2022-05-16T15:59:44-05:00 2021-06-30 346565596 ERNST & YOUNG US LLP 1101 NEW YORK AVE NW WASHINGTON DC 20005 990 2020-07-01 540506309 VCU HEALTH CHILDREN'S SERVICES AT BROOK ROAD VCUH 8042285874 2924 BROOK ROAD RICHMOND VA 232201298 ELIAS NEUJAHR PRESIDENT 8042285874 2022-05-16 1 ELIAS NEUJAHR XXX-XX-XXXX JUSTIN LOWE P01866796 2023276000 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CHILDREN'S HOSPITAL OF RICHMOND ELIAS NEUJAHR 2924 BROOK ROAD RICHMOND VA 232201298 27283268 0 X WWW.CHRICHMOND.ORG X 1920 VA SEE SCHEDULE O 9 5 240 6 0 0 3233009 2526525 30019177 24293608 28011 11575 100234 450362 33380431 27282070 0 215725 0 0 27637694 18286555 0 0 0 8171990 9852580 35809684 28354860 -2429253 -1072790 15836487 19176582 15523656 16421143 312831 2755439 X SEE SCHEDULE O 0 0 15069547 0 9497800 THE TRANSITIONAL CARE UNIT IS THE HOSPITAL'S ONLY INPATIENT UNIT. IT HAS 47 BEDS AND PROVIDES LONG TERM CARE FOR CHILDREN UP TO THE AGE OF 21 WHO REQUIRE SPECIALIZED, AROUND THE CLOCK, NURSING CARE. THE UNIT IS CERTIFIED BY THE VIRGINIA DEPARTMENT OF MEDICAL ASSISTANCE SERVICES AND 100% OF THE REVENUE IN THIS PROGRAM COMES FROM VIRGINIA MEDICAID AND MEDICAID MANAGED CARE ORGANIZATIONS. 6147246 0 14181888 CSBR IS THE PREMIER PROVIDER OF OUTPATIENT PEDIATRIC PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY SERVICES IN CENTRAL VIRGINIA. THERAPY SERVICES ARE PROVIDED AT THE MAIN HOSPITAL IN THE CITY OF RICHMOND AND AT FIVE COMMUNITY THERAPY CENTERS LOCATED IN GLEN ALLEN, BON AIR, FREDERICKSBURG, PETERSBURG, AND STAFFORD. APPROXIMATELY 50% OF THE THERAPY VISITS ARE FUNDED BY VIRGINIA MEDICAID AND MEDICAID MANAGED CARE ORGANIZATIONS. 1156942 215725 26844 DENTAL PROGRAM SERVICES ARE PROVIDED FOR THE TYPICAL WELL-CHILD AND FOR CHILDREN WITH SPECIAL NEEDS.THE MAJORITY OF THE DENTAL PROGRAM PATIENTS ARE FUNDED BY VIRGINIA MEDICAID AND MEDICAID MANAGED CARE ORGANIZATIONS. 615051 587076 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. 615051 587076 22988786 1 1 0 0 0 0 0 0 0 1 1 0 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 27 0 1 240 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 5 0 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 VA X MIN CUMMINGS 8048270545 PO BOX 980152 RICHMOND VA 23298 PETER BUCKLEY MD DIRECTOR 1.00 0.00 X 0 948774 44966 MARSHA D RAPPLEY MD DIRECTOR 1.00 40.00 X 0 819243 14332 DEBORAH DAVIS DIRECTOR 1.00 40.00 X 0 776393 49724 RALPH CLARK MD DIRECTOR 1.00 40.00 X 0 715904 32576 PAUL NEIMEYER SECRETARY/CHIEF GEN. COUNSEL 1.00 40.00 X 0 654004 39370 THOMAS YACKEL MD DIRECTOR, PRES. OF MCV 1.00 40.00 X 0 607459 63959 BRUCE K RUBIN MD DIRECTOR-EX-OFFICO (THRU 09/2020) 1.00 40.00 X 0 574352 66890 JOHN WARD MD DIRECTOR - EX - OFFICIO 1.00 40.00 X 0 541324 56854 ELIAS NEUJAHR PRESIDENT 5.00 35.00 X 0 549241 47091 SHARON DARBY ASSOCIATE VP OF OPERATIONS 40.00 0.00 X 267411 0 36998 TIMOTHY O'NEILL DIRECTOR OF FINANCE 40.00 0.00 X 149059 0 39786 MARK NICOL DIR. OF FACILITIES MGMT 40.00 0.00 X 139735 0 38998 MARY S TOGNARELLI DIRECTOR OF INPATIENT SERV 40.00 0.00 X 146200 0 26400 ROBIN CROTTS DIR. PERFORMANCE IMPROV. 40.00 0.00 X 135458 0 30056 STACY COLEMAN INTERIM NURSING DIRECTOR 40.00 0.00 X 124869 0 24399 KAREN HENDRICKS-MUNOZ MD DIRECTOR EX-OFFICIO (SEPT-JUNE) 1.00 40.00 X 0 103755 9764 FRANCES LW KAY DIRECTOR 1.00 0.00 X 0 0 0 JEFFREY MAPP MD DIRECTOR 1.00 0.00 X 0 0 0 LESLIE WYATT DIRECTOR 1.00 0.00 X 0 0 0 LINDA PEARSON VICE CHAIR AND TREASURER 1.00 0.00 X X 0 0 0 THOMAS S CAIN CHAIRMAN 1.00 0.00 X X 0 0 0 962732 6290449 622163 8 1 1 0 MCV PHYSICIANS LLC PO BOX 980620 RICHMOND VA 23298 CONTRACTED PHYSICIANS 624292 VCU SCHOOL OF DENTISTRY 521 NORTH 11TH STREET