2012-05-10T13:23:29-05:00 2011-06-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 INDIANAPOLIS IN 46204 990 2010-07-01 310672132 Children's Medical Center CHIL 9376413338 One Childrens Plaza Dayton OH 454041815 DAVID MILLER 2012-05-04 3176817000 2010 2016-02-24 21:20:13Z DAVID KINSAUL ONE CHILDRENS PLAZA DAYTON OH 454041815 342746321 false X www.childrensdayton.org X 1967 OH TO IMPROVE THE HEALTH STATUS OF ALL CHILDREN THROUGH SERVICE, EDUCATION, RESEARCH AND ADVOCACY. 19 12 1888 1096 96296 95296 19295153 10540270 181426163 194695740 -5572645 8188402 2443284 2687349 197591955 216111761 102429 100525 0 0 96856215 101995746 0 0 1008282 75063253 74336688 172021897 176432959 25570058 39678802 340268641 410865595 49322357 38047015 290946284 372818580 X TO IMPROVE THE HEALTH STATUS OF ALL CHILDREN THROUGH SERVICE, EDUCATION, RESEARCH AND ADVOCACY. false false 164183070 100525 194695740 SEE SCHEDULE O. 164183070 true true false true false false false false true true false false false true true false true false true true false false false true false true true false true true false false false false false false true true true false false false false true true true false false true 96 1 true 1888 true true true true BD false false false true true false false false false X 19 12 false false false false false false false true true false false true true true true true true true true true true OH X X DAVID T MILLER 9376413338 ONE CHILDRENS PLAZA DAYTON OH 454041815 X JEFFERY S ADAM MD 1.0 X 20000 0 0 JEFFREY CHRISTIAN MD 1.0 X 0 487084 52617 JEAN IRELAND 1.0 X 0 0 0 ROBERT E JOHNSON 1.0 X 0 0 0 ROBERT P MYERS DO 1.0 X 16352 0 0 TIMOTHY G PEPPER 1.0 X 0 0 0 ARTHUR PICKOFF 1.0 X 107276 0 0 COLLEEN RYAN 1.0 X 0 0 0 GREGORY SAMPLE 1.0 X 0 0 0 BEVERLY SHILLITO 1.0 X 0 0 0 EMILY CHAMBERS 1.0 X 0 0 0 ELIZABETH H EY MD 1.0 X 126875 0 0 JARED M BARNETT 1.0 X X 0 0 0 CHARLES M FOLEY 1.0 X X 912 0 0 LAURENCE KLABEN 1.0 X X 0 0 0 NEIL A MCLACHLAN 1.0 X X 0 0 0 VISHAL SOIN 1.0 X X 755 0 0 MARLA VICHICH 1.0 X X 0 0 0 DEBBIE WATTS ROBINSON 1.0 X X 0 0 0 DAVID KINSAUL 40.0 X X 572819 0 322770 THOMAS MURPHY MD 40.0 X X 315306 0 231541 DAVID T MILLER 40.0 X 289783 0 48509 RENAE PHILLIPS 40.0 X 224888 0 40847 GREGORY RAMEY 40.0 X 217898 0 97916 VICKI GIAMBRONE 40.0 X 215926 0 35946 LISA COFFEY 40.0 X 171612 0 38291 MATTHEW GRAYBILL 40.0 X 215998 0 64697 MARGARET HEMMEN 40.0 X 178861 0 12714 GREGORY HUFF 40.0 X 156256 0 34159 DUKE HADDAD JR 40.0 X 142330 0 18111 ELIZABETH FREDETTE 40.0 X 141034 0 32732 3114881 487084 1030850 45 false true true CHILDREN'S CARE GROUP 1 CHILDRENS PLAZA DAYTON OH 45404 PHYSICIAN SERVICES 9028848 WRIGHT STATE PHYSICIANS PO BOX 1144 DAYTON OH 45401 PHYSICIAN SERVICES 1658485 DAYTON CHILDREN'S CARDIOLOGY 1 CHILDRENS PLAZA DAYTON OH 45404 PHYSICIAN SERVICES 1649485 WRIGHT STATE UNIVERSITY PO BOX 927 DAYTON OH 45401 PHYSICIAN SERVICES 1042757 ORTHOPAEDIC CENTER FOR SPINAL PED 1 CHILDRENS PLAZA DAYTON OH 45404 PHYSICIAN SERVICES 438435 14 31956 49780 823021 9635513 391493 10540270 PATIENT SERVICES REVENUE 900099 121040854 121040854 MEDICARE/MEDICAID 900099 73558590 73558590 URGENT CARE CENTER 621400 121153 121153 SURGERY CENTER 621400 -24857 -24857 194695740 5697771 5697771 0 0 357648 737953 -380305 -380305 -380305 127721560 98737 125175032 154634 2546528 -55897 2490631 2490631 672704 49780 154272 518432 518432 0 635848 412669 223179 223179 CAFETERIA/KIDS CARE 