2011-08-12T12:07:40-05:00 2010-09-30 Moss Adams LLP 3121 West March Lane Suite 100 Stockton CA 952192303 990 2009-10-01 941294954 Children's Hospital Central California CHIL 5593533000 9300 Valley Childrens Place Madera CA 936368761 Michele Waldron 5593533000 2011-08-10 1 TRACY S PAGLIA 2099556100 2009 2016-02-24 21:20:13Z MICHELE WALDRON 9300 Valley Childrens Place Madera CA 936368761 926826338 0 X www.childrenscentralcal.org X 1949 CA PROVIDE HIGH QUALITY, COMPREHENSIVE HEALTHCARE SERVICES TO CHILDREN 15 12 3173 536 930914 -313 17238377 23867645 340623643 343754551 5056330 6102417 7477960 8319875 370396310 382044488 277868 239584 0 205515104 211444448 0 0 135235273 128644288 341028245 340328320 29368065 41716168 472811849 551109623 228641641 247720377 244170208 303389246 To provide high quality comprehensive healthcare services to children regardless of their ability to pay. 0 0 46591374 239584 144067796 SEE SCHEDULE O 212026800 199686755 SEE SCHEDULE O 258618174 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 272 0 1 3173 1 1 1 0 0 0 0 0 0 0 0 15 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CA X MICHELE WALDRON CFO 5593533000 9300 VALLEY CHILDRENS PLACE MADERA CA 93636 William F Haug 34.00 X X 844580 0 436027 Greg Coleman 1.00 X X 0 0 0 Octavia Diener 1.00 X X 0 0 0 Dan Dooley 1.00 X 0 0 0 Gracie Esquivel-Aguilar 1.00 X 0 0 0 Dennis Keller 1.00 X 0 0 0 Dr Robert Kubo 1.00 X 0 0 0 Mendy Laval 1.00 X 0 0 0 Jeff Mayer 1.00 X X 0 0 0 Pat Ricchiuti 1.00 X 0 0 0 Dr Charles Smith 1.00 X 0 0 0 Bill Smittcamp 1.00 X 0 0 0 Loren Booth 1.00 X 0 0 0 Susan Boyd 1.00 X 0 0 0 David Krause 1.00 X X 0 0 0 Tracy Lifer 1.00 X 0 0 0 Dave Olson 1.00 X 0 0 0 DR NEWTON SEIDEN 1.00 X 0 0 0 GORDON ALEXANDER 34.00 X X 0 0 0 STEPHANIE HOULDING 1.00 X 0 0 0 DR DEVONNA KAJI 1.00 X 22917 0 0 Michele R Waldron 38.00 X 429136 0 119549 Todd Suntrapak 40.00 X 449244 0 123692 JESSIE HUDGINS 40.00 X 318151 0 120982 JAMES MCCARTY 40.00 X 0 0 0 BEVERLY HAYDEN-PUGH 40.00 X 335709 0 134127 James Meinert 40.00 X 300721 0 66552 MARTA BOYER 40.00 X 309553 0 139009 Jane Willson 40.00 X 301434 0 94544 Mark Zielazinski 40.00 X 295096 0 31194 DAVID CHRISTENSEN 40.00 X 0 0 0 DAVID SINGH 40.00 X 244381 0 26528 Rick Wolf 40.00 X 258455 0 36451 Randall Guerrero 40.00 X 233609 0 43319 Stephanie Vance 40.00 X 245425 0 35142 Jeffrey Lefors 40.00 X 238152 0 36807 Kamela Loo 40.00 X 253784 0 57616 5080347 0 1501539 457 0 1 0 SPECIALTY MEDICAL GROUP 9300 VALLEY CHILDRENS PLACE MADERA CA 93636 SUBSPEC PYHSICIAN SERVICES 8997302 PEDIATRIC ANETHESIA ASSOCIATION 6235 NORTH FRESNO STREET STE 103 FRESNO CA 93710 ANETHESIA/CRITICAL CARE 7885361 EMERGENCY PHYSICIANS MEDICAL 3300 DOUGLAS BOULEVARD 200 ROSEVILLE CA 95661 EMERGENCY PHYSICIAN SERVICES 1449661 UCSF - FRESNO MEDICAL EDUCATION 855 M STREET TENTH FLOOR FRESNO CA 93721 RESIDENCY SERVICES 1191825 CROTHALL HEALTHCARE INC 1654 MARTHALER LANE WEST ST PAUL MN 55118 HOUSEKEEPING SERVICES 752943 46 1809261 21647138 411246 13710 23867645 PATIENT SERVICES 900099 343528573 343528573 OUTSIDE LAB SERVICES 900099 225978 225978 343754551 4000205 4000205 792745 792745 117488 78197 39291 39291 39291 545391747 355533 544276676 161137 1115071 194396 1309467 1309467 520017 265840 254177 254177 CAFETERIA REVENUE 900099 2542151 2542151 MANAGEMENT SERVICES 541610 930914 930914 CHANGE IN SWAP 900099 919967 919967 3633375 3633375 8026407 382044488 343754551 930914 13491378 47994 47994 191590 191590 5485022 5485022 142544151 113868046 28676105 12469720 10182816 2286904 38914628 29170787 9743841 12030927 9055985 2974942 1285880 24649 1261231 516126 516126 185000 185000 798008 798008 25881204 25558074 323130 526047 526047 42485062 36945453 5539609 2615345 2615345 4678646 3135877 1542769 404095 195272 208823 194879 95490 99389 8239921 6150314 2089607 15610169 8885129 6725040 2705965 93379 2612586 PURCHASED SERVICES 14489343 8909427 5579916 BAD DEBT 5071408 5071408 DUES 1091666 109029 982637 RECRUITMENT 670781 335391 335390 LOSS ON EXT. OF DEBT 40545 40545 1154198 66017 1088181 340328320 258618174 81710146 0 12764 13958 68934305 66636227 481961 443362 48050048 47075250 4601179 4398129 3153350 4210879 367157580 133039323 212713181 234118257 114007877 173623789 20857184 20589772 472811849 551109623 31105578 33468678 130448724 163930551 67087339 50321148 228641641 247720377 X 240003459 298209989 4166749 5179257 244170208 303389246 472811849 551109623 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 1 0 1 51868 1 7891 0 0 59759 0 2188788 2188788 237525072 50870625 186654447 2299393 1800037 499356 102333845 68199732 34134113 22810482 12168929 10641553 234118257 MALPRACTICE RESERVE 1800000 ACCRUED PENSION LIABILITY 43330345 457 LIABILITY 1534265 SB 1732 LIABILITY 786921 OTHER 57778 construction retains account 2811839 50321148 1 1 1 X 1 X 1 0 0 1 1 103000 103000 0.00030 210776650 199686755 11089895 0.03310 210879650 199686755 11192895 0.03340 460454 460454 0.00140 2379308 817427 1561881 0.00470 61841 61841 0.00020 2901603 817427 2084176 0.00630 213781253 200504182 13277071 0.03970 3000 3000 0.00000 3000 3000 1 1794980 0 232924 396962 -164038 X 1 1 CHILDREN'S HOSPITAL CENTRAL CALIFORNIA

9300 VALLEY CHILDRENS PLACE MADERA CA 936368761

X CHILDREN'S HOSPITAL CENTRAL CA HOME CARE

7555 N DEL MAR AVE FRESNO CA 93711

