAFF FUNDS MONEY MARKET AND CHECKING ACCOUNT. AN EMPLOYEE OF THE ORGANIZATION ALSO PROVIDES ALL MONTHLY ACCOUNTING FUNCTIONS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION, INC., A RELATED ENTITY, HOLDS ENDOWMENT FUNDS ON BEHALF OF CHILDREN'S HOSPITAL OF WISCONSIN, INC. INTENDED USES OF THE FUNDS INCLUDE VARIOUS HEALTH-RELATED SERVICES, CAPITAL PROJECTS AND RESEARCH. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: CHHS EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITONS RECORDED FOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011. 1 1 X 1 X 1 X 1 1 1 0 1 1 1042389 1042389 0.00200 231655711 179767603 51888108 0.09420 232698100 179767603 52930497 0.09620 6318423 992928 5325495 0.01000 31186325 7638384 23547941 0.04430 7464294 2741098 4723196 0.00890 6655528 6655528 0.01250 522191 522191 0.00100 52146761 11372410 40774351 0.07670 284844861 191140013 93704848 0.17290 1070998 5638 1065360 0.00200 1198911 17241 1181670 0.00220 62412 62412 0.00010 3308 3308 0.00000 2335629 22879 2312750 0.00430 0 4129248 100000 1194013 1148179 45834 X 1 1 2 1 CHILDREN'S HOSPITAL OF WISCONSIN INC

9000 W WISCONSIN AVE MILWAUKEE WI 53201

X X X X X X 2 CHILDREN'S HOSPITAL OF WI-FOX VALLEY

130 S 2ND STREET NEENAH WI 54956

X X X CHILDREN'S HOSPITAL OF WISCONSIN INC 1 1 1 200.000000000000 1 350.000000000000 1 X X X 1 1 X 1 0 X X X 1 X 0 0 CHILDREN'S HOSPITAL OF WI-FOX VALLEY 2 1 1 200.000000000000 1 350.000000000000 1 X X X 1 1 X 1 0 X X X 1 X 0 0 5 CHW FOX VALLEY BEHAVIORAL HEALTH

1820 N APPLETON RD MENASHA WI 54952

PATIENT CARE SERVICES CHILD ADVOCACY CENTER - FOX VALLEY

325 N COMMERCIAL ST SUITE 400 NEENAH WI 54956

PATIENT CARE SERVICES CHILD ADVOCACY CENTER - RACINE

2405 NORTHWESTERN AVE SUITE 2058 RACINE WI 53404

PATIENT CARE SERVICES CHILD ADVOCACY CENTER - WAUKESHA

101 W BROADWAY 2ND FLOOR WAUKESHA WI 53186

PATIENT CARE SERVICES DOWNTOWN HEALTH CENTER

1020 N 12TH ST MILWAUKEE WI 53233

URBAN HEALTH CENTER PART I, LINE 3C: CHILDREN'S HOSPITAL OF WISCONSIN, INC. ("THE HOSPITAL") USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY. THE HOSPITAL IS DEDICATED TO ENSURING THAT PATIENTS RECEIVE ALL MEDICALLY NECESSARY CARE. IN FURTHERANCE OF THAT OBJECTIVE, THE HOSPITAL MAINTAINS A FINANCIAL ASSISTANCE POLICY ("FAP"), PURSUANT TO WHICH THE HOSPITAL PROVIDES DISCOUNTED OR FREE CARE TO PATIENTS WHO ARE UNINSURED OR OTHERWISE UNABLE TO PAY ALL OR A PORTION OF THEIR BILLED CHARGES. THE POLICY GENERALLY PROVIDES THAT ELIGIBILITY IS DETERMINED BASED ON HOUSEHOLD INCOME, FAMILY SIZE AND AVAILABLE ASSETS, AND SPECIFICALLY INCORPORATES CRITERIA SET FORTH UNDER THE WISCONSIN MEDICAID PROGRAM AND THE FEDERAL POVERTY GUIDELINES. PART I, LINE 6A: CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS"), THE SOLE CORPORATE MEMBER OF THE HOSPITAL, PREPARES A COMMUNITY BENEFIT REPORT ON BEHALF OF THE HOSPITAL AND ITS AFFILIATES. THE REPORT IS FILED WITH THE WISCONSIN HOSPITAL ASSOCIATION AND IS ALSO AVAILABLE ON THE HOSPITAL'S WEBSITE OR UPON REQUEST. PART I, LINE 7: THE HOSPITAL USED A COST-TO-CHARGE RATIO, DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, TO CALCULATE THE AMOUNTS REPORTED IN LINES 7A AND 7B FOR CHARITY CARE AT COST AND UNREIMBURSED MEDICAID. FOR LINES 7E, 7F, 7G, 7H, AND 7I, THE HOSPITAL USED COSTS TAKEN FROM ITS ACCOUNTING SYSTEM. FOR LINE 7G, THE COSTS FROM THE ACCOUNTING SYSTEM WERE ADJUSTED FOR MEDICAID, MEDICARE, AND CHARITY CARE PATIENTS, AS THE COST RELATED TO THESE PATIENTS WAS TAKEN INTO ACCOUNT IN LINES 7A AND 7B. THE WISCONSIN MEDICAID PROGRAM PROVIDES COVERAGE FOR THE VAST MAJORITY OF CHILDREN WHO REQUIRE MEDICAL CARE BUT ARE UNINSURED OR UNDERINSURED. HOSPITAL REPRESENTATIVES WORK EXTENSIVELY WITH PATIENTS' FAMILIES TO HELP THEM UNDERSTAND THE AVAILABILITY OF STATE AID AND TO ASSIST THEM IN BECOMING ENROLLED IN THE PROGRAM THAT PROVIDES THE PATIENT WITH THE GREATEST BENEFIT. FOR THAT REASON, THE AMOUNT OF TRUE "CHARITY CARE" RENDERED BY THE HOSPITAL IS CONSIDERABLY SMALLER THAN LEVELS EXPERIENCED BY COMMUNITY HOSPITALS OR OTHER FACILITIES SERVING THE ADULT POPULATION.PART I, LINE 7, COLUMN (F): BAD DEBT EXPENSE OF $4,129,248 IS INCLUDED IN TOTAL EXPENSES IN PART IX, LINE 25, COLUMN (A), BUT EXCLUDED IN THE CALCULATION OF "PERCENT OF TOTAL EXPENSES" REPORTED IN COLUMN (F). PART I, LINE 7G: THE HOSPITAL INCLUDED AS SUBSIDIZED HEALTH SERVICES ON PART I, LINE 7G $375,000 PAID TO CHILDREN'S MEDICAL GROUP, INC. ("CMG"), WHICH IS A SECTION 501(C)(3) ORGANIZATION AND AN AFFILIATE OF THE HOSPITAL THAT PROVIDES PRIMARY CARE PHYSICIAN SERVICES IN SOUTHEASTERN WISCONSIN. THE PAYMENTS WERE MADE TO SUBSIDIZE THE NEXT DOOR PEDIATRIC CLINIC AND OTHER CMG CLINICS WITHIN MILWAUKEE COUNTY THAT PROVIDE PRIMARY CARE PRIMARILY TO CHILDREN ENROLLED IN THE WISCONSIN MEDICAID PROGRAM OR WHO ARE UNINSURED. PART II: THE HOSPITAL'S COMMUNITY-BUILDING ACTIVITIES INCLUDE PROGRAMS THAT ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS FOR CHILDREN, SUCH AS POVERTY AND ENVIRONMENTAL ISSUES. THESE COMMUNITY-BUILDING ACTIVITIES INCLUDE STAFF PARTICIPATION ON COMMUNITY BOARDS, COALITIONS AND/OR COMMITTEES WHICH ASSIST IN IMPROVING THE HEALTH OF THE COMMUNITY. THE HOSPITAL PROVIDES SUPPORT TO MANY PROGRAMS THAT HELP COMMUNITY MEMBERS KEEP THEIR CHILDREN AND FAMILIES HEALTHY. EXAMPLES INCLUDE CHILDREN'S HEALTH ALLIANCE OF WISCONSIN, THE SOUTHEAST AND NORTHEAST REGIONAL CENTERS FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS, THE DANIEL M. SOREF FAMILY RESOURCE CENTER, AND A FREE GUARDIANSHIP CLINIC. THE HOSPITAL ALSO PROVIDES FINANCIAL SUPPORT TO CHHS TO SUPPORT THE SAFE KIDS WISCONSIN COALITION AND SAFE KIDS SOUTHEAST WISCONSIN COALITION.THE HOSPITAL STAFFS THE CHILDREN'S HEALTH ALLIANCE OF WISCONSIN, A STATEWIDE COALITION THAT WORKS TO IMPROVE THE HEALTH OF WISCONSIN CHILDREN AND REDUCE DISPARITIES IN AVAILABILITY AND ACCESSIBILITY OF HEALTH CARE SERVICES. THE ALLIANCE IS GUIDED BY A STATEWIDE 28 MEMBER ADVISORY BOARD AND PARTNERS WITH HUNDREDS OF ORGANIZATIONS AND INDIVIDUALS TO RAISE AWARENESS OF CHILD HEALTH CONCERNS, MOBILIZE LEADERS, IMPACT PUBLIC HEALTH, AND IMPLEMENT PROGRAMS PROVEN TO WORK. THE ALLIANCE IS PARTIALLY FUNDED THROUGH A WISCONSIN DEPARTMENT OF HEALTH SERVICES MATERNAL CHILD HEALTH GRANT, THE CENTERS FOR DISEASE CONTROL AND PREVENTION, AND OTHER PUBLIC AND PRIVATE FUNDING. THE ALLIANCE IS FINANCIALLY SUPPORTED BY THE HOSPITAL THROUGH STAFF AND OTHER RESOURCES TO CARRY ON THE ALLIANCE'S PROGRAMS. THE ALLIANCE'S KEY INITIATIVES ARE: ASTHMA, GRIEF AND BEREAVEMENT, INJURY PREVENTION AND CHILD DEATH REVIEW, LEAD POISONING, ORAL HEALTH COALITION, AND REACH OUT AND READ PROGRAM. THE ALLIANCE LEADS AND MANAGES THE INFANT DEATH CENTER, REACH OUT AND READ WISCONSIN COALITION, WISCONSIN ASTHMA COALITION, AND THE WISCONSIN ORAL HEALTH