722210 1308518 1308518 PARKING LOT 624410 307861 307861 DAY CARE CENTER 812930 709664 709664 2326043 216111761 197148666 96296 8326529 0 100525 100525 0 0 2858537 2858537 0 75519954 71357563 3583448 578943 5993108 5662789 284375 45944 11896429 11340354 464067 92008 5727718 5412027 271782 43909 0 235574 235574 240895 240895 170243 170243 0 0 14345910 14092869 253033 8 695000 695000 28525487 27527348 848319 149820 3557092 3557092 0 2617757 2511239 97292 9226 631886 481100 127925 22861 0 89224 89224 0 0 14698898 14170708 475160 53030 355523 355523 PURCHASED SERVICES 6035129 4582903 1439693 12533 STATE HOSPITAL ASSESSMENT 2076563 2076563 MISCELLANEOUS 61507 61507 176432959 164183070 11241607 1008282 14610 14910 12773925 29801992 2165460 1738641 21512557 22926911 177608 98419 1294743 1474060 606832 787044 182150194 79717366 105259704 102432828 189896424 238360447 2078733 2071712 4488045 11158631 340268641 410865595 26376084 28833376 1415 1415 22944858 9212224 49322357 38047015 X 290084813 371563718 861471 1254862 290946284 372818580 340268641 410865595 X 39678802 42193494 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false true 150 false true 143165 true 12454 true 27868 false 183637 SCHEDULE C SUPPLEMENTAL INFORMATION SCHEDULE C, PART II-B OHA - OHIO HOSPITAL ASSOCIATION DUES: 51,244 % ALLOC. TO LOBBYING: 5.00% LOBBYING EXPENSE: 2,562 OCHA - OHIO CHILDREN'S HOSPITAL ASSOCIATION DUES: 160,426 % ALLOC. TO LOBBYING: 85.00% LOBBYING EXPENSE: 136,362 NACH DUES: 22,429 % ALLOC, TO LOBBYING: 7.92% LOBBYING EXPENSE: 1,776 NACHRI - NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED ORGANIZATIONS DUES: 45,539 % ALLOC. TO LOBBYING: 0.00% LOBBYING EXPENSE: 0 NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS DUES: 21,772 % ALLOC. TO LOBBYING: 11.32% LOBBYING EXPENSE: 2,465 CONSULTING EXPENSES LOBBYING EXPENSE: 26,628 PRINTING & SUPPLIES LOBBYING EXPENSE: 450 MANAGEMENT TIME LOBBYING EXPENSE: 13,394 TOTAL LINE 1J: 183,637 97132791 7689808 22325672 3402441 4113 0 123741717 71668979 19617386 8980654 2900616 233612 0 97132791 87947632 1194204 -14186547 3254832 31478 0 71668979 1.00000 0.00000 0.00000 false true true 3489979 3489979 49130270 19207579 29922691 0 0 0 125275596 59146431 66129165 4254349 1363356 2890993 102432828 0 RESERVE FOR PROFESSIONAL LIABILITY 4558551 DEFERRED COMPENSATION PAYABLE 1652158 SERP PENSION ACCRUAL 3001515 9212224 SUPPLEMENTAL INFORMATION Part V, Line 4 The endowments are held by the Children's Medical Center Foundation, a subsidiary of Children's Medical Center. The funds are used exclusively to support Children's Medical Center and its subsidiaries. The intended use of the funds is to support medical research, the child life program and the medical chairs of specific hospital departments. PART X, ASC 740-10(F/K/A FIN48) FOOTNOTE THE MEDICAL CENTER COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE, AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30. 