2020-11-13T10:11:18-06:00 2019-12-31 Grant Thornton LLP 1000 WILSON BLVD SUITE 1400 ARLINGTON VA 22209 990 2019-01-01 530204670 The Hospital for Sick Children % CORPORATE OFFICERS HOSP 2026524224 111 Michigan Ave NW Washington DC 20010 ALDWIN LINDSAY Interim CFO 2028324400 2020-11-12 true Mary Torretta P00847851 7038477500 2020-11-12 179.6.32.150 54681420203185000006 2020-11-13 P 03CBAE45BD8E2F188EB28F31E827C7F4869431D2 572EA00AEE499876D01B3E3EB758D1494967FEAB 2019 2021-01-29 14:40:06Z X HSC Pediatric Center Nathaniel Beers MD 111 Michigan Ave NW Washington DC 20010 35884524 false X www.hschealth.org X 1888 DC THE HOSPITAL FOR SICK CHILDREN, DBA THE HSC PEDIATRIC CENTER ("HSCPC"), PROVIDES QUALITY CARE FOR YOUTH WITH SPECIAL HEALTH CARE NEEDS IN THE WASHINGTON, D.C. AND BALTIMORE AREAS. 6 5 319 177 0 0 75973 175413 32134383 34636119 61055 69153 654249 1003839 32925660 35884524 1200 175 0 0 17489024 20758193 0 0 0 20253841 21200371 37744065 41958739 -4818405 -6074215 20170811 40262009 36417947 42996633 -16247136 -2734624 X HSCPC PROVIDES QUALITY REHABILITATIVE, TRANSITIONAL, AND SPECIALTY CARE FOR CHILDREN, ADOLESCENTS, AND YOUNG ADULTS WITH SPECIAL HEALTH CARE NEEDS IN THE WASHINGTON, D.C. AND BALTIMORE AREAS. false false 26042166 175 34636119 TO PROVIDE QUALITY REHABILITATIVE AND TRANSITIONAL CARE FOR INFANTS, CHILDREN, ADOLESCENTS, AND YOUNG ADULTS WITH SPECIAL HEALTH CARE NEEDS IN A SUPPORTIVE, CULTURALLY COMPETENT, RESPECTFUL ENVIRONMENT, AND TO PARTICIPATE IN RELATED LOCAL, REGIONAL, AND NATIONAL PROJECTS WITH GOVERNMENT, PRIVATE, AND PHILANTHROPIC ORGANIZATIONS. IN 2019, HSCPC PROVIDED 9,552 DAYS OF CARE. HSCPC ALSO PROVIDED ON AN OUTPATIENT BASIS MEDICAL CARE, APPROXIMATELY 22,288 VISITS IN 2019. 26042166 true true false false false false false false false true true false false true true true false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true false false false true 67 0 true 319 true false false false false false false false false false false false false X 6 5 false false true false true true true true true false false true true true true true true false false false X CORPORATE OFFICERS 2028324400 111 MICHIGAN AVE NW Washington DC 20010 X ALEC KING TREASURER FROM 9/1/19 1.0 54.0 X 0 1407862 40127 MARY ANNE HILLIARD SECRETARY FROM 9/1/19 1.0 54.0 X 0 823324 32736 Nathaniel Beers Pres & CEO, Board Member 14.0 41.0 X X 0 658927 36950 Victor Fields Former EVP & CFO 14.0 41.0 X 0 358489 38532 Donna Anthony EVP, Clinical Strategies 27.0 28.0 X 0 345110 42239 Debbie Holson COO, Pediatric Center 55.0 0.0 X 0 263668 39003 Kimberly Brown VP FINANCE/INT CFO TO 11/1/19 20.0 35.0 X 0 231324 19158 Samar Maamoun Pediatrician 55.0 0.0 X 218874 0 11748 Andrew Metinko Pediatrician 55.0 0.0 X 198918 0 9500 Adam Winebarger VP of Patient Care Serv 55.0 0.0 X 167586 0 4929 Anne Ruecktenwald Director of Outpat. Prog 55.0 0.0 X 158714 0 9476 Esther Kagulu Registered Nurse 55.0 0.0 X 157618 0 9369 Thomas W Chapman Former Pres & CEO HSCF 0.0 0.0 X 0 145373 0 Roger E Meyer Chairperson 1.0 1.0 X X 0 0 0 Michael D Ward Secretary/Treasurer 1.0 3.0 X X 0 0 0 Joan Christopher Board Member 1.0 0.0 X 0 0 0 Marsha Regenstein Board Member 1.0 0.0 X 0 0 0 Steve Riley Board Member 1.0 0.0 X 0 0 0 901710 4234077 293767 39 true true false ECLINICALWORKS LLC PO Box 847950 BOSTON MA 22847 IT Consulting 210004 HHS INTEGRATED FACILITIES MANAGEMEN PO Box 734369 DALLAS TX 75373 Facilities mgmt 262257 ABSOLUTE CONTROLS LLC 1395 Crescent Spot Ct FREDERICK MD 21703 HVAC Consulting 172424 SG OFFICE ASSOCIATES LLC 2000 Tower Oaks Blvd 8th Floor ROCKVILLE MD 20852 Mgmt Consulting 454847 ALTERNATIVE ENGINEERING CONSULTIN 5530 Cheryl Lane CHESAPEAKE BEACH MD 20732 Eng. 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THE INCOME DERIVED FROM THE ENDOWMENT FUND IS TO BE USED BY THE PEDIATRIC CENTER TO SUPPORT CURRENT OPERATIONS. LIABILITY FOR UNCERTAIN TAX POSITION (ASC 740) SCHEDULE D, PART X, LINE 2 THE FOLLOWING IS THE FIN 48 FINANCIAL STATEMENT FOOTNOTE FROM THE CONSOLIDATED FINANCIALS FOR THE HSC FOUNDATION AND SUBSIDIARIES, IN WHICH THE HOSPITAL FOR SICK CHILDREN D/B/A HSC PEDIATRIC CENTER ("THE CENTER") WAS INCLUDED: THE FOUNDATION, THE CENTER, AND HSCSN HAVE BEEN RECOGNIZED AS PUBLIC CHARITIES GENERALLY EXEMPT FROM FEDERAL INCOME TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE"). HOLDINGS HAS BEEN RECOGNIZED AS TAX-EXEMPT UNDER SECTION 501(C)(2) OF THE CODE. HSCS, AND HOME CARE ARE CONSIDERED DISREGARDED ENTITIES FOR FEDERAL AND STATE INCOME TAX PURPOSES. EACH ORGANIZATION IS SUBJECT TO TAX ON INCOME UNRELATED TO ITS EXEMPT PURPOSE, UNLESS THAT INCOME IS OTHERWISE EXCLUDED BY THE CODE. EACH ORGANIZATION HAS PROCESSES PRESENTLY IN PLACE TO ENSURE THE MAINTENANCE OF ITS TAX-EXEMPT STATUS; TO IDENTIFY AND REPORT UNRELATED INCOME; TO DETERMINE ITS FILING AND TAX OBLIGATIONS IN JURISDICTIONS FOR WHICH IT HAS NEXUS; AND TO IDENTIFY AND EVALUATE OTHER MATTERS THAT MAY BE CONSIDERED TAX POSITIONS. THE SYSTEM FOLLOWS GUIDANCE THAT CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN, INCLUDING ISSUES RELATING TO FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT. THIS GUIDANCE PROVIDES THAT THE TAX EFFECTS FROM AN UNCERTAIN TAX POSITION CAN ONLY BE RECOGNIZED IN THE FINANCIAL STATEMENTS IF THE POSITION IS "MORE-LIKELY-THAN-NOT" TO BE SUSTAINED IF THE POSITION WERE TO BE CHALLENGED BY A TAXING AUTHORITY. THE ASSESSMENT OF