2012-11-13T16:47:38-06:00 2011-12-31 391214345 KOLBCO SC 13400 BISHOPS LANE SUITE 300 BROOKFIELD WI 53005 990 2011-01-01 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 2012-11-08 1 BRYAN L PAUTSCH P00034913 2627549400 2012-11-13 2011 2016-02-24 21:20:13Z CINDY CHRISTENSEN 9000 W WISCONSIN AVE PO BOX 1997 NO MS 90 MILWAUKEE WI 53201 693302938 0 X WWW.CHW.ORG X 1894 WI PEDIATRIC HEALTH CARE SERVICES 24 18 3653 334 150942 -58189 19245594 22263687 524038329 537023949 8315179 10609400 7847097 8803401 559446199 578700437 495578 14355877 0 0 212227531 205262259 0 0 0 305533639 293217191 518256748 512835327 41189451 65865110 1153583040 1217648841 403541346 467244057 750041694 750404784 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 THE 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 - SHARING WHAT WE LEARN AND TEACHING OTHERS TO CARE FOR KIDS 0 0 416941430 882584 537023949 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 2011, 23,963 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 2011, 1,202 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 60,718 VISITS TO THE EMERGENCY DEPARTMENT IN 2011. 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 2011, THERE WERE A TOTAL OF 325,806 OUTPATIENT VISITS.RESEARCH, EDUCATION AND COMMUNITY OUTREACH:THE HOSPITAL IS INVOLVED IN EXTENSIVE RESEARCH, EDUCATION AND COMMUNITY OUTREACH PROGRAMS.RESEARCH: THE HOSPITAL AND 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 OUT TO 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). 416941430 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 626 0 3653 1 1 1 0 0 0 0 0 0 0 0 0 X 24 18 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X MR JASON PELSIS 4142665997 9000 W WISCONSIN AVE MILWAUKEE WI 53201 WILLIAM J ABRAHAM JR 1.00 X 0 0 0 MICHAEL W ALTSCHAEFL 1.00 X 0 0 0 THOMAS M BOLGER 1.00 X 0 0 0 ELIZABETH BRENNER 1.00 X 0 0 0 CURT S CULVER 1.00 X 0 0 0 DAVID J DRURY 1.00 X X 0 0 0 DAVID H GILBERT 1.00 X 0 0 0 SUSAN HERMA 1.00 X 0 0 0 MARK R HOGAN 1.00 X 0 0 0 PAUL W JONES 1.00 X 0 0 0 JOSEPH KERSCHNER MD 1.00 X 0 0 0 KEVIN MANSELL 1.00 X 0 0 0 C DAVID MYERS 1.00 X 0 0 0 ALBERT S ORR III 1.00 X 0 0 0 MICHAEL T PEPKE 1.00 X 0 0 0 J JOEL QUADRACCI 1.00 X 0 0 0 LARRY A RAMBO 1.00 X 0 0 0 JAY O ROTHMAN 1.00 X 0 0 0 JOHN E SCHLIFSKE 1.00 X 0 0 0 JOHN S SHIELY 1.00 X 0 0 0 PETER M SOMMERHAUSER 1.00 X X 0 0 0 OWEN J SULLIVAN 1.00 X 0 0 0 TIMOTHY W SULLIVAN 1.00 X 0 0 0 PAUL SWEENEY 1.00 X 0 0 0 MARK C WITT 1.00 X 0 0 0 MARGARET TROY 40.00 X X 0 1179464 273322 TIMOTHY L BIRKENSTOCK 40.00 X 0 758474 35788 MARC CADIEUX 40.00 X 0 249193 22555 CINTHIA S CHRISTENSEN 40.00 X 657222 0 86773 LEE ANNE EDDY 40.00 X 238468 0 5064 MICHAEL GUTZEIT MD 40.00 X 495334 0 77463 BARBARA JOERS 40.00 X 225609 0 26848 JULIET KERSTEN 40.00 X 170402 60533 40442 NANCY KOROM 40.00 X 401490 0 71110 SHEILA REYNOLDS 40.00 X 0 386500 71192 MARK SHIP 40.00 X 291787 0 33857 DONNA JAMIESON 40.00 X 171010 0 42773 TOM LAUSTEN 40.00 X 159097 0 35201 LORI BARBEAU DDS 40.00 X 260987 0 42867 ANDREW SCHMITT MD 40.00 X 243629 0 31034 SHANE FISHER DDS 40.00 X 226064 0 15773 THOMAS NICHOLS MD 40.00 X 213821 0 35026 A CHARLES POST DDS 40.00 X 204950 0 31085 RAMESH SACHDEVA MD 40.00 X 0 405469 67050 JON E VICE 0.00 X 0 261357 0 3959870 3300990 1045223 115 1 1 0 MEDICAL COLLEGE OF WISCONSIN INC 8701 WATERTOWN PLANK RD MILWAUKEE WI 53226 HEALTHCARE PROF/ ACAD/ADMIN 24910796 MEDICAL COLLEGE OF WI AFFILATED 8701 WATERTOWN PLANK RD MILWAUKEE WI 53226 RESIDENT SERVICES 10201534 BLOOD CENTER OF SE WISCONSIN INC 638 N 18TH ST MILWAUKEE WI 532332121 BLOOD PRODUCTS/LAB SERVICES 9884210 THEDA CARE INC 122 E COLLEGE AVE APPLETON WI 549128025 ANCILLARY HEALTH SERVICES 4150310 MIL REG MED CTR - FLIGHT FOR LIFE MILW 2661 AVIATION RD WAUKESHA WI 53188 AIR TRANSPORT