2011 OR 2010. false Central America and the Caribbean 1 2 Program Services SELF-INSURANCE 499941 1 2 1 2 499941 499941 true false true false false false SCHEDULE F SUPPLEMENTAL INFORMATION THE TOTAL EXPENDITURES WERE DETERMINED BASED ON THE ACCRUAL ACCOUNTING METHODOLOGY. CHA-CHA DINNER 400700 29100 371600 3827 27033 1300 28365 GOLF OUTING 155628 9700 145928 13519 26945 1 166156 10980 155176 5000 25649 1000 21634 722484 49780 672704 8827 66201 2300 76944 154272 518432 true true X true X true X true true true false true true 366886 85697 281189 0.00160 85578526 70401548 15176978 0.08600 0 0 0 0.00000 85945412 70487245 15458167 0.08760 419980 0 419980 0.00240 4410581 2970008 1440573 0.00820 14360466 5628217 8732249 0.04950 0 0 0 0.00000 103730 0 103730 0.00060 19294757 8598225 10696532 0.06070 105240169 79085470 26154699 0.14830 0 0 0 0.00000 7518 0 7518 0 0 0 0.00000 0 0 0 0.00000 2418 0 2418 1301 0 1301 21456 0 21456 0.00120 19770 0 19770 0.00010 0 0 0 0.00000 52463 0 52463 0.00130 false 2585250 700182 659618 659618 X true true 1 1 CHILDRENS MEDICAL CENTER

ONE CHILDRENS PLAZA DAYTON OH 454041815

X X X X X CHILDRENS MEDICAL CENTER 1 6 SPRINGBORO URGENT CARE CENTER

3333 WEST TECH ROAD MIAMISBURG OH 45342

URGENT CARE CENTER SPRINGBORO OUTPATIENT CARE CENTER

3333 WEST TECH ROAD MIAMISBURG OH 45342

OUTPATIENT CARE CENTER DIAGNOSTIC CENTER BEAVERCREEK OUTPATIENT TESTING CENTER

3224 DAYTON-XENIA ROAD BEAVERCREEK OH 45431

OUTPATIENT CARE CENTER DIAGNOSTIC CENTER KETTERING OUTPATIENT TESTING CENTER

4475 FAR HILLS AVENUE KETTERING OH 45429

OUTPATIENT CARE CENTER DIAGNOSTIC CENTER VANDALIA OUTPATIENT TESTING CENTER

810 FALLS CREEK DRIVE SUITE A VANDALIA OH 45377

OUTPATIENT CARE CENTER DIAGNOSTIC CENTER WARREN COUNTY SPECIALTY CARE CENTER

100 CAMPUS LOOP ROAD SUITE A FRANKLIN OH 45005

OUTPATIENT CARE CENTER Schedule H Part VI PART I, LINE 7G DAYTON CHILDREN'S DID INCLUDE $14,360,466 OF PHYSICIAN CLINIC COSTS IN THE SUBSIDIZED HEALTH SERVICES CATEGORY. PART I. LINE 7 THE FOLLOWING COSTING METHODOLOGIES WERE USED IN PREPARATION OF SCHEDULE H PART I, LINE 7: -CHARITY CARE AT COST WAS CALCULATED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT COST-TO-CHARGES. -UNREIMBURSED MEDICAID WAS CALCULATED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT COST-TO-CHARGES. -COMMUNITY HEALTH IMPROVEMENT SERVICES WERE VALUED AT THE ACTUAL CASH COSTS, INCLUDING DIRECTLY ASSIGNABLE PAYROLL COSTS, RELATED TO THESE ACTIVITIES. NO OVERHEAD ALLOCATION WAS CHARGED TO ANY AMOUNT INCLUDED IN THIS COMPUTATION. -HEALTH PROFESSIONS EDUCATION COSTS WERE DETERMINED USING THE FACILITY'S MEDICARE COST REPORTED, SUPPLEMENTED BY THE ACTUAL CASH COSTS, INCLUDING DIRECTLY ASSIGNABLE PAYROLL COSTS, RELATED TO THESE ACTIVITIES. -SUBSIDIZED HEALTH SERVICES COSTS WERE DETERMINED USING THE FACILITY'S INTERNAL COST ACCOUNTING SYSTEM. THE COST OF THESE SERVICES INCLUDES DIRECT COSTS ATTRIBUTABLE TO HEALTH SERVICES OPERATIONS, TOGETHER WITH AN ALLOCATION OF FACILITY DIRECT AND INDIRECT OVERHEAD USING A COST FINDING METHODOLOGY PATTERNED AFTER THE MEDICARE COST REPORT. -CASH AND IN KIND CONTRIBUTIONS WERE VALUED AT THE ACTUAL CASH COSTS, INCLUDING DIRECTLY ASSIGNABLE PAYROLL COSTS, RELATED TO THESE ACTIVITIES. NO OVERHEAD ALLOCATION WAS CHARGED TO ANY AMOUNT INCLUDED IN THIS COMPUTATION. PART III, LINE 4: THE COSTING METHODOLOGY USED IN PREPARATION OF BAD DEBT ATIRIBUTABLE TO PATIENT ACCOUNTS IS THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2, RATIO OF PATIENT COST-TO-CHARGE. THE CHILDREN'S MEDICAL CENTER'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE DISCUSSING BAD DEBT EXPENSE. A PROVISION FOR BAD DEBT EXPENSE IS SHOWN ON THE PROFIT AND LOSS STATEMENT. THE CALCULATION OF BAD DEBT EXPENSE IS IN CONFORMITY WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES REQUIRING MANAGEMENT TO MAKE ESTIMATES AND ASSUMPTIONS BASED ON HISTORICAL