THE TAX POSITION IS BASED SOLELY ON THE TECHNICAL MERITS OF THE POSITION, WITHOUT REGARD TO THE LIKELIHOOD THAT THE TAX POSITION MAY BE CHALLENGED. THE TAX YEARS ENDED DECEMBER 31, 2019, 2018, AND 2017 ARE STILL OPEN TO AUDIT FOR BOTH FEDERAL AND STATE PURPOSES. THE SYSTEM HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. true true true X true X 500. true true true false false 188630 188630 0.00470 30827699 27084485 3743214 0.09290 31016329 27084485 3931844 0.09760 26 26 0.00000 26 26 0.00000 31016355 27084485 3931870 0.09760 true 1681566 true true NA 1 1 The Hospital for Sick Children 1731 Bunker Hill Rd NE Washington DC 20017 www.hschealth.org HFD01-0 X X THE HOSPITAL FOR SICK CHILDREN 1 false true true X X X X X X X X 19 true true true true X hschealth.org/foundation/publications X dchealthmatters.org X true 19 true See Part V, Section C false true X 200. 500. X X X X X true true X X X true X www.hschealth.org X www.hschealth.org X www.hschealth.org X X X X X X X true X false X X X X false X X X false false HOSPITAL FACILITIES SCHEDULE H, PART V, SECTION A THE HOSPITAL FOR SICK CHILDREN IS A SELF-CONTAINED PEDIATRIC SPECIALTY HOSPITAL. THE HOSPITAL FACILITY DOES NOT CHARGE ANY INDIVIDUALS THAT IT KNOWS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE AN AMOUNT EQUAL TO THE GROSS CHARGE FOR ANY SERVICE. THE HOSPITAL USES THE CHARGE MASTER RATES FOR A SERVICE AS A STARTING POINT AGAINST WHICH THE DISCOUNTS MANDATED IN THE HOSPITAL FACILITY'S FINANCIAL ASSISTANCE POLICY ARE APPLIED TO DETERMINE THE AMOUNT ACTUALLY BILLED TO PATIENTS ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. THE HOSPITAL FACILITY WILL NOT COLLECT PAYMENT FROM ANY PATIENT ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY IN EXCESS OF THE REDUCED AMOUNT THAT IS ACTUALLY BILLED TO SUCH FINANCIAL ASSISTANCE PATIENT. ACQUISITION SCHEDULE H, PART V, LINE 2 THE HOSPITAL'S SOLE CORPORATE MEMBER, THE HSC FOUNDATION, WAS ACQUIRED BY CHILDREN'S NATIONAL MEDICAL CENTER EFFECTIVE SEPTEMBER 1, 2019. INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY SCHEDULE H, PART V, SECTION B, LINE 5 THROUGH THE DISTRICT OF COLUMBIA HEALTHY COMMUNITIES COLLABORATIVE (DCHCC) INPUT WAS RECEIVED VIA SEVERAL KEY INFORMANT INTERVIEWS, FOCUS GROUPS, TOWN HALLS, AND ONLINE SURVEYS. THESE GROUPS CONSISTED OF COMMUNITY RESIDENTS, MEMBERS FROM THE LOCAL HEALTH CARE COMMUNITY, AND COMMUNITY AND GOVERNMENT AGENCIES REPRESENTING THE SOCIAL DETERMINANTS OF HEALTH SUCH AS THE DEPARTMENTS OF HOUSING, ECONOMICS, HEALTH CARE FINANCE, TRANSPORTATION, AND BEHAVIORAL HEALTH. THE STAKEHOLDER INTERVIEWS REPRESENTED 60 ORGANIZATIONS AND INCLUDED AN ADDITIONAL 31 KEY INFORMANT INTERVIEWS, 113 ONLINE SURVEYS, 40 FOCUS GROUP PARTICIPANTS, 80 COMMUNITY FORUMS ATTENDEES, 6 COUNCIL MEMBERS, 11 GOVERNMENT AGENCIES, AND 15 HOSPITALS AND CLINICS. STAKEHOLDERS PROVIDED INPUT ON SEVERAL QUESTIONS RELATED TO OVERALL HEALTH AND THE COMPONENTS OF A HEALTHY COMMUNITY. PARTICIPANTS ALSO COMMENTED ON WAYS TO IMPROVE THE STATUS OF HEALTH IN THE CITY, DISCUSSED WHAT PROGRAMS/SYSTEMS WERE WORKING, AND PROVIDED INSIGHT INTO ADDITIONAL RESOURCES NEEDED TO ADVANCE HEALTH IN THE DISTRICT OF COLUMBIA. CHNA CONDUCTED WITH MULTIPLE HOSPITAL FACILITIES SCHEDULE H, PART V, SECTION B, LINES 6A & 6B THE CHNA WAS CONDUCTED WITH MEMBERS OF THE DC HEALTH MATTERS COLLABORATIVE INCLUDING FIVE NON-PROFIT HOSPITALS: CHILDREN'S NATIONAL HOSPITAL, HSC HEALTH CARE SYSTEM, HOWARD UNIVERSITY HOSPITAL, PROVIDENCE HEALTH SYSTEM AND SIBLEY MEMORIAL HOSPITAL. HSC CONDUCTED THE CHNA WITH MEMBERS OF THE DC HEALTH MATTERS COLLABORATIVE THAT INCLUDES FIVE HOSPITALS AND FOUR FEDERALLY QUALIFIED HEALTH CENTERS (FQHCS) (BREAD FOR THE CITY, COMMUNITY OF HOPE, MARY'S CENTER, AND UNITY HEALTH CARE); AND TWO EX-OFFICIO MEMBERS (DC HOSPITAL ASSOCIATION AND DC PRIMARY CARE ASSOCIATION). THE DC DEPARTMENT OF HEALTH IS ALSO A PARTNER OF THE COLLABORATIVE. THE COLLABORATIVE WORKS TO ELIMINATE HEALTH DISPARITIES AND CREATE HEALTH EQUITY FOR ALL COMMUNITIES IN DC TO REALIZE ONE HEALTHY CAPITAL CITY. WITH THE UNIQUE PERSPECTIVES OF EACH HOSPITAL AND COMMUNITY HEALTH CENTER, COLLABORATIVE MEMBERS PROVIDED GUIDANCE AND FEEDBACK RESPECTIVE TO POPULATIONS AND NEIGHBORHOODS SERVED. CHNA and Implementation Strategy Schedule H, Part V, Section B, Lines 3 and 10 HSCPC ADOPTED THE DC HEALTH MATTERS 2019 CHNA AND CHIP DURING THE FISCAL YEAR ENDING 12/31/2019. SCHEDULE H IS COMPLETED USING THIS INFORMATION. THE 2019 CHIP CAN BE FOUND HERE: HTTP://WWW.DCHEALTHMATTERS.ORG/ HOW THE HOSPITAL ADDRESSES SIGNIFICANT NEEDS SCHEDULE H, PART V, SECTION B, LINE 11 THE DC HEALTH MATTERS COLLABORATIVE (THE COLLABORATIVE) IS ADDRESSING THE FOLLOWING SIGNIFICANT NEEDS IDENTIFIED IN THE MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) - MENTAL HEALTH, HEALTH LITERACY, PLACE-BASED CARE, AND CARE COORDINATION. WHILE THE COMMUNITY IDENTIFIED NINE HEALTH NEEDS, THE COLLABORATIVE SELECTED FOUR OF THE NINE PRIORITY NEEDS USING A STRUCTURED PRIORITIZATION PROCESS. THE PRIORITIZATION PROCESS SCORED EACH OF THE NEEDS ACCORDING TO 1) IMPORTANCE TO OUR COMMUNITY, 2) CAPACITY TO ADDRESS (AVAILABILITY OF FINANCIAL AND OTHER RESOURCES), 3) ALIGNMENT WITH ORGANIZATIONAL AND CITYWIDE MISSION AND 4) STRENGTH OF EXISTING INTERVENTION/COLLABORATIONS. A DESCRIPTION OF HOW HSC AND DCHCC ARE ADDRESSING THE FOUR SELECTED NEEDS IS DETAILED IN