X Part I, Line 3c: Part I, Line 7: Charity care at cost was calculated using a cost-to-charge ratio derived from worksheet 2. The decision support system was used to calculate cost-to-charge for determining unreimbursed Medi-Cal. This decision support system addresses all patient segments (i.e inpatient, outpatient, etc.). Part I, Line 7f: Part III, Line 4: There is no financial statement footnote on bad debt. Allowance for doubtful accounts are estimated based on historical write-off percentages and review of large balance self-pay accounts. Doubtful accounts are written off against the allowance after adequate collection effort is exhausted and recorded as recoveries of bad debt if subsequently collected. The cost of bad debt write-offs were calculated by applying the overall cost to charge ratio of the organization to the charges written off. Part III, Line 8: Medicare allowable cost is calculated using the filed 2010 Medicare Cost Report. Medicare shortfall should be included as a component of Community Benefit because reimbursement is not negotiable and does not cover the cost to provide services. Additionally, the majority of the Hospital's Medicare patients would be covered by Medi Cal if they did not fall under the Medicare coverage option. Part III, Line 9b: Collection attempts are discontinued once charges are determined to be eligible for charity care or financial assistance; insurance collection attempts continue as appropriate. Part V: Part I, Line 7, Column f: Total bad debt expense removed from the denominator and reported on Form 990, Part IX is $5,071,408. Part VI, Line 2: Needs assessment: Children's Hospital Central California partners with a variety of community-based organizations to help address issues identified through the community health needs assessment. Consistent with state law, Children's Hospital completes a formal assessment of unmet health care needs among children every three years. The hospital's last assessment was completed in August 2008 and included the following activities.Stakeholder Interviews - The hospital interviewed leadership from nearly two dozen community based organizations, including county health departments, county offices of education, school districts, primary care clinics, and a variety of private non-profit agencies providing services to underserved children and their families.Health Status Indicators - The hospital also conducted an extensive review of available county and state data reports on key health status indicators for children. Data sources consulted included the California Department of Health Care Services' County Health Status Profiles, 2007; the Great Valley Center's Assessing the Region Via Indicators - Public Health and Access to Care, 2007; the California Health Interview Survey, 2007 administered by the UCLA Center for Health Policy Research, and; the California Department of Public Health's Immunization Kindergarten Assessment, 2007.In partnership with community based organizations, both public and private, Children's Hospital currently is conducting its next triennial community health needs assessment that will be used to inform the development of the hospital's Community Benefits Program activities for 2012 - 2014. Part VI, Line 3: Patient education of eligibility for assistance: Each patient that presents as a self pay patient is directed to a financial counselor. The Financial Counselor educates patients and their families about government and charity care programs and assists with related applications. If a patient is not counseled by a Financial Counselor on the date of service, follow up attempts are made by the counselors and the business office to continue to inform and educate patients of available programs. In addition, the Charity Care policy is posted on the Hospital's website and there is signage throughout the Hospital informing patients of the availability of the charity care program. Part VI, Line 4: Community Information: As the only pediatric specialty hospital located in Central California, Children's Hospital's primary service area extends from Stockton in the north to Bakersfield in the south, and from the Central Coast to the Eastern Sierra. The service area includes 10 counties, covers over 45,000 square miles and is home to over 1.2 million children ages 0 -17. In 2010, Children's Hospital had 13,330 inpatient cases, 67,120 Emergency Department visits and a combined 155,999 outpatient center, day surgery, radiology and laboratory visits. Medi-Cal benefits covered 73% of the inpatient cases and 63% of the outpatient visits at Children's Hospital. Over 70% of the hospital's inpatient population consisted of children 5 years of age or younger and over 2/3 were an ethnicity other than Caucasian. Part VI, Line 5: Community Building Activities: While the Hospital did not have systems in place to formally track Community Building Activities for 2010, Children's Hospital participated in and supported community coalitions committed to improving identified community health needs through education, advocacy, and coordination of services. Examples include the following. Children's Hospital participated on two separate collaboratives designed to ensure that newborns and infants with, or at risk for, development delays receive the appropriate care after discharge. The collaboratives included the Kern Medically Vulnerable Infant Project and the Fresno Model of Care Partnership Oversight Committee. Additionally, Children's Hospital implemented a Neonatal Stabilization Program through which hospital staff trained medical providers at community based birthing hospitals on how to care for high risk newborns before, during and after delivery. As part of its commitment to reducing childhood obesity, Children's Hospital founded the Childhood Obesity Prevention Task Force, a consortium of public and private agencies in Fresno and Madera counties committed to reducing the incidence of childhood obesity through networking among peer agencies, coordination of services, and implementation of best practices. Activities supported by the Task Force, and Children's Hospital, in 2010 included facilitating increased coordination among existing public and private and programs, and implementation of work plan activities designed to support primary care physician efforts to prevent or manage childhood obesity. Recognizing that unintentional injury is the nation's leading cause of death in children, Children's Hospital operates an Unintentional Injury Prevention Program to increase community awareness of childhood injuries and those measures that can be taken to decrease their prevalence throughout Central California. Supported by a cast of 25 hospital employee volunteers, the Program covered the following topics in 2010: Child Maltreatment, Distracted & Reckless Teen Driving, Pediatric Trauma, Water Safety, Wheeled Sports Safety, Child Passenger Safety, the Choking Game, Munchausen by Proxy Syndrome, and