SRVCS 1935530 33 4826255 16188715 1248717 22263687 NET PATIENT SVC REV 621990 529589121 529589121 RENTAL INCOME 531120 5310772 1068352 4242420 SHARED SERVICES 541900 2124056 2124056 537023949 10301984 10301984 114844187 65730 113621271 981230 1222916 -915500 307416 307416 CAFETERIA 722210 2496478 2496478 REBATES AND DISCOUNTS 900099 1414198 1414198 PHARMACY SALES TO EMPL 446110 1398172 1398172 3494553 2692651 150942 650960 8803401 578700437 536888378 150942 19397430 14355877 14355877 4527406 4527406 153228960 129949600 23279360 7226772 6132253 1094519 28508460 23837300 4671160 11770661 9810768 1959893 54733631 968186 53765445 419159 419159 26422010 26422010 28538 28538 4057138 2385724 1671414 844961 844961 19427084 18793772 633312 608367 286649 321718 162676 43011 119665 14545935 14545935 36760011 36760011 1509282 26071 1483211 MEDICAL SUPPLIES 55978187 55978187 PURCHASED SERVICES 35528953 35499652 29301 HOSPITAL ASSESSMENT TAX 13289760 13289760 RESIDENT STIPENDS AND B 10029413 10029413 18872086 16953752 1918334 512835327 416941430 95893897 0 14715003 25844365 2635976 2723265 58844806 72520526 555000 542960 3260083 3821990 5344745 5146262 657874552 241016945 404839535 416857607 281227397 302582557 382160495 387609309 1153583040 1217648841 59647371 68674395 765066 749791 276090977 272942555 67037932 124877316 403541346 467244057 X 603323347 603203769 32280031 31037095 114438316 116163920 750041694 750404784 1153583040 1217648841 X 65865110 -65502020 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 217661 267988 121412 364237 0 319718349 8809809 501862 7914215 914790 320201015 301025999 13508585 13344633 7310168 850700 319718349 246110966 12400322 48806039 6291328 301025999 294258148 20363545 -54457713 14053014 246110966 0.54000 0.36300 0.09700 0 1 1 471951286 161134877 310816409 7414508 3270504 4144004 145829694 75072587 70757107 32679064 1538977 31140087 416857607 DUE FROM AFFILIATES 31588422 BENEFICIAL INTEREST IN NET ASSETS OF CHILDREN'S HOSP & HEALTH SYSTEM FOUND. 355546772 457 PLAN ASSETS 474115 387609309 RESERVE FOR MEDICAL EDUCATION GRANT SETTLEMENTS 3668534 CAPITAL AND OTHER LEASE OBLIGATIONS 2263285 FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS 39923558 457 PLAN LIABILITY 474115 ACCRUED PENSION 76608101 ESTIMATED THIRD PARTY PAYER SETTLEMENTS 1939723 124877316 578700437 512835327 65865110 7258155 -72760175 -65502020 363090 556030174 7258155 -27106301 -19848146 575878320 2822117 2822117 578700437 493735418 0 493735418 19099909 19099909 512835327 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 AND HEALTH SYSTEM 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: THE HOSPITAL (CHILDREN'S HOSPITAL OF WISCONSIN, INC.) EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITONS RECORDED IN 2011 OR 2010. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -21,479,685. INCREASE IN BENEF. INTEREST IN NET ASSETS OF CHILDREN'S HOSPITAL FOUNDATION 731,458. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST -52,011,948. TOTAL TO SCHEDULE D, PART XI, LINE 8: -72,760,175. PART XII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -21,479,685 NET INTEREST COST - FIXED PAYER INTEREST RATE SWAPS -5,200,072 INVESTMENT FEES -419,159 TAX EXPENSE -7,385 TOTAL PART XII, LINE 2D -27,106,301 PART XII, LINE 4B - OTHER ADJUSTMENTS: NET ASSETS RELEASED FROM RESTRICTIONS-CAPITAL ACQUISITIONS 2,822,117 PART XIII, LINE 4B - OTHER ADJUSTMENTS: PAYMENTS TO AFFILIATES 13,473,293 NET INTEREST COST - FIXED PAYER INTEREST RATE SWAPS 5,200,072 INVESTMENT FEES 419,159 TAX EXPENSE 7,385 TOTAL PART XIII, LINE 4B 19,099,909 1 1 X 1 X 1 X 1 1 0 1 1 878055 878055 0.00170 205643325 171232324 34411001 0.06760 206521380 171232324 35289056 0.06930 4841082 12355 4828727 0.00950 32453250 6782679 25670571 0.05040 7204216 3152471 4051745 0.00800 7026719 7026719 0.01380 1958782 1958782 0.00380 53484049 9947505 43536544 0.08550 260005429 181179829 78825600 0.15480 500 500 0.00000 440083 440083 0.00090 200 200 0.00000 458 458 0.00000 1129929 48224 1081705 0.00210 3210 3210 0.00000 37747 37747 0.00010 8250 8250 0.00000 1620377 48224 1572153 0.00310 0 3989958 40000 1229102 2287856 -1058754 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 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 1 X 0 0 6 CHILDREN'S HOSPITAL OF WISCONSIN