OUR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). IT IS IMPORTANT TO NOTE THAT THESE FOUR PRIORITIZED COMMUNITY NEEDS CUT ACROSS NEARLY ALL CLINICAL CONDITIONS AND OFTEN CONTRIBUTE TO POOR HEALTH OUTCOMES, PARTICULARLY FOR CHILDREN WITH MEDICAL COMPLEXITY. THE QUANTITATIVE DATA PRESENTED IN THE REPORT HELPED GUIDE THE COLLABORATIVE IN DECIDING WHICH OF THE PRIORITY AREAS TO INVEST OUR RESOURCES FOR THE GREATEST IMPACT. FURTHERMORE, BECAUSE THE COLLABORATIVE IS COMPRISED OF HEALTH CARE ORGANIZATIONS, IT WAS IMPORTANT TO ALIGN THE PRIORITY AREAS ON HEALTH RELATED MATTERS VERSUS SOME OF THE NON-HEALTH AREAS IN ORDER TO BRING ABOUT THE GREATEST OPPORTUNITY TO AFFECT CHANGE. EACH COLLABORATIVE MEMBER ORGANIZATION RECEIVED APPROVAL OF THE CHIP BY THEIR BOARD OF DIRECTORS, INCLUDING HSC. ELIGIBILITY CRITERIA EXPLAINED IN THE FINANCIAL ASSISTANCE POLICY SCHEDULE H, PART V, SECTION B, LINE 13B HSCPC HAS A FINANCIAL ASSISTANCE POLICY THAT PROVIDES FOR FREE OR DISCOUNTED CARE TO INDIVIDUALS THAT QUALIFY UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE LEVEL OF FINANCIAL ASSISTANCE IS DETERMINED BY SEVERAL FACTORS, INCLUDING: THE INDIVIDUAL'S ANNUAL INCOME, FAMILY SIZE, AND LIQUID ASSETS, AS WELL AS WHETHER THE INDIVIDUAL IS COVERED BY GOVERNMENTAL OR OTHER INSURANCE. FREE CARE IS PROVIDED TO PATIENTS WHO ARE INELIGIBLE FOR GOVERNMENTAL OR OTHER INSURANCE COVERAGE, AND WHOSE FAMILY INCOME DOES NOT EXCEED 200% OF THE FEDERAL POVERTY GUIDELINES. DISCOUNTED CARE IS BASED ON A SLIDING DISCOUNTED SCALE OF GROSS CHARGES AND IS PROVIDED TO PATIENTS WHO ARE INELIGIBLE FOR GOVERNMENTAL OR OTHER INSURANCE COVERAGE AND WHOSE FAMILY INCOME IS BETWEEN 200% AND 500% OF THE POVERTY GUIDELINES. WHEN POSSIBLE, THE ORGANIZATION MAY MAKE A PROSPECTIVE DETERMINATION THAT CERTAIN PATIENTS QUALIFY FOR FREE OR DISCOUNTED CARE, ALTHOUGH THE PATIENT HAS NOT SUBMITTED A COMPLETED FINANCIAL ASSISTANCE APPLICATION. PRESUMPTIVE CHARITY CARE IS DETERMINED BASED ON DEFINED CRITERIA FOR DESTITUTE STATUS (HOMELESS, ILLEGAL ALIEN, INCARCERATED, ETC.). PATIENTS WITH SUFFICIENT ASSETS TO PAY FOR CARE WITHOUT BECOMING MEDICALLY INDIGENT MAY NOT BE ELIGIBLE FOR FINANCIAL ASSISTANCE. HOWEVER, THE RESIDENCE WHERE A PATIENT AND/OR THE PATIENT'S FAMILY RESIDES, AUTOMOBILES NEEDED TO TRANSPORT ALL WORKING PARTIES TO AND FROM WORK, SAVINGS ACCOUNTS WITH LESS THAN TWO MONTHS OF INCOME AND RETIREMENT ACCOUNTS WITH LESS THAN $50,000 ARE ALWAYS EXEMPTED FROM CONSIDERATION AS ASSETS IN CONSIDERING WHETHER THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE. ONCE CHARITY CARE ELIGIBILITY HAS BEEN ESTABLISHED, THE PATIENT ACCOUNT IN WHOLE OR IN PART, IS WRITTEN-OFF AND ALL COLLECTION EFFORTS ON THE WRITTEN OFF PORTION OF THE ACCOUNT CEASE. IF THE PATIENT RECEIVES PARTIAL CHARITY CARE, ALL EFFORTS WILL BE MADE TO PLACE THAT PATIENT ON AN EXTENDED PAYMENT PLAN. FURTHERMORE, HSCPC HAS A FINANCIAL ASSISTANCE POLICY THAT PROVIDES FOR FREE OR DISCOUNTED CARE TO THE MEDICALLY INDIGENT, WHICH IS A SEPARATE, SUPPLEMENTAL DETERMINATION OF FINANCIAL ASSISTANCE FOR PATIENTS THAT ARE NOT ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE PRIMARY SECTION OF THE FINANCIAL ASSISTANCE POLICY, BUT FOR WHOM THE RESULTING FINANCIAL LIABILITY FOR MEDICAL TREATMENT REPRESENTS A CATASTROPHIC LOSS. "CATASTROPHIC" IS DEFINED AS A SITUATION IN WHICH THE SELF-PAY PORTION OF THE HSCPC MEDICAL BILL IS GREATER THAN THE PATIENT'S ABILITY TO REPAY WITH CURRENT INCOME AND LIQUID ASSETS IN 18 MONTHS OR LESS. THE FACTORS TAKEN INTO CONSIDERATION WHEN EVALUATING A CATASTROPHIC ASSISTANCE APPLICATION ARE THE FOLLOWING: CURRENT MEDICAL DEBT, LIQUID ASSETS, LIVING EXPENSES, PROJECTED MEDICAL EXPENSES, ANNUAL INCOME, FAMILY SIZE, AND SPELL OF ILLNESS. AVAILABILITY OF FINANCIAL ASSISTANCE POLICY SCHEDULE H, PART V, SECTION B, LINE 16J HSCPC PUBLICIZES ITS FINANCIAL ASSISTANCE POLICY IN MANY DIFFERENT WAYS. FIRST, IT POSTS NOTICES REGARDING THE AVAILABILITY OF CHARITY CARE IN ADMISSIONS, PATIENT REGISTRATION, AND THE BUSINESS OFFICE. THE INFORMATION ON THE SIGNS IS IN BOTH ENGLISH AND SPANISH. IN ADDITION, THE POLICY IS DISTRIBUTED TO PATIENTS ON ADMISSION AND UPON REQUEST, AND IS AVAILABLE AT ALL PATIENT REGISTRATION DESKS AND IN ALL WAITING AREAS. FURTHERMORE, HSCPC, AS MANDATED BY ITS FINANCIAL ASSISTANCE POLICY, PUBLISHES A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY, ON AN ANNUAL BASIS, IN A NEWSPAPER OF GENERAL CIRCULATION IN THE HOSPITAL'S PRIMARY AND SECONDARY SERVICE AREAS. POLICY RELATING TO EMERGENCY MEDICAL CARE SCHEDULE H, PART V, SECTION B, LINE 21D THE HSC PEDIATRIC CENTER IS A LONG-TERM PEDIATRIC HOSPITAL FACILITY, WHICH DOES NOT PROVIDE EMERGENCY MEDICAL CARE. HOWEVER, THE HSC PEDIATRIC CENTER HAS ADOPTED A TRANSFER POLICY PURSUANT TO WHICH THE HOSPITAL WILL HELP TO TRANSFER, AS APPROPRIATE, ANY PATIENTS SHOWING SYMPTOMS OF AN EMERGENCY TO AN ACUTE CARE HOSPITAL. MAXIMUM AMOUNTS TO BE CHARGED TO FAP ELIGIBLE INDIVIDUALS SCHEDULE H, PART V, SECTION B, LINE 22D THE HSC PEDIATRIC CENTER DETERMINED MAXIMUM AMOUNTS TO BE CHARGED TO FAP ELIGIBLE INDIVIDUALS IS NOT MORE THAN AMOUNTS GENERALLY BILLED TO INSURED PATIENTS. THE PROSPECTIVE MEDICAID METHOD WAS USED. 3 The HSC Outpatient Center 4500 Forbes Blvd Suite 100 Lanham MD 20706 Provides outpatient rehab SERVICES TO THE SPECIAL NEEDS COMMUNITY The HSC Outpatient Center 14995 Shady Grove Rd Suite 200 Rockville MD 20850 Provides outpatient