2017-03-14T02:21:37-05:00 2015-12-31 861065772 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2015-01-01 131739922 BLYTHEDALE CHILDREN'S HOSPITAL BLYT 9145927555 95 BRADHURST AVE VALHALLA NY 10595 JOHN CANNING CFO 9145927555 2017-03-13 1 P00743140 5169187000 2015 2021-01-29 14:40:06Z X JOHN CANNING 95 BRADHURST AVE VALHALLA NY 10595 136890650 0 X WWW.BLYTHEDALE.ORG X 1891 NY BLYTHEDALE CHILDREN'S HOSPITAL IS DEDICATED TO IMPROVING THE HEALTH & WELL-BEING OF CHILDREN. 29 29 544 276 0 0 2755397 11361061 56650005 61164787 2270633 6052589 3595194 3788721 65271229 82367158 0 0 0 0 41062490 42609552 0 0 942852 20761082 21696322 61823572 64305874 3447657 18061284 215375612 219161961 55552944 55990865 159822668 163171096 X BLYTHEDALE CHILDREN'S HOSPITAL IS DEDICATED TO IMPROVING THE HEALTH & WELL-BEING OF CHILDREN. BLYTHEDALE IS A LEADER IN THE DIAGNOSIS &TREATMENT OF CHILDREN WITH DISABLING AND COMPLEX MEDICAL CONDITIONS. 0 0 36018985 47228428 SEE SCHEDULE O 7688157 10655339 SEE SCHEDULE O 3919228 6952669 SEE SCHEDULE O 47626370 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 0 1 0 0 0 1 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 1 142 0 1 544 1 0 0 0 0 0 1 1 0 0 0 0 X 29 29 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NY X JOHN CANNING 9145927555 95 BRADHURST AVE VALHALLA NY 10595 DAVID R PEDOWITZ CHAIR 1.00 0.00 X 0 0 0 PETER D RITTMASTER VICE CHAIR 1.00 0.00 X 0 0 0 SCOTT R LEVY VICE CHAIR 1.00 0.00 X 0 0 0 TIM EVNIN TREASURER 1.00 0.00 X 0 0 0 LUCY SCHMOLKA SECRETARY 1.00 0.00 X 0 0 0 ABBY POPPER TRUSTEE 1.00 0.00 X 0 0 0 ADAM GALEON TRUSTEE 1.00 0.00 X 0 0 0 ALAN GERSTEIN TRUSTEE 1.00 0.00 X 0 0 0 ANDREW MORRISON TRUSTEE 1.00 0.00 X 0 0 0 DARREN M FOGEL TRUSTEE 1.00 0.00 X 0 0 0 FARREL STARKER TRUSTEE 1.00 0.00 X 0 0 0 FRANK A STERN TRUSTEE 1.00 0.00 X 0 0 0 HOWARD ADLER TRUSTEE 1.00 0.00 X 0 0 0 JOHN J BARKER TRUSTEE 1.00 0.00 X 0 0 0 JOHN L FURTH TRUSTEE 1.00 0.00 X 0 0 0 JON M BURNHAM TRUSTEE 1.00 0.00 X 0 0 0 JORDANA HOLOVACH TRUSTEE 1.00 0.00 X 0 0 0 JUDITH R GOODHUE TRUSTEE 1.00 0.00 X 0 0 0 LANCE WACHENHIEM TRUSTEE 1.00 0.00 X 0 0 0 LARRY W COHEN TRUSTEE 1.00 0.00 X 0 0 0 LESLIE WEISSMAN TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL MARGULIES TRUSTEE 1.00 0.00 X 0 0 0 NANCY R BLAINE TRUSTEE 1.00 0.00 X 0 0 0 OWEN GUTFREUND TRUSTEE 1.00 0.00 X 0 0 0 PATRICIA B STANLEY TRUSTEE 1.00 0.00 X 0 0 0 STEVEN SOLOMON TRUSTEE 1.00 0.00 X 0 0 0 TERRI HERENSTEIN TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM ANDY CAHN TRUSTEE 1.00 0.00 X 0 0 0 WILLIAM G LEVY TRUSTEE 1.00 0.00 X 0 0 0 LAWRENCE LEVINE CHIEF EXECUTIVE OFFICER 37.50 0.00 X 896235 0 78493 JOHN CANNING CHIEF FINANCIAL OFFICER 37.50 0.00 X 418682 0 85334 SCOTT KLEIN CHIEF MEDICAL OFFICER 37.50 0.00 X 472204 0 54922 JILL WEGENER CHIEF NURSING OFFICER 37.50 0.00 X 212239 0 11001 JANE MACDONALD CHIEF DEVELOPMENT OFFICER 37.50 0.00 X 226612 0 43396 RONALD GALLO CHIEF HUMAN RESOURCES OFFICER 37.50 0.00 X 224833 0 68465 MAUREEN DESIMONE CHIEFF OPERATIONS OFFICER 37.50 0.00 X 312239 0 73751 REGINA KELLY CHIEF PLANNING OFFICER 37.50 0.00 X 151588 0 37918 JAY SELMAN CHIEF NEUROLOGY 22.50 0.00 X 204440 0 0 KATHY SILVERMAN UNIT CHIEF PEDIATRICS 37.50 0.00 X 218012 0 40040 SUSAN GOODBODY MURRAY CHIEF ENGAGEMENT OFFICER 37.50 0.00 X 188596 0 16936 MILICENT MITCHELL CHIEF PULMONOLOGY 37.50 0.00 X 265697 0 13033 BYRON FERNANDEZ UNIT CHIEF PEDIATRICS 37.50 0.00 X 278212 0 49543 JOELLE MAST FORMER CHIEF SCIENTIFIC OFFICER 0.00 0.00 X 284735 0 0 4354324 0 572832 97 1 1 0 BOVIS LEND LEASE 200 PARK AVENUE 9TH FLOOR NEW YORK NY 10166 CONSTRUCTION 5455995 SODEXO INC & AFFILIATES PO BOX 81049 WOBURN MA 018131049 FACILITIES, DEITARY, MAINTENANCE 2748637 MORRIS SWITZER 185 TALCOTT RD WILLISTON VT 05495 ARCHITECTS 591640 CENTIMARK CORP PO BOX 536254 PITTSBURGH PA 15253 CONSTRUCTION 538377 PAR ENVIRONMENTAL CORP 313 SPOOK ROCK ROAD SUFFERN NY 10901 ENVIRONMENTAL SERVICES 538030 53 1488048 9873013 11361061 INPATIENT 622110 47228428 47228428 DAY HOSPITAL 622110 10655339 10655339 OUTPATIENT / EARLY INT 621400 1489260 1489260 BUFSD SCHOOL 611710 948835 948835 OTHER SCHOOLS 611710 842925 842925 61164787 631144 631144 59631543 54210098 5421445 5421445 5421445 218877 1488048 313394 -94517 -94517 SPENDING POLICY 900099 3375231 3375231 CAFETERIA 722514 211584 211584 MEDICAL RECORDS 900099 92956 92956 203467 203467 3883238 82367158 64836441 0 6169656 3367912 362616 2543556 461740 28590116 25365528 3076776 147812 4303287 3402705 726522 174060 4097503 3390780 698700 8023 2250734 1665399 556873 28462 2475909 1945932 511826 18151 322429 322429 317519 317519 29014 29014 496656 496656 122059 122059 97674 40254 52252 5168 1031009 1012366 18643 5109031 4248684 858706 1641 36776 27812 8720 244 133388 67863 65525 8662 8662 5987550 4448750 1476036 62764 775785 775785 CONTRACTED LABOR 2676235 2014352 645739 16144 UTILITIES 869038 645695 223343 0 TAXES FEES ASSESSMENTS 749278 749278 DEBT SERVICE FEES 458310 458310 64305874 47626370 15736652 942852 12572143 12606698 2418076 4412696 341825 6386155 7894467 7667235 122942 353602 903851 400214 114999009 38126072 73944187 76872937 62269523 63525063 53998328 46082313 910270 855048 215375612 219161961 3950162 3741481 24645000 23960000 6262 0 26951520 28289384 55552944 55990865 X 148263324 145086231 7478736 14055979 4080608 4028886 159822668 163171096 215375612 219161961 X 18061284 -14950107 237251 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 29014 29014 0 PART II-B, LINE 1: BLYTHEDALE CHILDREN'S HOSPITAL, AS A MEMBER OF STATE-WIDE HOSPITAL ORGANIZATIONS, HAS A PORTION OF ITS DUES FOR LOBBYING. IN ADDITION, BLYTHEDALE HAS ENGAGED AN OUTSIDE LOBBYIST TO LOBBY ON ITS BEHALF ON ISSUES RELATING TO THE STATE BUDGET. 11559343 9177628 -154788 2497319 18084864 11065150 1908465 609854 2024123 11559346 10130991 926397 1758628 1750866 11065150 9207439 1230427 923951 1230826 10130991 14508992 911024 -687562 5525015 9207439 0.22280 0.77720 0 0 1383879 1383879 50756615 24872937 25883678 50811589 11426627 39384962 12046926 1826508 10220418 76872937 LIMITED LIABILITY PARTNERSHIP (HEDGE FUNDS) 46082313 C 46082313 ACCRUED PENSION LIABILITY 24449554 EST MALPRACTICE LIABILITIES 1064000 ASSET RETIREMENT 224039 DUE TO THIRD PARTIES 2551791 28289384 60583519 -14792655 2372569 -12420086 73003605 496655 8866898 9363553 82367158 64122613 313394 313394 63809219 496655 496655 64305874 PART V, LINE 4: TEMPORARILY RESTRICTED NET ASSETS ARE THOSE WHOSE USE BY BLYTHEDALE CHILDREN'S HOSPITAL (THE "HOSPITAL") HAS BEEN LIMITED BY DONORS TO A SPECIFIC PERIOD OR PURPOSE. PERMANENTLY RESTRICTED NET ASSETS HAVE BEEN RESTRICTED BY DONORS TO BE MAINTAINED BY THE HOSPITAL IN PERPETUITY. THE HOSPITAL'S ENDOWMENT CONSISTS OF APPROXIMATELY 20 INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. THE HOSPITAL BECAME SUBJECT TO NYPMIFA (THE NEW YORK PRUDENT MANAGEMENT OF INSTITUTIONAL FUNDS ACT) WHICH WAS ENACTED IN SEPTEMBER 2010. THE BOARD OF TRUSTEES INTERPRETED NYPMIFA AS (A) REQUIRING THE PRESERVATION OF THE ORIGINAL GIFT AS OF THE GIFT DATE OF THE DONOR-RESTRICTED ENDOWMENT FUNDS ABSENT EXPLICIT DONOR STIPULATIONS TO THE CONTRARY. AS A RESULT OF THIS INTERPRETATION, THE HOSPITAL CLASSIFIES AS PERMANENTLY RESTRICTED NET ASSETS: (A) THE ORIGINAL VALUE OF GIFTS DONATED TO THE PERMANENT ENDOWMENT, (B) THE ORIGINAL VALUE OF SUBSEQUENT GIFTS TO THE PERMANENT ENDOWMENT, AND (C) ACCUMULATIONS OF INCOME ARE ADDED TO THE FUND IN ACCORDANCE WITH THE DIRECTION OF THE APPLICABLE DONOR GIFT INSTRUMENT AT THE TIME THE ACCUMULATION IS ADDED TO THE FUND. THE REMAINING PORTION OF THE DONOR-RESTRICTED ENDOWMENT FUND THAT IS NOT CLASSIFIED IN PERMANENTLY RESTRICTED NET ASSETS IS CLASSIFIED AS TEMPORARILY RESTRICTED UNTIL THOSE AMOUNTS ARE APPROPRIATED FOR EXPENDITURE BY THE ORGANIZATION. IN ACCORDANCE WITH NYPMIFA THE ORGANIZATION CONSIDERS THE FOLLOWING FACTORS IN MAKING A DETERMINATION TO APPROPRIATE OR ACCUMULATE DONOR-RESTRICTED ENDOWMENT FUNDS: (A) THE DURATION AND PRESERVATION OF THE FUND (B) THE PURPOSES OF THE ORGANIZATION AND THE DONOR-RESTRICTED ENDOWMENTFUND (C) GENERAL