1020 N 12TH ST 5TH FLOOR MILWAUKEE WI 53233

MENTAL HEALTH OUTPATIENT CLINIC 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 $3,989,959 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 $650,721 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. THE ALLIANCE LEADS AND MANAGES THE INFANT DEATH CENTER, THE REACH OUT AND READ WISCONSIN COALITION, THE 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 PROGRAM. IT IS ONE OF FIVE REGIONAL CENTERS DEDICATED TO SUPPORTING FAMILIES WITH CHILDREN AND YOUTH WITH 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" AS WELL AS OTHER SESSIONS 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 2011, STAFF PARTICIPATED ON 17 DIFFERENT COMMUNITY COMMITTEES, WHICH INCLUDE WISCONSIN EARLY CHILDHOOD COLLABORATING PARTNERS, MILWAUKEE COUNTY COMMISSION FOR PERSONS WITH DISABILITIES, PATIENT AT RISK, THE ABC FOR HEALTH COUNCIL, AND MORE. THE SOUTHEAST 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. THE CENTER HAS FAMILY COMPUTERS, A CONSULT ROOM, FAMILY BUSINESS CENTER AND OTHER RESOURCES FOR FAMILIES. FAMILIES CAN ALSO CHECK OUT ENTERTAINMENT DVDS, VIDEO GAMES, AS WELL AS LAPTOPS FOR INPATIENT USE. 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 CENTER ALSO HAS A LENDING LIBRARY WITH BOOKS, VIDEOS AND ARTICLES ON A VARIETY OF HEALTH CONDITIONS AND TOPICS.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 HOSPITAL'S MAIN CAMPUS. ADDITIONALLY, IN 2011, THE HOSPITAL PARTNERED WITH EASTER SEALS TO BEGIN PROJECT SEARCH, WHICH IS AN INNOVATIVE WORKFORCE AND CAREER DEVELOPMENT MODEL FOR YOUNG ADULTS WITH INTELLECTUAL AND DEVELOPMENTAL DISABILITIES. THROUGH PROJECT SEARCH, YOUNG ADULTS WITH DISABILITIES WILL RECEIVE INTERNSHIPS WITHIN THE HOSPITAL TO GAIN ON-THE-JOB TRAINING AND OTHER CAREER DEVELOPMENT SKILLS TO SECURE COMPETITIVE EMPLOYMENT. IN THE FOX VALLEY, THE HOSPITAL AND THEDA CLARK MEDICAL CENTER PARTNER 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 DO NOT INCLUDE A FOOTNOTE DESCRIBING BAD DEBT EXPENSE. THE AMOUNT REPORTED IN PART III, SECTION A, LINE 2 IS THE HOSPITAL'S ACTUAL BAD DEBT EXPENSE INCLUDED ON THE FINANCIAL STATEMENTS, 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 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 10: 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 10: 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 13G: 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 WI-FOX VALLEY PART V, SECTION B, LINE 13G: 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 19D: THE MAXIMUM AMOUNT THAT THE HOSPITAL CHARGES TO FAP-ELIGIBLE INDIVIDUALS WHO APPLY FOR FINANCIAL ASSISTANCE IS 75% 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 19D: THE MAXIMUM AMOUNT THAT THE HOSPITAL CHARGES TO FAP-ELIGIBLE INDIVIDUALS WHO APPLY FOR FINANCIAL ASSISTANCE IS 75% 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 HEALTH CARE PROVIDERS, COMMUNITY AGENCIES, LOCAL 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 2011 APPROXIMATELY 47 PERCENT 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 PRIMARILY 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 MILWAUKEE SCHOOLS. THESE CENTERS PROVIDE PREVENTATIVE CARE, PHYSICALS, IMMUNIZATIONS AND TREATMENT FOR ILLNESSES TO AN AREA THAT PREVIOUSLY DID NOT HAVE PEDIATRIC PRACTICES AVAILABLE TO ATTEND TO THE COMMUNITY'S NEEDS. IN 2011, THERE WERE 14,574 SCHOOL-BASED NURSE ENCOUNTERS WHICH INCLUDED 1,001 VISION AND HEARING SCREENINGS.THE HOSPITAL, IN COLLABORATION WITH THE MEDICAL COLLEGE OF WISCONSIN, 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. APPROXIMATELY 6,500 CHILDREN, INCLUDING 500 CHILDREN IN FOSTER CARE, WERE SEEN AT THE CENTER IN 2011, AND 94 PERCENT OF THEM WERE INSURED BY MEDICAID/BADGERCARE PLUS. 