rehab SERVICES TO THE SPECIAL NEEDS COMMUNITY The HSC Skilled Nursing Facility 1731 Bunker Hill Road NE Washington DC 20017 Facility that provides skilled nursing services to children & young adults through age 21 OTHER CRITERIA USED FOR DETERMINING ELIGIBILITY SCHEDULE H, PART I, LINE 3C HSCPC HAS A FINANCIAL ASSISTANCE POLICY THAT PROVIDES FOR FREE OR DISCOUNTED CARE TO INDIVIDUALS THAT QUALIFY UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. THE LEVEL OF FINANCIAL ASSISTANCE IS DETERMINED BY SEVERAL FACTORS, INCLUDING: THE INDIVIDUAL'S ANNUAL INCOME, FAMILY SIZE, AND LIQUID ASSETS, AS WELL AS WHETHER THE INDIVIDUAL IS COVERED BY GOVERNMENTAL OR OTHER INSURANCE. FREE CARE IS PROVIDED TO PATIENTS WHO ARE INELIGIBLE FOR GOVERNMENTAL OR OTHER INSURANCE COVERAGE, AND WHOSE FAMILY INCOME DOES NOT EXCEED 200% OF THE FEDERAL POVERTY GUIDELINES. DISCOUNTED CARE IS BASED ON A SLIDING DISCOUNTED SCALE OF GROSS CHARGES AND IS PROVIDED TO PATIENTS WHO ARE INELIGIBLE FOR GOVERNMENTAL OR OTHER INSURANCE COVERAGE AND WHOSE FAMILY INCOME IS BETWEEN 200% AND 500% OF THE POVERTY GUIDELINES. WHEN POSSIBLE, THE ORGANIZATION MAY MAKE A PROSPECTIVE DETERMINATION THAT CERTAIN PATIENTS QUALIFY FOR FREE OR DISCOUNTED CARE, ALTHOUGH THE PATIENT HAS NOT SUBMITTED A COMPLETED FINANCIAL ASSISTANCE FORM. PRESUMPTIVE CHARITY CARE IS DETERMINED BASED ON DEFINED CRITERIA FOR DESTITUTE STATUS (HOMELESS, ILLEGAL ALIEN, INCARCERATED, ETC.). ONCE CHARITY CARE ELIGIBILITY HAS BEEN ESTABLISHED, THE PATIENT ACCOUNT IN WHOLE, OR IN PART, IS WRITTEN-OFF AND ALL COLLECTION EFFORTS ON THE WRITTEN OFF PORTION OF THE ACCOUNT CEASE. IF THE PATIENT RECEIVES PARTIAL CHARITY CARE, ALL EFFORTS WILL BE MADE TO PLACE THAT PATIENT ON AN EXTENDED PAYMENT PLAN. IN ADDITION, INDIVIDUALS THAT DO NOT QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY MAY STILL BE PROVIDED UP TO A 25% DISCOUNT ON BILLED SERVICES IN CERTAIN CIRCUMSTANCES. FINANCIAL ASSISTANCE POLICY FOR THE MEDICALLY INDIGENT SCHEDULE H, PART I, LINE 4 HSCPC HAS A FINANCIAL ASSISTANCE POLICY THAT PROVIDES FOR FREE OR DISCOUNTED CARE TO THE MEDICALLY INDIGENT, WHICH IS A SEPARATE, SUPPLEMENTAL DETERMINATION OF FINANCIAL ASSISTANCE FOR PATIENTS THAT ARE NOT ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER THE PRIMARY SECTION OF THE FINANCIAL ASSISTANCE POLICY, BUT FOR WHOM THE RESULTING FINANCIAL LIABILITY FOR MEDICAL TREATMENT REPRESENTS A CATASTROPHIC LOSS. "CATASTROPHIC" IS DEFINED AS A SITUATION IN WHICH THE SELF-PAY PORTION OF THE HSCPC MEDICAL BILL IS GREATER THAN THE PATIENT'S ABILITY TO REPAY WITH CURRENT INCOME AND LIQUID ASSETS IN 18 MONTHS OR LESS. THE FACTORS TAKEN INTO CONSIDERATION WHEN EVALUATING A CATASTROPHIC ASSISTANCE APPLICATION ARE THE FOLLOWING: CURRENT MEDICAL DEBT, LIQUID ASSETS, LIVING EXPENSES, PROJECTED MEDICAL EXPENSES, ANNUAL INCOME, FAMILY SIZE, AND SPELL OF ILLNESS. EXPLANATION OF COSTING METHODOLOGY USED FOR CALCULATING LINE 7 TABLE SCHEDULE H, PART I, LINE 7 THE COST OF CHARITY CARE WAS DETERMINED BY UTILIZING THE RATIO OF COST TO CHARGES CALCULATED ON WORKSHEET 2 APPLIED TO THE CHARGES WRITTEN OFF FOR PATIENTS QUALIFYING FOR CHARITY CARE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART I, LINE 7, COL (F) BAD DEBT EXPENSE EXCLUDED FROM FINANCIAL ASSISTANCE CALCULATION $1,681,566. METHODOLOGY USED TO ESTIMATE BAD DEBT SCHEDULE H, PART III, LINE 2 BAD DEBT EXPENSE IS DETERMINED BY ANALYZING PAST HISTORY AND IDENTIFYING TRENDS FOR EACH MAJOR PAYER SOURCE OF REVENUE. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY INSURANCE COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS NET OF ANY PAYMENTS OR DISCOUNTS MADE AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND BAD DEBT EXPENSE, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL RECORDS A SIGNIFICANT BAD DEBT EXPENSE IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE NET OF ANY PAYMENTS OF DISCOUNTS MADE. THE HOSPITAL REGULARLY PERFORMS HINDSIGHT PROCEDURES TO EVALUATE HISTORICAL WRITE-OFF AND COLLECTION EXPERIENCE THROUGHOUT THE YEAR TO ASSIST IN DETERMINING THE REASONABLENESS OF ITS PROCESS FOR ESTIMATING THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FAP ELIGIBLE PATIENT BAD DEBT CALCULATION METHODOLOGY SCHEDULE H, PART III, LINE 3 THE HOSPITAL DOES NOT REPORT AN ESTIMATE FOR THE PORTION OF BAD DEBT EXPENSE THAT MAY HAVE BEEN LIKELY TO QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY. HSCPC TAKES THE POSITION THAT AMPLE OPPORTUNITY AND ASSISTANCE IS PROVIDED TO THE PATIENT TO QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY. IF SUFFICIENT INFORMATION IS NOT PROVIDED THE HOSPITAL MUST ASSUME THE PATIENT DOES NOT QUALIFY FOR FINANCIAL ASSISTANCE. FOOTNOTE IN ORGANIZATION'S FINANCIAL STATEMENTS DESCRIBING BAD DEBT SCHEDULE H, PART III, LINE 4 THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS (NOTE 2) THAT DESCRIBES BAD DEBT EXPENSE IS AS FOLLOWS: PROVISIONS FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY INSURANCE COVERAGE, THE CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE CENTER RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE CENTER REGULARLY PERFORMS HINDSIGHT PROCEDURES TO EVALUATE HISTORICAL WRITE-OFF AND COLLECTION EXPERIENCE THROUGHOUT THE YEAR TO ASSIST IN DETERMINING THE REASONABLENESS OF ITS PROCESS FOR ESTIMATING THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. SHORTFALL TREATED AS COMMUNITY