Shaken Baby Syndrome. Regarding Water Safety, Children's Hospital partnered with Kohl's Department Store and Fresno Unified School District to convene a full day program for elementary children on how to play safe in our region's lakes, rivers, and swimming pools. Overall, the hospital's Injury Prevention Program provided education to over 46,700 children and families at a host of community based venues throughout the Central Valley. In addition, the hospital provided training and conducted outreach to 2,229 health care professionals at national, state, and regional conferences. The Program also provided workshops and in-services for education, law enforcement, and child welfare professionals.Children's Hospital also participated with a number of community based organizations to advocate for responsible public policy at the local, state and federal level re access to health care services for children, including the protection of funding for Medicaid and the federal Children's Health Insurance Program. Part VI, Line 6: The Mission of Children's Hospital is to provide high quality, comprehensive health care services to children regardless of their ability to pay. The Hospital operates an open medical staff and is an independent non profit organization governed by a volunteer board of trustees which is therefore accountable to our community and only our community. CA 1 PRIVATE HEALTH NEWS INC 1776 MENTOR AVE SUITE 210 CINCINNATI OH 45212 300059144 18000 CREATION OF E-HEALTH NEWSLETTER STAYWELL CONTENT SERVICES PO BOX 759 MORRISVILLE PA 190670759 134036258 9000 PROVIDES HEALTH INFORMATION VIA CHCC WEBSITE STATE CENTER COMMUNITY COLLEGE 1525 E WELDON FRESNO CA 93704 941574802 GOVERNMENT 14205 SUPPORT NURSING PROGRAM 1 2 NURSING SCHOLARSHIP 6 10042 EDUCATION SCHOLARSHIP - NEONATAL FOCUS 4 7779 CAFETERIA MEALS 9953 49765 FMV MEAL COUPONS FOR PATIENT FAMILIES AS NEEDED TAXI, BUS AND TRANSIT SERVICES 14186 124004 BOOK SUBSIDATION OF BUS AND TRANSIT SERVICES Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Nursing Scholarships are designed to help employee's meet financial needs that are not covered by other tuition reimbursement programs. A scholarship committee reviews applications bi-annually based on certain criteria. Recipients are chosen by the committee and the Chief Nursing Officer approves the selections. All recipients are employees of the Hospital and the Hospital is made aware when the recipient completes their education. Other services provided are purchased from various vendors and are supplied to patients and their families. The records for these purchased services are maintained by the Hospital. X X X X X 0 1 0 1 1 1 1 0 0 William F Haug 718677 0 104161 0 21742 0 432496 0 3531 0 1280607 0 0 0 Michele R Waldron 354159 0 41211 0 33766 0 105425 0 14124 0 548685 0 0 0 Todd Suntrapak 372861 0 46590 0 29793 0 109568 0 14124 0 572936 0 0 0 JESSIE HUDGINS 268511 0 30174 0 19466 0 110389 0 10593 0 439133 0 0 0 BEVERLY HAYDEN-PUGH 285592 0 30031 0 20086 0 127065 0 7062 0 469836 0 0 0 James Meinert 255529 0 26907 0 18285 0 52428 0 14124 0 367273 0 0 0 MARTA BOYER 264986 0 34534 0 10033 0 135478 0 3531 0 448562 0 0 0 Jane Willson 260713 0 31580 0 9141 0 87482 0 7062 0 395978 0 0 0 Mark Zielazinski 255529 0 30432 0 9135 0 17070 0 14124 0 326290 0 0 0 DAVID SINGH 230599 0 5000 0 8782 0 26528 0 0 0 270909 0 0 0 Rick Wolf 227382 0 22913 0 8160 0 22327 0 14124 0 294906 0 0 0 Randall Guerrero 214963 0 17926 0 720 0 29195 0 14124 0 276928 0 0 0 Stephanie Vance 207037 0 20065 0 18323 0 21018 0 14124 0 280567 0 0 0 Jeffrey Lefors 200537 0 20384 0 17231 0 33276 0 3531 0 274959 0 0 0 Kamela Loo 244722 0 4354 0 4708 0 47023 0 10593 0 311400 0 0 0 Part I, Line 4b: Supplemental nonqualified retirement plans include a Supplemental Executive Retirement Plan (SERP) and a Deferred Compensation Plan for selected executives. Employee and employer contributions to the Deferred Compensation Plan and the change in actuarial value of SERP benefits for the year ending 9/30/2010 are as follows (no amounts were paid out of either plan during the year): William Haug - Deferred Compensation Plan $16,500; Change in SERP actuarial value $366,549 Michele Waldron - Deferred Compensation Plan $16,500; Change in SERP actuarial value $62,624 Todd Suntrapak - Deferred Compensation Plan $16,500; Change in SERP actuarial value $72,854 Beverly Hayden-Pugh - Deferred Compensation Plan $16,500; Change in SERP actuarial value $70,141 Jessie Hudgins - Deferred Compensation Plan $16,500; Change in SERP actuarial value $61,665 Marta Boyer - Deferred Compensation Plan $16,500; Change in SERP actuarial value $81,358 Jane Willson - Deferred Compensation Plan $16,500; Change in SERP actuarial value $43,938 James Meinert - Deferred Compensation Plan $16,500; Change in SERP actuarial value $0 Mark Zielazinski - Deferred Compensation Plan $16,500; Change in SERP actuarial value $0 David Singh - Deferred Compensation Plan $16,508; Change in SERP actuarial value $0 Stephanie Vance - Deferred Compensation Plan $10,000; Change in SERP actuarial value $0 Jeffrey Lefors - Deferred Compensation Plan $16,500; Change in SERP actuarial value $0 Part I, Line 5 An Executive Incentive Plan has been established that allows for payment of incentives based on both organization-wide and individual goals. Such goals are related to a variety of metrics including revenue and operational results of both the Hospital and the Foundation. The Incentive Plan has been approved by the Compensation Committee of the Board of Trustees. The committee reviews the forecasted payouts at the end of each year based on the financial and operating results. Part I, Line 6 SEE EXPLANATION FOR LINE 5, ABOVE COUNTY OF MADERA 946000518 556902DN1 2010-02-04 39512854 To refund series 2006 Bonds issued on 6/26/06. 