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.THE HOSPITAL FUNDS CHILDREN'S HEALTH EDUCATION CENTER ("CHEC"), WHICH SEEKS TO EDUCATE THE PUBLIC REGARDING A WIDE RANGE OF ISSUES IMPACTING THE HEALTH AND SAFETY OF CHILDREN. THE CENTER OFFERS RESOURCES AND PROGRAMS FOR CHILDREN, PARENTS, TEACHERS, AND CAREGIVERS TO HELP KEEP WISCONSIN'S CHILDREN HEALTHY AND SAFE. ONLINE LEARNING PROGRAMS, OFFERED THROUGH CHEC, ARE A RESOURCE FOR TEACHERS TO USE IN THEIR CLASSROOMS TO DELIVER AN OUTCOMES-BASED HEALTH CURRICULUM TO STUDENTS IN GRADE K5-8. CHEC'S INJURY PREVENTION TEAM OFFERS COMMUNITY-BASED EDUCATIONAL EVENTS INCLUDING BIKE HELMET FITTINGS AND CAR SEAT CHECKS, AND DELIVERS IMPORTANT FIRE PROTECTION AND PEDESTRIAN SAFETY EDUCATION THROUGHOUT WISCONSIN. IN 2011, CHEC COMPLETED A SUCCESSFUL TOUR OF THE KOHL'S CARES: GREAT SAFETY ADVENTURE TO SCHOOLS AND COMMUNITY EVENTS THROUGHOUT EASTERN WISCONSIN TO TEACH KIDS AND PARENTS HOW TO BE SAFE AT HOME.THE HOSPITAL'S CAR SEAT CLINIC IS A COLLABORATION BETWEEN THE HOSPITAL, CHEC, SAFE KIDS WISCONSIN AND SAFE KIDS SOUTHEAST WISCONSIN TO OFFER CAR SEAT CLINICS IN TWO LOCATIONS NEAR THE MILWAUKEE HOSPITAL CAMPUS. TRAINED CHILD PASSENGER SAFETY SPECIALISTS MAKE CERTAIN THAT INFANT, TODDLER CAR SEATS AND/OR BOOSTER SEATS ARE INSTALLED CORRECTLY AND ARE APPROPRIATE FOR THE AGE AND SIZE OF THE CHILD USING THEM. THE PROGRAM ALSO PROVIDES LOW-COST OR FREE CAR AND/OR BOOSTER SEATS FOR FAMILIES IN NEED.THE WISCONSIN POISON CENTER, WHICH IS STAFFED BY REGISTERED NURSES 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. IN 2011, THE HOSPITAL CELEBRATED 50 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. DURING 2011, THE HOSPITAL PARTNERED WITH THE CITY OF MILWAUKEE HEALTH DEPARTMENT TO OFFER AN IMMUNIZATION CLINIC WHERE FAMILIES COULD ENSURE THEIR CHILDREN'S IMMUNIZATIONS WERE UP TO DATE. ADDITIONALY, THE HOSPITAL WORKED WITH THE STATE OF WISCONSIN TO CREATE AN IMMUNIZATION VERIFICATION PROCESS TO MEASURE SUCCESS OF THE INITIATIVE. DATA SHOWED A SIGNIFICANT INCREASE IN CHILDREN WHO WERE UP TO DATE ON THEIR IMMUNIZATIONS.IN 2011, THE HOSPITAL ALSO FOCUSED ON EDUCATING ALL WHO CARE FOR CHILDREN ABOUT SAFE INFANT SLEEP PRACTICES. A MULTIYEAR INITIATIVE FOCUSES ON REDUCING THE RISK FACTORS FOR SUDDEN INFANT DEATH SYNDROME AND OTHER SLEEP-RELATED DEATHS IN CHILDREN UNDER AGE 1. THE HOSPITAL CONDUCTED TRAINING ABOUT SAFE SLEEP PRACTICES FOR HEALTH CARE PROVIDERS AND OTHER STAFF, CREATED INFORMATION ON ITS WEBSITE AND DEVELOPED AND DISTRIBUTED FLIERS IN THE COMMUNITY AND TO PRIMARY CARE PROVIDERS. 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 PROGRAM 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 2011, 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 WORKED ON A NUMBER OF INJURY PREVENTION AND DETECTION POLICIES, AND LED THE ADVOCACY FOR THE 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. 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. 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 THE ROLE CHILDREN'S HOSPITALS PLAY IN TRAINING FUTURE PRIMARY CARE PEDIATRICIANS 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. 