DATA THAT AFFECT THE REPORTED AMOUNTS OF REVENUE AND EXPENSES DURING THE REPORTED PERIOD. LIKEWISE, AN ALLOWANCE FOR BAD DEBT IS SHOWN ON THE BALANCE SHEET UNDER THE SAME PRINCIPLE AFFECTING THE REPORTED AMOUNTS OF ASSETS AND LIABILITIES DURING THE REPORTED PERIOD. PART III, LINE 8: THE COSTS REPORTED FOR SERVICES PROVIDED TO MEDICARE PATIENTS COME FROM SCHEDULE E OF THE FACILITY'S COST REPORT AS FILED. SINCE DAYTON CHILDREN'S IS REIMBURSED FOR MEDICARE SERVICES UNDER A TEFRA METHODOLOGY, THERE IS NORMALLY NO SHORTFALL, AS ALLOWED COSTS AND PAYMENTS DUE ARE EQUAL. PART III, LINE 9B: THE HOSPITAL'S POLICIES ON BILLING AND COLLECTIONS ARE POSTED ON OUR WEBSITE UNDER THE "FINANCIAL MATTERS" TAB IT IS THE HOSPITAL'S POLICY TO PUBLICIZE THE AVAILABILITY OF FREE CARE, GOVERNMENT AND OTHER FINANCIAL ASSISTANCE PROGRAMS UP FRONT BEFORE SERVICES ARE PROVIDED THROUGH MEANS SUCH AS ONSITE FINANCIAL COUNSELORS AND BROCHURES PROVIDED IN THE REGISTRATION AREAS, AND THE WEBSITE. EACH OF THESE AVENUES OF COMMUNICATION INCLUDES DETAILED INSTRUCTIONS ON HOW PATIENTS AND FAMILIES MAY APPLY FOR ASSISTANCE. THE HOSPITAL'S POLICIES ON BILLING AND COLLECTIONS SPECIFY WHEN COLLECTION ACTION MAY BE TAKEN AND MAKES IT CLEAR THAT THESE MEASURES WILL ONLY OCCUR AFTER DAYTON CHILDREN'S HAS MADE REASONABLE EFFORTS TO CONTACT A FAMILY ABOUT ITS BILL AND THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAMS. THESE PRACTICES APPLY TO ALL PATIENTS IN GENERAL, NOT ONLY PATIENTS WHO MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE. IN ADDITION, PATIENTS ARE INFORMED OF THE AVAILABILTY OF FINANCIAL ASSISTANCE PROGRAMS THROUGH SIGNS DISPLAYED IN REGISTRATION AREAS AND THROUGH MESSAGES APPEARING ON BILLING STATEMENTS MAILED BY THE HOSPITAL. FINALLY, THE HOSPITAL EMPLOYS ON SITE FINANCIAL COUNSELORS, WHO CONTACT PATIENTS WITHOUT COVERAGE TO DISCUSS THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS VIA PHONE OR THROUGH FACE TO FACE INTERVIEWS. THESE FINANCIAL COUNSELORS WILL ASSIST FAMILIES IN APPLYING FOR FINANCIAL ASSISTANCE PROGRAMS IF DESIRED. PART V: DAYTON CHILDREN'S HAS 7 HEALTH CARE FACILITIES OTHER THAN THOSE REQUIRED TO BE LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED AS A HEALTH CARE FACILITY UNDER STATE LAW. WE HAVE 4 TESTING CENTERS, 2 OFFSITE CLINICS, AND 1 URGENT CARE CENTER(50% OWNED). #2. Needs Assessment Describe how the organization assesses the health care needs of the communities it serves. Improving the health status of children is a key component of The Children's Medical Center of Dayton's mission. To help develop meaningful strategies in this area, Dayton Children's evaluates the status of our region's pediatric health through a regional pediatric health assessment conducted every three years. The first assessment was conducted in 2002, the second in 2005, third in 2008. Our fourth and current assessment was completed in March 2011. We worked with Schwartz Consulting Partners and community health advocates including the Wright State School of Medicine, CareSource, ReadySetSoar and Public Health Dayton & Montgomery County to develop the questionnaire. The survey was administered online through telephone. Note: Previous waves of the assessment have been conducted exclusively using random telephone interviewing. However in recent years the proportion of families who rely exclusively on mobile phones has increased dramatically, leading to declines