ECONOMIC CONDITIONS (D) THE POSSIBLE EFFECT OF INFLATION AND DEFLATION (E) THE EXPECTED TOTAL RETURN FROM INCOME AND THE APPRECIATION OF INVESTMENTS (F) OTHER RESOURCES OF THE ORGANIZATION (G) THE INVESTMENT POLICIES OF THE ORGANIZATION TEMPORARILY RESTRICTED NET ASSETS AS OF DECEMBER 31, 2015 AND 2014, ARE AVAILABLE FOR THE FOLLOWING PURPOSES: 2015 2014 PLANT REPLACEMENT $6,501,832 $242,466 TEMPORARILY RESTRICTED $4,582,599 $4,974,609 MEDICAL EQUIPMENT $15,873 $0 OTHER $2,955,675 $2,261,661 TOTALS $14,055,979 $7,478,736 PERMANENTLY RESTRICTED NET ASSETS AS OF DECEMBER 31, 2015 AND 2014, ARE RESTRICTED TO THE FOLLOWING: 2015 2014 INVESTMENTS TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS EXPENDABLE TO SUPPORT HEALTH CARE SERVICES $4,028,886 $4,080,608 BLYTHEDALE CHILDREN'S HOSPITAL HAS A CHARITABLE REMAINDER TRUST HELD BY TRUSTEES CITIBANK, CALLED THE HENRY STERN TRUST. THE PRINCIPLE IS PERMANENTLY RESTRICTED. PART XI, LINE 2D - OTHER ADJUSTMENTS: NET ASSETS RELEASE FROM RESTRICTION 2,372,569. PART XI, LINE 4B - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES RECLASS -313,394. RESTRICTED CONTRIBUTIONS 9,177,628. RESTRICTED INVESTMENT INCOME 2,664. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES RECLASS 313,394. CENTRAL AMERICA & THE CARIBBEAN 0 0 INVESTMENTS 33139521 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 INVESTMENTS 1841336 0 0 0 0 0 0 34980857 0 34980857 1 0 1 1 0 0 SPRING GALA 817969 743468 74501 1313 19550 74501 4160 21582 GOLF EVENT 1 456621 376117 80504 86296 0 0 3084 4 432335 368463 63872 5000 54174 15666 15000 13068 1706925 1488048 218877 6313 160020 90167 19160 37734 313394 -94517 1 1 1 X 400.000000000000 1 X 1 1 0 0 343417 0 343417 0.00530 36450306 38216088 36793723 38216088 343417 0.00530 135325 32745 102580 0.00160 305894 301078 4816 0.00010 472171 275000 197171 0.00310 194436 194436 220078 186147 33931 0.00050 1327904 989406 338498 0.00530 38121627 39205494 681915 0.01060 3242259 1384980 1857279 0.02890 3242259 1384980 1857279 0.02890 1 582899 0 113 0 113 X 1 1 1 1 BLYTHEDALE CHILDREN'S HOSPITAL 95 BRADHURST AVE VALHALLA NY 10595 WWW.BLYTHEDALE.ORG 5957000H X X BLYTHEDALE CHILDREN'S HOSPITAL 1 0 0 1 X X X X X X 13 1 0 1 1 X WWW.BLYTHEDALE.ORG 1 14 1 WWW.BLYTHEDALE.ORG 0 0 1 X 400.000000000000 400.000000000000 1 1 X X X 1 X WWW.BLYTHEDALE.ORG X WWW.BLYTHEDALE.ORG X X 1 X 0 X X X 0 X X 0 0 BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 5: IN JANUARY 2013, THE WESTCHESTER COUNTY DEPARTMENT OF HEALTH CONVENED A WORKGROUP OF LOCAL HOSPITALS TO SELECT TWO PRIORITIES FROM THE STATE'S PREVENTION AGENDA AND COLLABORATIVELY DEVELOP PLANS TO ADDRESS THESE PRIORITIES AS PART OF THE COUNTY HEALTH DEPARTMENT'S COMMUNITY HEALTH ASSESSMENT AND THE HOSPITALS' COMMUNITY SERVICE PLANS. IN ADDITION TO WORKGROUP MEETINGS, THE COUNTY HEALTH DEPARTMENT ALSO HELD A HEALTH CARE SUMMIT ON AUGUST 10, 2013 TO GATHER ADDITIONAL COMMUNITY INPUT. THE FOLLOWING COMMUNITY ORGANIZATIONS PARTICIPATED IN THE SUMMIT:AFFINITY HEALTH PLANAMERICAN DIABETES ASSOCIATIONAMERICAN HEART ASSOCIATIONAMERICAN LUNG ASSOC.POW'R TOBACCO CESSATION CENTERHAGAN SCHOOL OF BUSINESS, IONA COLLEGEHUDSON HEALTH PLANLOWER HUDSON VALLEY PERINATAL NETWORKCHILDREN'S HEALTH AND RESEARCH FOUNDATION, INC.MARCH OF DIMESNEW YORK MEDICAL COLLEGESCHOOL OF HEALTH SCIENCES AND PRACTICEPACE UNIVERSITYPLANNED PARENTHOOD HUDSON PECONIC, INC.POW'R AGAINST TOBACCORYE YMCAST. FRANCES AFRICAN METHODIST EPISCOPAL ZION CHURCHTHINCUNITED WAY OF WESTCHESTER AND PUTNAMWESTCHESTER COUNTY DEPARTMENT OF SOCIAL SERVICESWESTCHESTER COUNTY OFFICE OF WOMENWESTCHESTER COUNTY DEPT. OF SENIOR PROGRAMS & SERVICESYONKERS PUBLIC SCHOOLS BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 6B: BURKE REHABILITATION CENTERHUDSON VALLEY HOSPITAL CENTERLAWRENCE HOSPITAL CENTERMOUNT VERNON NEIGHBORHOOD CENTERNORTHERN WESTCHESTER HOSPITALOPEN DOOR FAMILY MEDICAL CENTERPHELPS MEMORIAL HOSPITAL CENTERSAINT JOSEPH'S HOSPITALSOUND SHORE MEDICAL CENTERST. JOHN'S RIVERSIDE HOSPITALST. VINCENT'S HOSPITAL