COALITION. THE HOSPITAL ALSO SUPPORTS THE SOUTHEAST REGIONAL CENTER FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS. IT IS 1 OF 5 REGIONAL CENTERS DEDICATED TO SUPPORTING FAMILIES WITH CHILDREN WHO HAVE SPECIAL HEALTH CARE NEEDS AND THE PROVIDERS WHO CARE FOR THEM. IT IS FUNDED THROUGH A TITLE 5 MATERNAL AND CHILD HEALTH BLOCK GRANT, EXPENDITURES INCURRED BY CHILDREN'S HOSPITAL TO MATCH THE BLOCK GRANT INCLUDING STAFF AND OTHER PROGRAM EXPENSES, AND CHARITABLE DONATIONS. FAMILIES AND PROVIDERS CAN CALL THE CENTER FOR INFORMATION, REFERRAL AND PROBLEM-SOLVING RELATED TO COMMUNITY AND STATE SERVICES, HEALTH BENEFITS ASSISTANCE, TRANSITION PLANNING, AND EMOTIONAL SUPPORT. EACH YEAR THE STAFF OFFERS TRAINING SUCH AS "CARE IN THE COMMUNITY" AND OTHER SESSIONS THAT FOCUS ON YOUTH TRANSITIONS. STAFF ALSO PARTICIPATE IN NUMEROUS COMMUNITY INITIATIVES AND PARTNER WITH AREA PEDIATRICIANS AND OTHER HEALTH CARE PROVIDERS TO INCORPORATE EARLY IDENTIFICATION AND SCREENING METHODS INTO THEIR PRACTICES. IN 2012, STAFF SHARED THEIR EXPERTISE, LEADERSHIP AND TECHNICAL ASSISTANCE WITH MORE THAN 18 COMMUNITY AGENCIES AND COMMITTEES, WHICH INCLUDE SOUTHEAST REGION AUTISM CORE TEAM, MILWAUKEE COUNTY COMMISSION FOR PERSONS WITH DISABILITIES, PATIENT AT RISK, WISCONSIN CHILDREN'S LONG TERM CARE ADVISORY COMMITTEE AND MANY MORE. THE CENTER SERVES EIGHT COUNTIES. IN THE FOX VALLEY, THE HOSPITAL ALSO SUPPORTS THE NORTHEAST REGIONAL CENTER FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS, WHICH PROVIDES SIMILAR SERVICES TO THE SOUTHEAST CENTER DESCRIBED ABOVE WITH A FOCUS ON COUNTIES IN WISCONSIN'S FOX VALLEY. THE DANIEL M. SOREF FAMILY RESOURCE CENTER LOCATED ON THE FIRST FLOOR OF THE HOSPITAL'S MILWAUKEE CAMPUS OFFERS PARENT-TO-PARENT SUPPORT, INFORMATION, REFERRALS AND HELP CONNECTING TO HOSPITAL AND COMMUNITY RESOURCES. THE CENTER OFFERS SPIRITUAL CARE, THE KATIE BECKETT PROGRAM, PATIENT RELATIONS, INTERPRETERS, FAMILY ACCOMMODATIONS AND THE SOUTHEAST REGIONAL CENTER FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS. STAFF MEMBERS ARE TRAINED TO HELP CHILDREN, YOUNG ADULTS AND THEIR FAMILIES FIND ANSWERS TO QUESTIONS ABOUT LOCAL RESOURCES, SUPPORT GROUPS, FUNDING OPTIONS AND MORE. THE RESOURCE CENTER HAS COMPUTERS, A CONSULT ROOM, BUSINESS CENTER AND OTHER RESOURCES FOR FAMILIES. THEY CAN CHECK OUT ENTERTAINMENT DVDS, VIDEO GAMES, TABLETS AND LAPTOPS FOR INPATIENT USE. THE RESOURCE CENTER ALSO HAS A LENDING LIBRARY WITH BOOKS, VIDEOS AND ARTICLES ON A VARIETY OF HEALTH CONDITIONS AND TOPICS. IN 2012, THE FAMILY RESOURCE CENTER SERVED MORE THAN 22,500 VISITORS. THE HOSPITAL ALSO OPERATES A FREE GUARDIANSHIP CLINIC, WHICH PROVIDES PARENTS IN NEED WITH PRO BONO LEGAL SERVICES TO SECURE GUARDIANSHIP WHEN THEIR SPECIAL NEEDS CHILD TURNS 18.THE HOSPITAL SUPPORTS WORKFORCE DEVELOPMENT THROUGH JOB SHADOWING, WHICH MOSTLY OCCURS AT THE MILWAUKEE HOSPITAL CAMPUS. ADDITIONALLY, THE HOSPITAL CONTINUES TO PARTNER WITH EASTER SEALS ON A PROGRAM CALLED PROJECT SEARCH, AN INNOVATIVE WORKFORCE AND CAREER DEVELOPMENT MODEL FOR YOUNG ADULTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. THROUGH PROJECT SEARCH, YOUNG ADULTS WITH DISABILITIES RECEIVE INTERNSHIPS WITHIN THE HOSPITAL TO GAIN ON-THE-JOB TRAINING AND OTHER CAREER DEVELOPMENT SKILLS TO SECURE COMPETITIVE EMPLOYMENT. LAST YEAR, 12 INTERNS GRADUATED FROM THE PROGRAM-TWO WERE HIRED ON AT CHILDREN'S HOSPITAL. IN THE FOX VALLEY, THE HOSPITAL AND THEDA CLARK MEDICAL CENTER PARTNERED WITH ROOSEVELT ELEMENTARY SCHOOL TO PROMOTE HEALTHY HABITS AND CIVIC RESPONSIBILITY TO STUDENTS.THE HOSPITAL'S PARENT ORGANIZATION, CHHS, ALSO PERFORMS COMMUNITY BUILDING ACTIVITIES INCLUDING COMMUNITY HEALTH IMPROVEMENT ADVOCACY, WHICH ARE FURTHER DISCUSSED IN SCHEDULE H PART VI, LINE 6. PART III, LINE 4: THE HOSPITAL'S FINANCIAL STATEMENTS INCLUDE A FOOTNOTE DESCRIBING BAD DEBT EXPENSE. SEE PAGES 25-26 OF THE ATTACHED FINANCIAL STATEMENTS. THE AMOUNT REPORTED IN PART III, SECTION A, LINE 2 IS THE HOSPITAL'S ACTUAL BAD DEBT EXPENSE INCLUDED AS A REDUCTION OF PATIENT REVENUE, AND IS THE SUM OF ALL OF THE UNCOLLECTED PATIENT ACCOUNT BALANCES SENT TO THIRD PARTY COLLECTIONS, REDUCED BY ACTUAL COLLECTIONS, REDUCED BY ANY ACCOUNTS RETURNED TO THE HOSPITAL BY THE THIRD PARTY COLLECTION AGENCY, AND INCREASED BY AN ESTIMATE FOR UNCOLLECTIBLE ACCOUNTS WHEN APPLICABLE. THE AMOUNT DOES NOT INCLUDE DISCOUNTS PROVIDED UNDER THE HOSPITAL'S FAP, INCLUDING DISCOUNTS PROVIDED TO SELF-PAY ACCOUNTS, WHICH ARE ALSO REPORTED AS A REDUCTION OF PATIENT REVENUE. THE AMOUNT REPORTED IN PART III, SECTION A, LINE 3 IS AN ESTIMATE BASED ON THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY BY ANALYZING PAST ACTIVITY FOR ACCOUNTS CLASSIFIED AS BAD DEBT THAT SUBSEQUENTLY QUALIFIED FOR CHARITY CARE WHEN ADDITIONAL ELIGIBILITY INFORMATION WAS RECEIVED. THE HOSPITAL DID NOT INCLUDE BAD DEBT EXPENSE AS A COMMUNITY BENEFIT IN PART III, LINE 7 OR IN THE CALCULATION OF COMMUNITY BENEFIT EXPENSES, WHERE APPLICABLE. PART III, LINE 8: THE HOSPITAL USED ITS FILED MEDICARE COST REPORT TO OBTAIN THE MEDICARE ALLOWABLE COST REPORTED ON PART III, SECTION B. AS A CHILDREN'S HOSPITAL, THE HOSPITAL HAS A SMALL POPULATION OF MEDICARE PATIENTS AND IS PAID SUBSTANTIALLY LESS THAN COST DUE TO THE REIMBURSEMENT METHODOLOGY USED BY MEDICARE. THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT BECAUSE THE REIMBURSEMENT IS NOT NEGOTIABLE AND DOES NOT COVER THE COST TO PROVIDE THESE MEDICALLY NECESSARY SERVICES TO THIS POPULATION. PART III, LINE 9B: UNDER THE HOSPITAL'S POLICIES AND PROCEDURES, THE HOSPITAL UNDERTAKES EXTENSIVE MEASURES TO COMMUNICATE WITH THE FAMILIES OF PATIENTS WITH SELF-PAY BALANCES. IN MANY CASES, THE HOSPITAL AND FAMILIES WORK TOGETHER TO OBTAIN COVERAGE THROUGH THE STATE MEDICAID PROGRAM. IN CASES WHERE MEDICAID COVERAGE IS NOT AVAILABLE, THE HOSPITAL SEEKS TO OBTAIN INFORMATION NECESSARY TO DETERMINE THE PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FAP. ONCE A PATIENT'S ELIGIBILITY FOR FREE OR DISCOUNTED CARE HAS BEEN DETERMINED, THE BALANCE ON THE PATIENT'S ACCOUNT IS ADJUSTED ACCORDINGLY. IN ADDITION, HOSPITAL PERSONNEL WORK CLOSELY WITH FAMILIES TO DETERMINE THEIR ABILITY TO PAY THE ADJUSTED BALANCES; SUCH EFFORTS OFTEN RESULT IN PAYMENT PLANS INTENDED TO PERMIT THE GRADUAL PAYMENT OF AMOUNTS DUE WITHOUT IMPOSING UNDUE FINANCIAL HARDSHIP ON FAMILIES ALREADY DEALING WITH THE CHALLENGES OF CHILDREN'S HEALTH ISSUES. UNFORTUNATELY, THERE REMAIN CIRCUMSTANCES WHERE PATIENTS CANNOT BE DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE DUE TO THE INACCESSIBILITY OF THE FAMILY, OR THE FAMILY'S INABILITY OR REFUSAL TO PROVIDE THE REQUIRED INFORMATION; IN SUCH CASES, THE HOSPITAL FOLLOWS AN ESTABLISHED MULTI-STEP PROCESS IN AN EFFORT TO REACH THE FAMILY AND PROVIDE THEM