RICHMOND VA 23298 CONTRACTED DENTISTS 419795 EUREST DINING SERVICES 2400 YORKMONT ROAD CHARLOTTE NC 28217 DINING SERVICES 132306 MEDICAL INFORMATION TECHNOLOGY MEDITECH CIRCLE WESTWOOD VA 02090 IT SUPPORT FOR MEDITECH 127598 4 2419267 107258 2526525 PATIENT SERVICE REVENUE 623000 24266765 24266765 PHYSICAL THERAPY CONTRACT 623000 26843 26843 24293608 11575 11575 434200 0 434200 434200 434200 4767 1198 3569 3569 MEDICAL RECORDS 622110 6439 6439 OTHER MISC REVENUE 622110 3031 3031 REBATES AND DISCOUNTS 622110 101 101 3022 3022 12593 27282070 24293608 0 461937 215725 215725 304408 262649 41759 12933427 11204104 1729323 841021 683298 157723 3201077 2890974 310103 1006622 877346 129276 314733 314733 4656 4656 1345832 1313338 32494 477166 350440 126726 810462 292261 518201 7188 6687 501 21083 19633 1450 1252387 1252387 401138 401138 SHARED SVCS. ALLOCATION 2571984 2571984 MEDICAL SUPPLIES 1345750 1345154 596 REPAIRS & MAINTENACE 870726 189634 681092 BAD DEBT EXPENSE 287207 287207 142268 77214 65054 28354860 22988786 5366074 0 1795 1818 964783 76027 2934455 2699079 45750 51988 1682 4708 28378763 21767070 7406598 6611693 2031404 5843971 4481424 1855894 15836487 19176582 5763957 3934816 9759699 12486327 15523656 16421143 X -4143511 -3088532 4456342 5843971 312831 2755439 15836487 19176582 X -1072790 1387630 2127770 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4456341 19500 1514399 146269 5843971 4300336 98615 161599 104209 4456341 4131404 331900 410713 573681 4300336 3921929 303029 315250 408804 4131404 3572986 371488 443961 466506 3921929 0.00750 0.45800 0.53450 1 0 54914 54914 18360322 13923395 4436927 9029849 7843675 1186174 933678 933678 6611693 EQUITY INVESTMENT IN CHILDREN'S FOUNDATION 5843971 C 5843971 DUE FROM CHILDREN'S FOUNDATION 599 DEPOSITS 23034 DUE FROM AFFILIATES 1790784 ACCOUNTS RECEIVABLE FROM NONPATIENTS 39777 RESIDENTS FUNDS 1700 1855894 DUE TO AFFILIATES 12375866 OTHER MISC LIABILITIES 110461 12486327 X PART V, LINE 4: THE HOSPITAL HAS RECORDED ITS BENEFICIAL INTEREST IN CERTAIN TEMPORARILY AND PERMANENTLY RESTRICTED NET ASSETS OF THE FOUNDATION THAT BENEFIT THE HOSPITAL. TEMPORARILY RESTRICTED NET ASSETS IN THE FOUNDATION ARE AVAILABLE FOR THE PURCHASE OF CAPITAL ASSETS AND TO SUPPORT THE OPERATIONS OF THE HOSPITAL. PERMANENTLY RESTRICTED NET ASSETS IN THE FOUNDATION ARE INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT PROGRAMS AT THE HOSPITAL. PART X, LINE 2: FIN 48 (ASC 740) FOOTNOTE THE AUTHORITY IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES BECAUSE IT IS A POLITICAL SUBDIVISION OF THE COMMONWEALTH OF VIRGINIA. MCVAP, CMH, CHILDREN'S, VCCN, TAPP, AND UHS ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE). ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 1 1 0 1 1 9500 0 9500 0.00030 20566545 11167194 9399351 0.33150 20576045 11167194 9408851 0.33180 126158 0 126158 0.00440 126158 126158 0.00440 20702203 11167194 9535009 0.33620 1 19406 5787 5787 X 1 0 1 1 VCU HEALTH CHILDREN'S SERVICES AT BROOK ROAD 2924 BROOK ROAD RICHMOND VA 23220 WWW.CHRICHMOND.ORG H1842 X X X PEDIATRIC LONG TERM CARE VCU HEALTH CHILDREN'S SERVICES AT BROOK 1 0 0 1 X X X X X X X X X 19 1 0 0 1 X SEE PART V, SECTION C NARRATIVE X 1 19 1 SEE PART V, SECTION C NARRATIVE 0 1 X 100.