in telephone survey responses, especially among parents of young children. This has led health and epidemiological organizations such as the National Center for Health Statistics to recommend mixed online and telephone sampling methods. The combination of online and telephone sampling methods coupled with demographic weighting allowed this study to come within one or two percentage points of the most recent census figures for key demographic statistics for the Miami Valley area (based on 2009 U.S. Census results for 13 counties served by Dayton Children's ). The hospital uses the insight from the assessment to learn more about the health status of the region's children, to determine a course of action to meet their needs and improve children's quality of life and give children a voice regarding their health and safety. Our 2011 study reveals three areas requiring greater attention: 1. Managing colds and flu 2. Dealing with diet and nutrition/Childhood obesity, and 3. Preventing Injuries and improving safety. These areas suggest a focus for the region's pediatric health agenda for the coming years, particularly in areas where we are able to prevent the preventable. These findings are used to plan much of our community health and outreach programming. Because the survey is very robust and one of the few assessments that directly addresses children's health needs and parent perceptions in our community, Dayton Children's shares the data with community leaders and potential partners so that additional programming can be developed throughout our region. The assessment is intended to provide community health advocates with a guide to the health issues impacting the region's children and suggest some areas of focus for future programming and education beyond the walls of Dayton Children's. Dayton Children's also works with partners such as local health departments and child-serving organizations to gain additional information regarding these needs to create comprehensive action plans. Using data from the Regional Pediatric Health Assessment, our injury database, input from our pediatric experts, other local and national studies, Dayton Children's sets a robust agenda of injury prevention, health promotion and advocacy to address the health care needs facing our region's children. #4: Community information: Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves The Children's Medical Center of Dayton (Dayton Children's) is located in Old North Dayton, northeast of downtown Dayton and the urban core, in Montgomery County in southwestern Ohio. The hospital's roots can be traced back to 1919, when philanthropist and activist Anna Barney Gorman planned a North Dayton community center to offer health services, education and recreation. The Barney Community Center later developed into the Barney Convalescent Hospital, which cared for polio victims. In 1967 a full-service children's hospital, The Barney Children's Medical Center, opened, and in 1970 the name was changed to The Children's Medical Center of Dayton. Dayton Children's now serves 20 Ohio counties, including the primary (Clark, Greene, Miami and Montgomery counties), the northern (Allen, Auglaize and Shelby counties), and the southern (parts of Butler and Warren counties) service areas and our secondary service area including Preble, Darke, Mercer, Van Wert, Clinton, Madison, Hancock, Hardin, Logan, Fayette, Champaign