WITH INFORMATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THE PROGRAM. ACCOUNTS ARE SENT TO COLLECTIONS (AN AFFILIATED ORGANIZATION WITH SUBSTANTIAL EXPERIENCE IN COLLECTION OF PATIENT ACCOUNTS) ONLY AFTER ALL ESTABLISHED STEPS HAVE BEEN UNDERTAKEN WITHOUT SUCCESS. CHILDREN'S HOSPITAL OF WISCONSIN, INC. PART V, SECTION B, LINE 11: ALTHOUGH THE HOSPITAL'S FAP LIMITS ELIGIBILITY AT 350 PERCENT OF THE FPG, THE HOSPITAL MAY PROVIDE FINANCIAL ASSISTANCE FOR FAMILIES ABOVE 350 PERCENT OF THE FPG SINCE THE HOSPITAL MAKES ADDITIONAL CONSIDERATIONS FOR THE MEDICALLY INDIGENT. CHILDREN'S HOSPITAL OF WI-FOX VALLEY PART V, SECTION B, LINE 11: ALTHOUGH THE HOSPITAL'S FAP LIMITS ELIGIBILITY AT 350 PERCENT OF THE FPG, THE HOSPITAL MAY PROVIDE FINANCIAL ASSISTANCE FOR FAMILIES ABOVE 350 PERCENT OF THE FPG SINCE THE HOSPITAL MAKES ADDITIONAL CONSIDERATIONS FOR THE MEDICALLY INDIGENT. CHILDREN'S HOSPITAL OF WISCONSIN, INC. PART V, SECTION B, LINE 14G: THE HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE CHILDREN'S FAP VIA ITS WEBSITE, BILLING INVOICES, AND AT VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES HAVE ACCESS TO THE FAP IN THE PATIENT HANDBOOK UPON ADMISSION. HOWEVER, THE FULL WRITTEN POLICY WAS NOT POSTED OR PROVIDED ON ADMISSION OR IN BILLING INVOICES. CHILDREN'S HOSPITAL OF WI-FOX VALLEY PART V, SECTION B, LINE 14G: THE HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE CHILDREN'S FAP VIA ITS WEBSITE, BILLING INVOICES, AND AT VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES ARE INFORMED OF THE FAP UPON ADMISSION. HOWEVER, THE FULL WRITTEN POLICY WAS NOT POSTED OR PROVIDED ON ADMISSION OR IN BILLING INVOICES. CHILDREN'S HOSPITAL OF WISCONSIN, INC. PART V, SECTION B, LINE 20D: THE MAXIMUM AMOUNT THAT THE HOSPITAL CHARGES TO FAP-ELIGIBLE INDIVIDUALS WHO APPLY FOR FINANCIAL ASSISTANCE IS 80% OF THE HOSPITAL'S GROSS CHARGE. PATIENTS WITH FAMILY INCOME EQUAL TO 200 PERCENT OF THE FPG AND BELOW WILL RECEIVE FREE CARE WHEN THEY APPLY FOR FINANCIAL ASSISTANCE, AND A SLIDING SCALE IS USED WHEN FAMILY INCOME IS BETWEEN 200 AND 350 PERCENT OF THE FPG. TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL USED THE OVERALL AVERAGE DISCOUNT GIVEN TO COMMERCIAL PAYERS. CHILDREN'S HOSPITAL OF WI-FOX VALLEY PART V, SECTION B, LINE 20D: THE MAXIMUM AMOUNT THAT THE HOSPITAL CHARGES TO FAP-ELIGIBLE INDIVIDUALS WHO APPLY FOR FINANCIAL ASSISTANCE IS 80% OF THE HOSPITAL'S GROSS CHARGE. PATIENTS WITH FAMILY INCOME EQUAL TO 200 PERCENT OF THE FPG AND BELOW WILL RECEIVE FREE CARE WHEN THEY APPLY FOR FINANCIAL ASSISTANCE, AND A SLIDING SCALE IS USED WHEN FAMILY INCOME IS BETWEEN 200 AND 350 PERCENT OF THE FPG. TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE, THE HOSPITAL USED THE OVERALL AVERAGE DISCOUNT GIVEN TO COMMERCIAL PAYERS. PART VI, LINE 2: THE HOSPITAL, IN COLLABORATION WITH A TEAM OF OTHER HOSPITAL SYSTEMS, HEALTH CARE PROVIDERS, COMMUNITY AGENCIES, LOCAL PUBLIC HEALTH DEPARTMENTS, COMMUNITY STAKEHOLDERS AND OTHER HEALTH PROFESSIONALS, HAS DEVELOPED A COMMUNITY NEEDS ASSESSMENT SURVEY TO ASSESS THE NEEDS OF THE COMMUNITY. IN ADDITION, THE HOSPITAL USES SECONDARY DATA SUCH AS THE WISCONSIN FAMILY HEALTH SURVEY, COUNTY HEALTH RANKING REPORT AND THE WISCONSIN HEALTHIEST PEOPLE 2020 TO ASSESS THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: AS INDICATED ABOVE, THE HOSPITAL WORKS CLOSELY WITH PATIENTS' FAMILIES TO HELP THEM UNDERSTAND AND ENROLL IN MEDICAL ASSISTANCE PROGRAMS AVAILABLE THROUGH THE STATE OF WISCONSIN, AND WHERE APPROPRIATE, FEDERAL PROGRAMS. WHERE SUCH PROGRAMS ARE NOT AVAILABLE, HOWEVER, PATIENTS MAY BE ELIGIBLE FOR FREE OR DISCOUNTED CARE UNDER THE HOSPITAL'S ESTABLISHED POLICIES AND PROCEDURES. THE AVAILABILITY OF FINANCIAL ASSISTANCE IS PUBLICIZED THROUGH VARIOUS MEASURES, INCLUDING INFORMATION ON THE HOSPITAL'S WEBSITE AND WRITTEN BROCHURES OR OTHER MATERIALS PROVIDED TO PATIENTS' FAMILIES. THE MOST SIGNIFICANT EDUCATION, HOWEVER, OCCURS IN DIRECT DIALOGUE BETWEEN PATIENT FAMILIES AND THE HOSPITAL'S TRAINED FINANCIAL SERVICES COUNSELORS AND SOCIAL WORKERS. THE HOSPITAL MAKES EXTENSIVE EFFORTS TO PROVIDE FACE-TO-FACE DIALOGUE, AS WELL AS COMMUNICATION VIA TELEPHONE, E-MAIL AND OTHER MEANS, AS NECESSARY TO ENSURE THAT FAMILIES ARE PROVIDED WITH SUFFICIENT INFORMATION REGARDING ALTERNATIVES FOR OBTAINING FREE OR DISCOUNTED CARE, AS WELL AS THE BILLING AND COLLECTION PROCESS GENERALLY. THE COMMUNICATION PROCESS IS SUPPORTED BY INTERPRETER SERVICES AS NEEDED. PART VI, LINE 4: THE HOSPITAL PROVIDES CARE TO CHILDREN FROM URBAN, RURAL, AND SUBURBAN AREAS, REGARDLESS OF RACE, GENDER, ETHNICITY, INCOME, DISABILITY, OR COUNTRY OF ORIGIN. THE HOSPITAL PROVIDES ACUTE LEVEL SERVICES, AS WELL AS EMERGENCY AND SPECIALTY CARE PRIMARILY TO CHILDREN FROM SOUTHEASTERN WISCONSIN, BUT TREATS PATIENTS FROM THE ENTIRE STATE OF WISCONSIN, THE UPPER PENINSULA OF MICHIGAN, NORTHERN ILLINOIS, AND THROUGHOUT THE UNITED STATES. APPROXIMATELY HALF OF THE HOSPITAL'S PATIENTS ARE MEDICAID BENEFICIARIES, AND IN 2012 APPROXIMATELY HALF OF GROSS CHARGES WERE FROM PATIENTS ENROLLED IN MEDICAID. PART VI, LINE 5: THE HOSPITAL PROMOTES THE HEALTH AND SAFETY OF CHILDREN LOCATED THROUGHOUT ITS SERVICE AREA. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO THE ABILITY TO PAY. THE HOSPITAL'S BOARD OF DIRECTORS CONSISTS OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS, AS SET FORTH IN THE MEDICAL STAFF BYLAWS, RULES AND REGULATIONS. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION AND RESEARCH PROGRAMS. IN THESE AND OTHER RESPECTS, THE HOSPITAL IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND THEREFORE FULFILLS CHARITABLE PURPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3). THE HOSPITAL OFFERS SPECIALTY CLINICS THAT ARE COMFORTABLE AND ACCESSIBLE TO FAMILIES. IN MILWAUKEE, THE HOSPITAL OFFERS CLINICS IN THE CENTRAL, DOWNTOWN AND SOUTHWEST PART OF THE CITY. FAMILIES MAY ALSO ACCESS SERVICES IN THE FOX VALLEY, GREEN BAY AND KENOSHA AREAS. THE HOSPITAL FUNDS SCHOOL-BASED HEALTH CENTERS IN EIGHT MILWAUKEE PUBLIC SCHOOLS. THESE CENTERS PROVIDE PREVENTATIVE CARE, PHYSICALS, IMMUNIZATIONS AND TREATMENT FOR ILLNESSES TO AREAS THAT PREVIOUSLY DID NOT HAVE PEDIATRIC PRACTICES AVAILABLE TO ATTEND TO THE COMMUNITY'S NEEDS. IN 2012, THERE WERE 17,476 SCHOOL-BASED NURSE ENCOUNTERS WHICH INCLUDED 2,206 VISION AND HEARING SCREENINGS.THE HOSPITAL SPONSORS THE DOWNTOWN HEALTH CENTER. LOCATED IN DOWNTOWN MILWAUKEE, THE MISSION OF THIS CLINIC IS TO IMPROVE HEALTH AND ADVANCE HEALTH EQUITY FOR THE MOST VULNERABLE CHILDREN IN MILWAUKEE THROUGH AN ACADEMIC PRIMARY CARE MEDICAL HOME. ON-SITE SERVICES INCLUDE ACUTE AND CHRONIC CARE, WELL-CHILD EXAMINATIONS, LABORATORY STUDIES, AND VISION AND HEARING SCREENINGS. CRIB, CAR SEAT AND BIKE HELMET DISTRIBUTION