0 0 39512854 4256483 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 1 Wishon Radiology Medical Group Entity for which Dr. Charles Smith is an officer 486775 DR. SMITH PROVIDES MEDICAL DIRECTOR SERVICES AND TELERADIOLOGIST COVERAGE THROUGH WISHON RADIOLOGY MEDICAL GROUP 0 Form 990, Part VI, Section B, line 11 A DRAFT OF THE FORM 990 IS UPLOADED TO A SECURED BOARD PORTAL PRIOR TO THE FILING DATE. BOARD MEMBERS ARE ASKED TO REVIEW THE FORM 990 AND PRESENT ANY QUESTIONS THEY MAY HAVE TO THE CFO. THE CFO PRESENTS HIGHLIGHTS OF KEY SECTIONS OF THE FORM 990 AT THE FINANCE COMMITTEE MEETING THAT IS HELD BEFORE THE FILING DATE AND ANSWERS QUESTIONS OR ADDRESSES ANY CONCERNS AT THIS MEETING. CHANGES CAN THEN BE MADE IF WARRANTED BEFORE THE 990 IS FILED. Form 990, Part VI, Section B, line 12c THE HOSPITAL BOARD OF TRUSTEES MAINTAINS A CONFLICT OF INTEREST POLICY WITHIN THE HOSPITAL'S CORPORATE BYLAWS. THE POLICY REQUIRES EACH TRUSTEE TO DISCLOSE PERSONAL FINANCIAL INTERESTS BY EXECUTING ANNUAL STATEMENTS AND REPORTING SPECIFIC INTERESTS ON AN AD HOC BASIS. A STANDING GOVERNANCE COMMITTEE IS TASKED TO REVIEW DISCLOSED INTERESTS, TO ASSESS WHETHER A CONFLICT OF INTEREST EXISTS AND MAKE RECOMMENDATIONS REGARDING FURTHER ACTION AS MAY BE NECESSARY TO MITIGATE OR ELIMINATE A CONFLICT. THE HOSPITAL MAINTAINS A SEPARATE BUT SIMILAR POLICY GOVERNING INDIVIDUALS EMPLOYED IN COVERED POSITIONS. Form 990, Part VI, Section B, line 15 AS PROVIDED BY THE HOSPITAL BYLAWS, A COMPENSATION COMMITTEE HAS BEEN ESTABLISHED THAT CONSISTS OF A CHAIR AND AT LEAST THREE MEMBERS OF THE BOARD OF TRUSTEES. THE PRIMARY ROLE OF THE COMMITTEE IS TO ENSURE THAT COMPENSATION IS REASONABLY RELATED TO THE DUTIES PERFORMED FOR THE HOSPITAL AND WITH THE COMPETITIVE EMPLOYMENT MARKET. DUTIES AND ACTIVITIES SPECIFIC TO CEO, OFFICER, AND KEY EMPLOYEES OF THE ORGANIZATION INCLUDE: 1) PERIODIC REVIEW BASED ON THE INDEPENDENT ADVICE OF AN EXTERNAL QUALIFIED COMPENSATION CONSULTANT 2) REVIEW OF MARKET DATA FOR EQUIVALENT POSITIONS 3) REVIEW AND APPROVAL OF TERMS AND CONDITIONS OF THE CEO'S EMPLOYMENT AND OVERSIGHT TO ASSURE FORMAL AND TIMELY PERFORMANCE ASSESSMENTS ARE CONDUCTED 4) REVIEW AND APPROVAL OF EXECUTIVE LEVEL COMPENSATION TO ASSURE THAT TERMS AND CONDITIONS OF EMPLOYMENT ARE MARKET COMPETITIVE Form 990, Part VI, Section C, line 19 A COPY OF CHILDREN'S HOSPITAL'S ARTICLES OF INCORPORATION IS ON FILE WITH THE CALIFORNIA SECRETARY OF STATE. A COPY OF THE CORPORATE BYLAWS OF CHILDREN'S HOSPITAL CENTRAL CALIFORNIA IS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. CONFLICT OF INTEREST MANAGEMENT IS DESCRIBED IN ARTICLE 10 OF THE BYLAWS. THE HOSPITAL PREPARES ANNUAL FINANCIAL STATEMENTS WHICH ARE AUDITED BY AN INDEPENDENT ACCOUNTING FIRM PRIOR TO SUBMITTAL TO RELEVANT STATE AGENCIES. FORM 990, PART VII, SECTION A, COLUMN B HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS WILLIAM F. HAUG'S TIME IS DIVIDED AS FOLLOWS: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 34 HRS CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION 6 HRS MICHELE WALDRON'S TIME IS DIVIDED AS FOLLOWS: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 38 HRS CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION 2 HRS GORDON ALEXANDER'S TIME IS DIVIDED AS FOLLOWS: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 34 HRS CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION 6 HRS DR. ROBERT KUBO'S TIME IS DIVIDED AS FOLLOWS: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 1 HR CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION 1 HR JEFF MAYER'S TIME IS DIVIDED AS FOLLOWS: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 1 HR CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION 1 HR DAVE OLSON'S TIME IS DIVIDED AS FOLLOWS: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 1 HR CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION 1 HR Susan Boyd'S TIME IS DIVIDED AS FOLLOWS: CHILDREN'S HOSPITAL CENTRAL CALIFORNIA 1 HR CHILDREN'S HOSPITAL CENTRAL CALIFORNIA FOUNDATION 1 HR FORM 990 PART III, LINE 4A Statement of Program Service Accomplishments - Program Service One Children's Hospital Central California has a rich history. In 1949, a group of five civic-minded women decided the children in the Central San Joaquin Valley needed and deserved to be cared for, close to home, by physicians and health care professionals dedicated just to children's health. In 1952, through persistence and devotion to their dream, Valley Children's Hospital and Guidance Clinic became a reality. In the ensuing years, Children's Hospital continued to add beds and services to meet a growing demand, and today, at 340 beds, is the premier pediatric specialty provider in the heart of the Golden State. Mission The Mission of Children's Hospital Central California is to provide high quality, comprehensive health care services to children regardless of their ability to pay. Vision Children's Hospital Central California, with its physician partners, will be the pre-eminent provider of pediatric services for Central California and the western United States, and an indisputable resource for healthcare solutions, information and advocacy for children in an expanding pediatric market place. Core Values The following core organizational values guide the investments and support provided by Children's Hospital's Community Benefits Program. Excellence - We depend on exceptional people to provide exceptional quality health care and services throughout Children's Hospital. We set high standards and we support each other as we strive to achieve them. We invest in each other and we value the individual and cultural differences that make us strong. We are proud of our superior services as measured by quality outcomes. Compassionate Care - We treat every child, every family, each other, our visitors and our vendors with respect, kindness, hope, joy and good humor. We display our helpful, healing, family-centered spirit at every opportunity. We recognize the importance of playfulness in human interaction and in the health of children. We look for ways to ease suffering and provide comfort. Integrity - We are honest, ethical and responsible in our work and in the way we deal with others. We keep our promises and admit our mistakes. We know ourselves and we avoid hidden agendas. By the way we live our lives everyday, we are worthy of the trust people place in us. Innovation - We embrace change, creativity, continuous