1 ALIANZA LATINA APLICANDO SOLUCIONES 1615 S 22ND STREET MILWAUKEE WI 53204 205974351 501(C)(3) 18500 MCH BLOCK GRANT - CHILDREN WITH SPECIAL NEEDS 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 8006 DENTAL SEALANT EXPANSION GRANT BELOIT AREA COMMUNITY HEALTH CENTER 74 ECLIPSE CENTER BELOIT WI 53511 391919806 501(C)(3) 20115 DENTAL SEALANT EXPANSION GRANT BROWN COUNTY ORAL HEALTH PARTNERSHIP 331 N BROADWAY GREEN BAY WI 54303 208969896 501(C)(3) 26425 DENTAL SEALANT EXPANSION GRANT PROFESSIONAL DENTAL HYGIENE EXPRESS 5388 STATE HWY 64 BLOOMER WI 54724 389808600 11097 DENTAL SEALANT EXPANSION GRANT CLARK COUNTY HEALTH DEPARTMENT 517 COURT STREET NIELSVILLE WI 54456 396005679 CLARK COUNTY 11509 DENTAL SEALANT EXPANSION GRANT COLUMBIA CO PO BOX 132 PORTAGE WI 53901 396005681 COLUMBIA COUNTY 19559 DENTAL SEALANT EXPANSION GRANT COLUMBIA ST MARY'S FOUNDATION 2320 N LAKE DRIVE MILWAUKEE WI 53211 391494981 501(C)(3) 85134 DENTAL SEALANT EXPANSION GRANT COMMUNITY DENTAL CLINIC 520 HANDEYSIDE LANE 4 FORT ATKINSON WI 53538 205297560 501(C)(3) 6286 DENTAL SEALANT EXPANSION GRANT COOPERATIVE EDUCATION SERVICE AGENCY #11 225 OSTERMANN DRIVE TURTLE LAKE WI 54889 391483818 17476 DENTAL SEALANT GRANT COOPERATIVE EDUCATION SERVICE AGENCY #11 225 OSTERMANN DRIVE TURTLE LAKE WI 54889 391483818 27080 DENTAL SEALANT EXPANSION GRANT FOND DU LAC SCHOOL DISTRICT 72 W 9TH STREET FOND DU LAC WI 54935 391411371 5000 ADDRESSING ASTHMA FROM A PUBLIC HEALTH PERSPECTIVE GUNDERSEN LUTHERAN 1836 SOUTH AVENUE LACROSSE WI 54601 390813416 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) 6400 DENTAL SEALANT EXPANSION GRANT JANESVILLE SCHOOL DISTRICT 527 S FRANKLIN STREET JANESVILLE WI 53548 396002726 501(C)(3) 8589 DENTAL SEALANT EXPANSION GRANT SOUTHERN WI BRIGHT SMILES 2253 16TH STREET MONROE WI 53566 388827033 9772 DENTAL SEALANT EXPANSION GRANT JUNEAU COUNTY HEALTH DEPARTMENT 220 E STATE STREET ROOM 104 MAUSTON WI 53948 396005706 JUNEAU COUNTY 6689 DENTAL SEALANT EXPANSION GRANT KENOSHA COUNTY DIVISION OF HEALTH 8600 SHERIDAN ROAD 600 KENOSHA WI 53143 396005707 KENOSHA COUNTY 31525 DENTAL SEALANT EXPANSION GRANT LINCOLN COUNTY HEALTH DEPARTMENT 607 N SALES STREET 101 MERRILL WI 54452 396005714 LINCOLN COUNTY 2640 DENTAL SEALANT GRANT LINCOLN COUNTY HEALTH DEPARTMENT 607 N SALES STREET 101 MERRILL WI 54452 396005714 LINCOLN COUNTY 12754 DENTAL SEALANT EXPANSION GRANT MARQUETTE UNIVERSITY PO BOX 1881 MILWAUKEE WI 53201 390806251 501(C)(3) 93477 DENTAL SEALANT EXPANSION GRANT MARSHFIELD CLINIC 1000 NORTH OAK AVENUE MARSHFIELD WI 54449 390452970 501(C)(3) 20727 STATE OF WI - GENETICS SYSTEM GRANT MEDICAL COLLEGE OF WISCONSIN 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 390806261 501(C)(3) 11975 STATE OF WI - GENETICS SYSTEM GRANT MENASHA HEALTH DEPARTMENT 316 RACINE STREET MENASHA WI 54952 396005525 CITY OF MENASHA 7611 DENTAL SEALANT EXPANSION GRANT NORTHERN HEALTH CENTERS PO BOX 179 LAKEWOOD WI 54138 391550213 501(C)(3) 10489 DENTAL SEALANT EXPANSION GRANT NORTHERN HILLS 511 SPRUCE STREET ONALASKA WI 54650 391411237 6656 DENTAL SEALANT EXPANSION GRANT PORTAGE COUNTY HEALTH & HUMAN SERVICES 817 WHITING AVENUE STEVENS POINT WI 54481 396005731 PORTAGE COUNTY 7909 DENTAL SEALANT GRANT PORTAGE COUNTY HEALTH & HUMAN SERVICES 817 WHITING AVENUE STEVENS POINT WI 54481 396005731 PORTAGE COUNTY 25024 DENTAL SEALANT EXPANSION GRANT PREFERRED DENISTRY ASSOC OF WI LLC 1029 HOWARD STREET EVANSTON IL 60202 272634563 50000 DENTAL SEALANT EXPANSION GRANT PRICE COUNTY HEALTH DEPARTMENT 104 S EYDER AVENUE PHILLIPS WI 54555 396005733 PRICE COUNTY 17926 DENTAL SEALANT EXPANSION GRANT PROFESSIONAL DENTAL HYGIENE EXPRESS 5388 STATE HWY 64 BLOOMER WI 54724 274969600 16437 DENTAL SEALANT EXPANSION GRANT SAUK COUNTY HEALTH DEPARTMENT 505 BROADWAY 372 BARABOO WI 53913 396005740 SAUK COUNTY 9637 DENTAL SEALANT EXPANSION GRANT SHEBOYGAN COUNTY 1011 N 8TH STREET SHEBOYGAN WI 53081 396005744 SHEBOYGAN