and Wayne County, Indiana. Our service area spans 9,000 squ false TRANSPORTATION 597 25937 MEALS/FOOD 251 13141 RENT/UTILITIES 21 13919 PHARMACY 241 36835 SPECIAL EQUIPMENT 9 4639 OTHER 56 6054 X X true true X X X X X true true false false false false false false false JEFFREY CHRISTIAN MD 0 464199 0 0 0 22885 0 30094 0 22523 0 539701 0 0 ARTHUR PICKOFF 107276 0 0 0 0 0 0 0 0 0 107276 0 0 0 ELIZABETH H EY MD 126875 0 0 0 0 0 0 0 0 0 126875 0 0 0 DAVID KINSAUL 381340 0 140953 0 50526 0 303602 0 19168 0 895589 0 0 0 THOMAS MURPHY MD 216317 0 46529 0 52460 0 213933 0 17608 0 546847 0 0 0 DAVID T MILLER 196787 0 44227 0 48769 0 29292 0 19217 0 338292 0 0 0 RENAE PHILLIPS 183432 0 35329 0 6127 0 21664 0 19183 0 265735 0 0 0 GREGORY RAMEY 146817 0 39899 0 31182 0 74398 0 23518 0 315814 0 0 0 VICKI GIAMBRONE 141902 0 33211 0 40813 0 25709 0 10237 0 251872 0 0 0 LISA COFFEY 136795 0 27250 0 7567 0 18690 0 19601 0 209903 0 0 0 MATTHEW GRAYBILL 172655 0 33266 0 10077 0 42618 0 22079 0 280695 0 0 0 MARGARET HEMMEN 177289 0 0 0 1572 0 12410 0 304 0 191575 0 0 0 GREGORY HUFF 141042 0 5470 0 9744 0 10950 0 23209 0 190415 0 0 0 DUKE HADDAD JR 39739 0 0 0 102591 0 10066 0 8045 0 160441 0 0 0 ELIZABETH FREDETTE 124378 0 5638 0 11018 0 10187 0 22545 0 173766 0 0 0 SUPPLEMENTAL INFORMATION PART I, LINE 1A DAVID KINSAUL ($2,563), GREG RAMEY ($790), DAVID MILLER ($755), AND THOMAS MURPHY ($283) DID RECEIVE SPOUSE TRAVEL BENEFITS AND THEY WERE TAXED ON THIS BENEFIT. DAVID KINSAUL ($1,764) AND DAVID MILLER ($1,596) DID RECEIVE SOCIAL CLUB BENEFITS. THEY WERE NOT TAXED ON THESE BENEFITS AS THE MEMBERSHIP IS FOR BUSINESS. PART I, QUESTION 4A DUKE HADDAD JR. RECEIVED A SEVERANCE PAYMENT OF 76,502. PART I, QUESTION 4B PARTICIPANTS IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND THE INCREASE IN ACTUARIAL VALUE: DAVID KINSAUL $264,829 DAVID MILLER $ 9,395 THOMAS MURPHY $166,565 GREGORY RAMEY $ 22,681 VICKI GIAMBRONE $ 9,034 MATHEW GRAYBILL $ 11,622 RENAE PHILLIPS $ 1,645 LIAS COFFEY $ 6,417 CARRELL PICKOFF SPOUSE OF TRUSTEE 11976 EMPLOYMENT false SOUTHWEST OHIO ENT SPECIALISTS BUSINESS OF TRUSTEE 131346 PHYSICIAN SERVICES false X 6 391493 SELLING PRICE false true true SUPPLEMENTAL INFORMATION ALL STOCK DONATIONS ARE TRANSFERRED TO EITHER MORGAN STANLEY/SMITH BARNEY OR CHILDREN'S MEDICAL CENTER KEY BANK TRUST ACCOUNT TO SELL STOCK. MORGAN STANLEY/SMITH BARNEY SENDS CHECK FOR CASH RECEIVED TO CHILDREN'S. KEY BANK DIRECTLY DEPOSITS PROCEEDS INTO CHILDREN'S CHECKING ACCOUNT. SUPPLEMENTAL INFORMATION FORM 990, PART III, LINE 4A The Children's Medical Center is a pediatric hospital located in downtown Dayton, Ohio. The Medical Center and its staff are committed to serving as an advocate for the children and their families in the Miami Valley through a variety of different programs. It offers inpatient, outpatient and ancilliary services to the children in the surrounding 20 counties. Services are provided to patients without regard to their ability to pay. For the fiscal year ending June 30, 2011, the hospital's mix of patients was 51.7% Medicaid, 41.9% Commercial, 5.5% Other Government Programs and .9% Self Pay. The hospital provides a Level III neonatal nursery for premature newborns as well as critical care and general pediatric inpatient beds. A 24 hour emergency department is available to all children in the area. Some of the specialities offered at the hospital are