BENEFIT AND COSTING METHOD USED SCHEDULE H, PART III, LINE 8 HSCPC DOES NOT PARTICIPATE IN THE MEDICARE PROGRAM. PROVISIONS ON COLLECTION PRACTICES FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR ASSISTANCE SCHEDULE H, PART III, LINE 9B THE DETERMINATION OF A PATIENT'S QUALIFICATION UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS ATTEMPTED PRIOR TO THE PATIENT BEING DISCHARGED FROM THE HOSPITAL. THIS MAY INCLUDE A PROSPECTIVE DETERMINATION THAT CERTAIN PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE, ALTHOUGH THE PATIENT HAS NOT SUBMITTED A COMPLETE FINANCIAL ASSISTANCE POLICY. AS SOON AS THE PATIENT'S FINANCIAL ASSISTANCE ELIGIBILITY HAS BEEN ESTABLISHED, THE PATIENT ACCOUNT IN WHOLE OR IN PART, IS WRITTEN-OFF AND ALL COLLECTION EFFORTS CEASE ON THE PORTION OF THE ACCOUNT THAT HAS BEEN WRITTEN-OFF. IF THE PATIENT RECEIVES DISCOUNTED CARE, ALL EFFORTS WILL BE MADE TO PLACE THAT PATIENT ON AN EXTENDED PAYMENT PLAN. FOR THOSE PATIENTS THAT DO NOT INITIALLY APPLY OR QUALIFY FOR FINANCIAL ASSISTANCE, THE ORGANIZATION CONTINUES TO MONITOR WHETHER THE PATIENT MAY QUALIFY FOR FINANCIAL ASSISTANCE THROUGHOUT THE COLLECTION PROCESS. IF THE PATIENT IS FOUND TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY POINT (INCLUDING ONCE COLLECTION EFFORTS HAVE BEGUN), THE ORGANIZATION WILL APPROVE THE PATIENT FOR FINANCIAL ASSISTANCE IMMEDIATELY. NEEDS ASSESSMENT SCHEDULE H, PART VI, LINE 2 HSC PEDIATRIC CENTER USES A VARIETY OF METHODS TO ASSESS HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. NEEDS ARE IDENTIFIED THROUGH A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT, PARTNERSHIPS AND COLLABORATIONS WITH OTHER MEDICAL, NON-PROFIT AND PUBLIC HEALTH AGENCIES. HSC PEDIATRIC CENTER ASSUMES THE RESPONSIBILITY OF LEADING THE REGION IN THE PROVISION OF CHRONIC CARE FOR PEDIATRIC PATIENTS AND IS TRUSTED THROUGHOUT ITS COMMUNITY AS A RESOURCE READY AND WILLING TO ADDRESS ESTABLISHED AND EMERGENT PEDIATRIC NEEDS WHEREVER AND HOWEVER THEY ARE IDENTIFIED. HSC PEDIATRIC CENTER'S CURRENT COMMUNITY NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY CAN BE FOUND AT WWW.DCHEALTHMATTERS.ORG. PATIENT EDUCATION SCHEDULE H, PART VI, LINE 3 THE HSC PEDIATRIC CENTER HAS A STRONG COMMITMENT TO PROVIDING SERVICES TO FAMILIES AT NO COST TO THEM IF AT ALL POSSIBLE. MANY OF THE FAMILIES WHO RECEIVE SERVICES FROM HSC HAVE ALREADY QUALIFIED FOR MEDICAID BY THE TIME OF THEIR ARRIVAL AT HSC DUE TO PRIOR SERVICES AT OTHER FACILITIES. IF A FAMILY ARRIVES AT HSC WITH PRIVATE INSURANCE, OFTEN TIMES THEY QUALIFY FOR MEDICAID BY THE TIME THEY ARE DISCHARGED TO CARE AT HOME. FAMILIES ARE INFORMED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE AT THE TIME OF THEIR ADMISSION TO HSCPC. THEY ARE GIVEN WRITTEN COPIES OF THE STATEMENT: "NOTICE OF AVAILABILITY OF UNCOMPENSATED SERVICES" IN THE APPROPRIATE LANGUAGE. IF THEY BELIEVE THEY MAY BE IN NEED OF THE SERVICES, AN APPLICATION IS FILLED OUT AT THE TIME OF ADMISSION. IF A FAMILY DOES NOT QUALIFY FOR MEDICAID THEY WOULD BE ELIGIBLE TO PURSUE THE AVAILABLE UNCOMPENSATED SERVICES. IF PATIENTS ARE NOT ELIGIBLE FOR MEDICAID AND OTHER GOVERNMENTAL PROGRAMS SUBSEQUENT TO DISCHARGE, HSCPC BOTH INFORMS AND ATTEMPTS TO QUALIFY THEM PROSPECTIVELY FOR THE CHARITY CARE SERVICES PROVIDED BY HSCPC. THE HSC PEDIATRIC CENTER POSTS SIGNAGE ABOUT PATIENT RIGHTS AND FINANCIAL ASSISTANCE IN BOTH ENGLISH AND SPANISH. SEE BELOW FOR AN EXCERPT FROM THE SIGNAGE: PATIENTS, MEMBERS, CLIENTS, AND FAMILIES HAVE THE RIGHT TO: - EXPECT APPROPRIATE QUALITY CARE AND SERVICES REGARDLESS OF SEX, RACE, RELIGION, COLOR, CREED, ETHNIC ORIGIN, DISABILITY, SEXUAL PREFERENCE, GENDER IDENTITY OR SOURCE OF PAYMENT; - BE INFORMED, IN A TIMELY FASHION, OF ALL EXPENSES NOT COVERED BY THE PATIENT/MEMBER/CLIENT'S INSURANCE THAT WILL BE INCURRED BY THE PATIENT/MEMBER/CLIENT'S HEALTH CARE; - AN ACCOUNTING OF ALL DISCLOSURES. STAFF OF THE ORGANIZATION HELP IDENTIFY GOVERNMENT OR NON-PROFIT ASSISTANCE WHICH MAY BE AVAILABLE, AND THE ORGANIZATION WILL ASSIST PATIENTS' FAMILIES WITH APPLYING FOR SUCH PROGRAMS, SUCH AS MEDICAID. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4 TTHE HSC PEDIATRIC CENTER SERVES CHILDREN AND YOUNG ADULTS UP TO THE AGE OF 21 IN THE WASHINGTON DC METRO AREA WHO HAVE SPECIAL HEALTH CARE NEEDS. HSCPC SERVES THE WASHINGTON DC METRO AREA WHICH IS A DIVERSE COMMUNITY THAT COVERS TWO STATES AND THE DISTRICT OF COLUMBIA. OF THE DC SPECIAL NEEDS CHILDREN APPROXIMATELY 5,500 WERE ENROLLED IN HEALTH SERVICES FOR CHILDREN WITH SPECIAL NEEDS, INC., HSCPC'S SISTER ORGANIZATION THAT PROVIDES CARE MANAGEMENT SERVICES TO CHILDREN WHO HAVE SSI OR SSI RELATED DIAGNOSES. THE PRIMARY CONDITIONS OF CHILDREN WITH SPECIAL HEALTH CARE NEEDS TREATED AT THE HSCPC ARE CONDITIONS REQUIRING LONGER TERM TRANSITIONAL CARE AND/OR SPECIALTY REHABILITATION CARE PRIOR TO THEIR DISCHARGE TO HOME OR NURSING/GROUP HOME. THESE CONDITIONS INCLUDE CEREBRAL PALSY, ANOXIC BRAIN DAMAGE, SPINA BIFIDA, FAILURE TO THRIVE RELATED TO PREMATURITY, CHRONIC LUNG DISEASE AND INTESTINAL OR OTHER FEEDING DISORDERS. IN 2019, APPROXIMATELY 75% OF HSCPC'S PATIENTS WERE COVERED BY MEDICAID (I.E. DC, MD OR VA MEDICAID). IN 2019, HSCPC PROVIDED 9,552 DAYS OF CARE. HSCPC ALSO PROVIDED ON AN OUTPATIENT BASIS MEDICAL CARE, APPROXIMATELY 22,288 VISITS IN 2019. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 WITH THE EXCEPTION OF THE CEO OF THE HSC FOUNDATION, WHO SERVES AS AN EX OFFICIO NON VOTING BOARD MEMBER, THE HSC PEDIATRIC CENTER'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION OR ITS AFFILIATES, NOR FAMILY MEMBERS THEREOF. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS OR SPECIALTIES. THE ORGANIZATIONS SURPLUS FUNDS ARE USED TO FURTHER ITS EXEMPT PURPOSE, MEDICAL EDUCATION AND COMMUNITY PROGRAMS. DESCRIPTION OF AFFILIATED GROUP SCHEDULE H, PART VI, LINE 6 AS OF SEPTEMBER 1, 2019, THE HSC PEDIATRIC CENTER IS PART OF AFFILIATED HEALTH CARE SYSTEM COMPRISED OF THE FOLLOWING OTHER TAX-EXEMPT ENTITIES: - CHILDREN'S NATIONAL MEDICAL CENTER - 501(C)(3), OVERSIGHT AND FINANCIAL RESPONSIBILITY FOR HEALTH CARE SYSTEM - CHILDREN'S HOSPITAL FOUNDATION - 501(C)(3), FUNDRAISING - CHILDREN'S RESEARCH INSTITUTE - 501(C)(3), CONDUCTING CLINICAL MEDICAL RESEARCH AND EDUCATION PROGRAMS - SAFE KIDS WORLDWIDE - 501(C)(3), INJURY PREVENTION FOR CHILDREN - BRAINY CAMPS ASSOCIATION - 501(C)(3), PROVISION OF CAMPS FOR CHILDREN - CHILDREN'S NATIONAL ADVOCACY & PUBLIC POLICY INC. - 501(C)(3), ADVOCATING FOR CHILDREN'S HEALTH ISSUES - CHILDREN'S HOSPITAL SELF-INSURANCE TRUST - 501(C)(3), PROVISION OF INSURANCE TO SYSTEM EACH ENTITY PARTICIPATES IN THE CHILDREN'S NATIONAL MEDICAL CENTER'S ABILITY TO DELIVER PEDIATRIC HEALTH CARE SERVICES ON AN INTEGRATED BASIS. - CHILDREN'S SCHOOL SERVICES - 501(C)(3), SCHOOL NURSING SERVICES - CHILDREN'S HOSPITAL - 501(C)(3), HOSPITAL - HSC FOUNDATION - 501(C)(3), SUPPORT FOR THE HSC ENTITIES - HEALTH SERVICES FOR CHILDREN WITH SPECIAL NEEDS - 501(C)(3), HEALTHCARE, SOCIAL, AND EDUCATIONAL SERVICES FOR YOUNG INDIVIDUALS WITH SPECIAL NEEDS STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 DC false true false false false false false false false Nathaniel Beers Pres & CEO, Board Member 0 608927 0 50000 0 0 0 34835 0 2115 0 695877 0 0 Victor Fields Former EVP & CFO 0 358489 0 0 0 0 0 26475 0 12057 0 397021 0 0 Debbie Holson COO, Pediatric Center 0 263668 0 0 0 0 0 28946 0 10057 0 302671 0 0 Kimberly Brown VP FINANCE/INT CFO TO 11/1/19 0 231324 0 0 0 0 0 11303 0 7855 0 250482 0 0 Donna Anthony EVP, Clinical Strategies 0 345110 0 0 0 0 0 29965 0 12274 0 387349 0 0 Andrew Metinko Pediatrician 198918 0 0 0 0 0 9500 0 0 0 208418 0 0 0 Samar Maamoun Pediatrician 218874 0 0 0 0 0 10088 0 1660 0 230622 0 0 0 Thomas W Chapman Former Pres & CEO HSCF 0 0 0 0 0 145373 0 0 0 0 0 145373 0 0 Adam Winebarger VP of Patient Care Serv 167586 0 0 0 0 0 3269 0 1660 0 172515 0 0 0 Anne Ruecktenwald Director of Outpat. Prog 158714 0 0 0 0 0 7956 0 1520 0 168190 0 0 0 Esther Kagulu Registered Nurse 157618 0 0 0 0 0 7924 0 1445 0 166987 0 0 0 ALEC KING TREASURER FROM 9/1/19 0 655110 0 629498 0 123254 0 14000 0 26127 0 1447989 0 79685 MARY ANNE HILLIARD SECRETARY FROM 9/1/19 0 482118 0 263608 0 77598 0 14000 0 18736 0 856060 0 50567 ARRANGEMENT USED TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION SCHEDULE J, PART I, LINE 3 THE ORGANIZATION RELIED ON A RELATED ORGANIZATION AND THAT RELATED ORGANIZATION USED THE FOLLOWING METHODS TO ESTABLISH THE CEO/PRESIDENT'S COMPENSATION: 1) COMPENSATION COMMITTEE; 2) INDEPENDENT COMPENSATION CONSULTANT; 3) COMPENSATION SURVEY OR STUDY; AND 4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. ALL COMPENSATION PAID TO OFFICERS IS PAID BY A RELATED ORGANIZATION. EFFECTIVE SEPTEMBER 1, 2019, CHILDREN'S NATIONAL MEDICAL CENTER (CHILDREN'S NATIONAL) BECAME THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. COMMENCING IN 2020, THE ORGANIZATION AND ITS AFFILIATES WILL ADOPT THE EXECUTIVE COMPENSATION PRACTICE AND APPROVAL PROCESS OF CHILDREN'S NATIONAL MEDICAL CENTER, WHICH IS SUBSTANTIALLY SIMILAR TO THE PROCESS OUTLINED ABOVE. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B A RELATED ORGANIZATION MAINTAINS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) AS PART OF THE TOTAL COMPENSATION ARRANGEMENT FOR THE ORGANIZATION'S FORMER CEO, THOMAS CHAPMAN. THE SERP PLAN IS MEANT TO PROVIDE THOMAS CHAPMAN WITH A RETIREMENT BENEFIT FOR OVER 20 YEARS OF SERVICE PROVIDED TO THE RELATED ORGANIZATION. THE RELATED ORGANIZATION'S COMPENSATION COMMITTEE HAS CAREFULLY REVIEWED AND APPROVED THE SERP PLAN FOR THOMAS CHAPMAN AND CONCLUDED THAT THOMAS CHAPMAN'S ENTIRE COMPENSATION PACKAGE, INCLUDING THE BENEFITS PROVIDED BY THE SERP PLAN, IS REASONABLE WHEN COMPARED TO MARKET DATA. A District of Columbia 536001131 254839J53 2010-12-17 11525000 Refund series 2005 bond false false false A 2675000 0 11525000 0 0 0 0 0 0 0 11525000 0 1992 true false true true A false false true true false 0.00000 0.00000 0.00000 false false false true A false false false true true false 0 false 0 false true A true Schedule K, Part III, Line 7 ALL COSTS OF ISSUANCE WITH RESPECT TO THE BONDS WERE PAID FROM FUNDS OTHER THAN PROCEEDS OF THE BONDS. Schedule K, Part IV, Line 2c - COlumn A ISSUER NAME: DISTRICT OF COLUMBIA THE CALCULATION FOR COMPUTING NO REBATE DUE WAS PERFORMED ON 7/27/2015. CHANGE IN CORPORATE STRUCTURE ON SEPTEMBER 1, 2019, CHILDREN'S NATIONAL MEDICAL CENTER BECAME THE SOLE MEMBER OF THE HSC FOUNDATION. CHILDREN'S NATIONAL IS A DISTRICT OF COLUMBIA TAX-EXEMPT, NONSTOCK CORPORATION WHO ALONG WITH ITS SUBSIDIARIES, PROVIDE HEALTH CARE SERVICES TO INFANTS, CHILDREN, AND YOUTH IN THE DISTRICT OF COLUMBIA AND THE SURROUNDING METROPOLITAN AREA. NO CONSIDERATION WAS PAID BY CHILDREN'S NATIONAL. BOTH PRIOR TO