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 VCU HEALTH CHILDREN'S SERVICES AT BROOK ROAD PART V, SECTION B, LINE 5: THE HOSPITAL USED A WRITTEN SURVEY TO OBTAIN INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. THE SURVEY WAS CONDUCTED IN THE SPRING OF 2019. THE SURVEY RESPONDENTS REPRESENTED SOME OF THE FOLLOWING ORGANIZATIONS: VIRGINIA DEPARTMENT OF HEALTH, CARE CONNECTION FOR CHILDREN, DISABILITY LAW CENTER OF VIRGINIA, FREDERICKSBURG CITY SCHOOLS, VIRGINIA DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES AND GREATER RICHMOND FIT4KIDS. VCU HEALTH CHILDREN'S SERVICES AT BROOK ROAD PART V, SECTION B, LINE 7D: HTTPS://WWW.CHRICHMOND.ORG/MEDIA/FILE/CHILDREN'SREHABSVCS2019CHNA.PDFPART V, SECTION B, LINE 10HTTPS://WWW.CHRICHMOND.ORG/MEDIA/FILE/CHNA%20IMPLEMENTATION%20PLAN%20FY20-22%20.PDF VCU HEALTH CHILDREN'S SERVICES AT BROOK ROAD PART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY TAKING THE FOLLOWING ACTIONS:1. ADOPTION OF AN IMPLEMENTATION STRATEGY THAT ADDRESSES THE MAJORITY OF THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA 2. EXECUTION OF THE IMPLEMENTATION STRATEGY 3. INCLUSION OF A COMMUNITY BENEFIT SECTION IN OPERATIONAL PLANS 4. ADOPTION OF A BUDGET FOR PROVISION OF SERVICES THAT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA 5. PRIORITIZATION OF SERVICES THAT THE HOSPITAL WILL UNDERTAKE TO MEET HEALTH NEEDS IN ITS COMMUNITY THE TOP HEALTH NEEDS OF THE CHILDREN'S HOSPITAL COMMUNITY INCLUDE THOSE THAT ARE SUPPORTED BY THE DATA AND FEEDBACK PROVIDED IN THE ASSESSMENT: A. CHILDREN'S HEALTH SUPPORTSTRATEGY: LEVERAGE THE PROGRAMS AND RESOURCES AVAILABLE WITHIN AND ASSOCIATED WITH VCUHS TO PROVIDE EDUCATION AND SUPPORT TO FAMILIES.ACTION PLAN: - SUPPORT ADVOCACY EFFORTS THROUGH THE OFFICE OF GOVERNMENT RELATIONS AT VIRGINIA COMMONWEALTH UNIVERSITY- ACCESS CARE CONNECTION FOR CHILDREN FOR PATIENTS AND FAMILIES- REFER ELIGIBLE PATIENTS AND FAMILIES TO MEDICAL LEGAL PARTNERSHIP-RICHMOND- UTILIZE PARENT ADVISORY GROUP TO IDENTIFY NEEDS AND POTENTIAL SOLUTIONS- UTILIZE RESOURCES AND FUNDING FROM CHILDREN' HOSPITAL FOUNDATION TO PROVIDE SUPPORT AND EDUCATION TO FAMILIESSTRATEGY: IMPROVE ACCESS TO CARE FOR SERVICES. ACTION PLAN:- ONGOING SUPPORT FOR GROWTH OF THERAPY CENTERS THRU RELOCATION AND EXPANSION OF EXISTING PROGRAMS- INCREASE NUMBER OF BEDS FOR VENTILATOR DEPENDENT CHILDREN REQUIRING LONG TERM CARE SERVICES- IMPLEMENT IMPROVEMENTS TO SCHEDULING APPOINTMENTS FOR THERAPY SERVICES- EXPLORE OPPORTUNITIES TO ADD SERVICES- COORDINATE HOSPITAL SERVICES WITH SERVICES WITH VCUHS- REFER PATIENTS AND FAMILIES TO SERVICES WITHIN THE COMMUNITY AS NEEDEDB. CHILDREN'S HEALTH CONDITIONSSTRATEGY: LEVERAGE THE PROGRAMS AND RESOURCES AVAILABLE WITHIN THE HOSPITAL AND CHOR TO ADDRESS LEADING HEALTH RISKS IN THE COMMUNITY INCLUDING INJURIES, AVOIDABLE HOSPITALIZATIONS, BEHAVIORAL HEALTH DISORDERS, LIFESTYLE, AND DISABILITIES.ACTION PLAN:- ONGOING SUPPORT FOR GROWTH OF THERAPY CENTERS TO PROVIDE SERVICES FOR: - INJURY PREVENTION AND RECOVERY; - SHORT AND LONG TERM REHABILITATION; - ASSISTIVE TECHNOLOGY; - ACTIVITIES OF DAILY LIVING;- COLLABORATION WITH CONCUSSION/TRAUMATIC BRAIN INJURY MULTI-DISCIPLINARY CLINIC FOR SERVICES AND EDUCATION- COLLABORATION WITH SAFE KIDS VA FOR CREATING SAFE ENVIRONMENTS FOR CHILDREN IN THE COMMUNITY- SUPPORT OF PSYCHOLOGY SERVICES RELATED MEDICAL, EMOTIONAL AND BEHAVIORAL ISSUES, AND NEUROPSYCHOLOGICAL EVALUATIONS FOLLOWING A NEUROLOGICAL INJURY OR ILLNESS- REFERRALS TO VCU'S VIRGINIA TREATMENT CENTER FOR CHILDREN FOR OUTPATIENT AND INPATIENT MENTAL HEALTH CARE- EXPANSION OF LONG-TERM CARE SERVICES FOR CHILDREN WHO ARE VENTILATOR DEPENDENT AND/OR REQUIRE TOTAL PARENTERAL NUTRITION- GROWTH OF PEDIATRIC DENTAL SERVICES FOR CARE OF CHILDREN WITH DISABILITIESIMPLEMENTATION STRATEGIESKEY OBJECTIVE:PROVIDE CARE TO CHILDREN REQUIRING POST-ACUTE REHABILITATIVE AND RESTORATIVE CARE; PROVIDE TRAINING FOR DISCIPLINES FOCUSED ON THE CARE OF CHILDREN WITH DISABILITIES; AND ADVOCATE FOR THOSE WITH DISABILITIES. DUE TO THE REHABILITATIVE SPECIALTY FOCUS OF