neurosurgery, hematology/oncology, pulmonary, gastroenterology, neurology, developmental disorders, psychology, endocrinology, genetics, cardiology, and general surgery. Without Children's Medical Center, many children in the area would have to travel a good distance to receive these services. The Medical Center also offers a Pediatric Residency Program that trains new pediatricians who will care for the next generation of children. Children's also sponsors many community events where children's health and safety are promoted. Some statistics for the fiscal year ending June 30, 2011 are as follows: # of beds: 155, Inpatient days: 29,622, Admissions: 6,744, Average length of stay: 4.43 days. Average daily census: 81 Occupancy rate: 52%, Surgeries performed: 12,013, X-Ray studies: 66,319, Lab Test: 838,090, Respiratory therapy procedures: 173,447, Pharmacy doses dispensed: 3,434,353 cardiology procedures: 35,836 Neurology procedures: 3,492, Urgent care visits: 15,158, Emergency department visits: 68,380, Outpatient clinics: 73,340. Form 990, Part VI, Lines 11a The CFO reviews key disclosures with appropriate committees of the Board of Trustees. Then prior to filing, the Form 990 is electronically loaded to a secure website for the entire Board of Trustees to review. An email is sent to all members notifying them that the form is available for their review and that it will be filed on or before 05/15/12. Form 990, Part VI, Line 12c - Monitoring conflict of interest At the beginning of each meeting, the chairman of the board asks each member to identify and disclose any potential conflicts of interest based on the agenda or any changes in their business practice that might be relevant. If there are any conflicts, the member(s) recuse themselves and do not participate in the discussion and do not vote on the item. This then is noted in the minutes of that meeting. Board members annually agree to abide by written conflict of interest and confidentiality policies. Board members also work to represent and balance the interests of Children's Medical Center's many constituents. The board annually evaluates its own performance. Form 990, Part VI, line 15a & 15b Compensation for the hospital's Chief Executive Officer (CEO) is set by an Executive Compensation Committee (the Committee) made up of three independent trustees who are also officers of the Board. This Committee also approves compensation levels, incentive plan payouts and executive benefits for each executive employed by the hospital. The Committee operates under a formal charter and keeps contemporaneous minutes of its proceedings. The Committee uses a total compensation philosophy to guide all decisions related to executive compensation at Dayton Children's Medical Center (DCMC), and as such determines and approves all aspects of the CEO's total compensation package, including benefits and expense allowances. These are detailed in a written employment agreement for the CEO. The Committee uses an outside consultant to conduct periodic reviews of the executive compensation levels of the organization versus those of similarly sized and situated organizations using published surveys. These survey results are used by the Committee in setting executive levels and the CEO's compensation in particular. The Committee follows a formal calendar of meetings and the chairman of the Committee reports to the Board of