WESTCHESTERSTELLARIS HEALTH NETWORKWESTCHESTER MEDICAL CENTERWHITE PLAINS HOSPITALWESTCHESTER COUNTY DEPARTMENT OF HEALTH BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 11: ONE OF THE PRIORITY INITIATIVES IDENTIFIED BY THE COALITION ASSEMBLED BY THE WESTCHESTER COUNTY DEPARTMENT OF HEALTH RELATED TO CHRONIC DISEASE IN THE ADULT POPULATION AND THUS IS NOT WITHIN BLYTHEDALE'S MISSION AND SCOPE. THUS BLYTHEDALE HAS SELECTED ANOTHER PRIORITY FROM THE STATE'S PREVENTION AGENDA WHICH ADDRESSES AN ISSUE OF CONCERN TO BLYTHEDALE'S COMMUNITY OF REFERRING HOSPITALS: PREVENT HOSPITAL ACQUIRED INFECTIONS, SPECIFICALLY REDUCING INFECTIONS CAUSED BY MULTIDRUG-RESISTANT ORGANISMS (MDROS). BLYTHEDALE CHILDREN'S HOSPITAL PART V, SECTION B, LINE 22D: THE HOSPITAL FACILITY USED THE PUBLISHED MEDICAID RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. PART I, LINE 7: EXPLANATION: BLYTHEDALE DETERMINES A PATIENT'S COST USING AVAILABLE COSTDATA AND RATIOS FROM THE MOST RECENTLY FILED NYS ICR. A PROSPECTIVEPATIENT'S GROSS CHARGES ARE ESTIMATED FOR EACH OF THE SERVICES ANDALLOWANCED DOWN TO COST BASED UPON THE RATIO OF COST TO CHARGES. WE THENDISCOUNT THE COST DOWN ON A SLIDING % BASIS IN THE FAP SCHEDULE USING APATIENT'S ADJUSTED GROSS INCOME (AGI) FROM THEIR MOST RECENT TAX RETURNAND TAKING INTO ACCOUNT THEIR NUMBER OF DEPENDENTS / FAMILY SIZE REPORTED. PART II, COMMUNITY BUILDING ACTIVITIES: BLYTHEDALE IS INVOLVED IN NUMEROUS COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF THE COMMUNITIES IT SERVES. NUMEROUS COMMUNITY CONCERNS ARE ADDRESSED, INCLUDING HEALTH IMPROVEMENT (SEE DETAILS UNDER LINE 6 BELOW) AND ACCESS TO CARE. BLYTHEDALE ACTIVELY PARTICIPATES IN THE WESTCHESTER CHILDREN'S ASSOCIATION'S CHILD HEALTH TASK FORCE, WHOSE PRINCIPAL GOAL IS TO MAXIMIZE ENROLLMENT OF ELIGIBLE CHILDREN IN NEW YORK STATE'S MEDICAID AND CHILD HEALTH PLUS PROGRAMS. ADDITIONALLY, THROUGH THE NEW YORK STATE WORKGROUP ON MEDICALLY FRAGILE CHILDREN, BLYTHEDALE HAS WORKED TO ADVOCATE FOR SERVICES TO SUPPORT FAMILIES CARING FOR MEDICALLY FRAGILE CHILDREN AT HOME. PART III, LINE 2: REVENUE IS RECOGNIZED WHEN THE CLAIM HAS (1) PERVASIVE EVIDENCE OF A PAYMENT AGREEMENT / AUTHORIZATION, RATE SHEET OR CONTRACT (2) SERVICES HAVE BEEN RENDERED (3) PRICE IS FIXED AND DETERMINABLE (4) COLLECTABILITY IS REASONABLE ASSURED. BAD DEBT IS RECOGNIZED IF MANAGEMENT IS UNABLE TO COLLECT THE DEBT AFTER THESE CRITERIA HAVE BEEN MET.BAD DEBTS DO NOT INCLUDE CHARITY CARE, COURTESY DISCOUNTS, SELF PAY ALLOWANCES, OR ALLOWANCES FOR OUTPATIENT SERVICES PROVIDED THAT ARE NOT AUTHORIZED.BAD DEBTS WILL BE RECORDED AND RECOGNIZED IN THE PERIOD IN WHICH IT IS DETERMINED THE DEBT IS UNCOLLECTIBLE. BAD DEBT IS RECOGNIZED AS THE AMOUNT CONTRACTUALLY OBLIGATED AND RECOGNIZED AS REVENUE FOR WHICH ALL AVENUES OF COLLECTION HAVE BEEN EXHAUSTED. ALL WRITE OFFS IN EXCESS OF $10,000 REQUIRE APPROVAL FROM THE CFO PRIOR TO RECORDING ENTRY IN MEDITECH SYSTEM. ALL BAD DEBT ALLOWANCE ENTRIES ARE TO BE CODED USING "XFR PROCEDURE IN MEDITECH.THE FOLLOWING EXAMPLE WILL DEMONSTRATE THE COMPONENTS OF BAD DEBT TO BE RECORDED.TOTAL PATIENT CHARGES: $250,000LESS CONTRACTUAL ALLOWANCES: -$150,000NET REVENUE: $100,000ACTUAL PAYMENTS: -$75,000ACCOUNT BALANCE UNCOLLECTED: $25,000 <==BAD DEBT VALUE AFTER ALLEFFORTS TO COLLECT ARE EXHAUSTED.COMPONENTS OF BAD DEBT REPORTING:THE RESERVE BALANCE SHOULD REFLECT 9.0% OF THE GROSS AR AS RECORDED INSTEP 1. THE VARIANCE FROM THE 12/31 RESERVE BALANCE IS RECORDED ON AMONTHLY BASIS. THE NET OF THE ACTUAL BAD DEBTS + CHANGE IN RESERVE BALANCE FROM 12/31 IS RECORDED AS BAD DEBT EXPENSE IN THE FINANCIAL STATEMENT. PART III, LINE 4: CHARITY CARE - THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAINCRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE THE COLLECTIONS OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE IS NOT PURSUED, THEY ARE NOT REPORTED AS REVENUE. THE AMOUNT OF IDENTIFIED CHARITY CARE PROVIDED AT COST, NET OF ANY REIMBURSEMENTS DURING THE YEARS ENDED DECEMBER 31, 2015 AND 