THE HOSPITAL IT CANNOT DIRECTLY ADDRESS CERTAIN COMMUNITY HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT. HOWEVER, IT CAN AND DOES SUPPORT OTHER AGENCIES TO HELP WITH THESE NEEDS.OTHER NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT:EACH OF THE HEALTH NEEDS IDENTIFIED IN THE ATTACHED COMMUNITY HEALTH NEEDS ASSESSMENT IS IMPORTANT AND MANY ARE BEING ADDRESSED BY NUMEROUS PROGRAM AND INITIATIVES THROUGHOUT VCUHS. THE HOSPITAL CANNOT DIRECTLY ADDRESS CERTAIN COMMUNITY HEALTH NEEDS THAT DO NOT RELATE TO ITS MISSION. THESE MAY BE COMMUNITY HEALTH NEEDS THAT GOVERNMENTAL OR OTHER NON-PROFIT AGENCIES HAVE THE MORE APPROPRIATE EXPERTISE AND RESOURCES NECESSARY TO ADDRESS. ALTHOUGH THE HOSPITAL CANNOT ADDRESS THESE NEEDS DIRECTLY, IT CAN AND DOES SUPPORT THE EFFORTS OF GOVERNMENTAL AND OTHER AGENCIES TO HELP WITH THESE NEEDS. VCU HEALTH CHILDREN'S SERVICES AT BROOK ROAD PART V, SECTION B, LINE 16J: HTTPS://WWW.CHRICHMOND.ORG/MEDIA/FILE/PATIENT-FINANCIAL-ASSISTANCE-POLICY-518.PDFPART V, SECTION B, LINE 16BHTTPS://WWW.VCUHEALTH.ORG/MEDIA/FILE/VCUHEALTH-FINANCIALCOUNSELING-0118.PDFPART V, SECTION B, LINE 16CHTTPS://WWW.CHRICHMOND.ORG/MEDIA/FILE/PATIENT-FINANCIAL-ASSISTANCE-PROGRAM-OVERVIEW.PDF 5 1 - FREDERICKSBURG THERAPY CENTER 10530 SPOTSYLVANIA AVENUE SUITE 102 FREDERICKSBURG VA 22408 OUTPATIENT THERAPY CENTER 2 - BON AIR THERAPY CENTER 206 TWINRIDGE LANE SUITE A RICHMOND VA 23235 OUTPATIENT THERAPY CENTER 3 - GLEN ALLEN THERAPY CENTER 10124 WEST BROAD STREET SUITE P GLEN ALLEN VA 23060 OUTPATIENT THERAPY CENTER 4 - PETERSBURG THERAPY CENTER 321 B POPLAR DRIVE SUITE 4 PETERSBURG VA 23805 OUTPATIENT THERAPY CENTER 5 - STAFFORD THERAPY CENTER 2781 JEFFERSON DAVIS HIGHWAY SUITE 103 STAFFORD VA 22554 OUTPATIENT THERAPY CENTER PART I, LINE 3C: SEE DETAILS IN SCH H, PART V, SECTION B, LINE 16. PART I, LINE 7: COMMUNITY BENEFIT COST FOR EACH CATEGORY IS DETERMINED BY USING EITHER A COST TO CHARGE RATIO OR A COST ACCOUNTING METHODOLOGY. THE SCHEDULE H WORKSHEETS ARE USED TO COMPUTE THE CORRESPONDING LINE.PART I, LN 7 COL(F):NO ATTEMPT HAS BEEN MADE TO DETERMINE THE AMOUNT IN BAD DEBT THAT COULD HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE. PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL'S ADVOCACY EFFORTS ARE SUPPORTED BY THE OFFICE OF GOVERNMENT RELATIONS AT VIRGINIA COMMONWEALTH UNIVERSITY. THE OFFICE SERVES AS A LIAISON AMONG THE GOVERNOR'S OFFICE, THE GENERAL ASSEMBLY, AGENCIES OF THE COMMONWEALTH, RICHMOND CITY COUNCIL LOCAL BOARDS OF SUPERVISORS AND VIRGINIA'S CONGRESSIONAL DELEGATION. GOVERNMENT RELATIONS CULTIVATES RELATIONSHIPS WITH ELECTED AND APPOINTED GOVERNMENT OFFICIALS IN AN EFFORT TO SECURE FINANCIAL AND LEGISLATIVE SUPPORT. IN COLLABORATION WITH THE CHILDREN'S HOSPITAL FOUNDATION THE HOSPITAL SUPPORTS A VARIETY OF PEDIATRIC INITIATIVES AND OUTREACH PROGRAMS FOR THE GENERAL COMMUNITY, SUCH AS HEALTH AND SAFETY DAYS IN RICHMOND AND PETERSBURG, FIRE PREVENTION DAY IN RICHMOND AND THE DENTAL OUTREACH PROGRAM. EVERY YEAR, THESE PROGRAMS EDUCATE THOUSANDS OF YOUNG CHILDREN AND GIVE THEM THE TOOLS AND KNOWLEDGE TO LEAD SAFE AND HEALTHY LIVES. THE CHOR COMMUNITY HEALTH EDUCATION CENTER PROVIDES PATIENTS, FAMILIES AND THE PUBLIC UP-TO-DATE INFORMATION FROM RELIABLE SOURCES ABOUT HEALTH AND MEDICINE. RESOURCES INCLUDE BOOKS, JOURNALS, VIDEOS AND COMPUTERS WITH INTERNET CONNECTIONS. THE CENTER IS STAFFED BY A FULL-TIME HEALTH SCIENCES LIBRARIAN, A PART-TIME LIBRARY ASSISTANT, AND TRAINED VOLUNTEERS. PART III, LINE 2: CHARGED AMOUNTS NOT EXPECTED TO BE PAID ARE RESERVED AND EXPENSED TO BAD DEBT. A COST TO CHARGE RATIO IS APPLIED TO DETERMINE THE COST OF THE BAD DEBT. PART