Trustees at least annually on the Committee's activities and on details of the CEO's compensation and benefits package. The Committee also reviews and approves disclosures related to executive compensation made as part of IRS Form 990. Part VI, line 19 - availability of financial statements, conflict of interest, organizing documents Children's Medical Center's conflict of interest policy is made available on our website. The financial statements and the organizing documents are made available as required by the extent of the law. Form 990, Part VII - Jeffery Adam MD is compensated by Children's Medical Center to perform the services of Medical Director for our Ears, Nose and Throat Clinic. - Jeffrey Christian MD works 40 hours per week for the subsidiary, Children's Care Group. -Robert Myers MD is compensated by Childrens Medical Center to perform services as the Chairman of the Professional Staff. - Arthur Pickoff MD is employed by Wright State University. Children's Medical Center contracts with Wright State University for Dr. Pickoff to provide services at Children's Medical Center as the Chairman of the Department of Pediatrics. -Elizabeth Ey MD is employed by Dayton Pediatric Imaging. Childrens Medical Center contracts with Dayton Pediatric Imaging for Dr. Ey to provide services at Childrens Medical Center as the Medical Director of Radiology. Schedule R, Part II, Column B Children's Homecare of Dayton - to provide pediatric healthcare in the home. Children's Medical Center Foundation - to accumulate funds to benefit for and to assist in its charitable missions. Form 990 Part XI Total Adjustment Unrealized gain on investment - 28,256,191 Transfer to Children's Medical Center Foundation - (6,491,983) Net assets released from restrictions used for purchase of property & equipment - 956,889 Net assets released from restrictions -temporarily restricted net assets - (3,068,254) Change in pension benefit obligation and plan assets - 22,540,651 ------------ Total 42,193,494 ------------ CHILDREN'S HOMECARE OF DAYTON ONE CHILDRENS PLAZA DAYTON OH 45404 311356037 SEE SCH O OH 501(C)(3) 9 NA CHILDREN'S MEDICAL CENTER FOUNDATION ONE CHILDRENS PLAZA DAYTON OH 45404 311045247 SEE SCH O OH 501(C)(3) 11a NA AMCH COMPANY LLC 935 STATE RT 28 MILFORD OH 45150 311610708 URGENT CARE CTR OH NA UNRELATED 123163 0 false 0 false 0.50000 MIDDLETOWN SURGERY CENTER LLC 5950 INNOVATION DRIVE FRANKLIN OH 45005 205160579 SURGERY CENTER OH NA UNRELATED -24857 784084 false 0 false 0.10000 CHILDREN'S CARE GROUP ONE CHILDRENS PLAZA DAYTON OH 45404 311411364 SPEC PHYS GROUP OH NA C-CORP 11607910 6388937 1.00000 CHILDREN'S ANESTHESIA GROUP ONE CHILDRENS PLAZA DAYTON OH 45404 260887231 ANESTHESIA SVCS OH NA C-CORP 3746836 2140953 1.00000 PEDIATRIC ASSURANCE COMPANY LTD BUTTERFIELD BANK BLDG 6TH FLOOR HAMILTON BERMUDA BD HM12 980478183 SELF-INSURANCE BD NA N/A 1303977 36846146 1.00000 false true true false false false false false false false true true false true false true true true CHILDRENS MEDICAL CENTER FOUNDATION B 6491984 CHILDRENS MEDICAL CENTER FOUNDATION C 3424899 CHILDRENS HOME CARE OF DAYTON L 421079 CHILDRENS MEDICAL CENTER FOUNDATION K 72905 CHILDRENS CARE GROUP L 8852728 CHILDRENS CARE GROUP N 118044 CHILDRENS CARE GROUP P 2524897 CHILDRENS HOME CARE OF DAYTON P 7434382 CHILDRENS CARE GROUP Q 1067600 CHILDRENS HOME CARE OF DAYTON Q 166614 CHILDRENS HOME CARE OF DAYTON R 500000