2014, WERE APPROXIMATELY $343,417 AND $547,645, RESPECTIVELY. THE ESTIMATED COST OF THESE CHARITY CARE SERVICES WAS DETERMINED USING A RATIO OF COST TO GROSS CHARGES AND APPLYING THAT RATIO TO THE GROSS CHARGES ASSOCIATED WITH PROVIDING CARE TO CHARITY PATIENTS FOR THE PERIOD.PROVISION AND ALLOWANCE FOR DOUBTFUL ACCOUNTS - TO PROVIDE FOR ACCOUNTS RECEIVABLE THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE, THE HOSPITAL ESTABLISHES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR DOUBTFUL ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR DOUBTFUL ACCOUNTS FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE EXHAUSTED THIRD PARTY BENEFITS RELATIVE TO SERVICESPROVIDED AT THE HOSPITAL AND HAVE NO SECONDARY SOURCE OF COVERAGE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IFNEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLECOLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THEALLOWANCE FOR DOUBTFUL ACCOUNTS.THE HOSPITAL DID NOT CHANGE ITS CHARITY CARE OR UNINSURED DISCOUNTPOLICIES DURING FISCAL YEAR 2015. THE HOSPITAL MAINTAINED AN ALLOWANCE FOR DOUBTFUL ACCOUNTS IN 2015 AND 2014 IN THE AMOUNTS OF APPROXIMATELY $892,000 AND $865,000, RESPECTIVELY. THESE AMOUNTS REPRESENT 1.5% AND 1.58% OF NET PATIENT SERVICE REVENUE RESPECTIVELY. PART III, LINE 8: BLYTHEDALE, AS A CHILDREN'S HOSPITAL RECEIVED IMMATERIAL AMOUNTS OF MEDICARE REIMBURSEMENT. IN 2015, THE HOSPITAL FILED A LOW/NO COST UTILIZATION REPORT WITH CMS. PART III, LINE 9B: COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. ALL PATIENTS HAVING DIFFICULTY PAYING THEIR BILLS ARE DIRECTED TO HOSPITAL STAFF WHO ASSIST THE FAMILY IN COMPLETING A FINANCIAL ASSESSMENT AND TRY TO QUALIFY THE PATIENT FOR ASSISTANCE. ONCE A LEVEL OF FINANCIAL ASSISTANCE IS DETERMINED, THE ACCOUNT BALANCE IS PRORATED FOR CONTRACTUAL ADJUSTMENTS AND THEN PRO-RATED TO COST. FROM COSTS, THE LEVEL OF FINANCIAL ASSISTANCE IS THEN APPLIED, ANY REMAINING BALANCE IS COLLECTABLE AS PATIENT RESPONSIBILITY.PATIENTS ARE SCREENED FOR ELIGIBILTY FOR FINANCIAL ASSISTANCE BEFORECOLLECTION PROCEDURE BEGIN. IF AT ANY POINT IN THE COLLECTION PROCESS,DOCUMENTATION IS RECEIVED THAT INDICATES THAT THE PATIENT IS POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT APPLIED FOR IT, THE ACCOUNT IS REFERRED BACK FOR A FINANCIAL ASSISTANCE REVIEW. BLYTHEDALE DOES NOT PURSUE COLLECTION OF AMOUNTS FROM PATIENTS DETERMINED TO QUALIFY FOR CHARITY CARE.IF A PATIENT HAS REQUESTED AND/OR FILLED OUT A FINANCIAL ASSISTANCEAPPLICATION, ALL DEBT COLLECTION ACTIVITIES STOP UNTIL ELIGIBILTY FORFINANCIAL ASSISTANCE CAN BE DETERMINED. BLYTHEDALE'S POLICY PROVIDES THAT WE WILL NOT REFER ANY ACCOUNTS FOR COLLECTION UNTIL IT IS DETERMINED WHETHER THE INDIVIDUAL IS INSURED AND NOT ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 2: SINCE THE VAST MAJORITY OF ADMISSIONS TO BLYTHEDALE COME BY REFERRAL FROM OTHER HOSPITALS, PARTICULARLY THE LARGE MEDICAL CENTERS IN THEMETROPOLITAN NEW YORK AND HUDSON VALLEY AREA, BLYTHEDALE'S SENSE OF NEED FOR CLINICAL SERVICES LARGELY EMANATES FROM REFERRING HOSPITALS AND THEIR PHYSICIANS. BLYTHEDALE CONTINUOUSLY REVIEWS WITH REFERRING HOSPITALS AND PHYSICIANS THEIR NEEDS FOR SERVICES.HOWEVER, IN ADDITION TO ITS REFERRAL HOSPITALS, BLYTHEDALE ALSO WORKSCLOSELY WITH A VARIETY OF LOCAL AGENCIES, NOTABLY THE WESTCHESTER,ROCKLAND AND PUTNAM COUNTY DEPARTMENTS OF HEALTH TO IDENTIFY COMMUNITY HEALTH PRIORITIES THAT ARE RELEVANT TO BLYTHEDALE'S MISSION AND SERVICES. PARTICIPANTS IN THESE COALITIONS INCLUDE THE MAJOR CHILD AND ADOLESCENT HEALTH-FOCUSED COMMUNITY-BASED ORGANIZATIONS IN WESTCHESTER. BLYTHEDALE ALSO HAS CLOSE WORKING RELATIONSHIPS WITH MANY OF THE SCHOOL DISTRICTS IN WESTCHESTER COUNTY, THROUGH ITS NUTRITION EDUCATION ACTIVITIES, AND THROUGH ARRANGEMENTS WHEREBY BLYTHEDALE STAFF ARE CONTRACTED TO PROVIDEPHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES TO CHILDREN IN THESCHOOLS. PART VI, LINE 3: CONSISTENT WITH ITS MISSION AND STATE REQUIREMENTS (NEW YORK STATE PUBLIC HEALTH LAW 2807(K) (9-A), BLYTHEDALE