III, LINE 4: THE HOSPITAL RECOGNIZES REVENUE NET OF CONTRACTUAL ALLOWANCE PER THE STANDARD CONTRACTED RATE. HISTORICAL EXPERIENCE HAS DEMONSTRATED A PORTION OF REVENUE IS UNCOLLECTABLE. THE HISTORICAL UNCOLLECTABLE RATE IS APPLIED TO OUTSTANDING NET ACCOUNTS RECEIVABLE AND A PROVISION IS RECORDED PERIODICALLY.THE HOSPITAL PROVIDES HEALTHCARE SERVICES TO INFANTS, CHILDREN, AND ADOLESCENTS UP TO THE AGE OF 21 YEARS. HOSPITAL WILL PROVIDE FINANCIAL ASSISTANCE AS ESTABLISHED UNDER THE GUIDELINES. SERVICES ARE PROVIDED REGARDLESS OF RACE, CREED, RELIGION, NATIONAL ORIGIN, SEX, DISABILITY, SOCIOECONOMIC STATUS, PAYOR SOURCE, OR ANY OTHER MANNER PROHIBITED BY LAW.AS A TAX-EXEMPT ENTITY AND AS PART OF ITS COMMITMENT TO SERVE THE COMMUNITY, HOSPITAL PROVIDES FINANCIAL ASSISTANCE IN THE FORM OF CHARITY CARE ("FINANCIAL ASSISTANCE") TO PATIENTS' FAMILIES WHO QUALIFY BY MEETING THE REQUIREMENTS.PATIENT FAMILIES ARE ELIGIBLE IF THEIR YEARLY HOUSEHOLD INCOME, AS DOCUMENTED ON THE FINANCIAL ASSISTANCE APPLICATION IS LESS THAN OR EQUAL TO 200% OF THE POVERTY GUIDELINES UPDATED ANNUALLY IN THE FEDERAL REGISTER BY THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES ("FEDERAL POVERTY GUIDELINES").FOOTNOTE 2(E) OF THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS STATES: THE AUTHORITY RECORDS AN ALLOWANCE FOR DOUBTFUL ACCOUNTS DURING THE PERIOD IN WHICH COLLECTION IS CONSIDERED DOUBTFUL. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS APPROXIMATELY $19,406 AT JUNE 30, 2021. ACCOUNTS WAS APPROXIMATELY $49,712 AT JUNE 30, 2020. PART III, LINE 8: MEDICARE ALLOWABLE COST WAS CALCULATED USING A COMBINATION OF COST FROM THE FILED FY 2020 MEDICARE COST REPORT; COST TO CHARGE RATIOS FROM FILED THE FY 2020 MEDICARE COST REPORT; AND A CALCULATION OF DIRECT COSTS PLUS ALLOCATED OVERHEAD.SERVICES PROVIDED UNDER MEDICARE ARE FOR PATIENTS IN ASSISTIVE TECHNOLOGY. THIS SERVICE IS A SPECIAL PROGRAM OFFERED TO PATIENTS REGARDLESS OF AGE SINCE THESE SERVICES ARE NOT WIDELY AVAILABLE IN THE COMMUNITY. PART III, LINE 9B: A FINANCIAL COUNSELOR ASSISTS PATIENTS IN UNDERSTANDING THE AVAILABILITY OF COMMUNITY OR GOVERNMENTAL ASSISTANCE PROGRAMS, AS WELL AS, THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. NEW PATIENTS RECEIVE NOTIFICATION THROUGH THE PATIENT BOOKLET. THE HOSPITAL PROVIDES A BILLING STATEMENT TO THE FAP INDIVIDUAL THAT SHOWS THE AMOUNTS GENERALLY BILLED FOR THE CARE AND HOW THE HOSPITAL DETERMINED THE AMOUNT THE INDIVIDUAL OWES. THE HOSPITAL WILL ALSO REFUND ANY EXCESS PAYMENTS MADE AND TAKE MEASURES TO REVERSE ANY EXTRAORDINARY COLLECTION ACTION TAKEN. PART VI, LINE 2: THE HOSPITAL USED A WRITTEN SURVEY TO OBTAIN INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY. THE SURVEY RESPONDENTS REPRESENTED SOME OF THE FOLLOWING ORGANIZATIONS: VIRGINIA DEPARTMENT OF HEALTH, VIRGINIA DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL, RICHMOND CITY HEALTH DISTRICT, CARE CONNECTION FOR CHILDREN, AND GREATER RICHMOND FIT4KIDS. PART VI, LINE 3: THE HOSPITAL PROVIDES CHARITY CARE IN THE FORM OF FINANCIAL ASSISTANCE TO THOSE PATIENTS AND THEIR FAMILIES WHICH QUALIFY FOR THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THE FINANCIAL ASSISTANCE POLICY ALONG WITH A PLAIN LANGUAGE SUMMARY THAT INCLUDES A BRIEF OVERVIEW OF OUR DISCOUNT PROGRAM IS AVAILIBLE ON OUR WEB SITE. INFORMATION CONCERNING THE FINANCIAL ASSISTANCE PROGRAM IS INCLUDED IN THE PATIENT HANDBOOK AND THE TRANSITIONAL CARE UNIT (TCU) ADMISSION PACKAGE THAT IS GIVEN TO ALL NEW PATIENTS. COPIES OF BOTH THE FINANCIAL ASSISTANCE POLICY AND THE PLAIN LANGUAGE SUMMARY ARE AVAILABLE AT EVERY LOCATION FROM THE PATIENT ACCESS REPRESENTATIVES. PART