learning and personal growth. We incorporate new ideas, technology and methods to improve the health care and services we provide. We anticipate future trends and we create strategic plans to ensure future growth and continued vitality. Collaboration - We build enduring internal and external relationships, joining with colleagues across organizational boundaries to improve the care and services we provide. We encourage and reward both individual and team achievements. We put the common good ahead of narrow interests. Stewardship - We are resourceful, adaptable and resilient. We have a "can do" attitude that gets the job done. We are fiscally responsible and efficient with our time. We protect our reserves and manage our operating costs in order to invest in our future. We are each personally dedicated to making Children's Hospital better because we were here. Commitment to the Community As a not for profit organization governed by its own Board of Trustees, Children's Hospital is solely committed to addressing the medical needs of our region's sickest children. With over 220 physicians and almost 2,200 full-time equivalent employees, Children's Hospital performs more than 11,000 pediatric surgeries a year and the hospital's Neonatal and Pediatric Intensive Care Units have some of the lowest mortality rates in the country while treating some of the sickest children. While providing high quality patient care is the single greatest contribution the hospital makes towards advancing the health and wellbeing of children, the hospital also appreciates that it is uniquely positioned to support the needs of children in other ways as well. As an extension of the hospital's mission and vision, the goal of Children's Hospital's Community Benefits Program is to advance the health and wellbeing of underserved, medically needy children through collaboration and common concern. This Community Benefits Report summarizes the contributions provided by Children's Hospital to its community for fiscal year (FY) 2010 (October 1, 2009 thru September 30, 2010). Service Area Demographics As the only pediatric specialty hospital located in Central California, Children's Hospital's primary service area extends from Stockton in the north to Bakersfield in the south, and from the Central Coast to the Eastern Sierra. The service area includes 10 counties, covers over 45,000 square miles and, is home to over 1.2 million children ages 0-17. According to data reported by the state of California (County Health Status Profiles, Department of Health Care Services, 2010), children in Central California are disproportionally disadvantaged when compared to children in other parts of the state. Consider the following statistics for the eight county region including San Joaquin, Stanislaus, Merced, Madera, Fresno, Kings, Tulare, and Kern counties. Infant Mortality: 6.1 deaths per 1,000 live births in the eight county region compared to 5.3 statewide Prenatal Care: 24% of live births with late or no prenatal care in the eight county region compared to 16% statewide Teen Births: 56 births per 1,000 population in the eight county region compared to 37 statewide Children Living in Poverty: 22.5% in the eight county region compared to 16% statewide Additionally, Central Valley children tend to suffer higher rates of asthma, have fewer children enrolled in preschool, higher school drop out rates, higher percentages of uninsured, and higher rates of obesity when compared to statewide averages. (SOURCES: CHILDRENNOW.ORG AND KIDSDATA.ORG) The short term and long term implications of these statistics are significant. For children and their families, it means chronic illness accompanied by frequent visits to physician offices, clinics or hospital emergency rooms, missed days at school, and for the parents missed days at work. For service providers, like Children's Hospital, it means already scarce resources are stretched even thinner to address significant health needs. The opportunity is for health services providers and the broader community to address these and other health challenges facing Central Valley children through collaboration and common concern. Children's Hospital's Patient Volume In 2010, Children's Hospital had 13,330 inpatient cases, 67,120 Emergency Department visits and a combined 155,999 outpatient center, day surgery, radiology and laboratory visits. Medi-Cal benefits covered 73% of the inpatient cases and 63% of the outpatient visits treated at Children's Hospital. Over 70% of our patient days were for children 5 years of age or younger and over two-thirds of our patient population were an ethnicity other than caucasian. Assessing and Understanding Community Needs Children's Hospital Community Benefit Program is built upon the outcomes of a collaborative community health needs assessment that includes the following activities: Formal Needs Assessment - Consistent with state law, Children's Hospital completes a formal assessment of unmet health care needs among children every three years. The hospital's last assessment was completed in August 2008 and included the following activities. Participation in Community-Based Organizations - Children's Hospital participates in a number of community-based organizations and initiatives, that keeps the hospital current on community health needs and allows the hospital to make adjustments to its community benefits program activities. Examples of organizations and initiatives in which the hospital was involved include the following: Central California Coalition of Child Abuse Prevention Councils Central California Children's Institute Central Valley Health Policy Institute Central Valley School Health Advisory Panel Childhood Obesity Prevention Task Force Children's Health Initiative Fresno County County Pediatric Death Review Teams Exceptional Parents Unlimited Fresno Healthy Community Access Partners Fresno-Kings-Madera Regional Health Authority March of Dimes Central Valley Division Safe Kids Central Valley Interagency Council for Children (Fresno and Madera counties) Kern County Medically Vulnerable Infant