AND FITTINGS, SAFE-SLEEPING TECHNIQUES, AND GUN-LOCK EDUCATION ARE OTHER SPECIAL CLINIC ACTIVITIES THAT ARE AVAILABLE AT THIS SITE, MOSTLY FREE OF CHARGE. THE CENTER HAD APPROXIMATELY 6,300 VISITS IN 2012, AND 91 PERCENT OF THE CHILDREN SEEN WERE INSURED BY MEDICAID. ADOLESCENTS HAVE ACCESS TO SOCIAL SERVICES, CONTRACEPTIVE MANAGEMENT, FAMILY PLANNING, AND ALCOHOL AND DRUG ABUSE COUNSELING SERVICES. IN ADDITION, CHILDREN'S HOSPITAL PROVIDES SPECIALTY CARE SERVICES INCLUDING DENTAL, PSYCHOLOGICAL AND CHILD PROTECTIVE SERVICES AT THIS DOWNTOWN LOCATION. THE DOWNTOWN HEALTH CENTER ALSO OFFERS FREE LEGAL CONSULTATIONS TO FAMILIES IN COLLABORATION WITH MARQUETTE LAW SCHOOL TO HELP FAMILIES ADDRESS HOUSING, UTILITY, AND OTHER ISSUES THAT IMPACT THEIR CHILD'S HEALTH.CHILDREN'S HOSPITAL OF WISCONSIN'S EDUCATION ARM, COMMUNITY HEALTH, EDUCATES CHILDREN AND FAMILIES REGARDING A WIDE RANGE OF ISSUES IMPACTING THE HEALTH AND SAFETY OF CHILDREN. RESOURCES AND PROGRAMS ARE AVAILABLE FOR CHILDREN, PARENTS, TEACHERS, AND CAREGIVERS TO HELP KEEP WISCONSIN'S CHILDREN HEALTHY AND SAFE. ONLINE LEARNING PROGRAMS ARE A RESOURCE FOR TEACHERS TO USE IN THEIR CLASSROOMS TO DELIVER AN OUTCOMES-BASED HEALTH CURRICULUM TO STUDENTS IN GRADE K5-8. COMMUNITY HEALTH'S INJURY PREVENTION TEAM OFFERS COMMUNITY-BASED EDUCATIONAL EVENTS INCLUDING BIKE HELMET FITTINGS AND CAR SEAT CHECKS. THEY ALSO DELIVER IMPORTANT FIRE PROTECTION AND PEDESTRIAN SAFETY EDUCATION THROUGHOUT WISCONSIN. IN 2012, COMMUNITY HEALTH STAFF COMPLETED A SUCCESSFUL TOUR OF THE KOHL'S CARES: GREAT SAFETY ADVENTURE TO SCHOOLS AND COMMUNITY EVENTS THROUGHOUT EASTERN WISCONSIN. MORE THAN 20,000 KIDS AND PARENTS WERE TAUGHT HOW TO BE SAFE AT HOME. THE HOSPITAL'S CAR SEAT CLINIC IS A COLLABORATION BETWEEN THE HOSPITAL, ITS INJURY PREVENTION PROGRAM, SAFE KIDS WISCONSIN COALITION AND SAFE KIDS SOUTHEAST WISCONSIN COALITION. IT OFFERS CAR SEAT CLINICS IN TWO LOCATIONS NEAR THE MILWAUKEE HOSPITAL CAMPUS AND DOWNTOWN MILWAUKEE. TRAINED CHILD PASSENGER SAFETY TECHNICIANS MAKE CERTAIN THAT INFANT AND TODDLER CAR SEATS AND BOOSTER SEATS ARE INSTALLED CORRECTLY AND ARE APPROPRIATE FOR THE AGE AND SIZE OF THE CHILDREN USING THEM. THE PROGRAM ALSO PROVIDES LOW-COST OR FREE CAR OR BOOSTER SEATS FOR FAMILIES IN NEED.THE WISCONSIN POISON CENTER, WHICH IS STAFFED BY REGISTERED NURSES SUPPORTED BY M.D. TOXICOLOGISTS 24 HOURS A DAY, 365 DAYS A YEAR, PROVIDES IMMEDIATE AND AUTHORITATIVE PHONE CONSULTATION IN CASES OF ACCIDENTAL OR INTENTIONAL POISONING IN ADULTS AND CHILDREN FOR PATIENTS AND HOSPITALS ACROSS WISCONSIN. THE CENTER ALSO HAS A VARIETY OF PROFESSIONAL AND COMMUNITY EDUCATION PROGRAMS ALERTING PEOPLE TO SPECIFIC TOXIC DANGERS. THESE INCLUDE HOSPITAL GRAND ROUNDS LECTURES FOR PHYSICIANS, TRAINING FOR EMERGENCY MEDICAL TECHNICIANS, BABY SITTER WORKSHOPS, AND PRESCHOOL POISON PREVENTION EDUCATION. THE POISON CENTER ALSO TRIAGES CALLS FOR MPOWER, AN ALCOHOL AND DRUG CRISIS LINE FOR TEENS. PROJECT ADAM (AUTOMATIC DEFIBRILLATORS IN ADAM'S MEMORY) IS A PROGRAM OF THE HOSPITAL COMMITTED TO MAKING AUTOMATED EXTERNAL DEFIBRILLATORS UNIVERSALLY AVAILABLE TO ALL CHILDREN AND ADOLESCENTS BY BEING A NATIONAL RESOURCE FOR IMPLEMENTING PEDIATRIC PUBLIC ACCESS DEFIBRILLATION PROGRAMS IN SCHOOLS. IT IS ALSO WORKING TOWARD ERADICATING SUDDEN CARDIAC DEATH IN CHILDREN THROUGH EDUCATION AND PREVENTION INITIATIVES. SINCE IT BEGAN, THE HOSPITAL CELEBRATED 71 LIVES SAVED THROUGH PROJECT ADAM. ADDITIONALLY, THE HOSPITAL OPERATES CHILD ADVOCACY CENTERS IN MILWAUKEE, RACINE, KENOSHA, WALWORTH COUNTY, CENTRAL WISCONSIN (WAUSAU), THE FOX VALLEY, AND CHIPPEWA VALLEY (EAU CLAIRE). EACH CENTER IS A SAFE PLACE FOR KIDS WHO MAY HAVE BEEN ABUSED OR NEGLECTED. THE CENTERS BRING TOGETHER A TEAM OF SPECIALLY TRAINED PROFESSIONALS WHO EVALUATE AND INVESTIGATE CASES OF CHILD ABUSE, PROVIDE MEDICAL CARE AND HELP CHILDREN AND THEIR FAMILIES TO HEAL. THE CENTERS ARE A COLLABORATION OF THE HOSPITAL AND DOZENS OF LAW ENFORCEMENT, JUDICIAL AND LOCAL AND SOCIAL SERVICE ORGANIZATIONS.THE HOSPITAL'S SPECIAL NEEDS PROGRAM OFFERS COMPREHENSIVE CARE COORDINATION FOR CHILDREN WITH MULTIPLE MEDICAL NEEDS. THE GOAL IS TO ENSURE FAMILIES HAVE THE BEST POSSIBLE CARE IN AND OUT OF THE HOSPITAL. THE HOSPITAL PARTNERS WITH PATIENTS, FAMILIES, PRIMARY CARE AND OTHER HEALTH CARE PROVIDERS TO IMPROVE CARE COORDINATION. STAFF ALSO WORK WITH FAMILIES TO DEVELOP WRITTEN TRANSITION PLANS BASED ON NEEDS OR ISSUES THAT SHOULD BE ADDRESSED BEFORE A YOUTH IS READY TO TRANSITION TO ADULT CARE.FIGHT ASTHMA MILWAUKEE, WHICH IS LED AND SUPPORTED BY MEDICAL STAFF AT THE HOSPITAL, IS A COALITION THAT WORKS TO REDUCE AND ELIMINATE DISPARITIES IN ASTHMA CARE AND DEVELOP A SUSTAINABLE STRATEGY FOR ASTHMA CONTROL IN THE COMMUNITY. FIGHT ASTHMA MILWAUKEE PROVIDES COMMUNITY-WIDE ASTHMA EDUCATION FOR PARENTS, CAREGIVERS, HEALTH CARE PROFESSIONALS AND SCHOOL STAFF.THE INFANT DEATH CENTER ("IDC") IS A STATEWIDE PROGRAM ADMINISTERED THROUGH CHILDREN'S HEALTH ALLIANCE OF WISCONSIN, A HOSPITAL LED AND STAFFED COALITION. THE CENTER PROVIDES INFORMATION AND SUPPORT TO WISCONSIN FAMILIES AND OTHERS AFFECTED BY THE SUDDEN AND UNEXPECTED DEATH OF AN INFANT. THE IDC STRIVES TO INCREASE HEALTHY BIRTH OUTCOMES AND REDUCE INFANT DEATHS. THE CENTER WORKS TOGETHER WITH OTHER PROFESSIONALS IN OUTREACH, EDUCATION AND INFANT MORTALITY REVIEW PROGRAMS. IN PARTNERSHIP WITH PUBLIC HEALTH SYSTEMS AND NATIONAL INFANT MORTALITY PROGRAMS, THE IDC MAINTAINS INFORMATION THAT ASSISTS IN THE STUDY AND UNDERSTANDING OF THE CAUSES OF INFANT DEATHS. THE INFORMATION IS USED FOR STATISTICAL REPORTING.IN 2010, THE HOSPITAL LAUNCHED A MULTIYEAR, SYSTEM WIDE EFFORT TO INCREASE IMMUNIZATION RATES FOR ALL CHILDREN IN THE HOSPITAL'S SERVICE AREA. THIS INITIATIVE IS KEY TO ACHIEVING THE HEALTH SYSTEM'S VISION OF HELPING WISCONSIN'S CHILDREN TO BE THE HEALTHIEST IN THE NATION. THE HOSPITAL PARTNERS WITH THE LOCAL HEALTH DEPARTMENTS AS WELL AS COMMUNITY INITIATIVES TO ENHANCE ITS PROGRAM IMPROVEMENT EFFORTS AND TO LEARN FROM AND CONTRIBUTE TO COMMUNITY EFFORTS. ADDITIONALY, THE HOSPITAL WORKS WITH THE STATE OF WISCONSIN TO RECEIVE ITS PERFORMANCE DATA FROM THE WISCONSIN IMMUNIZATION REGISTRY. DATA SHOW AN INCREASE IN PERCENT IMMUNIZATION COMPLIANCE FOR CHILDREN'S FOR EACH OF THE THREE YEARS OF THE INITIATIVE SO FAR. LAST YEAR, MORE THAN 225 DOSES OF VACCINES WERE ADMINISTERED AT CHILDREN'S IMMUNIZATION CLINIC, A PARTNERSHIP BETWEEN THE HOSPITAL AND THE CITY OF MILWAUKEE HEALTH DEPARTMENT. IN 2012, THE HOSPITAL ALSO FOCUSED ON EDUCATING ALL WHO CARE FOR CHILDREN ABOUT SAFE INFANT SLEEP PRACTICES. THIS MULTIYEAR INITIATIVE FOCUSES ON REDUCING THE RISK FACTORS FOR SUDDEN INFANT DEATH SYNDROME AND OTHER SLEEP-RELATED DEATHS IN CHILDREN UNDER AGE 1. DOOR HANGERS WERE