VI, LINE 4: SUPRLUS FUNDS OF THE ORGANIZATION ARE RE-INVESTED INTO THE PROGRAMS AND OPERATIONS OF THE ORGANIZATION IN ORDER TO BETTER SERVE THE COMMUNITY. THE HOSPITAL SERVICES AREA INCLUDES 51 ZIP CODES ADJACENT TO ITS SIX LOCATIONS. MOST OF THESE ZIP CODES FALL WITHIN THE COUNTIES OF CHESTERFIELD, HENRICO, KING GEORGE, POWHATAN, SPOTSYLVANIA AND STAFFORD AND THE CITIES OF COLONIAL HEIGHTS, FREDERICKSBURG, HOPEWELL, PETERSBURG, AND RICHMOND. AS A CHILDREN'S HOSPITAL, THE SERVICE POPULATION IS AGED 0-21 YEARS AND AS OF 2019, THE SERVICE AREA INCLUDED MORE THAN 413,331 PERSONS AGED 0-21. AT ANY GIVEN TIME IN 2017, 16,636 CHILDREN AGE 0-18 ARE UNINSURED. REGION DEATH RATES WERE HIGHER THAN THE STATEWIDE RATE OVERALL AND WERE RELATED TO PREMATURITY AND LOW BIRTH WEIGHTS, HOMICIDE AND MOTOR VEHICLE TRAFFIC ACCIDENTS. NINE OF THE 12 LOCALITIES OF OUR SERVICE AREA HAVE BEEN FULLY OR PARTIALLY DESIGNATED AS MEDICALLY UNDERSERVED AREAS AND MEDICALLY UNDERSERVED POPULATIONS (MUAS/MUPS). PART VI, LINE 6: THE HOSPITAL IS AFFILIATED WITH THE VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM (VCUHS) AND IS COMPONENT OF THE CHILDREN'S HOSPITAL OF RICHMOND AT VCU (CHOR) THAT IS CENTRAL VIRGINIA'S ONLY COMPREHENSIVE, FULL-SERVICE CHILDREN'S HOSPITAL. AS VIRGINIA'S ONLY LEVEL 1 PEDIATRIC TRAUMA CENTER, CHOR OFFERS A WIDE RANGE OF CHILDREN'S HEALTH SERVICES, INCLUDING PEDIATRIC EMERGENCY SERVICES, PRIMARY CARE, SPECIALTY AND SUBSPECIALTY CARE, BURN, TRAUMA, TRANSPLANT AND LONG-TERM CARE. WITH MORE THAN 15 LOCATIONS ACROSS CENTRAL VIRGINIA, CHOR PROVIDES PEDIATRIC INPATIENT AND OUTPATIENT SERVICES THAT COVER NEARLY ALL CHILDREN'S HEALTH-RELATED NEEDS. CHOR IS COMMITTED TO 5 ENSURING ACCESS TO CARE FOR ALL CHILDREN, TRAINING FUTURE PEDIATRIC CAREGIVERS AND MAKING NEW DISCOVERIES THAT IMPROVE UNDERSTANDING AND TREATMENT OF CHILDHOOD DISEASES. SURPLUS FUNDS OF THE ORGANIZATION ARE RE-INVESTED INTO THE PROGRAMS AND OPERATIONS OF THE ORGANIZATION IN ORDER TO BETTER SERVE THE COMMUNITY.PART VI, LINE 7:VIRGINIA IS THE ONLY STATE WHERE THE ORGANIZATION FILES A COMMUNITY BENEFIT REPORT. PART VI, LINE 1: SEE DETAILS IN SCHEDULE H, PART V, SECTION B, LINE 16 1 VCUHSA PO BOX 980648 RICHMOND VA 23298 541848065 170(C)(1) 215725 BOOK VARIOUS ASSETS TRANSFER OF ASSETS RELATED TO PATIENT SERVICES THAT WERE TRANSFERED TO VCUHSA 1 0 PART I, LINE 2: THE FILING ORGANIZATION IS AFFILIATED WITH THE RECIPIENT. THE ORGANIZATIONS COORDINATE THEIR HEALTHCARE EFFORTS, SUCH THAT THE FILING ORGANIZATION HAS AN UNDERSTANDING OF HOW THE SERVICES ARE USED BY THE RECIPIENT. 0 0 0 0 0 0 0 0 0 PETER BUCKLEY MD DIRECTOR 0 849882 0 93643 0 5249 0 32621 0 12345 0 993740 0 0 MARSHA D RAPPLEY MD DIRECTOR 0 499503 0 0 0 319740 0 12576 0 1756 0 833575 0 0 DEBORAH DAVIS DIRECTOR 0 765987 0 0 0 10406 0 34200 0 15524 0 826117 0 0 RALPH CLARK MD DIRECTOR 0 628774 0 66627 0 20503 0 29409 0 3167 0 748480 0 0 PAUL NEIMEYER SECRETARY/CHIEF GEN. COUNSEL 0 483539 0 109204 0 61261 0 28500 0 10870 0 693374 0 0 THOMAS YACKEL MD DIRECTOR, PRES. OF MCV 0 502819 0 101340 0 3300 0 40371 0 23588 0 671418 0 0 BRUCE K RUBIN MD DIRECTOR-EX-OFFICO (THRU 09/2020) 0 495082 0 63722 0 15548 0 52970 0 13920 0 641242 0 0 JOHN WARD MD DIRECTOR - EX - OFFICIO 0 528094 0 725 0 12505 0 38036 0 18818 0 598178 0 0 ELIAS NEUJAHR PRESIDENT 0 474781 0 72306 0 2154 0 22800 0 24291 0 596332 0 0 SHARON DARBY ASSOCIATE VP OF OPERATIONS 230255 0 30070 0 7086 0 26689 0 10309 0 304409 0 0 0 TIMOTHY O'NEILL DIRECTOR OF FINANCE 127536 0 8857 0 12666 0 16351 0 23435 0 188845 0 0 0 MARK NICOL DIR. OF FACILITIES MGMT 123160 0 8472 0 8103 0 15641 0 23357 0 178733 0 0 0 MARY S TOGNARELLI DIRECTOR OF INPATIENT SERV 134570 0 8842 0 2788 0 16334 0 10066 0 172600 0 0 0 ROBIN CROTTS DIR. PERFORMANCE IMPROV. 