2011-02-15T08:52:47-06:00 2010-06-30 GOODMAN & COMPANY 4510 COX ROAD SUITE 200 GLEN ALLEN VA 230603394 990 2009-07-01 540506309 CRIPPLED CHILDREN'S HOSPITAL CRIP 8042285814 2924 BROOK ROAD RICHMOND VA 232201298 SAMUEL G WEIDMAN 8042285814 2011-02-15 1 CHRISTOPHER T BENNETT CPA 8042827636 2009 2016-02-24 21:20:13Z CHILDREN'S HOSPITAL LESLIE G WYATT 2924 BROOK ROAD RICHMOND VA 232201298 25651006 0 X www.childrenshosp-richmond.org X 1920 VA CRIPPLED CHILDREN'S HOSPITAL IS A RESOURCE AND PROVIDER OF SPECIALIZED MEDICAL AND THERAPEUTIC SERVICES CUSTOMIZED TO MEET THE SPECIFIC NEEDS OF CHILDREN AND THEIR FAMILIES. NEARLY 8,000 CHILDREN WERE SERVED THIS PAST YEAR. WE CONTINUE TO FOCUS ON EXPANDING OUR CAPACITY TO SERVE MORE CHILDREN. 27 25 374 90 0 0 4368223 959016 21151056 24478110 12489 15944 217039 187434 25748807 25640504 0 0 16759846 18989548 0 0 6961737 7844879 23721583 26834427 2027224 -1193923 19966381 20430682 7129720 8942630 12836661 11488052 Children's Hospital is a resource and provider of specialized medical and therapeutic services customized to meet the specific needs of children and their families. Nearly 8,000 children were served this past year. We continue to focus on expanding our capacity to serve more children. 0 0 7599435 9913386 IN THE FALL OF 2008, THE HOSPITAL COMPLETED A $5.8 MILLION RENOVATION/EXPANSION OF THE INPATIENT TRANSITIONAL CARE UNIT. THE UNIT NOW HAS 47 BEDS AND PROVIDES LONG TERM CARE FOR CHILDREN UP TO AGE 21 WHO REQUIRE SPECIALIZED ROUND THE CLOCK NURSING CARE. THE UNIT HAD 39 RESIDENTS AS OF JUNE 30, 2010. THIS IS AN INCREASE FROM THE 23 RESIDENTS JUST TWO YEARS PRIOR. THE HOSPITAL'S TRANSITIONAL CARE UNIT WAS THE RECIPIENT OF THE 2010 COMMITMENT TO QUALITY AWARD GIVEN BY THE AMERICAN HEALTH CARE ASSOCIATION AND THE NATIONAL CENTER FOR ASSISTED LIVING. THE HOSPITAL WAS AMONG FOUR PERCENT OF THE MORE THAN 11,000 MEMBER FACILITIES WHO WERE RECOGNIZED THIS YEAR AND AMONG 18 PERCENT OF FACILITIES RECOGNIZED IN THE LAST 10 YEARS. TO DATE, THE HOSPITAL IS THE ONLY RICHMOND FACILITY TO HAVE RECEIVED THIS NATIONAL RECOGNITION AWARD. 6901555 8813813 THE HOSPITAL IS THE PREMIER PROVIDER OF OUTPATIENT PEDIATRIC PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY IN CENTRAL VIRGINIA. OUTPATIENT THERAPY VISITS APPROXIMATED 64,000 IN FISCAL YEAR 2010, AN INCREASE OF 6% FROM THE PRIOR YEAR. THERAPY SERVICES ARE OFFERED AT THE MAIN HOSPITAL AND AT FOUR THERAPY CENTERS LOCATED IN FREDRICKSBURG, PETERSBURG, GLEN ALLEN, AND BON AIR. BON AIR WAS OPENED IN FISCAL 2010 AS A RESULT OF THE NEED TO RELOCATE FROM THE EXISTING CHESTERFIELD FACILITY BECAUSE OF SPACE NEEDS. THE COMMUNITY THERAPY CENTERS NOW ACCOUNT FOR 61% OF ALL THERAPY SERVICES. 2351368 3947875 THE HOSPITAL'S DENTAL PROGRAM CONTINUED TO GROW IN FISCAL YEAR 2010. OVER 700 OUTPATIENT SURGERIES WERE COMPLETED. THIS REPRESENTS AN INCREASE OF 20% OVER THE PRIOR YEAR. DURING THE SAME TIME, DENTAL CLINIC VISITS INCREASED BY 20%. THE DENTAL PROGRAM CONTINUES WITH A DENTAL OUTREACH PROGRAM TO TAKE IMPORTANT DENTAL EDUCATION AND MATERIALS TO AREA ELEMENTARY SCHOOLS. DURING THE 2009/2010 SCHOOL YEAR, THE DENTAL OUTREACH PROGRAM HAS PROVIDED SUPPLIES AND INSTRUCTION TO 9,492 CHILDREN IN 82 SCHOOLS. THE PROGRAM WAS DESIGNED BY THE HOSPITAL AND THE VIRGINIA DEPARTMENT OF HEALTH-DENTAL DIVISION TO MEET THE STANDARDS OF LEARNING (SOL) HEALTH REQUIREMENT. 