CREATED TO EDUCATE AND REMIND CAREGIVERS ABOUT THE ABC'S OF SAFE INFANT SLEEP. (CONTINUED ON PAGE 59). PART VI, LINE 6: THE HOSPITAL IS PART OF AN AFFILIATED GROUP OF ORGANIZATIONS UNDER THE CONTROL OF CHHS, WHICH PROVIDES VARIOUS CENTRALIZED ADMINISTRATIVE AND SUPPORTING SERVICES FOR THE HOSPITAL AND ITS AFFILIATES. AMONG THE AFFILIATED ENTITIES, THE HOSPITAL AND CERTAIN OTHER ENTITIES (INCLUDING CHILDREN'S MEDICAL GROUP, INC. AND CHILDREN'S PHYSICIAN GROUP, P.C.) DIRECTLY PROVIDE INSTITUTIONAL AND PROFESSIONAL PEDIATRIC HEALTHCARE SERVICES IN A VARIETY OF ACCESSIBLE LOCATIONS THROUGHOUT WISCONSIN AND NORTHERN ILLINOIS. ANOTHER HOSPITAL AFFILIATE IS CHILDREN'S SERVICE SOCIETY OF WISCONSIN ("CSSW"). THIS SOCIAL SERVICE ORGANIZATION ADDRESSES THE CHALLENGES FACED BY CHILDREN, WHICH OFTEN DIRECTLY IMPACT THEIR PHYSICAL AND MENTAL HEALTH AND WELLBEING. CSSW OFFERS CHILD WELFARE SERVICES IN FOUR CORE AREAS (PUBLIC CHILD WELFARE, CHILD AND FAMILY COUNSELING, OUT-OF-HOME CARE AND PREVENTION SERVICES) FROM LOCATIONS THROUGHOUT WISCONSIN. SERVICES INCLUDE: FINDING LOVING, STABLE HOMES FOR CHILDREN IN NEED OF A FAMILY THROUGH FOSTER CARE AND ADOPTION; REDUCING STRESS AND CONFLICT, ENHANCING PARENTING SKILLS AND STRENGTHENING FAMILY TIES THROUGH TRAUMA-INFORMED MENTAL HEALTH SERVICES COUNSELING; PROVIDING SERVICES TO CHILDREN IN OUT-OF-HOME CARE, ADVOCATING FOR THEIR SAFETY, WELL-BEING AND TIMELY REUNIFICATION WITH BIRTHPARENTS WHENEVER POSSIBLE; PROVIDING FOSTER PARENTS WHO ARE CARING FOR CHILDREN WITH SPECIAL MEDICAL OR EMOTIONAL NEEDS WITH A MUCH NEEDED BREAK THROUGH OUR RESPITE CARE PROGRAM; OFFERING FREE, CONFIDENTIAL AND SUPPORTIVE GUIDANCE TO HELP PARENTS DEALING WITH AN UNPLANNED PREGNANCY; PROVIDING INTENSIVE IN-HOME THERAPY TO KEEP CHILDREN SAFE IN THEIR HOMES AND PREVENT OUT-OF-HOME PLACEMENT; ASSISTING YOUNG ADULTS TRANSITIONING OUT OF FOSTER CARE BY GIVING THEM THE SKILLS, TRAINING, GUIDANCE AND SUPPORT ENABLING THEM TO MAKE IT ON THEIR OWN; PROVIDING PARENTS WITH SUPPORT AND GUIDANCE TO HELP THEM BE THE BEST PARENTS THEY CAN BE; AND PROVIDING CHILDREN WHO HAVE BEEN HARMED OR HURT A SAFE PLACE TO GO TO BE INTERVIEWED AND PROVIDING THEM RESOURCES TO HELP THEM HEAL.CSSW ALSO RUNS PROJECT UJIMA, A PROGRAM THAT PROVIDES CASE MANAGEMENT, EMOTIONAL SUPPORT AND RESOURCES TO FAMILIES WHOSE CHILDREN HAVE EXPERIENCED INTERPERSONAL COMMUNITY-BASED VIOLENCE OR WHO HAVE LOST A FAMILY MEMBER (OF ANY AGE) TO HOMICIDE IN MILWAUKEE COUNTY.CHHS HAS TWO KEY PROGRAMS TO PROMOTE HIGH QUALITY CARE. CHILDREN'S RESEARCH INSTITUTE CARRIES ON RESEARCH INITIATIVES AIMED AT IMPROVING THE DIAGNOSIS AND TREATMENT OF PEDIATRIC HEALTH CONDITIONS, AND THE NATIONAL OUTCOMES CENTER GATHERS AND PUBLICIZES DATA TO ASSIST PEDIATRIC HEALTHCARE PROVIDERS IN IDENTIFYING THE MOST EFFECTIVE TREATMENT METHODS. CHHS PERFORMS COMMUNITY HEALTH IMPROVEMENT ADVOCACY ON BEHALF OF THE HOSPITAL AND ITS AFFILIATES. IN 2012, CHHS ACTIVELY ADVOCATED BEFORE THE STATE LEGISLATURE FOR ADEQUATE COVERAGE AND ACCESS TO HEALTH SERVICES FOR PREGNANT WOMEN AND CHILDREN AND WAS SUCCESSFUL IN SECURING STATE FUNDING FOR THE STATE'S MEDICAID PROGRAM AND MAINTAINING PROGRAM ELIGIBILITY. CHHS ALSO LED THE ADVOCACY FOR THE SUCCESSFUL PASSAGE OF YOUTH SPORTS CONCUSSION LEGISLATION, WHICH NOW ENSURES THAT ALL YOUTH PLAYING SCHOOL AND CLUB SPORTS WILL BE EDUCATED ABOUT CONCUSSIONS AND THAT SAFE CRITERIA ARE IN PLACE FOR REMOVAL FROM AND RETURN TO PLAY. IN ADDITION, CHHS CHAMPIONED EFFORTS TO PARTNER WITH THE STATE IN THE FUNDING OF A FAMILY JUSTICE CENTER WHICH WILL SERVE WOMEN AND CHILDREN WHO ARE VICTIMS OF DOMESTIC VIOLENCE. CHHS ALSO PARTNERED WITH OTHER ORGANIZATIONS TO EDUCATE POLICY MAKERS AND THE PUBLIC ABOUT THE IMPORTANCE OF PULSE OXIMETRY SCREENING FOR ALL NEWBORNS IN WISCONSIN AND TO FIGHT EFFORTS TO LEGALIZE RAW (UNPASTEURIZED) MILK. ON THE FEDERAL LEVEL, CHHS ADVOCATED TO PROTECT MEDICAID PROGRAMS AND EDUCATED OUR DELEGATION ABOUT THE IMPORTANCE OF ACCESS AND COVERAGE OF MEDICAL SERVICES FOR PREGNANT WOMEN AND CHILDREN. CHHS ALSO ADVOCATED FOR AND EDUCATED CONGRESSIONAL MEMBERS ABOUT THE IMPORTANCE OF TRAINING FOR PEDIATRIC PHYSICIANS AND PEDIATRIC SPECIALISTS.IN ADDITION TO ADVOCACY, CHHS'S COMMUNITY SERVICES DIVISION HAS INITIATED A COMMUNITY-BASED EFFORT TO IMPROVE CHILD HEALTH THAT ACKNOWLEDGES THE INFLUENCE OF SOCIAL, CULTURAL AND ENVIRONMENTAL FACTORS ON HEALTH AND RECOGNIZES THAT SUCH INFLUENCES MAY HAVE PARTICULARLY DELETERIOUS EFFECTS WHEN THEY OCCUR DURING CRITICAL PERIODS OVER ONE'S LIFE COURSE. CHHS IS BRINGING THE FULL SPECTRUM OF THE SYSTEM'S RESOURCES TO BEAR IN THE COMMUNITY ENGAGEMENT EFFORT. BY CONNECTING OUR VAST CLINICAL AND COMMUNITY-BASED RESOURCES - SCHOOL NURSES, COMMUNITY PEDIATRICIANS, SOCIAL WORKERS, HEALTH EDUCATORS, FOSTER CARE PARENTS, HOSPITALISTS, EMERGENCY DEPARTMENT STAFF, RESEARCHERS AND POLICY MAKERS - CHHS IS FACILITATING COMMUNITY HEALTH IMPROVEMENT BOTH DIRECTLY (E.G. EXPANDING MENTAL HEALTH AND DENTAL CARE IN UNDERSERVED AREAS), AND INDIRECTLY (E.G. BRINGING LAW ENFORCEMENT TO THE COMMUNITY CONVERSATION RE: CRIME REDUCTION; SUPPORTING POLICY CHANGES AT THE LOCAL, STATE AND NATIONAL LEVELS THAT HAVE AN IMPACT ON CHILD HEALTH). AS A PARTNER AND FACILITATOR, CHHS'S STAFF HAS ENCOURAGED LEADERS FROM THE PRIORITY COMMUNITIES TO IDENTIFY KEY AREAS FOR STRATEGIC INTERVENTION. AS A RESULT OF SEVERAL FACILITATED LISTENING SESSIONS, TWO OF THE THREE COMMUNITIES HAVE ARTICULATED HEALTH AS A KEY AREA FOR STRATEGIC INTERVENTION AND THE COMMUNITIES NOW ARE IDENTIFYING SPECIFIC CATEGORIES WITHIN THE LARGER RUBRIC OF "HEALTH" ON WHICH TO CONCENTRATE IMPROVEMENT EFFORTS. CHHS HAS SELECTED THREE NEIGHBORHOODS FOR INITIAL ENGAGEMENT EFFORTS. THESE NEIGHBORHOODS - METCALFE PARK, FRANKLIN HEIGHTS/AMANI NEIGHBORHOOD AND LINDSAY HEIGHTS - WERE IDENTIFIED BECAUSE THEY HAD A HIGH CONCENTRATION OF PEDIATRIC-AGED RESIDENTS; THERE WERE SIGNIFICANT, BUT MODIFIABLE, CHALLENGES TO CHILD HEALTH OUTCOMES; AND THEY HAD EXISTING TRUSTED COMMUNITY RESOURCES THAT WERE WILLING TO PARTNER WITH CHHS TO ENGAGE THE COMMUNITY IN NEW WAYS TO IMPROVE CHILD HEALTH OUTCOMES. ONE STRATEGY BEING IMPLEMENTED IS USING COMMUNITY "NAVIGATORS" - TRUSTED LOCAL RESIDENTS WHO EDUCATE NEIGHBORS ABOUT A SPECIFIC BEHAVIOR CHANGE OR RESOURCE UTILIZATION THAT WILL RESULT IN IMPROVED HEALTH OUTCOMES. CHHS'S FOCUS IS TO HAVE RELEVANT, ACCURATE, RESIDENT-LEVEL INFORMATION REGARDING TRUSTED SOURCES OF INFORMATION AND DIRECT INFLUENCES ON RESIDENT'S BEHAVIORS. CHHS IS PARTNERING WITH THE COMPREHENSIVE CENTER OF EXCELLENCE FOR HEALTH EQUITY IN WISCONSIN TO UTILIZE COMMUNITY-MAPPED "WAYS OF KNOWING" TO BEST UNDERSTAND DIRECT INFLUENCES ON HEALTH BEHAVIORS IN THE SELECTED COMMUNITIES. THE COMMUNITY NAVIGATORS ARE WORKING COLLABORATIVELY WITH THE CENTER'S