116626 0 8354 0 10478 0 15422 0 14634 0 165514 0 0 0 PART I, LINE 3 FOR FISCAL YEAR ENDING JUNE 30, 2021 THE COMPENSATION (SALARIES AND INCENTIVES) FOR THE EXECUTIVE DIRECTOR, IS DETERMINED BY THE CEO OF THE HEALTH SYSTEM. THIS IS CONSISTENT WITH THE REQUIREMENTS ESTABLISHED IN THE BYLAWS OF VCUHS. THE CEO USES A THIRD PARTY COMPENSATION CONSULTING FIRM TO CONDUCT A MARKET STUDY TO DETERMINE MARKET POSITION. THE CEO MAY ALSO CONDUCT A 360 DEGREE EVALUATION OF ALL SENIOR LEVEL ADMINISTRATORS. THESE DATA ELEMENTS IN CONJUNCTION WITH A REVIEW OF INDIVIDUAL PERFORMANCE AND THE ATTAINMENT OF GOALS FOR THE YEAR, ARE THE BASIS FOR COMPENSATION RECOMMENDATIONS. THE CEO THEN MEETS WITH THE COMPENSATION COMMITTEE OF THE VCUHS BOARD OF DIRECTORS TO DISCUSS THE MATTER AND PRESENT RECOMMENDATIONS AND RECEIVE FINAL APPROVAL. THE COMPENSATION COMMITTEE MAY DISCUSS THESE RECOMMENDATIONS IN EXECUTIVE SESSION OF THE VCUHS BOARD OF DIRECTORS. PART I, LINE 1 VCU HEALTH CHILDREN'S SERVICES AT BROOK ROAD (CSBR), FKA 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. PART III, LINE 1 CSBR IS A RESOURCE AND PROVIDER OF SPECIALIZED MEDICAL AND THERAPEUTIC SERVICES CUSTOMIZED TO MEET THE SPECIFIC NEEDS OF CHILDREN AND THEIR FAMILIES. OVER 8,445 CHILDREN WERE SERVED THIS PAST YEAR. WE CONTINUE TO FOCUS ON EXPANDING OUR CAPACITY TO SERVE MORE CHILDREN. FORM 990, PART V, LINE 2A EMPLOYEES ARE PAID THROUGH A COMMON PAYMASTER. THE COMMON PAYMASTER IS VCU HEALTH SYSTEM AUTHORITY. THE ORGANIZATION FALLS UNDER A MASTER PAY AGENT AND DOES NOT FILE ANY PAYROLL RETURNS UNER ITS OWN EIN. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION CHANGED FROM A CLASSIFICATION AS A HOSPITAL ORGANIZATION TO AN ORGANIZATION THAT PROVIDES PROGRAM SERVICES TO THE GENERAL PUBLIC (509(A)(2)). FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION IS VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY (VCUHS), A STATUTORY AUTHORITY CREATED UNDER THE CODE OF VIRGINIA. FORM 990, PART VI, SECTION A, LINE 7A 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. FORM 990, PART VI, SECTION A, LINE 7B LISTED BELOW ARE VCUHS'S RESERVED POWERS: (A) APPROVAL OF AMENDMENTS TO THE CORPORATION'S ARTICLES OF INCORPORATION OR BYLAWS; (B) APPROVAL OF THE CORPORATION'S CAPITAL AND OPERATING BUDGETS; (C) ELECTION AND REMOVAL OF AN ELECTED DIRECTOR (AS HEREINAFTER DEFINED); (D) APPROVAL OF THE INCURRENCE OF DEBT OR THE ISSUANCE OF GUARANTEES BY THE CORPORATION IN EXCESS OF $500,000 FOR A SINGLE EXPENDITURE; (E) APPROVAL OF ANY NON-BUDGETED CAPITAL EXPENDITURE IN EXCESS OF $500,000 FOR A SINGLE CAPITAL EXPENDITURE OR $1 MILLION FOR ALL SUCH CAPITAL EXPENDITURES ON AN AGGREGATE BASIS IN ANY TWELVE (12) MONTH PERIOD; (F) ANY PROPOSED EXPENDITURE IN EXCESS OF $500,000 FROM FUNDED DEPRECIATION MAINTAINED BY OR ON BEHALF OF THE CORPORATION FOR THE RENOVATION AND REPLACEMENT OF THE CORPORATION'S CAPITAL ASSETS; (G) AUTHORIZATION OF ANY ACTION THAT COULD CAUSE THE CORPORATION TO OPERATE IN A MANNER INCONSISTENT WITH THE COMMUNITY BENEFIT STANDARD ARTICULATED BY THE INTERNAL REVENUE SERVICE, OR OTHERWISE CAUSE THE CORPORATION TO ACT IN POTENTIAL DEROGATION OF ITS FEDERAL, STATE, OR LOCAL TAX-EXEMPTION AND/OR CHARITABLE PURPOSE; (H) SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; (I) MERGER, CONSOLIDATION, DISSOLUTION, OR DIVISION OF THE CORPORATION; (J) ASSIGNMENT OF PROPERTY OR OTHER ASSETS OF THE CORPORATION IN TRUST FOR CREDITORS OR ON THE ASSIGNEE'S PROMISE TO PAY THE DEBTS OF THE CORPORATION; (K) DECLARATION OF BANKRUPTCY BY THE CORPORATION; (L) AUTHORIZATION