COUNTY 17159 DENTAL SEALANT EXPANSION GRANT TREMPEALEAU COUNTY HUMAN SERVICES 36245 MAIN STREET WHITEHALL WI 54773 396005747 TREMPELEAU COUNTY 26619 DENTAL SEALANT EXPANSION GRANT TREMPEALEAU COUNTY HUMAN SERVICES 36245 MAIN STREET WHITEHALL WI 54773 396005747 TREMPELEAU COUNTY 6691 ADDRESSING ASTHMA FROM A PUBLIC HEALTH PERSPECTIVE UNIVERSITY OF WISCONSIN - MADISON DRAWER 538 MILWAUKEE WI 53278 396006492 501(C)(3) 61060 STATE OF WI - GENETICS SYSTEM GRANT VILAS COUNTY HEALTH DEPARTMENT 330 COURT STREET EAGLE RIVER WI 54521 396005751 VILAS COUNTY 20728 DENTAL SEALANT EXPANSION GRANT WALWORTH COUNTY W4051 COUNTY ROAD NN ELKHORN WI 53121 396005752 WALWORTH COUNTY 30967 DENTAL SEALANT EXPANSION GRANT WAUKESHA COUNTY COMMUNITY DENTAL CENTER 210 NW BARSTOW STREET 305 WAUKESHA WI 53188 391355301 WAUKESHA COUNTY 20219 DENTAL SEALANT EXPANSION GRANT WAUPACA CO DEPT OF HEALTH & HUMAN SERVICES 811 HARDING STREET WAUPACA WI 54981 396005758 WAUPACA COUNTY 16704 DENTAL SEALANT GRANT WAUPACA CO DEPT OF HEALTH & HUMAN SERVICES 811 HARDING STREET WAUPACA WI 54981 396005758 WAUPACA COUNTY 21329 DENTAL SEALANT EXPANSION GRANT WAUSHARA COUNTY HEALTH DEPARTMENT PO BOX 837 WAUTOMA WI 54982 396005759 WAUSHARA COUNTY 14684 DENTAL SEALANT EXPANSION GRANT WEST ALLIS HEALTH DEPARTMENT 7120 W NATIONAL AVENUE WEST ALLIS WI 53214 396005651 CITY OF WEST ALLIS 5000 ADDRESSING ASTHMA FROM A PUBLIC HEALTH PERSPECTIVE WOOD COUNTY HEALTH DEPARTMENT 400 MARKET STREET WISCONSIN RAPIDS WI 54494 396005763 WOOD COUNTY 19000 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) 9387572 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 SERVICE SOCIETY OF WISCONSIN 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 390806380 501(C)(3) 935000 GRANTS TO AFFILIATE CHILDREN'S MEDICAL GROUP INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 391789197 501(C)(3) 650721 GRANTS TO AFFILIATE 41 8 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 736762 0 336229 0 106473 0 241301 0 32021 0 1452786 0 70103 TIMOTHY L BIRKENSTOCK 0 163222 0 130024 0 465228 0 20500 0 15288 0 794262 0 118537 MARC CADIEUX 0 169387 0 66000 0 13806 0 15600 0 6955 0 271748 0 0 CINTHIA S CHRISTENSEN 389948 0 118956 0 148318 0 58566 0 28207 0 743995 0 42557 0 LEE ANNE EDDY 75358 0 38976 0 124134 0 0 0 5064 0 243532 0 26566 0 MICHAEL GUTZEIT MD 280824 0 107484 0 107026 0 51002 0 26461 0 572797 0 17287 0 BARBARA JOERS 185856 0 22813 0 16940 0 8250 0 18598 0 252457 0 0 0 JULIET KERSTEN 157813 37441 0 22974 12589 118 13768 3278 18897 4499 203067 68310 12066 0 NANCY KOROM 274497 0 54349 0 72644 0 47844 0 23266 0 472600 0 25878 0 SHEILA REYNOLDS 0 237263 0 68372 0 80865 0 44305 0 26887 0 457692 0 21941 MARK SHIP 213519 0 53966 0 24302 0 13150 0 20707 0 325644 0 18015 0 DONNA JAMIESON 169675 0 500 0 835 0 14120 0 28653 0 213783 0 0 0 TOM LAUSTEN 157185 0 500 0 1412 0 12977 0 22224 0 194298 0 0 0 LORI BARBEAU DDS 236490 0 0 0 24497 0 20246 0 22621 0 303854 0 0 0 ANDREW SCHMITT MD 227680 0 0 0 15949 0 7350 0 23684 0 274663 0 0 0 SHANE FISHER DDS 201393 0 0 0 24671 0 7920 0 7853 0 241837 0 0 0 THOMAS NICHOLS MD 199044 0 0 0 14777 0 14755 0 20271 0 248847 0 0 0 A CHARLES POST DDS 196093 0 0 0 8857 0 18064 0 13021 0 236035 0 0 0 RAMESH SACHDEVA MD 0 287819 0 65997 0 51653 0 42150 0 24900 0 472519 0 15854 JON E VICE 0 0 0 0 0 261357 0 0 0 0 0 261357 0 259360 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 2011 TOTALED $329,655. UNTIL FEBRUARY 2011, LEE ANNE EDDY SERVED AS VP AMBULATORY & DIAGNOSTIC SERVICES. CHW PAID CERTAIN AMOUNTS AS SEVERANCE TO MS. EDDY PURSUANT TO A WRITTEN AGREEMENT. CASH PAYMENTS MADE TO MS. EDDY IN 2011 TOTALED $97,499. PART I, LINE 4B: IN 2011, 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 2011 WERE AS FOLLOWS: M. TROY $52,472; C. CHRISTENSEN $38,066; M. GUTZEIT, M.D. $30,502; N. KOROM $28,094; S. REYNOLDS $26,255; R. SACHDEVA, M.D. $29,509. AFTER A VESTING PERIOD, PARTICIPANTS MAY ELECT TO WITHDRAW AMOUNTS PREVIOUSLY CONTRIBUTED AND REPORTED. AMOUNTS WITHDRAWN BY PARTICIPANTS IN 2011 WERE: M. TROY $70,103; T. BIRKENSTOCK $118,357; C. CHRISTENSEN $42,557; L. EDDY $26,566; M. GUTZEIT, M.D. $17,287; J. KERSTEN $12,066; N. KOROM $25,878; S. REYNOLDS $21,941; M. SHIP $18,015; R. SACHDEVA, M.D. $15,854; J. VICE $259,360. CHHS HAS REPORTED ADDITIONAL AMOUNTS SET ASIDE FOR A NONQUALIFIED RETIREMENT PLAN ON BEHALF OF ITS PRESIDENT & CEO. THE AMOUNT SET ASIDE IN 2011 WAS $180,579. 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 ESTABLISHED ON AN EXECUTIVE BY EXECUTIVE BASIS. SUCH CRITERIA PERTAIN TO MATTERS IN THE EXECUTIVE'S AREA OF RESPONSIBILITY, AS WELL AS ACHIEVEMENT OF OVERALL STRATEGIC OBJECTIVES OF CHHS AND ITS AFFILIATES. SUPPLEMENTAL INFORMATION PART III FORM 990, PART VII, COLUMN E & SCHEDULE J, PART II: SALARIES PAID BY RELATED ORGANIZATIONS: 1. MARGARET TROY, DIRECTOR & PRESIDENT OF CHW (JANUARY - SEPTEMBER 2011) AND PRESIDENT & CEO 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. SERVICES AS A MEMBER OF THE BOARD OF DIRECTORS OF CHW WERE PROVIDED ON A PART-TIME VOLUNTARY BASIS. 2. TIMOTHY L. BIRKENSTOCK, TREASURER OF CHW (THROUGH MARCH 2011) AND TREASURER & CFO OF CHHS (THROUGH MARCH 2011) - 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. 3. MARC CADIEUX, INTERIM TREASURER OF CHW (APRIL - DECEMBER 2011) AND INTERIM TREASURER & CFO OF CHHS (APRIL - DECEMBER 2011) - 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. 4. JULIET KERSTEN, VICE PRESIDENT OF AMBULATORY & REGIONAL SERVICES - 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 CHW AND ITS AFFILIATES. THESE AMOUNTS WERE PAID BY CHHS. 5. SHEILA REYNOLDS, SECRETARY OF CHW AND CORPORATE VICE PRESIDENT & GENERAL COUNSEL 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. 6. 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. 7. JON E. VICE, FORMER DIRECTOR & PRESIDENT OF CHW AND FORMER PRESIDENT & CEO OF CHHS - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS LISTED IN PART VII AND SCHEDULE J WERE PAID BY CHHS AS PART OF THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DESCRIBED ABOVE FOR PREVIOUS SERVICE AS THE PRESIDENT & CEO OF CHHS AND CHW. WI HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710BCS9 2008-07-29 152300000 SEE PART VI 0 0 0 WI HEALTH & EDUCATIONAL FACILITIES AUTHORITY 391337855 97710BCC4 2008-06-25 100771610 SEE PART VI 0 0 0 152300953 1000301 2075652 2009 1 0 0 1 113903904 771610 13132293 2009 1 0 0 1 0 1 1 1 0 0.00200 0.00100 0.00300 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 1 0 0 0 0 0 1 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. UNIVERSITY OF WI-MILWAUKEE DIRECTOR(D GILBERT) 157241 MR. GILBERT IS PRESIDENT OF THE UNIVERSITY OF WISCONSIN-MILWAUKEE FOUNDATION, WHICH IS PART OF THE UNIVERSITY OF WISCONSIN-MILWAUKEE SYSTEM. THE ORGANIZATION PAID $157,241 TO THE UNIVERSITY OF WISCONSIN-MILWAUKEE FOUNDATION FOR EDUCATIONAL PROGRAMS. 0 JOHNSON CONTROLS INC DIRECTOR (CD MYERS) 994929 MR. MYERS IS PRESIDENT-BUILDING EFFICIENCY DIVISION OF JOHNSON CONTROLS, INC. THE ORGANIZATION PAID $994,929 TO JOHNSON CONTROLS, INC. FOR HEATING, VENTILATION, AND AIR CONDITIONING INSTALLATION AND REPAIR. 0 HUMANA DIRECTOR (L RAMBO) 630368 MR. RAMBO IS THE REGIONAL CHIEF EXECUTIVE OFFICER OF HUMANA, INC. THE ORGANIZATION PAID HUMANA FOR TPA SERVICES FOR ITS SELF-INSURED HEALTH PLAN IN THE AMOUNT OF $630,368. 0 HUMANA DIRECTOR (L RAMBO) 44030912 MR. RAMBO IS THE REGIONAL CHIEF EXECUTIVE OFFICER OF HUMANA, INC. THE ORGANIZATION RECEIVED APPROXIMATELY $44,030,912 FROM HUMANA FOR HEALTH CARE SERVICES PROVIDED TO HUMANA ENROLLEES. 