Project Stakeholder Interviews - The hospital interviewed leadership from nearly two dozen social service organizations, including county health departments, county offices of education, school districts, primary care clinics, and a variety of private non profit agencies providing services to underserved children and their famalies. Health Status Indicators - The hospital also conducted an extensive review of available county and state data reports on key health status indicators for children. Data sources consulted included the California Department of Health Care Services' County Health Status Profiles, 2007; the Great Valley Center's Assessing the Region Via Indicators - Public Health and Access to Care, 2007; the California Health Interview Survey, 2007 administered by the UCLA Center for Health Policy Research, and; the California Department of Public Health's Immunization Kindergarten Assessment, 2007. Children's Hospital's Community Benefits Advisory Committee - The hospital's Community Benefits Advisory Committee provides oversight and direction regarding the development and implementation of the hospital's community benefits program. Using the information and input received through the needs assessment and its ongoing engagement with the community, the Committee agrees upon priority needs and develops and monitors programs or interventions to address those needs. The Committee consists of both administrative and clinical leadership from various hospital departments. Community Benefits Program A community benefit is generally defined as a clinical or non-clinical program or service that, provides treatment and/or promotes health and healing in response to an identified community health need or service gap identified through the community needs assessment process, is intended to benefit the community as opposed to the hospital, and results in a low or negative financial margin for the hospital. Also included in the definition is the provisionof charity care and the unreimbursed cost of providing health care services to those enrolled in public programs, such as Medi-Cal or county indigent programs. For FY 2010, Children's Hospital dedicated in excess of $13,240,615 in Community Benefits that continue the hospital's long tradition of being an active and integral part of Central California. A summary of the hospital's Community Benefits Program activities is provided below. Community Health Needs Children's Hospital partners with a variety of community-based organizations to help address issues identified through the community health needs assessment, including the following. Child Abuse Prevention - Preventing and protecting children from abuse and neglect form the cornerstone of The Guild's of Children's Hospital Child Abuse Prevention and Treatment Center. In partnership with a number of private and public agencies, the Program provided education, leadership, and direct services for children who were victims of abuse and to parents and community-based organizations to help prevent abuse. Capacity for Meeting the Needs of Medically Complex Children - Children's Hospital recognizes the critical role that community based providers and organizations play in meeting the needs of medically complex children and is committed to making sure they have the clinical skills to take care of this patient population. School Nurses - To help ensure these children receive medically appropriate care at school, Children's Hospital partnered with the California School Nurse Organization and individual school districts to provide training to school nurses on a variety of clinical procedures, including care of gastrostomy tubes and tracheostomy tubes. Additionally, Children's Hospital participated in and hosted the School Health Advisory Panel's quarterly meetings. The Panel is a consortium of school district health directors throughout the Central Valley that serves as a link between school-based health care professionals and Children's Hospital for the purpose of identifying and addressing emerging issues impacting the health and wellbeing of students in grades K - 12. Referring Hospitals/Community Based Organizations - Children's Hospital provided significant outreach education to referring hospitals and community based organizations to make sure they have the clinical expertise needed to care for medically complex children, Examples include a) Development of a Neonatal Stabilization Program in which clinical and educational staff from Children's Neonatal Intensive Care Unit worked with staff from other hospitals to improve the health outcomes of newborns and infants and b) Education to primary care providers on how to care for children with diabetes. Primary Care Physicians ($32,667) -In 2010, Children's Hospital provided 21 separate continuing medical education programs to a total of 286 primary care providers. Pediatric subspecialty physicians from Children's Hospital served as the featured faculty, providing community based physicians with guidance on how to manage a host of complex pediatric medical conditions in the outpatient setiing, including obesity, cancer, neurological conditions, asthma therapy and compliance, headaches, and many others. Programs were provided at locations throughout the hospital's service area, including Bakersfield, Madera, Merced, Modesto and San Luis Obispo. Developmental Disabilities - Children's Hospital helped improve care coordination for childhood with, or at risk for, developmental disabilities through its participation in Fresno First 5's Model of Care Partnership Oversight Committee and the Kern Medically Vulnerable Infant Project. Injury Prevention - Recognizing that unintentional injury is the nation's leading cause of death in children, Children's Hospital operates an Unintentional Injury Prevention Program to increase community awareness of childhood injuries and those measures that can be taken to decrease their prevalence throughout Central California. Supported by a cast of 25 hospital employee volunteers, the Program covered the following topics in 2010: Child Maltreatment, Distracted & Reckless