HAS DEVELOPED GUIDELINES THAT DELINEATE THE CIRCUMSTANCES AND PROCEDURES UNDER WHICH FREE OR REDUCED COST CARE IS AVAILABLE. THESE GUIDELINES ARE MADE AVAILABLE TO ALL FAMILIES UPON REGISTRATION, AND HOSPITAL STAFF PROVIDE COUNSELING AS NECESSARY. INTERPRETATION SERVICES ARE AVAILABLE FOR PATIENTS NEEDING INFORMATION IN LANGUAGES OTHER THAN ENGLISH. PATIENTS ARE ALSO NOTIFIED OF BLYTHEDALE'S CHARITY CARE FINANCIAL ASSISTANCE POLICIES THROUGH NOTICES IN ENGLISH AND SPANISH POSTED IN THE HOSPITAL'S LOBBY AND IN PATIENT REGISTRATION AND WAITING AREAS. IN ADDITION, BLYTHEDALE'S PATIENT ASSISTANCE FUNDS HELPS PROVIDE CHILDREN WITH VARIOUS ITEMS (I.E., EQUIPMENT, CLOTHING, ETC.) WHERE FAMILY RESOURCES ARE LIMITED AND INSURANCE DOES NOT COVER. PART VI, LINE 4: AS A SPECIALTY CHILDREN'S HOSPITAL SERVING CHILDREN WITH A BROAD RANGE OF DIAGNOSES, BLYTHEDALE'S SERVICE AREA IS WIDESPREAD, WITH PATIENTS COMING FROM THE ENTIRE SOUTHERN PORTION OF NEW YORK STATE AS WELL AS ADJACENT AREAS OF NEW JERSEY AND CONNECTICUT: WESTCHESTER (60%), BRONX (16%), QUEENS/KINGS (7%), ROCKLAND COUNTY (6%), NEW YORK CITY (4%), LONG ISLAND (2%), ALL OTHER (6%).THE HOSPITAL IS LOCATED IN A SUBURBAN COUNTY (WESTCHESTER) THAT IS PART OF THE GREATER NEW YORK METROPOLITAN AREA. BLYTHEDALE'S PATIENT POPULATION REFLECTS THE ETHNIC AND RACIAL DIVERSITY OF ITS LARGE SERVICE AREA, AS ILLUSTRATED BY ITS INPATIENT POPULATION: ASIAN (4%); BLACK OR AFRICAN-AMERICAN (19%); HISPANIC OR LATINO (24%); WHITE (45%); OTHER (8%). TO ADDRESS THIS DIVERSITY, THE HOSPITAL PROVIDES STAFF TRAINING IN CULTURAL DIVERSITY, INTERPRETER SERVICES, DIETARY VARIETY AND OTHER ACCOMMODATIONS TO SUPPORT FAMILIES FROM DIFFERENT CULTURAL BACKGROUNDS WHILE THEIR CHILDREN ARE PATIENTS AT BLYTHEDALE. PART VI, LINE 5: BLYTHEDALE OFFERS A NUMBER OF COMMUNITY HEALTH IMPROVEMENT PROGRAMS AND SPECIAL PROGRAMS FOR DEVELOPMENT OF THE PEDIATRIC PROFESSIONAL COMMUNITY: FIRST RESPONDER TRAINING PROGRAM: BLYTHEDALE, IN COORDINATION WITH THEWESTCHESTER REGIONAL EMS OFFICE, WESTCHESTER COUNTY DEPARTMENT OFEMERGENCY SERVICES, AND THE NYS EMS FOR CHILDREN PROGRAM, HASDEVELOPED A SPECIAL PEDIATRIC CME SERIES FOR FIRST RESPONDERS OF THEWESTCHESTER EMS REGION. THIS YEAR THE PROGRAM CENTERED ON RESPIRATORY EQUIPMENT AND CARE OF THE PEDIATRIC PATIENT. THE CLASS WAS GIVEN BY THE RESPIRATORY CARE STAFF FROM BLYTHEDALE. THE SERIES COVERS SUBJECTS VITAL TO FIRST RESPONDS, INCLUDING TRAUMATIC BRAIN INJURY, AUTISM, TECHNOLOGY AND CARE.NUTRITION EDUCATION: IN A MAJOR INITIATIVE TO HELP REDUCE THE PREVALENCEOF CHILDHOOD OBESITY AND PREVENT ITS LONG TERM NEGATIVE HEALTH EFFECTS,BLYTHEDALE IS REACHING OUT TO SCHOOL DISTRICTS THROUGHOUT WESTCHESTER ANDSURROUNDING COUNTIES WITH ITS EAT WELL BE WELL SCHOOL BASED NUTRITIONEDUCATION PROGRAM. THE EAT WELL, BE WELL PROGRAM, SUPPORTED BY KOHLS DEPARTMENT STORES, IS DESIGNED TO PROVIDE SCHOOL STAFF AND STUDENTS WITHTHE TOOLS NECESSARY TO HELP CHILDREN DEVELOP HEALTHY EATING HABITS THROUGHA COMPREHENSIVE CURRICULUM DEVELOPED BY BLYTHEDALE'S REGISTEREDDIETICIANS. TO DATE THIS PROGRAM HAS REACHED MORE THAN 110,000 STUDENTS,AS WELL AS OVER 5,500 PARENTS AND SCHOOL STAFF IN SCHOOLS THROUGHOUTWESTCHESTER, ROCKLAND AND PUTNAM COUNTIES, WITH INFORMATION ON HOW TO MAKEFOOD AND LIFESTYLE CHOICES THAT WILL PROMOTE HEALTHY LIVING FOR ALIFETIME. THIS PAST YEAR THE PROGRAM WAS PROVIDED IN 23 SCHOOLS (OFTENMORE THAN ONE VISIT) AND 16 SCHOOL DISTRICTS, TO 17,595 K-8 STUDENTS AND1,233 ADULTS. IN 2015, BLYTHEDALE CONTINUED ITS VITAL COMMUNITY SERVICE AS A CERTIFIED TRAINING CENTER FOR THE AMERICAN HEART ASSOCIATION (AHA) IN BOTH PEDIATRIC ADVANCED LIFE SUPPORT (PALS) AND BASIC LIFE SUPPORT (BLS). IN ADDITION TO BRINGING THESE VITAL PROGRAM OUT INTO THE COMMUNITY, THE HOSPITAL OFFERED A VARIETY OF COURSES ON-SITE. IN 2015, 3,956 PEOPLE WERE TRAINED IN CPR, PALS AND FIRST AID THROUGH BLYTHEDALE'S TRAINING CENTER. IN ADDITION, 109 PARENTS AND CAREGIVERS WERE TRAINED LAST YEAR. OF THIS NUMBER, 6 PARENTS WERE TAUGHT IN SPANISH AND 2 PARENTS WERE TAUGHT IN CREOLE. WE HAVE 120 INSTRUCTORS REGISTERED WITH OUR TRAINING CENTER. 