0 FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS EXIST BETWEEN THE FOLLOWING BOARD MEMBERS: ABRAHAM AND QUADRACCI; ABRAHAM AND ROTHMAN; ALTSCHAEFL AND PEPKE; BRENNER AND DRURY; BRENNER AND O. SULLIVAN; DRURY AND SOMMERHAUSER; DRURY AND SCHLIFSKE; DRURY AND O. SULLIVAN; SCHLIFSKE AND SOMMERHAUSER; SOMMERHAUSER AND HERMA; O. SULLIVAN AND KERSCHNER; BRENNER AND KERSCHNER; CULVER AND KERSCHNER; AND BRENNER AND CULVER. 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 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 REQUIRED 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 OF PATIENT CARE SERVICES 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 INVOLVED REVIEW BY INDEPENDENT PERSONS WHO 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 5: NET UNREALIZED GAINS ON INVESTMENTS: 7,258,155. CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS -21,479,685. INCREASE IN BENEF. INTEREST IN NET ASSETS OF CHILDREN'S HOSPITAL FOUNDATION 731,458. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST -52,011,948. TOTAL TO FORM 990, PART XI, LINE 5: -65,502,020. 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 AND HEALTH SYSTEM 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. CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 391500074 OPERATIONAL SUPPORT SERVICES WI 501(C)(3) LINE 3 N/A 0 CHILDREN'S HOSPITAL & HEALTH SYSTEM FOUNDATION INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 391500075 FUND DEVELOPMENT WI 501(C)(3) LINE 7 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 1 CHILDREN'S MEDICAL GROUP INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 391789197 PEDIATRIC PHYSICIAN SERVICES WI 501(C)(3) LINE 3 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 1 CHILDREN'S PHYSICIAN GROUP PC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 364303682 PEDIATRIC PHYSICIAN SERVICES IL 501(C)(3) LINE 9 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 1 CHILDREN'S SERVICE SOCIETY OF WISCONSIN 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 390806380 CHILD WELFARE SERVICES WI 501(C)(3) LINE 7 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 1 CHILDREN'S COMMUNITY HEALTH PLAN INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 271494977 WISCONSIN MEDICAID HMO WI 501(C)(3) LINE 9 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 1 MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS INC 8701 WATERTOWN PLANK ROAD MILWAUKEE WI 53226 391341366 GRADUATE MEDICAL EDUCATION SUPPORT WI 501(C)(3) LINE 11 TYPE 1 N/A 0 VIRTUAL PICU SYSTEMS LLC 401 WYTHE STREET SUITE 101 ALEXANDRIA VA 22314 201414664 QUALITY/OUTCOMES ANALYSIS DE CHILDREN'S HOSPITAL & HEALTH SYSTEM INC RELATED 0 0 MED-HEALTH FINANCIAL SERVICES INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 391547907 COLLECTION SERVICES WI CHILDREN'S HOSPITAL & HEALTH SYSTEM INC C 1 1 1 0 1 0 0 0 1 1 1 1 0 0 1 1 0 1 CHILDREN'S MEDICAL GROUP INC - RENT (LINE 1A (IV) ABOVE) A 339868 CASH PAID/RECEIVED CHILDREN'S SERVICE SOCIETY OF WISCONSIN - RENT (LINE 1A (IV) ABOVE) A 11968 CASH PAID/RECEIVED CHILDREN'S PHYSICIAN GROUP PC B 2500000 CASH PAID/RECEIVED CHILDREN'S MEDICAL GROUP INC B 650721 CASH PAID/RECEIVED CHILDREN'S SERVICE SOCIETY OF WISCONSIN B 935000 CASH PAID/RECEIVED CHILDREN'S HOSPITAL AND HEALTH SYSTEM FOUNDATION INC C 4826255 CASH PAID/RECEIVED CHILDREN'S HOSPITAL AND HEALTH SYSTEM FOUNDATION INC E 253352555 NET BOOK VALUE CHILDREN'S MEDICAL GROUP INC K 76685 CASH PAID/RECEIVED CHILDREN'S COMMUNITY HEALTH PLAN INC - PATIENT REIMBURSEMENT K 8583172 CASH PAID/RECEIVED CHILDREN'S SERVICE SOCIETY OF WISCONSIN K 315929 CASH PAID/RECEIVED MED-HEALTH FINANCIAL SERVICES INC L 1030931 CASH PAID/RECEIVED CHILDREN'S COMMUNITY HEALTH PLAN INC - WI MEDICAID PASS THROUGH PAYMENTS R 5816414 CASH PAID/RECEIVED