OF ANY ACTION THAT COULD HAVE A MATERIAL ADVERSE IMPACT ON ANY LICENSURE, ACCREDITATION, OR CERTIFICATION HELD OR DESIRED TO BE HELD BY THE CORPORATION, INCLUDING, WITHOUT LIMITATION, STATE LICENSURE, MEDICARE OR MEDICAID CERTIFICATION, THE JOINT COMMISSION OR OTHER FACILITY ACCREDITATION, MEDICAL RESIDENCY PROGRAM ACCREDITATION, OR CLINICAL DESIGNATION OR CERTIFICATION; (M) ANY SIGNIFICANT PROPOSED AFFILIATIONS WITH OTHER HEALTH CARE PROVIDERS OR ACADEMIC INSTITUTIONS, INCLUDING, WITHOUT LIMITATION, ACQUISITION, MERGER, JOINT OPERATION, MANAGEMENT, STAFFING, CLINICAL COORDINATION, OR 'CO-BRANDING; (N) ANY ACTION INVOLVING USE OF THE CORPORATION'S LOGO, SERVICE MARK, TRADE OR OTHER DRESS, OTHER THAN FOR THE DIRECT BENEFIT OF THE CORPORATION OR THE DEPARTMENT OF PEDIATRICS OF THE MEMBER; AND (O) HIRING OR TERMINATION OF THE CORPORATION'S CHIEF EXECUTIVE OFFICER (IRRESPECTIVE OF TITLE). FORM 990, PART VI, SECTION B, LINE 11B FINANCIAL INFORMATION IS PROVIDED BY VCUHS' FINANCE DEPARTMENT TO AN INDEPENDENT ACCOUNTING FIRM. THE FIRM PREPARES THE FORM 990 FOR REVIEW. THE FINANCE DEPARTMENT REVIEWS THE FORM 990 WITH THE APPROPRIATE EXECUTIVE DIRECTOR AND FINANCE LEADER OF THE ORGANIZATION. UPON FINAL REVIEW WITH LEADERSHIP, THE GOVERNING BODY OF THE ORGANIZATION IS PROVIDED WITH A COPY OF THE RETURN PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, TRUSTEES AND KEY EMPLOYEES SHALL DISCLOSE A POTENTIAL CONFLICT TO THE CHAIRMAN OF THE BOARD OR COMPLIANCE OFFICER FOR INVESTIGATION AND RESOLUTION. UPON APPOINTMENT TO THE BOARD OR EMPLOYMENT AND ANNUALLY THEREAFTER, OFFICERS, TRUSTEES AND KEY EMPLOYEES SHALL COMPLETE AN AFFIRMATION STATEMENT AND DISCLOSURE FORM FOR REVIEW BY THE BOARD. THE PERSON WITH THE CONFLICT WILL BE PROHIBITED FROM PARTICIPATING IN THE BOARD'S DELIBERATIONS AND DECISIONS IN THE AREA OF CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 AN OUTSIDE CONSULTANT IS USED TO COMPLETE A REVIEW AND ESTABLISH RANGES TO BE USED BY THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES. THESE RANGES MEET THE 4958 SAFE HARBOR REQUIREMENTS. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE FOR INSPECTION AT THE MAIN HOSPITAL LOCATION UPON REQUEST. FORM 990, PART XI, LINE 9: OPEN ITEM 2,127,770. 7TH AND MARSHALL CORPORATION PO BOX 980152 RICHMOND VA 23298 311568886 SUPPORT ACTIVITY VA 501(C)(3) LINE 12A, I UHS 0 COMMUNITY MEMORIAL HOSPITAL 1754 N MECKLENBERG AVE RICHMOND VA 23970 540551711 HOSPITAL VA 501(C)(3) LINE 3 VCUHSA 0 COMMUNITY MEMORIAL HOSPITAL FOUNDATION 1755 N MECKLENBERG AVE RICHMOND VA 23970 541831331 FUNDRAISING ORG VA 501(C)(3) LINE 12A, I CMH 0 MCV ASSOCIATED PHYSICIANS PO BOX 980620 RICHMOND VA 23298 541581185 HEALTHCARE VA 501(C)(3) LINE 12A, I VCUHSA 0 UHS PROFESSIONAL EDUCATION PROGRAM PO BOX 980048 RICHMOND VA 23298 541790553 EDU SEMINARS VA 501(C)(3) LINE 12A, I UHS 0 UNIVERSITY HEALTH SERVICES INC PO BOX 980152 RICHMOND VA 23298 541790550 PROPERTY VA 501(C)(3) LINE 12A, I VCUHSA 0 VCU AMBULATORY SURGERY CENTER LLC 11958 WEST BROAD ST 5TH FLOOR HENRICO VA 23294 863310585 AMBULATORY SERVICES VA 170(C)(1) LINE 3 VCUHSA 0 VCU HEALTH SYSTEM AUTHORITY PO BOX 980510 RICHMOND VA 23294 541848065 HOSPITAL VA 170(C)(1) LINE 3 N/A 0 VCU HEALTH TAPPAHANNOCK HOSPITAL 618 HOSPITAL ROAD TAPPAHANNOCK VA 22560 541489410 HOSPITAL VA 501(C)(3) LINE 3 VCUHSA 0 VIRGINIA COMMONWEALTH UNIVERSITY PO BOX 842512 RICHMOND VA 23284 546001758 EDU INSTITUTE VA 170(C)(1) N/A 0 CHILDREN'S PAVILION OF RICHMOND CONDO 1010 EAST MARSHALL ST PO BOX 980240 RICHMOND VA 23298 CONDOMINIUMS VA N/A C 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 VCU HEALTH SYSTEM ATHORITY R 215725 BOOK