COMMUNITY HEALTH EDUCATOR TO FOSTER KEY RELATIONSHIPS WITHIN THE COMMUNITY. CHHS WILL FACILITATE THE DEVELOPMENT OF CULTURALLY AND LINGUISTICALLY APPROPRIATE EDUCATIONAL MATERIALS FOR THE COMMUNITY NAVIGATORS AND WILL LEAD THE TRAINING OF BOTH THE COMMUNITY NAVIGATORS AND THE CENTER'S COMMUNITY HEALTH EDUCATOR. THIS COORDINATED APPROACH WILL ALLOW CHHS AND THE CENTER TO FACILITATE EFFECTIVE COMMUNITY TRANSFORMATION THAT IS RESPECTFUL OF THE LOCAL CULTURE. IN ADDITION, THE COLLABORATION ALLOWS FOR COMMUNITY-LED MEASUREMENT OF IDENTIFIED OUTCOMES - FACILITATING COMMUNITY EMPOWERMENT AND CONTRIBUTING TO SUSTAINABLE CHANGES.THESE AFFILIATED PROGRAMS AND ACTIVITIES SEEK TO ENSURE THAT CHILDREN HAVE ACCESS TO HIGH-QUALITY HEALTH AND SOCIAL SERVICES.PART VI, LINE 7: CHHS, THE SOLE CORPORATE MEMBER OF THE HOSPITAL, PREPARES A COMMUNITY BENEFIT REPORT ON BEHALF OF THE HOSPITAL AND ITS AFFILIATES. THE REPORT IS FILED WITH THE WISCONSIN HOSPITAL ASSOCIATION AND IS ALSO AVAILABLE ON THE HOSPITAL'S WEBSITE OR UPON REQUEST. DESCRIPTION OF COMMUNITY HEALTH PROMOTION-CONTINUED SCHEDULE H, PART VI, LINE 5 MORE THAN 10,000 HANGERS WERE DISTRIBUTED AT COMMUNITY EVENTS. WINDOW CLINGS ALSO WERE CREATED AND DISPLAYED IN PATIENT ROOMS AT THE HOSPITAL. SAFE SLEEP MESSAGES WERE PRINTED IN ENGLISH AND SPANISH. THE HOSPITAL ALSO PARTNERED WITH THE MILWAUKEE ADMIRALS HOCKEY TEAM TO PRODUCE A VIDEO HIGHLIGHTING THE ABCS OF SAFE SLEEP. IT WAS PLAYED ON THE JUMBOTRON DURING ADMIRALS GAMES FOR MOST OF THE SEASON. 1 AMERICAN FAMILY CHILDREN'S HOSPITAL 600 HIGHLAND AVENUE MADISON WI 53792 391835630 501(C)(3) 5000 ADDRESSING ASTHMA FROM A PUBLIC HEALTH PERSPECTIVE BAYFIELD COUNTY PUBLIC HEALTH DEPARTMENT 117 E 5TH STREET WASHBURN WI 54891 396005670 BAYFIELD COUNTY 9972 DENTAL SEALANT EXPANSION GRANT BROWN COUNTY ORAL HEALTH PARTNERSHIP 331 N BROADWAY GREEN BAY WI 54303 208969896 501(C)(3) 26957 DENTAL SEALANT EXPANSION GRANT CHIPPEWA COUNTY HEALTH DEPARTMENT 711 N BRIDGE ST ROOM 121 CHIPPEWA FALLS WI 54729 396005678 CHIPPEWA COUNTY 6523 ADDRESSING ASTHMA FROM A PUBLIC HEALTH PERSPECTIVE CITY OF WEST ALLIS 11301 W LINCOLN AVE WEST ALLIS WI 53227 396005651 CITY OF WEST ALLIS 5000 ADDRESSING ASTHMA FROM A PUBLIC HEALTH PERSPECTIVE CLARK COUNTY HEALTH DEPARTMENT 517 COURT STREET NEILLSVILLE WI 54456 396005679 CLARK COUNTY 3431 DENTAL SEALANT GRANT CLARK COUNTY HEALTH DEPARTMENT 517 COURT STREET NEILLSVILLE WI 54456 396005679 CLARK COUNTY 2411 DENTAL SEALANT EXPANSION GRANT COLUMBIA COUNTY PO BOX 132 PORTAGE WI 53901 396005681 COLUMBIA COUNTY 18078 DENTAL SEALANT EXPANSION GRANT COLUMBIA ST MARY'S FOUNDATION 2320 N LAKE DRIVE MILWAUKEE WI 53211 391494981 501(C)(3) 51250 DENTAL SEALANT GRANT FOND DU LAC SCHOOL DISTRICT 72 W 9TH STREET FOND DU LAC WI 54935 391411371 501(C)(3) 5000 ADDRESSING ASTHMA FROM A PUBLIC HEALTH PERSPECTIVE IN HEALTH COMMUNITY WELLNESS FREE CLINIC 109 E BLUFF STREET BOSCOBEL WI 53805 331170597 501(C)(3) 5538 DENTAL SEALANT EXPANSION GRANT JUST KIDS DENTAL PO BOX 146 TWO HARBORS MN 55616 272311353 501(C)(3) 10539 DENTAL SEALANT GRANT KENOSHA COMMUNITY CENTER 625 57TH STE 700 KENOSHA WI 53140 391789874 KENOSHA COUNTY 40998 DENTAL SEALANT GRANT KENOSHA COMMUNITY CENTER 625 57TH STE 700 KENOSHA WI 53140 391789874 KENOSHA COUNTY 9002 DENTAL SEALANT EXPANSION GRANT MARATHON COUNTY 1000 LAKE VIEW DRIVE RM 100 WAUSAU WI 54403 396005716 MARATHON COUNTY 5000 ADDRESSING ASTHMA FROM A PUBLIC HEALTH PERSPECTIVE MARQUETTE UNIVERSITY PO BOX 1881 MILWAUKEE WI 53201 390806251 501(C)(3) 8792 DENTAL SEALANT GRANT MARQUETTE UNIVERSITY PO BOX 1881 MILWAUKEE WI 53201 390806251 501(C)(3) 48703 DENTAL SEALANT EXPANSION GRANT PORTAGE COUNTY HEALTH & HUMAN SERVICES 817 WHITING AVENUE STEVENS POINT WI 54481 396005731 PORTAGE COUNTY 18818 DENTAL SEALANT GRANT PORTAGE COUNTY HEALTH & HUMAN SERVICES 817 WHITING AVENUE STEVENS POINT WI 54481 396005731 PORTAGE COUNTY 6986 DENTAL SEALANT EXPANSION GRANT PRICE COUNTY HEALTH DEPARTMENT 104 S EYDER AVENUE PHILLIPS WI 54555 396005733 PRICE COUNTY 26415 DENTAL SEALANT EXPANSION GRANT PROFESSIONAL DENTAL HYGIENE EXPRESS 5388 STATE HWY 64 BLOOMER WI 54724 274969600 25000 DENTAL SEALANT GRANT PROFESSIONAL DENTAL HYGIENE EXPRESS 5388 STATE HWY 64 BLOOMER WI 54724 274969600 20238 DENTAL SEALANT EXPANSION GRANT RICHLAND COUNTY 221 W SEMINARY RICHLAND CENTER WI 53581 396005735 RICHLAND COUNTY 3990 DENTAL SEALANT GRANT RICHLAND COUNTY 221 W SEMINARY RICHLAND CENTER WI 53581 396005735 RICHLAND COUNTY 13810 DENTAL SEALANT EXPANSION GRANT SCENIC BLUFFS COMMUNITY HEALTH CENTER 268 FRONT STREET CASHTON WI 54619 391760445 501(C)(3) 7153 DENTAL SEALANT EXPANSION GRANT SHAWANO COUNTY HEALTH DEPARTMENT 311 N MAIN ST RM 7 SHAWANO WI 54166 396005743 SHAWANO COUNTY 2455 DENTAL SEALANT GRANT SHAWANO COUNTY HEALTH DEPARTMENT 311 N MAIN ST RM 7 SHAWANO WI 54166 396005743 SHAWANO COUNTY 3065 DENTAL SEALANT EXPANSION GRANT SMILES 4 LIFE W286 N991 SHEPHERDS WAY WAUKESHA WI 53188 454063576 501(C)(3) 9900 DENTAL SEALANT EXPANSION GRANT TREMPEALEAU COUNTY HUMAN SERVICES 36245 MAIN STREET WHITEHALL WI 54773 396005747 TREMPEALEAU COUNTY 12845 DENTAL SEALANT EXPANSION GRANT VILAS COUNTY HEALTH DEPARTMENT 330 COURT STREET EAGLE RIVER WI 54521 396005751 VILAS COUNTY 26434 DENTAL SEALANT EXPANSION GRANT WALWORTH COUNTY W4051 COUNTY ROAD NN ELKHORN WI 53121 396005752 WALWORTH COUNTY 60895 DENTAL SEALANT EXPANSION GRANT WAUKESHA COUNTY COMMUNITY DENTAL CENTER 210 NW BARSTOW STREET 305 WAUKESHA WI 53188 391355301 WAUKESHA COUNTY 7521 DENTAL SEALANT EXPANSION GRANT WAUSHARA COUNTY HEALTH DEPARTMENT PO BOX 837 WAUTOMA WI 54982 396005759 WAUSHARA COUNTY 5459 DENTAL SEALANT EXPANSION GRANT WOOD COUNTY HEALTH DEPARTMENT 400 MARKET STREET WISCONSIN RAPIDS WI 54494 396005763 WOOD COUNTY 12910 DENTAL SEALANT GRANT WOOD COUNTY HEALTH DEPARTMENT 400 MARKET STREET WISCONSIN RAPIDS WI 54494 396005763 WOOD COUNTY 19001 DENTAL SEALANT EXPANSION GRANT CHILDREN'S HOSPITAL AND HEALTH SYSTEM INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 391500074 501(C)(3) 9136944 RESEARCH, HEALTH EDUCATION, AND OTHER GRANTS TO AFFILIATE CHILDREN'S PHYSICIAN GROUP PC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 364303682 501(C)(3) 2500000 GRANTS TO AFFILIATE CHILDREN'S MEDICAL GROUP INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 391789197 501(C)(3) 375000 GRANTS TO AFFILIATE 26 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: MONITORING PROCEDURES - THE ORGANIZATION RECEIVES GRANT FUNDING FROM VARIOUS STATE AND FEDERAL AGENCIES. SOME OF THE GRANT AWARDS ARE SUB-AWARDED TO OTHER AGENCIES BASED ON THE REQUIREMENTS OF THE INDIVIDUAL GRANT AGREEMENTS. IN ORDER TO MONITOR THE USE OF THE FUNDS, THE ORGANIZATION ENTERS INTO SIGNED AGREEMENTS WITH THE SUB-GRANTEE AGENCIES TO OUTLINE THE TERMS OF THE ARRANGEMENTS INCLUDING