109 EMPLOYEES WERE TAUGHT IN BLS AND 36 EMPLOYEES WERE RENEWED IN PALS. WE HAVE INSTRUCTORS ALIGNED WITH US FROM TAPPAN ZEE HS, CLARKSTOWN NORTH AND SOUTH HS, BYRAM HILLS HS, EASTCHESTER HS, SCARSDALE MS, MERCY COLLEGE, BRONX COMMUNITY COLLEGE DOBBS FERRY PD, POUND RIDGE PD, MT VERNON FD, GREENBURGH FD, HARSDALE FD, LAKE MOHEGAN FD PM PEDIATRICS, SHELTERING ARMS (FORMERLY EPISCOPAL SOCIAL SERVICES), EDWIN GOULD FAMILY SERVICES, JCCA, JANSEN HOSPICE, 3A SOLUTIONS, HISPANOAMERICANA DE EDUCADORES INFANTILES. 8 CLASSES ARE HELD ANNUALLY AT 9TH DISTRICT DENTAL ASSOCIATION.SERVICES TO THE PROFESSIONAL COMMUNITY: BLYTHEDALE ALSO PROVIDES CLINICAL TRAINING FOR SCORES OF PROFESSIONAL STUDENTS IN A WIDE RANGE OF FIELDS, INCLUDING MEDICINE, NURSING, RESPIRATORY THERAPY, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY AND SOCIAL WORK. BLYTHEDALE ALSO SPONSORS SPECIALIZED COURSES ON PEDIATRIC ISSUES FOR AREA PHYSICAL, OCCUPATIONAL AND SPEECH THERAPISTS. PART VI, LINE 7, REPORTS FILED WITH STATES NY X X X X X 1 1 0 0 0 0 0 1 0 LAWRENCE LEVINE CHIEF EXECUTIVE OFFICER 566319 0 106000 0 223916 0 37269 0 41224 0 974728 0 0 0 JOHN CANNING CHIEF FINANCIAL OFFICER 349399 0 60000 0 9283 0 44760 0 40574 0 504016 0 0 0 SCOTT KLEIN CHIEF MEDICAL OFFICER 411363 0 60000 0 841 0 13530 0 41392 0 527126 0 0 0 JILL WEGENER CHIEF NURSING OFFICER 210145 0 1170 0 924 0 10346 0 655 0 223240 0 0 0 JANE MACDONALD CHIEF DEVELOPMENT OFFICER 211270 0 12463 0 2879 0 28221 0 15175 0 270008 0 0 0 RONALD GALLO CHIEF HUMAN RESOURCES OFFICER 207383 0 14571 0 2879 0 38683 0 29782 0 293298 0 0 0 MAUREEN DESIMONE CHIEFF OPERATIONS OFFICER 269017 0 31682 0 11540 0 44868 0 28883 0 385990 0 0 0 REGINA KELLY CHIEF PLANNING OFFICER 129983 0 0 0 21605 0 0 0 37918 0 189506 0 0 0 JAY SELMAN CHIEF NEUROLOGY 196209 0 5664 0 2567 0 0 0 0 0 204440 0 0 0 KATHY SILVERMAN UNIT CHIEF PEDIATRICS 217476 0 0 0 536 0 27607 0 12433 0 258052 0 0 0 SUSAN GOODBODY MURRAY CHIEF ENGAGEMENT OFFICER 176118 0 12250 0 228 0 16651 0 285 0 205532 0 0 0 MILICENT MITCHELL CHIEF PULMONOLOGY 264114 0 0 0 1583 0 0 0 13033 0 278730 0 0 0 BYRON FERNANDEZ UNIT CHIEF PEDIATRICS 278025 0 0 0 187 0 14805 0 34738 0 327755 0 0 0 JOELLE MAST FORMER CHIEF SCIENTIFIC OFFICER 0 0 0 0 284735 0 0 0 0 0 284735 0 0 0 PART I, LINES 4A-B LINE 4A - DURING 2015, JOELLE MAST WAS PAID SEVERANCE IN THE AMOUNT OF $284,735 AFTER TERMINATING EMPLOYMENT ON MUTUALLY AGREED TERMS AT THE END OF 2014. REGINA KELLY WAS PAID 18,519 AFTER TERMINATING EMPLOYMENT ON MUTUALLY AGREED TERMS IN NOVEMBER OF 2015 LINE 4B - SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN - EFFECTIVE AS OF JANUARY 1, 2008, THE HOSPITAL IMPLEMENTED THE BLYTHEDALE CHILDREN'S HOSPITAL SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) TO PROVIDE PENSION BENEFITS FOR A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES. THIS PLAN IS UNFUNDED AND A TARGET DEFINED BENEFIT PLAN. LAWRENCE LEVINE RECEIVED PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DURING THE YEAR IN THE AMOUNT OF $176,814 UNDER THE TERMS OF THE BLYTHEDALE CHILDREN'S HOSPITAL SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN FOR LAWRENCE LEVINE. EFFECTIVE AS OF JANUARY 1, 2012 THE HOSPITAL IMPLEMENTED AN ADDITIONAL SERP. THIS PLAN IS UNFUNDED AND A DEFINED CONTRIBUTION PLAN. FOR EACH PLAN YEAR THE HOSPITAL WILL MAKE A CONTRIBUTION ON BEHALF OF THE PARTICIPANT IN AN AMOUNT EQUAL TO TEN PERCENT (10%) OF THE PARTICIPANT'S BASE COMPENSATION. BOTH PLANS ARE MAINTAINED TO PROVIDE DEFERRED COMPENSATION TO A MEMBER OF A SELECT GROUP OF MANAGEMENT OR HIGHLY COMPENSATED EMPLOYEES. IN 2015 THE HOSPITAL CONTRIBUTED $35,842 TO A SERP ON BEHALF OF JOHN CANNING. PART I, LINE 7 BLYTHEDALE ENGAGED SULLIVAN COTTER IN 2015 TO DEVELOP AND PROVIDE RECOMMENDATIONS TO THE COMPENSATION COMMITTEE OF THE BOARD REGARDING PAYMENT OF AN ANNUAL PERFORMANCE INCENTIVE PLAN FOR EMPLOYEES WITH MANAGEMENT RESPONSIBILITIES. THIS INCENTIVE PLAN CONDITIONS PAYMENTS