3554186 1949719 PHYSICIAN SPECIALTY SERVICES - PEDIATRIC PHYSICIAN SPECIALIST, NURSE PRACTITIONERS AND THERAPIST PROVIDE EVALUATION, DIAGNOSIS AND TREATMENT OF A WIDE VARIETY OF MEDICAL CONDITIONS IN OUR OUTPATIENT CENTER. CLINICS INCLUDE: PHYSICAL MEDICINE AND REHABILITATION; CEREBRAL PALSY; MUSCULAR DYSTROPHY; SPASTICITY AND SPINA BIFIDA. CHILDREN'S FEEDING PROGRAM - THE CHILDREN'S FEEDING PROGRAM IS DESIGNED TO HELP CHILDREN WHO HAVE A MEDICAL CONDITION THAT HAS AFFECTED THEIR FEEDING AND GROWTH. THE CHILD IS INITIALLY SEEN IN THE FEEDING CLINIC BY A TEAM OF SPECIALISTS WHO EVALUATE THE CHILD'S NEEDS AND MAKE RECOMMENDATIONS FOR TREATMENT AND/OR PROVIDES TIPS FOR THE FAMILY. TREATMENT PROGRAMS, EITHER OUTPATIENT OR DAY PATIENT, FOCUS ON ESTABLISHING APPROPRIATE FEEDING AND NUTRITIONAL HABITS. 3554186 1949719 20406544 1 1 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 52 0 374 1 0 0 0 0 0 0 0 0 0 0 27 25 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 VA X Jim Deyarmin 8042825874 2924 Brook Road Richmond VA 232201298 Frances W Kay RN 1.00 X X 0 0 0 Thomas S Cain 1.00 X X 0 0 0 Randolph A Beales 1.00 X X 0 0 0 Eugenio A Monasterio Md 1.00 X X 0 0 0 Anne C Adams DDS 1.00 X 0 0 0 Judith B Collins RN NP 1.00 X 0 0 0 Scott C Denicourt 1.00 X 0 0 0 GEORGE C FREEMAN III 1.00 X 0 0 0 SANDY D GULLQUIST MD 1.00 X 0 0 0 Alexander Hamilton IV 1.00 X 0 0 0 Ann E Honeycutt 1.00 X 0 0 0 May Ligon Huff 1.00 X 0 0 0 James F Jollay 1.00 X 0 0 0 Frank Lennon 1.00 X 0 0 0 William C McAllister 1.00 X 0 0 0 John M O'Bannon III MD 1.00 X 0 0 0 Meera A Gokli DDS 1.00 X 0 0 0 Kathy Raouf 1.00 X 0 0 0 Michael Sesnowitz PhD 1.00 X 0 0 0 Chester Sharps MD 1.00 X 0 0 0 Rex L Smith III 1.00 X 0 0 0 Katie Taylor 1.00 X 0 0 0 William B Thalhimer III 1.00 X 0 0 0 Henry L Valentine III 1.00 X 0 0 0 John D Ward MD 1.00 X 0 0 0 KRISTEN GOODE 1.00 X 0 0 0 Leslie G Wyatt 45.00 X X X 267274 0 42785 Samuel G Weidman 45.00 X X 234547 0 42948 Sharon W Darby 45.00 X X 176886 0 11219 Karen A Bennett 45.00 X 127638 0 22263 Satish K Mahajan MD 45.00 X 171477 0 18062 Elizabeth B Bortell DDS 45.00 X 176147 0 13364 DEEPA SIMON 40.00 X 134520 0 11367 JAMES A DEYARMIN 45.00 X 105877 0 10078 1394366 0 172086 9 0 1 0 MCV PHYSICIANS PO BOX 79203 BALTIMORE MD 212790203 CONTRACT PHYSICIANS 377766 ARKANSAS COUNTY ANESTHESIA 48180 KIPPER DRIVE MOSELEY VA 23120 ANESHESIA SERVICES 288750 MEDSITES LLC PO BOX 127 SPOTSYLVANIA VA 22553 CONSTRUCTIONS SERVICES 106561 3 959016 959016 Patient Services 623000 24478110 24478110 24478110 15794 15794 12800 12800 12800 12800 150 150 150 150 1909 1909 1909 19834 10502 9332 9332 PAYMENT FROM AFFILIATE 623990 100000 100000 Infant services 621610 23477 23477 Asst tech loan fund 900099 17051 17051 22865 6155 16710 163393 25640504 24624793 0 56695 706343 536387 169956 14712195 12293626 2418569 1329408 1104429 224979 1107079 912949 194130 1134523 955072 179451 262362 262362 314011 314011 58625 58625 2016956 1495728 521228 164431 2668 161763 2163082 1565815 597267 209038 24082 184956 784406 328625 455781 35824 25515 10309 85941 70769 15172 1175635 881726 293909 314322 314322 RESTrictED GIFT EXPENSE 313059 313059 Dues & Licenses 48057 6692 41365 Miscellaneous 26192 16464 9728 Bad Debt -127062 -127062 26834427 20406544 6427883 0 1601469 1260804 1567 1005507 2490419 2842904 154925 159790 348661 266897 37996241 26347756 12189852 11648485 3179488 3246295 19966381 20430682 2175087 2770128 4954633 6172502 7129720 8942630 X 10272922 8878105 511817 557925 2051922 2052022 12836661 11488052 19966381 20430682 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2563739 597294 41040 592126 2609947 3089602 1034025 82059 1641947 2563739 0.00000 0.79000 0.21000 1 1 1 54914 54914 17574281 9262316 8311965 472015 91035 380980 19497363 16607668 2889695 397668 386737 10931 11648485 OTHER CURRENT ASSETS 72856 EQUITY INTEREST IN FOUNDATION NET ASSETS 2609947 DUE FROM FOUNDATION 178828 DUE FROM AFFILIATES 47575 OTHER NONCURRENT ASSETS 337089 3246295 SETTLEMENTS DUE TO THIRD-PARTY PAYORS 1841488 PENSION LIABILITY 3908779 DUE TO AFFILIATES 3395 Deferred Compensation 325693 deferred mda revenue 85301 unearned grant revenue 7846 6172502 25640504 26834427 -1193923 -154686 -154686 -1348609 25640504 0 25640504 0 25640504 26834427 0 26834427 0 26834427 Part V, Line 4: Description of Intended Use of Endowment Funds: PROCEEDS FROM ENDOWMENT FUNDS SUPPORT THE HOSPITAL PROGRAMS. 