Teen Driving, Pediatric Trauma, Water Safety, Wheeled Sports Safety, Child Passenger Safety, the Choking Game, Munchausen by Proxy Syndrome, and Shaken Baby Syndrome. The Program provided education to over 46,700 children and families at a host of community based venues throughout the Central Valley. In addition, the hospital provided training and conducted outreach to 2,229 health care professionals at national, state, and regional conferences. The Program also provided workshops and in-services for education, law enforcement, and child welfare professionals. Children's Hospital also supported trauma care coordination activities organized through county Emergency Medical Services Agencies, and was a $1,000 sponsor of the Fresno County Trauma Intervention Program. Obesity Prevention - Children's Hospital founded the Childhood Obesity Prevention Task Force, a consortium of public and private agencies in Fresno and Madera counties committed to reducing the incidence of childhood obesity through networking among peer agencies, coordination of services, and implementation of best practices. Activities supported by the Task Force in 2010 included increased coordination among existing programs and the development of a work plan to support primary care physician efforts to prevent or manage childhood obesity. Children's Hospital contributed $3,000 towards the development of the work plan. For its commitment to childhood obesity prevention, Children's Hospital was recognized by the Central Valley Health and Nutrition Collaborative as a 2010 "Central Valley Champion for Health Care". Poison Control ($53,703) - The Central California Poison Control Center is located on the Children's Hospital campus and receives a donation of office space and supplies. In addition to providing emergency telephone advice regarding poison exposures, the Poison Control Center operates several programs critical to a culturally diverse, agriculturally based community like the Central Valley. The Center has been expressly responsive to the growing and largely underserved Latino population by developing specialized teaching tools and program interventions in Spanish, and providing customized trainings for community health workers in Spanish. Also, the Center contracts with the State Department of Pesticide Regulation (DPR) to assist physicians in complying with mandatory reporting requirements for pesticide exposures. The Poison Control Center also provides the state DPR with case data and information on the health issues related to pesticide exposure in California. Other ($7,000) - Children's provided support to other programs that target the needs of underserved children or broader community based health issues including Camp Taylor (a summer camp for children with cancer and their families), the American Heart Association, and the Junior League of Fresno. Health Care Work Force Development Children's is committed to promoting an adequate supply of highly trained professionals to meet our region's future demand for pediatric health care services. Activities supported by the hospital in 2010 included the following: Support for Nursing Faculty ($11,078) - Children's Hospital supported two staff to teach at a local community college based registered nursing program. Valley Coalition for UC Merced Medical School- The proposed medical school at UC Merced will play a critical role in ensuring that the Central Valley has the physicians, including pediatric specialists, needed to take care of a growing population. Children's Hospital continued to provide guidance and advocacy in support of the school's development. Hematology Class ($3,800) - Children's Hospital made a donation to California State University, Fresno for a Hematology Class taught at Children's Hospital. Association of PeriOperative Nurses ($500) - Children's Hospital provided support for the continued education and training of operating room nurses. Pediatric Residency Program ($1,514,336) - Children's Hospital is a major affiliate of the University of California San Francisco - Fresno Pediatric Residency Program. Structured as a three-year fully accredited post-graduate residency, the training program is helping to address the critical shortage of both pediatricians and pediatric subspecialty physicians in the Central Valley by offering rotations in general pediatrics, pediatric surgery, family practice, and emergency medicine. In 2010, 30 medical school residents received training at Children's Hospital. Community Health Education Community health education is a paramount priority to the hospital, which has a long-standing commitment to providing community wellness and prevention education programs. Classes were offered at the hospital as well as at other community venues. Classes were taught by Children's Hospital professionals who have spent years studying and gaining experience in their chosen fields. Classes were open to the community at no cost. Examples of classes offered in 2010 include the following: Asthma Basics - This class provided information about controlling asthma; proper use of medications; peak flow meters; meter dose inhalers and spacers; recognizing early warning signs of asthma; environmental control and what triggers an asthma attack. CPR for Family and Friends - Offered to families who were taking a child home from Children's, this class presented information on the American Heart Association's (AHA) pediatric chain of survival, signs of choking, prevention of sudden infant death syndrome, and prevention of the most common fatal injuries in infants and children. The course also presented information about the AHA adult chain of survival and signs of cardiac arrest, heart attack, stroke and choking in adults. Children's Hospital also provided access to educational information via its website, include the following two services. E-Health Newsletter ($18,000) - Children's Hospital appreciates how difficult it is for parents to keep up with all the latest child health and safety information. E-Health Newsletter provides trusted, credible child health and safety information from hospital