THE PROPER USE OF FUNDS. THESE AGREEMENTS REQUIRE AGENCIES TO PROVIDE CERTIFICATIONS OF EXPENSES SUBMITTED FOR REIMBURSEMENT ALONG WITH DESCRIPTIONS OF THE ACTUAL EXPENSES INCURRED COMPARED TO THE BUDGETED AWARD TOTAL. EACH AWARD IS MONITORED BY A DESIGNATED EMPLOYEE OF THE ORGANIZATION WHO VERIFIES THAT ALL SERVICES ARE PROVIDED ACCORDING TO THE CONTRACT, APPROVES PAYMENTS TO THE AGENCY, AND ENSURES THAT THE AWARD OBJECTIVES ARE MET. IN SOME CASES, THE ORGANIZATION REQUIRES THE AGENCY TO SUBMIT A COPY OF ITS ANNUAL OMB 133 AUDIT ALONG WITH ANY RELEVANT AUDIT FINDINGS. ADDITIONALLY, CHW AWARDS GRANTS TO ITS TAX-EXEMPT AFFILIATES. GRANTS ARE AWARDED BASED ON THE STRATEGIC INITIATIVES OF THE HEALTH SYSTEM, THE NEEDS OF THE AFFILIATES, AND ANY PURPOSE RESTRICTIONS SET BY THE DONORS. THE NEEDS OF THE AFFILIATES ARE EVALUATED IN THE ANNUAL BUDGET PROCESS. FINAL BUDGETS REQUIRE APPROVAL FROM MANAGEMENT, THE ENTITY'S BOARD OF DIRECTORS AND THE CHHS BOARD OF DIRECTORS AND SENIOR MANAGEMENT. IN ADDITION, THE OPERATIONS OF ALL AFFILIATES ARE SUBJECT TO SYSTEM CONTROLS, POLICIES AND PROCEDURES, AND ARE REFLECTED IN THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF CHHS AND ITS AFFILIATES. X X X X X X 1 1 0 0 0 0 0 1 0 MARGARET TROY 0 759976 0 376671 0 126977 0 259150 0 31918 0 1554692 0 50833 MARC CADIEUX 0 189232 0 34000 0 15679 0 15814 0 6706 0 261431 0 0 CINTHIA S CHRISTENSEN 424640 0 152683 0 101778 0 65020 0 27854 0 771975 0 33569 0 WELDON GAGE 0 336629 0 25000 0 457 0 51785 0 18387 0 432258 0 0 MICHAEL GUTZEIT MD 293944 0 98893 0 82649 0 53030 0 27188 0 555704 0 24709 0 BARBARA JOERS 197229 0 62672 0 17472 0 8500 0 20506 0 306379 0 0 0 JULIET KERSTEN 212342 0 67842 0 14019 0 18500 0 21343 0 334046 0 13331 0 NANCY KOROM 284040 0 83844 0 63175 0 49010 0 23909 0 503978 0 23511 0 SHEILA REYNOLDS 0 259682 0 78354 0 50992 0 48690 0 27695 0 465413 0 18023 MARK SHIP 32876 186798 0 77404 163 20967 0 16000 3548 18028 36587 319197 0 18414 DONNA JAMIESON 171010 0 1000 0 864 0 14591 0 33727 0 221192 0 0 0 TOM LAUSTEN 155010 0 1000 0 10310 0 13519 0 22780 0 202619 0 0 0 ERIN YALE 158985 0 2000 0 6949 0 7088 0 22782 0 197804 0 0 0 SUZAN BUCHAKLIAN 150215 0 0 0 2110 0 6315 0 21037 0 179677 0 0 0 LORI BARBEAU DDS 243324 0 0 0 25293 0 21000 0 23296 0 312913 0 0 0 ANDREW SCHMITT MD 241970 0 0 0 8538 0 7500 0 25146 0 283154 0 0 0 MARYLYN RANTA MD 218838 0 500 0 19280 0 20808 0 27724 0 287150 0 0 0 SHANE FISHER DDS 203777 0 0 0 29706 0 12315 0 14829 0 260627 0 0 0 A CHARLES POST DDS 193987 0 0 0 41112 0 20044 0 8302 0 263445 0 0 0 TIMOTHY L BIRKENSTOCK 0 0 0 0 0 232256 0 0 0 1866 0 234122 0 0 RAMESH SACHDEVA MD 0 168842 0 84377 0 21132 0 0 0 10232 0 284583 0 20257 PART I, LINE 3 CHW AND CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS"), THE CORPORATE MEMBER OF CHW, SHARE A BOARD OF DIRECTORS WHICH INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE. THIS COMMITTEE IS RESPONSIBLE FOR ESTABLISHING THE COMPENSATION OF CHW'S PRESIDENT, AND USED THE METHODS LISTED AND CHECKED IN SCHEDULE J LINE 3. PART I, LINES 4A-B UNTIL MARCH 2011, TIMOTHY BIRKENSTOCK SERVED AS TREASURER & CFO OF CHHS. BY VIRTUE OF THAT ROLE, MR. BIRKENSTOCK SERVED AS THE TREASURER OF CHW UNTIL HIS SEPARATION FROM CHHS IN 2011. CHHS PAID CERTAIN AMOUNTS AS SEVERANCE TO MR. BIRKENSTOCK PURSUANT TO A WRITTEN AGREEMENT. CASH PAYMENTS MADE TO MR. BIRKENSTOCK IN 2012 TOTALED $234,122. PART I, LINE 4B: IN 2012, THERE WAS A CHHS FLEXIBLE BENEFIT PLAN IN PLACE WHICH WAS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (457(F) PLAN). THE CORPORATION CONTRIBUTES 7% OF EACH PARTICIPATING EXECUTIVE'S SALARY. THE AMOUNTS OF EMPLOYER CONTRIBUTIONS TO THIS PLAN FOR PARTICIPATING EXECUTIVES IN 2012 WERE AS FOLLOWS: M. TROY, $54,180; C. CHRISTENSEN, $44,020; W. GAGE, $43,852; M. GUTZEIT, M.D., $32,030; N. KOROM, $29,010; AND S. REYNOLDS, $30,190. AFTER A VESTING PERIOD, PARTICIPANTS MAY ELECT TO WITHDRAW AMOUNTS PREVIOUSLY CONTRIBUTED AND REPORTED. AMOUNTS WITHDRAWN BY PARTICIPANTS IN 2012 WERE: M. TROY, $50,833; C. CHRISTENSEN, $33,569; M. GUTZEIT, M.D., $24,709; J. KERSTEN, $13,331; N. KOROM, $23,511; S. REYNOLDS, $18,023; M. SHIP, $18,414; AND R. SACHDEVA, M.D. $20,257. CHHS HAS REPORTED ADDITIONAL AMOUNTS SET ASIDE FOR A NONQUALIFIED RETIREMENT PLAN ON BEHALF OF ITS PRESIDENT AND CEO. THE AMOUNT SET ASIDE IN 2012 WAS $191,470. PART I, LINE 7 CERTAIN EXECUTIVES PARTICIPATE IN AN ANNUAL BONUS PLAN THAT PROVIDES COMPENSATION BASED ON ACHIEVING SPECIFIC PRE-DEFINED GOALS. BONUS CRITERIA ARE COMPRISED OF BOTH SYSTEM LEVEL AND EXECUTIVE SPECIFIC COMPONENTS. SUCH CRITERIA PERTAIN TO MATTERS WITHIN THE EXECUTIVE'S AREA OF RESPONSIBILITY, AS WELL AS ACHIEVEMENT OF OVERALL STRATEGIC OBJECTIVES OF THE ORGANIZATION AND ITS AFFILIATES IN ALIGNMENT WITH SYSTEM-WIDE BALANCED MEASURES. SUPPLEMENTAL INFORMATION PART III FORM 990, PART VII, COLUMN E & SCHEDULE J, PART II: SALARIES PAID BY RELATED ORGANIZATIONS: 1. MARGARET TROY, PRESIDENT & CEO OF CHHS, ELIZABETH BEDWELL, VP RESEARCH ADMINISTRATION, MARC CADIEUX, INTERIM TREASURER OF CHW (JANUARY 2012) AND INTERIM TREASURER & CFO OF CHHS (JANUARY 2012), WELDON GAGE, TREASURER OF CHW AND TREASURER & CFO OF CHHS, SHEILA REYNOLDS, SECRETARY OF CHW AND CORPORATE VICE PRESIDENT & GENERAL COUNSEL OF CHHS, AND MARK SHIP, VP REVENUE CYCLE - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SERVICES PROVIDED (40 HOURS PER WEEK) TO CHHS AND ITS AFFILIATES. THESE AMOUNTS WERE PAID BY CHHS. SERVICES BY MS. TROY AS A MEMBER OF THE BOARD OF DIRECTORS OF CHW WERE PROVIDED ON A PART-TIME VOLUNTARY BASIS. 2. RAMESH SACHDEVA, M.D., CHHS VP AND CHIEF QUALITY OFFICER OF CHHS - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SERVICES PROVIDED (40 HOURS PER WEEK) TO CHHS AND ITS AFFILIATES. THESE AMOUNTS WERE PAID BY CHHS. DR. SACHDEVA IS LISTED AS A FORMER OFFICER OF CHW AS HE PREVIOUSLY SERVED AS VICE PRESIDENT OF QUALITY & OUTCOMES PRIOR TO HIS TRANSFER TO CHHS. 3. TIMOTHY L. BIRKENSTOCK, FORMER TREASURER OF CHW AND FORMER TREASURER & CFO OF CHHS - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID BY CHHS AS SEVERANCE FOR PREVIOUS SERVICES PROVIDED AS TREASURER & CFO OF CHHS. A WI HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710BCS9 2008-07-29 152300000 SEE PART VI 0 0 0 B WI HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710BCC4 2008-06-25 100771610 SEE PART VI 0 0 0 A 152300953 149225000 1000301 2075652 2009 1 0 1 1 B 113903904 100000000 771610 13132293 2009 1 0 1 1 A 0 1 1 1 0 0.00300 0.00100 0.00400 1 0 1 B 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 1 A 0 0 1 0 0 0 0 0 1 B 0 0 1 0 0 0 0 0 1 A 0 B 0 SCHEDULE K SUPPLENTAL INFORMATION CONSIDER THE FOLLOWING FOR PART VI: SCHEDULE K, PART I, LINE A, COLUMN (F): THE SERIES 2008B BONDS WERE ISSUED TO REFUND SEVERAL