AND IMMEDIATELY THEREAFTER, THE HSC FOUNDATION WAS AND REMAINS THE SOLE MEMBER OF THE HOSPITAL FOR SICK CHILDREN (DBA THE HSC PEDIATRIC CENTER AND REFERRED TO HEREIN AS "HSCPC.") DELEGATE BROAD AUTHORITY TO A COMMITTEE FORM 990, PART VI, SECTION A, LINE 1A UNDER THE FOUNDATION'S PRIOR BYLAWS, AND UNTIL SEPTEMBER 1, 2019, THE EXECUTIVE COMMITTEE OF THE HSC FOUNDATION, THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, HAS THE POWER TO EXERCISE EACH AND ALL OF THE POWERS OF THE BOARD OF DIRECTORS IN THE SAME MANNER AND TO THE SAME EXTENT AS IF THE COMMITTEE WERE IN FACT THE BOARD OF DIRECTORS, PROVIDED THAT ANY ACTION TAKEN SHALL NOT CONFLICT WITH PREVIOUSLY ESTABLISHED POLICIES OR DIRECTIVES OF THE BOARD. HOWEVER, NOTHING CONTAINED IN THESE BYLAWS SHALL CONSTITUTE A DELEGATION TO THE EXECUTIVE COMMITTEE OF THE FOLLOWING POWERS OF THE BOARD OF DIRECTORS: TO INCREASE OR DECREASE THE NUMBER OF DIRECTORS; TO FILL VACANCIES ON OR REMOVE DIRECTORS FROM THE BOARD; TO ELECT OFFICERS; TO FILL OFFICERS' VACANCIES; TO REMOVE OFFICERS; TO SELL, ENCUMBER OR OTHERWISE DISPOSE OF ALL OR ANY MATERIAL PART OF THE ASSETS OF THE CORPORATION; TO MERGE OR CONSOLIDATE THE CORPORATION WITH ANOTHER ENTITY; OR TO AMEND THESE BYLAWS. ALL EXECUTIVE COMMITTEE MINUTES WILL BE PROVIDED TO ALL MEMBERS OF THE BOARD OF DIRECTORS PRIOR TO THE NEXT MEETING OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE CHAIRMAN, VICE CHAIRMAN, SECRETARY AND TREASURER OF THE HSC FOUNDATION AND UP TO FOUR (4) ADDITIONAL AT-LARGE MEMBERS WHO MAY BE APPOINTED BY THE CHAIRMAN OF THE BOARD, IN HIS OR HER DISCRETION. THE PRESIDENT SHALL BE AN EX OFFICIO MEMBER OF THE COMMITTEE. EFFECTIVE SEPTEMBER 1, 2019, CHILDREN'S NATIONAL BECAME THE SOLE CORPORATE MEMBER OF THE HSC FOUNDATION. UPON THAT AFFILIATION, THE EXISTING BOARD COMMITTEES OF THE HSC FOUNDATION AND HSCPC BECAME ADVISORY ONLY. SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS FORM 990, PART VI, LINE 4 THE HSC FOUNDATION (THE FOUNDATION) IS THE SOLE CORPORATE MEMBER OF THE HOSPTIAL FOR SICK CHILDREN. ON SEPTEMBER 1, 2019, THE FOUNDATION AFFILIATED WITH CHILDREN'S NATIONAL MEDICAL CENTER. IN ACCORDANCE WITH AN AFFILIATION AGREEMENT BY AND BETWEEN THE FOUNDATION AND CHILDREN'S NATIONAL, CHILDREN'S NATIONAL BECAME THE SOLE CORPORATE MEMBER OF THE FOUNDATION. THE FOUNDATION AMENDED AND RESTATED ITS ARTICLES OF INCORPORATION TO DESIGNATE CHILDREN'S NATIONAL AS ITS SOLE MEMBER. ADDITIONALLY, THE FOUNDATION AND HSCPC AMENDED AND RESTATED ITS BYLAWS TO COMPLY WITH CHILDREN'S NATIONAL'S SYSTEM OF GOVERNANCE. UNDER CHILDREN'S NATIONAL'S SYSTEM OF GOVERNANCE, CHILDREN'S NATIONAL RETAINS CERTAIN AUTHORITY OVER SUBSIDIARY ENTITIES (INCLUDING SUBSIDIARIES OF SUBSIDIARIES). THE RETENTION OF AUTHORITY INCLUDES ITEMS SUCH AS: THE AUTHORITY TO AMEND A SUBSIDIARY'S GOVERNING DOCUMENTS, AUTHORIZE THE SALE OF SUBSTANTIALLY ALL ASSETS, APPOINT/REMOVE OFFICERS AND DIRECTORS, APPROVE BUDGETS, SET SIGNATURE AUTHORITY, AND ADOPT AN ENTERPRISE-WIDE COMPLIANCE PLAN. THE AFFILIATION AGREEMENT AND THE FOUNDATION'S AMENDED AND RESTATED BYLAWS ANTICIPATE A FIVE-YEAR INTEGRATION PERIOD, DURING SUCH PERIOD THE FOUNDATION AND CHILDREN'S NATIONAL WILL SHARE RESPONSIBILITY FOR CERTAIN AUTHORITIES THAT ARE OTHERWISE SET UNDER THE SYSTEM OF GOVERNANCE. MEMBERS OR STOCKHOLDERS FORM 990, PART VI, SECTION A, LINE 6 THE HSC FOUNDATION IS THE SOLE MEMBER OF THE HOSPITAL FOR SICK CHILDREN. AS OF SEPTEMBER 1, 2019, CHILDREN'S NATIONAL MEDICAL CENTER IS THE SOLE MEMBER OF THE HSC FOUNDATION. ELECTION OF MEMBERS FORM 990, PART VI, SECTION A, LINES 7A & 7B THE SOLE MEMBER (THE HSC FOUNDATION) SHALL HAVE ALL OF THE POWERS SPECIFIED IN THE ARTICLES OF INCORPORATION AND BYLAWS, INCLUDING THE POWER TO: (A) ESTABLISH THE HOSPITAL'S POLICIES AND GOALS, AND APPROVE THE BYLAWS INCLUDING ANY AMENDMENTS THERETO; (B) APPOINT AND REMOVE THE HOSPITAL'S BOARD OF DIRECTORS; (C) MONITOR THE DECISIONS OF THE HOSPITAL'S BOARDS OF DIRECTORS; AND (D) APPROVE THE HOSPITAL'S BUDGET. THE HSC FOUNDATION IS THE SOLE CORPORATE MEMBER OF THE HOSPTIAL FOR SICK CHILDREN. ON SEPTEMBER 1, 2019, THE FOUNDATION AFFILIATED WITH CHILDREN'S NATIONAL MEDICAL CENTER. EFFECTIVE SEPTEMBER 1, 2019 AND FOR A PERIOD OF FIVE YEARS THEREAFTER, THE MEMBERS OF THE FOUNDATION'S GOVERNING BODY TOGETHER WITH THE BOARD OF CHILDREN'S NATIONAL APPOINT THE MEMBERS OF HSCPC'S GOVERNING BODY. AFTER SEPTEMBER 1, 2024, CHILDREN'S NATIONAL WILL APPOINT MEMBERS OF THE HSCPC'S GOVERNING BODY. ON SEPTEMBER 1, 2019, AND BY MEANS OF AN AFFILIATION AGREEMENT, THE FOUNDATION AFFILIATED WITH CHILDREN'S NATIONAL. EFFECTIVE AS OF THAT DATE, THE FOUNDATION AND THE HSCPC AMENDED AND RESTATED THEIR BYLAWS TO COMPLY WITH CHILDREN'S NATIONAL'S SYSTEM OF GOVERNANCE. UNDER CHILDREN'S NATIONAL'S SYSTEM OF GOVERNANCE, CHILDREN'S NATIONAL RETAINS CERTAIN AUTHORITY OVER SUBSIDIARY (AND A SUBSIDIARY OF A SUBSIDIARY) ENTITIES. THE RETENTION OF AUTHORITY INCLUDES ITEMS SUCH AS: THE AUTHORITY TO AMEND A SUBSIDIARY'S GOVERNING DOCUMENTS, AUTHORIZATION OF THE SALE OF SUBSTANTIALLY ALL ASSETS, APPOINT/REMOVE OFFICERS AND DIRECTORS, APPROVE BUDGETS, SET SIGNATURE AUTHORITY, AND ADOPT AN ENTERPRISE-WIDE COMPLIANCE PLAN. THE AFFILIATION AGREEMENT AND THE FOUNDATION AND HSCPS'S AMENDED AND RESTATED BYLAWS ANTICIPATE A FIVE-YEAR INTEGRATION PERIOD, DURING SUCH PERIOD THE ORGANIZATION AND CHILDREN'S NATIONAL WILL SHARE