pediatric experts as well as other experts from around the country. Most important, families are able to customize the information to meet a child's health and safety information needs. Health Encyclopedia ($9,000) - The Children's Health Encyclopedia contains thousands of pages of information on pediatric diseases, conditions and treatments, as well as sections on how to keep kids healthy. The encyclopedia is available in English and Spanish. Family Assistance Family centered care is a cornerstone of Children's Hospital. The Hospital understands that families must be given support and resources to effectively participate in their child's care. Care Pages ($2,385) - Through the Care Pages program, Children's Hospital. offers families a free web site through which families create their own web page to stay in touch with family and friends during times of illness or injury. Culturally Competent Health Care - With a service area that is home to over 100 documented languages and 37 distinct cultures, Children's Hospital is committed to meeting the needs of a very diverse patient population. As it has done for years, the hospital in 2010 provided language assistant 24 hours a day, seven days a week. Children's Hospital also worked with a variety of ethnic groups to ensure that the hospital was providing care in as culturally sensitive a manner as possible. For its commitment to culturally competent health care, Children's Hospital was recognized by Fresno Interdenominational Refugee Ministries as a "Community Partnership Builder" in 2010. Children's Hospital was also recognized by the Hmong Health Collaborative (HHC) for its participation in a two year program designed to increase understanding between the hospital and Hmong spiritual healers, or Shamans. Through the program, hospital staff received training in Shamanism and its healing practices, and Shamans received training in Western medicine and on hospital facilities and regulations. HHC is a group of nine community-based organizations that helps providers better meet the need of the Hmong population. Transportation ($124,004) - Children's Hospital's Social Work Department assisted families with transportation by providing taxi vouchers and bus tokens. In addition, Children's Hospital subsidized bus and transit services from Fresno and the Kings County rural areas. Public transportation has been, a problem in the Central Valley for years and thus Children's Hospital is continuing to work with the community to improve public transportation and in turn improve access to care. Cafeteria Meals ($49,765) - Meal coupons were provided to breast feeding moms whose infants were in the hospital. Social Workers also provided patients' families with meal coupons when they arrived and were not prepared for a long stay at the hospital. Family Assistance Fund ($23,535) - When support for services were not available through a community program or another funding source, social workers were able to access these hospital funds to help patients and families obtain items needed upon return home or assist with transportation for follow up care. Enrollment into Health Insurance ($193,309) - Children's Hospital commits significant resources in helping families find health insurance coverage for themselves and their uninsured children. With the support of both financial counselors employed by the hospital as well as a contracted vendor with expertise in enrollment services, Children's Hospital screens uninsured and under-insured families for eligibility in Medi-Cal, Healthy Families, the California Children's Services Program, as well as the Children's Hospital Financial Assistance Program (Charity). Once eligibility is determined, the hospital assists in the completion of applications, and submits applications to the appropriate processing or funding agencies. Big and Little Heroes ($638) - Big and Little Heroes is a collaboration between Children's Hospital, California State University, Fresno, and the Fresno Downtown Rotary through which patients at the hospital are paired with university athletes. The program provides a rewarding mentoring opportunity for the students and gives the patients something special to look forward to all through the year. Part III, Line 4b Statement of Program Service Accomplishments - Program Service Two Commitment to Medi-Cal Children's Hospital's commitment to serving its community is evidenced by the large number of patients its serves that are covered by Medi-Cal. In 2010, of the hospital's 13,330 inpatient cases, 9,327 were covered by Medi-Cal. The Hospital has historically been able to negotiate increases to its Medi-Cal inpatient reimbursement. These increases, however, have not offset the rising cost of care for these patients and in recent years, cutbacks in government funding continued to put pressure on the hospital's ability to provide care. In addition, the Medi-Cal outpatient fee schedule reimbursement remains significantly below cost. The combined net effect of the total Medi-Cal reimbursement and disproportionate share funding (DSH) in relation to the cost of these services resulted in a net loss to the hospital in 2010 of $11,089,895. Charity Care In keeping with our Mission, Children's Hospital continues to accept all patients, regardless of their ability to pay. In 2010, Children's Hospital provided $103,000 in charity care. The amount represents costs associated with patients who meet certain criteria under the hospital's charity care policy without charge, or at amounts less than its established rates in relation to the cost of these services. Charity Care includes county indigent and free care, which is based on the patient's inability to pay for services. In order to assist families with ongoing care needs, Children's Hospital's Financial Assistance policy requires patient families to apply for appropriate government funding in conjunction with applying for financial assistance (charity care). As a result, many families qualify for government programs and do not ultimately require charity care. 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