SERIES OF PRIOR BONDS, INCLUDING: (1) THE ISSUER'S SERIES 2007-3 BONDS (CHILDREN'S HOSPITAL OF WISCONSIN), WHICH WERE ISSUED ON NOVEMBER 20, 2007 TO REFUND A PORTION OF THE ISSUER'S SERIES 1998 BONDS (CHILDREN'S HOSPITAL OF WISCONSIN), WHICH WERE ISSUED ON JUNE 2, 1998. (2) THE ISSUER'S SERIES 2004B BONDS (CHILDREN'S HOSPITAL OF WISCONSIN), WHICH WERE ISSUED ON MAY 6, 2004 TO CONSTRUCT AND EQUIP CERTAIN HEALTH CARE FACILITIES (INCLUDING A MEDICAL OFFICE BUILDING/CHILDREN'S CORPORATE CENTER, PARKING STRUCTURE, TUNNEL, UTILITIES AND A NEW PATIENT TOWER) AND TO PAY COSTS OF ISSUANCE. THE SERIES 2008 BONDS ALSO FUNDED CONSTRUCTION, RENOVATION AND EQUIPPING OF CERTAIN HEALTH CARE FACILITIES (A NEW PATIENT TOWER) AND TO PAY COSTS OF ISSUANCE. SCHEDULE K, PART I, LINE B, COLUMN (F): THE SERIES 2008A BONDS WERE ISSUED TO REFUND THE ISSUER'S SERIES 2007-1 AND SERIES 2007-2 BONDS (CHILDREN'S HOSPITAL OF WISCONSIN), WHICH WERE ISSUED ON NOVEMBER 20, 2007 FOR THE CONSTRUCTION, RENOVATION AND EQUIPPING OF CERTAIN HEALTH CARE FACILITIES (A NEW PATIENT TOWER) AND TO PAY COSTS OF ISSUANCE. SCHEDULE K, PART II, LINE 3, COLUMN (A): THE TOTAL PROCEEDS OF THE ISSUE EXCEED THE ISSUE PRICE DUE TO INVESTMENT PROCEEDS OF $953. SCHEDULE K, PART II, LINE 3, COLUMN (B): THE TOTAL PROCEEDS OF THE ISSUE EXCEED THE ISSUE PRICE DUE TO INVESTMENT PROCEEDS OF $48,153 AND TRANSFERRED PROCEEDS FROM THE SERIES 2007-1 AND SERIES 2007-2 BONDS OF $13,084,140. SCHEDULE K, PART III, COLUMN B, LINE 3A: THE ORGANIZATION HAS DETERMINED BASED ON A LEGAL REVIEW THAT A MANAGEMENT CONTRACT WITH RESPECT TO THE PROPERTY FINANCED BY THE BOND ISSUE LISTED IN COLUMN B DOES NOT RESULT IN PRIVATE BUSINESS USE. SUZAN BUCHAKLIAN KEY EMPLOYEE RECRUITMENT INCENTIVE APPROVED BY SENIOR LEADERSHIP X 10000 10000 0 0 1 10000 JOHNSON CONTROLS INC DIRECTOR (CD MYERS) 464870 MR. MYERS IS VICE PRESIDENT AND PRESIDENT, BUILDING EFFICIENCY AT JOHNSON CONTROLS, INC. THE ORGANIZATION PAID $464,870 TO JOHNSON CONTROLS, INC. IN MAINTENANCE FEES FOR HEATING, VENTILATION, AND AIR CONDITIONING INSTALLATION AND REPAIR. 0 HUMANA DIRECTOR (L RAMBO) 675197 MR. RAMBO WAS THE SENIOR EXECUTIVE FOR STRATEGIC PARTNERSHIIPS OF HUMANA, INC. THE ORGANIZATION PAID HUMANA FOR THIRD PARTY ADMINISTRATOR SERVICES FOR ITS SELF-INSURED HEALTH PLAN IN THE AMOUNT OF $675,197. 0 HUMANA DIRECTOR (L RAMBO) 28861515 MR. RAMBO WAS THE SENIOR EXECUTIVE FOR STRATEGIC PARTNERSHIPS OF HUMANA, INC. THE ORGANIZATION RECEIVED APPROXIMATELY $28,861,515 FROM HUMANA FOR HEALTH CARE SERVICES PROVIDED TO HUMANA ENROLLEES. 0 BAIRD ADVISORS DIRECTOR (T BOLGER) 276606 MR. BOLGER, WHO IS ON THE ORGANIZATION'S BOARD OF DIRECTORS, HAS A FAMILY RELATIONSHIP WITH MARY ELLEN STANEK, THE MANAGING DIRECTOR AND CHIEF INVESTMENT OFFICER FOR BAIRD ADVISORS. THE ORGANIZATION PAID BAIRD ADVISORS $276,606 FOR INVESTMENT SERVICES. 0 WE ENERGIES DIRECTOR (C CULVER) 6354821 MR. CULVER IS ON THE BOARD OF DIRECTORS AT WE ENERGIES. THE ORGANIZATION PAID WE ENERGIES $6,354,821 FOR UTILITIES. 0 UNIVERSITY OF WISCONSIN-MILWAUKEE DIRECTOR (D GILBERT) 165716 MR. GILBERT IS PRESIDENT OF THE UNIVERSITY OF WISCONSIN-MILWAUKEE FOUNDATION, WHICH IS PART OF THE UNIVERSITY OF WISCONSIN-MILWAUKEE SYSTEM. THE ORGANIZATION PAID $165,716 TO THE UNIVERSITY OF WISCONSIN-MILWAUKEE FOUNDATION FOR EDUCATIONAL PROGRAMS. 0 FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS EXIST BETWEEN THE FOLLOWING BOARD MEMBERS: ORR AND PEPKE, DRURY AND SCHLIFSKE, DRURY AND SOMMERHAUSER, DRURY AND BRENNER, DRURY AND SULLIVAN, BRENNER AND SULLIVAN, ROTHMAN AND ABRAHAM, SCHLIFSKE AND SOMMERHAUSER, SCHLIFSKE AND MANSELL, PEPKE AND ALTSCHAEFL, MANSELL AND SOMMERHAUSER, ABRAHAM AND QUADRACCI, HERMA AND SOMMERHAUSER, WITT AND SOMMERHAUSER, KERSCHNER AND BRENNER, KERSCHNER AND CULVER, KERSCHNER AND MELLOWES, AND KERSCHNER AND SULLIVAN. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SOLE CORPORATE MEMBER WHICH IS CHHS. FORM 990, PART VI, SECTION A, LINE 7A CHHS, THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, ELECTS THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE CORPORATE MEMBER, CHHS, HAS CERTAIN RESERVE POWERS OVER THE CORPORATION, INCLUDING AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS; APPROVAL OF MERGER, CONSOLIDATION OR THE CREATION OF ANY SUBSIDIARIES BY THE CORPORATION; APPROVAL OF THE ANNUAL BUDGET AND ANY DEBT; AND SELECTION OF THE PRESIDENT. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE CHHS/CHW BOARD OF DIRECTORS, AND PRIOR TO FILING, A COPY WAS PROVIDED TO ALL DIRECTORS OF CHW. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUESTED TO SUBMIT A CONFLICT OF INTEREST DISCLOSURE TO THE CORPORATE VICE PRESIDENT AND GENERAL COUNSEL OF CHHS. A LIST OF POTENTIAL CONFLICTS IS PREPARED AND IS AVAILABLE AT EACH BOARD AND COMMITTEE MEETING. THE COMPLIANCE DEPARTMENT MONITORS AND PERIODICALLY REVIEWS TRANSACTIONS BETWEEN THE ORGANIZATION AND BOARD MEMBERS OR ENTITIES WITH WHICH THEY ARE AFFILIATED. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S PRESIDENTS, TREASURER, SECRETARY, VP CHIEF MEDICAL OFFICER, AND VP CHIEF NURSING OFFICER WAS REVIEWED AND APPROVED BY THE INDEPENDENT COMPENSATION COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS. WITH THE ASSISTANCE OF AN INDEPENDENT COMPENSATION CONSULTANT AND INFORMATION FROM A VARIETY OF EXTERNAL SOURCES (AS INDICATED ON SCHEDULE J), THE COMMITTEE CONFIRMED THAT TOTAL COMPENSATION AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES WAS SET BY SUPERVISORY EXECUTIVES IN CONSULTATION WITH CHHS HUMAN RESOURCES LEADERS. THE PROCESS INCLUDED REVIEW BY INDEPENDENT PERSONS WHO, USING A VARIETY OF EXTERNAL SOURCES (AS INDICATED ON SCHEDULE J), CONFIRMED THAT TOTAL COMPENSATION AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. THE PROCESS AND DATA RELIED ON WERE THOROUGHLY AND TIMELY DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION OF CHHS ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE CHHS PUBLIC RELATIONS DEPARTMENT. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS 790,221. INCREASE IN BENEF. INTEREST IN NET ASSETS OF CHILDREN'S HOSPITAL FOUNDATION 27,471,082. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 1,573,768. FORM 990, SCHEDULE R, PART V, LINE 1E: PURSUANT TO AN AMENDED AND RESTATED MASTER TRUST INDENTURE DATED MAY 1, 2004, CHILDREN'S HOSPITAL OF WISCONSIN, INC. AND CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION, INC. ARE MEMBERS OF AN OBLIGATED GROUP WHICH JOINTLY AND SEVERALLY GUARANTEE CERTAIN DEBT ISSUED BY A MEMBER OF THE OBLIGATED GROUP THROUGH THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY. PAYMENT OF SCHEDULED PRINCIPAL AND INTEREST IS SECURED BY A PLEDGE OF THE HOSPITAL'S AND FOUNDATION'S GROSS UNRESTRICTED RECEIPTS. 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