RESPONSIBILITY FOR CERTAIN AUTHORITIES THAT ARE OTHERWISE SET UNDER THE SYSTEM OF GOVERNANCE. AFTER SEPTEMBER 1, 2024, CHILDREN'S NATIONAL WILL HAVE SOLE RESPONSIBILITY FOR AUTHORITY THAT IS RESERVED UNDER THE SYSTEM OF GOVERNANCE. FORM 990 REVIEW PROCESS FORM 990, PART VI, SECTION B, LINE 11B EFFECTIVE SEPTEMBER 1, 2019, CHILDREN'S NATIONAL MEDICAL CENTER BECAME THE SOLE CORPORATE MEMBER OF THE HSC FOUNDATION. THE HSC FOUNDATION IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. THE FORM 990 IS PREPARED BY AN ACCOUNTING FIRM AND THEN REVIEWED BY SENIOR LEADERSHIP, INCLUDING THE ORGANIZATION'S CHIEF OPERATING OFFICER AND THE CFOS OF THE HSC FOUNDATION AND CHILDREN'S NATIONAL. ONCE COMMENTS FROM THE COO AND CFOS HAVE BEEN INCORPORATED INTO THE FORM 990, THE FORM 990 IS REVIEWED BY THE FINANCE & INVESTMENT COMMITTEE OF CHILDREN'S NATIONAL AND MADE AVAILABLE TO THE BOARD OF DIRECTORS PRIOR TO FILING. CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C PRIOR TO SEPTEMBER 1, 2019, THE HSC FOUNDATION MAINTAINED A WRITTEN CONFLICT OF INTEREST POLICY THAT COVERS ITSELF AND ALL OF ITS DIRECT AND INDIRECT SUBSIDIARIES (INCLUDING THE HOSPITAL FOR SICK CHILDREN). UNDER THAT POLICY, WHENEVER A POTENTIAL CONFLICT ARISES FOR THE HOSPITAL FOR SICK CHILDREN BOARD OF DIRECTORS AND/OR OFFICERS, IT IS BROUGHT TO THE ATTENTION OF THE PRESIDENT AND EXECUTIVE COMMITTEE OF THE HSC FOUNDATION BOARD, WHICH ANALYZES THE SITUATION AND MAKES A DETERMINATION OF WHETHER OR NOT AN ACTUAL CONFLICT EXISTS. IF IT IS DETERMINED THAT AN ACTUAL CONFLICT EXISTS, THE PRESIDENT AND EXECUTIVE COMMITTEE REPORTS TO THE HSC PEDIATRIC CENTER BOARD OF DIRECTORS REGARDING THE NATURE OF THE CONFLICT AND THAT PERSON IS THEREAFTER RECUSED FROM ANY DISCUSSION AND VOTE REGARDING THE MATTER. WHENEVER A POTENTIAL CONFLICT ARISES FOR EMPLOYEES OF THE HOSPITAL FOR SICK CHILDREN MANAGEMENT TEAM, IT WILL BE BROUGHT TO THE BOARD CHAIR BY THE PRESIDENT WHICH ANALYZES THE SITUATION AND MAKES A DETERMINATION OF WHETHER OR NOT AN ACTUAL CONFLICT EXISTS. IF IT IS DETERMINED THAT AN ACTUAL CONFLICT EXISTS, STEPS WILL BE TAKEN TO ELIMINATE THE CONFLICT AND COMMUNICATED TO THE EMPLOYEE INVOLVED. THE BOARD CHAIR AND PRESIDENT WILL REPORT ALL CONFLICTS OF INTEREST TO THE EXECUTIVE COMMITTEE FOUNDATION. EFFECTIVE SEPTEMBER 1, 2019, CHILDREN'S NATIONAL MEDICAL CENTER BECAME THE SOLE CORPORATE MEMBER OF THE HSC FOUNDATION, THEREAFTER THE HSC FOUNDATION AND ITS SUBSIDIARIES BECAME SUBJECT TO THE CONFLICTS OF INTEREST POLICY OF CHILDREN'S NATIONAL. THAT POLICY IS SUBSTANTIALLY SIMILAR TO THE PROCESS SETOUT ABOVE; PROVIDED HOWEVER, THE CHILDREN'S NATIONAL POLICY REQUIRES THE COMPLETION OF AN ANNUAL CONFLICT OF INTEREST DISCLOSURE FORM, AND, IF APPLICABLE A CONFLICT MANAGEMENT PLAN IS IMPLEMENTED INCONJUCTION WITH THE COMPLIANCE OFFICER OF CHILDREN' NATIONAL. GOVERNING POLICIES FORM 990, PART VI, LINES 13 & 14 EFFECTIVE SEPTEMBER 1, 2019 THE HSC FOUNDATION IS GOVERNED BY THE COMPLIANCE POLICIES OF ITS PARENT, CHILDREN'S NATIONAL MEDICAL CENTER. THESE POLICIES INCLUDE A WRITTEN WHISTLEBLOWER POLICY AND A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY. PROCESS FOR DETERMINING COMPENSATION FORM 990, PART VI, SECTION B, LINES 15A AND 15B THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, THE HSC FOUNDATION, TO DETERMINE COMPENSATION OF THE ORGANIZATION'S CEO. IN ADDITION, THE ORGANIZATION DETERMINES THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, AS DISCUSSED BELOW. THE ORGANIZATION AND HSC FOUNDATION BOTH USE A FOUR STEP APPROACH TO EXECUTIVE COMPENSATION: 1. THE EXECUTIVE COMMITTEE IS MADE UP OF INDEPENDENT BOARD MEMBERS WITHOUT A CONFLICT OF INTEREST. THE COMMITTEE ESTABLISHES AND DETERMINES THE REASONABLENESS OF TOTAL COMPENSATION FOR THE SYSTEM'S DISQUALIFIED EXECUTIVES AND FORWARDS PROPOSED COMPENSATION TO THE FULL BOARD FOR APPROVAL. 2. PERIODICALLY, THE EXECUTIVE COMMITTEE WILL ENGAGE AN INDEPENDENT CONSULTANT TO PREPARE A DETAILED WRITTEN REPORT ON APPROPRIATE COMPARABILITY DATA FOR COMPARABLE POSITIONS. 3. THE EXECUTIVE COMMITTEE REVIEWS AND RELIES UPON THE REPORT OF THE INDEPENDENT CONSULTANT, ALONG WITH OTHER INDIVIDUAL AND MARKET DATA, THEN DEBATES AND FULLY DOCUMENTS ITS DECISION ABOUT WHAT IS REASONABLE COMPENSATION FOR DISQUALIFIED EXECUTIVES. 4. ONCE THE EXECUTIVE COMMITTEE DEVELOPS EXECUTIVE COMPENSATION RECOMMENDATIONS, THEY ARE PRESENTED TO THE SYSTEM'S FULL BOARD FOR APPROVAL. EFFECTIVE SEPTEMBER 1, 2019, CHILDREN'S NATIONAL MEDICAL CENTER (CHILDREN'S NATIONAL) BECAME THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. COMMENCING IN 2020, THE ORGANIZATION AND ITS AFFILIATES WILL ADOPT THE EXECUTIVE COMPENSATION PRACTICE AND APPROVAL PROCESS OF CHILDREN'S NATIONAL MEDICAL CENTER. REQUIRED DOCUMENTS AVAILABLE TO THE PUBLIC FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 9 Change in fair value of interest rate swap $23,644 Business Combination - Fair Value Adjustment $19,266,687 --------------------------------------------- ------------- Total $19,290,331 The HSC Foundation 111 Michigan Avenue NW Washington DC 20010 521346603 Healthcare DC 501(c)(3) 12-III FI CNMC false Hlth Svcs for Children W Spec Needs 111 Michigan Avenue NW Washington DC 20010 521862406 Healthcare DC 501(c)(3) 10 HSC Fndn false 2013 Holdings Inc 111 Michigan Avenue NW Washington DC 20010 272882469 Holding Co. 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