1 1 1 X 1 X 1 0 1 1 1 56 14734 0 14734 0.00050 1 4221 1166182 269092 897090 0.03300 0 0 0 0 0.00000 2 4277 1180916 269092 911824 0.03350 159 32150 192086 0 192086 0.00710 5 2130 156489 25337 131152 0.00480 2 5000 1338142 273888 1064254 0.03920 0 0 0 0 0.00000 75 800 3600 0 3600 0.00010 241 40080 1690317 299225 1391092 0.05120 243 44357 2871233 568317 2302916 0.08470 1 78818 0 41004 41004 X 1 1 CRIPPLED CHILDREN'S HOSPITAL

2924 BROOK ROAD RICHMOND VA 23220

X X X PEDIATRIC LONG TERM CARE Part I, Line 3c: Part I, Line 6a: The hospital and Children's Hospital Foundation reports through it many publications and web sites the activitiesthat supports the community. The Foundation includes information in an annual report that is distributed throughout the community. Part I, Line 7: COST IS USED TO DETERMINE THE AMOUNT OF COMMUNITY BENEFIT FOR EACH CATEGORY. COST IS DETERMINED BY USING EITHER A COSTACCOUNTING METHODOLOGY OR A COST TO CHARGE RATIO. Part I, Line 7g: The cost of certain physician clinics that meet the definition of a subsidized healthcare service is included in SubsidizedHealthcare Services. Direct cost for the specialty physician clinics was $652,749. Part I, Line 7f: Total community benefit cost before direct offsetting revenue was 10.56% of total expense. Part III, Line 4: Revenue from the Medicaid program accounted for approximately 70% of the Hospital's net patient service revenue for the year ended June 30, 2010. Amounts not expected to be paid are reserved and charged to bad debt expense.The amounted reported as bad debt expense is at cost and is based on a cost to charge ratio. No attempt has been made to determine the amount in bad debt expense that could have been eligible for charity care.The hospital will refer to a contracted collection agency accounts where the responsible party has not attempted to resolve the balance due. The hospital does enter into payment plans where the responsible party is attempting to resolve outstanding balances. Part III, Line 8: The bad debt expense or Medicare allowable cost is determined based upon a cost to charge ratio. Part III, Line 9b: A financial counselor assists patients in understanding availability of community or governmental assistance programs, as well as the hospital's charity care policy. Patient families receive notification through the patient booklet each receives as a new patient. Part V: The hospital serves patients from throughout Virginia. In addition, patients needing to access some of the special programs we offer, may come from throughout the United States. Part VI, Line 2: Free care is provided to eligible participants at 100% of FPG. Between 100% of FPG and 200% of FPG, patients are responsible for either 10% or 20% of their patient bill. Patients can qualify for a 70% discount when they meet certain requirements TO BE DEEMED MEDICALLY INDIGENT.The hospital does offer self-pay allowances (avg 60% charges) to uninsured patients beyond those who qualify for charity care. Patients can also be offered the spreading of payments over a period of time interest free. The hospital also provides discounts based upon the anticipated amount of the patient's total annual out-of-pocket liability for hospital and/or other medical care (medically indigent discount). Part VI, Line 3: See Part III, Line 9B EXPLANATION. Part VI, Line 4: See Part V explanation. Part VI, Line 7: See Part V explanation. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 Leslie G Wyatt 228014 0 27260 0 12000 0 30523 0 12262 0 310059 0 0 0 Samuel G Weidman 192638 0 32309 0 9600 0 30656 0 12292 0 277495 0 0 0 Sharon W Darby 164652 0 12234 0 0 0 7303 0 3916 0 188105 0 0 0 Satish K Mahajan MD 171477 0 0 0 0 0 8154 0 9908 0 189539 0 0 0 Elizabeth B Bortell DDS 176147 0 0 0 0 0 2241 0 11123 0 189511 0 0 0 EUGENIO A MONASTERIO MD MEDICAL DIRECTOR 233825 INDEPENDENT CONTRACTOR 0 Form 990, Part VI, Section A, line 6 Also Lines 7A and 7B - The sole corporate member for most of the fiscal year was Children's Hospital Health Service (CHHS), a Virginia nonstock, non-profit corporation. On the close of business June 30, 2010, the sole member of the corporation became Virginia commonwealth University Health System Authority (VCUHS), a statutory authority created under the code of Virginia and CHHS would be dissolved. VCUHS has the exclusive right and power to elect, appoint, or remove the members of the corporation's board of directors as provided in the bylaws. The board of directors of VCUHS shall act on VCUHS's behalf in exercising VCUHS's reserved powers over the corporation. Certain committees of the board of directors of VCUHS shall oversee the activities of the corporation. Until close of business June 30, 2010, Crippled Children's Hospital Foundation (CHF), had CHHS as a common parent with governing decisions approved by the CHHS board. As of June 30, 2010 this relationship was dissolved and CHF became Children's Hospital and Healthcare services Foundation (Foundation)which exists as a non-membership, non-stock corporation whose purpose is to provide finanical support to, and engage in fundraising activities to support the health and general welfare of children. Neither VCUHS nor the hospital has power to appoint to the Foundation's board. Form 990, Part VI, Section A, line 7a see above response. Form 990, Part VI, Section A, line 7b SEE ABOVE RESPONSE. Form 990, Part VI, Section B, line 11 THE FORM 990 IS FURNISHED TO THE BOARD OF DIRECTORS FOR THEIR REVIEW BEFORE THE FORM IS FILED. QUESTIONS ARE ADDRESSED AND ALL DIRECTORS ARE UPDATED. Form 990, Part VI, Section B, line 12c All officers, trustees and key employees shall disclose a potential conflict to the compliance officer of the VCUHS for investigation and resolution. Upon appointment to the Board or employment and annually thereafter, officers, directors and key employees shall complete a conflict of interest questionnare which goes to the compliance officer. Form 990, Part VI, Section B, line 15 An outside consultant was used to complte a review and establish ranges to be used for compensation levels for all senior management positions (CEO, EVP/CFO, VP of clinical operations/CNO, VP of HR and compliance officer.) Form 990, Part VI, Section C, line 19 The public viewing document is available for inspection at the main hospital location upon request. PART XI, LINE 2B AND 2C THE HOSPITAL'S FINANCIAL STATEMENTS ARE AUDITED ON A SEPARATE AND CONSOLIDATED BASIS. THE BOARD OF DIRECTORS OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. CRIPPLED CHILDREN'S HOSPITAL FOUNDATION (UNTIL JUNE 30 2010) 2924 brook road richmond VA 23220 510220692 PUBLIC FOUNDATION VA 501(C)(3) Line 7 CHILDREN'S HOSPITAL HEALTH SERVICE UNTIL JUNE 30 2010 CHILDREN'S HOSPITAL HEALTH SERVICE (UNTIL JUNE 30 2010) 2924 brook road Richmond VA 23220 541632424 HOLDING COMPANY - HEALTHCARE VA 501(C)(3) Line 3 N/A VCU HEALTH SYSTEM AUTHORITY PO BOX 980152 RICHMOND VA 23298 541848065 HEALTHCARE VA 501(C)(3) N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 CRIPPLED CHILDREN'S HOSPITAL FOUNDATION C 959016 CRIPPLED CHILDREN'S HOSPITAL FOUNDATION N 300437 CRIPPLED CHILDREN'S HOSPITAL FOUNDATION P 100000