BASED UPON THE ACHIEVEMENT OF MULTIPLE INDIVIDUAL AND ORGANIZATIONAL MEASURES. FUNDING FOR THE PLAN IS DEPENDENT UPON ANNUAL BOARD OF TRUSTEES APPROVAL. BASED UPON THE FINANCIAL CONDITIONS TOWARD THE END OF EACH FISCAL YEAR, THE BOARD WILL EVALUATE THE APPROPRIATENESS OF ESTABLISHING A LUMP SUM POOLED AMOUNT. EVEN IF ALL RELEVANT PERFORMANCE MEASURES ARE ACHIEVED, THE BOARD OF TRUSTEES RETAINS FULL DISCRETION TO MAKE, NOT MAKE OR REDUCE THE AMOUNT OF ANY INCENTIVE AWARDS. A DORMITORY AUTHORITY OF NY (DASNY) 146000293 649905DG8 2009-06-19 27000000 CONSTRUCTION 0 0 0 A 3040000 26748127 66383 540000 820868 25387259 2011 0 0 1 1 A 0 0 1 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 1 0 A 0 PART I, COLUMN (E) & PART II, LINE 3 THE DIFFERENCE BETWEEN THE ISSUE PRICE (PART I, COLUMN (E)) AND TOTAL PROCEEDS (PART II, LINE 3) IS DUE TO (A) AN INCREASE FOR INVESTMENT EARNINGS OF $227,835, AND (B) A DECREASE DUE TO SALE PROCEEDS OF $479,707 THAT WAS USED TO CALL AND RETIRE OUTSTANDING BONDS. PART II, LINE 4 THE AMOUNT ENTERED HERE IS A DEBT SERVICE FUND BALANCE. PART IV, LINE 2C THE DATE OF THE COMPUTATION IS NOT KNOWN BY BLYTHEDALE CHILDREN'S HOSPITAL. ARBITRAGE REPORTING IS HANDLED BY THE ACTUAL ISSUER OF THE BONDS, AND BLYTHEDALE CHILDREN'S HOSPITAL DOES NOT HAVE A COPY OF THE ACTUAL REBATE REPORT. PART IV, LINE 6 SUCH AMOUNTS WERE APPROPRIATELY YIELD RESTRICTED. DONOR NO 58 SUBSTANTIAL CONTRIBUTOR 5455995 PROFESSIONAL SERVICES 0 DONOR NO 63 SUBSTANTIAL CONTRIBUTOR 244496 PROFESSIONAL SERVICES 0 X 23 218728 FMV 0 1 0 PART I, COLUMN (B): THE AMOUNT REPORTED IN COLUMN (B) REFERS TO THE NUMBER OF CONTRIBUTIONS RECEIVED. THERE WERE 14 CONTRIBUTORS IN 2015. FORM 990, PART III, LINE 4A INPATIENT SERVICES - BLYTHEDALE CHILDREN'S HOSPITAL, FOUNDED IN 1891, IS A LICENSED ACUTE CARE FREE-STANDING CHILDREN'S HOSPITAL THAT SPECIALIZES IN THE CARE OF CHILDREN REQUIRING REHABILITATIVE, RESPIRATORY AND COMPLEX MEDICAL CARE. BLYTHEDALE IS DESIGNATED BY CMS AS A PPS EXEMPT, FREESTANDING CHILDREN'S HOSPITAL. WITHIN BLYTHEDALE CHILDREN'S HOSPITAL, WE PROVIDE A COMPREHENSIVE RANGE OF SERVICES WHICH INCLUDE BUT ARE NOT LIMITED TO GENERAL PEDIATRICS, ADOLESCENT MEDICINE, PEDIATRIC PULMONOLOGY, CHILD NEUROLOGY, PSYCHIATRY, ORTHOPEDICS, PHYSICAL MEDICINE, AND REHABILITATION OF MULTIPLE PEDIATRIC SPECIALTIES (SUCH AS CARDIOLOGY, INFECTIOUS DISEASE, ENT, OPHTHALMOLOGY, ETC.) BLYTHEDALE MAINTAINS A CORE GROUP OF FULL TIME SPECIALTY COVERAGE IN PEDIATRICS, PULMONOLOGY, ADOLESCENT MEDICINE, NEUROLOGY, AND PSYCHIATRY. OTHER SUBSPECIALTY COVERAGE IS MAINTAINED AND UTILIZED AS NEEDED THROUGH A VARIETY OF CONTRACTUAL RELATIONSHIPS WITH THE AREA'S LEADING ACADEMIC MEDICAL CENTERS. BLYTHEDALE ALSO PROVIDES OTHER VITAL CLINICAL SERVICES SUCH AS NURSING, RESPIRATORY THERAPY, PSYCHOLOGY, CHILD LIFE, RESPIRATORY, SPEECH, OCCUPATIONAL AND PHYSICAL THERAPY, THERAPEUTIC RECREATION, SOCIAL WORK AND CASE MANAGEMENT. THE INPATIENT SERVICES ARE PRIMARILY COMPOSED OF 4 MAJOR PROGRAMS, PHYSICAL MEDICINE AND REHABILITATION SERVICES, VENTILATOR WEANING, TRAUMATIC BRAIN INJURY AND MEDICAL THERAPIES FOR COMPLEX AND CHRONIC HEALTH CONDITIONS. THE HOSPITAL OPERATES 86 LICENSED BEDS AND PROVIDED CARE TO OVER 75 INPATIENTS PER DAY ON AVERAGE IN 2015. THE HOSPITAL HAD 817 UNIQUE REFERRALS AND 495 UNIQUE ADMISSIONS IN 2015. OVER 70% OF OUR INPATIENT DAYS WERE REIMBURSED THROUGH THE MEDICAID PROGRAM (FFS & MANAGED) IN 2015. WHILE 100% OF THE HOSPITALS INPATIENT POPULATION IS REFERRED IN FROM OTHER ACUTE CARE HOSPITALS IN THE REGION, OVER >71% COME DIRECTLY FROM INTENSIVE CARE UNITS (ICU'S). THIS SPEAKS TO THE HIGH ACUITY OF THE PATIENT POPULATION BEING MANAGED AT BLYTHEDALE. IN 2015 OVER 56% OF PATIENTS TREATED WERE BELOW THE AGE OF 4 YEARS. THIS FACT PRESENTS MANY UNIQUE CHALLENGES TO THE DELIVERY OF CARE AS THE HOSPITAL PROVIDES HIGH QUALITY TO BOTH THE PATIENTS AND THE FAMILY. BLYTHEDALE CHILDREN'S HOSPITAL DOESN'T OPERATE PRIMARY CARE CLINICS, OR AN EMERGENCY DEPARTMENT OR OBSTETRICAL SERVICES. THESE SERVICES ARE OFTEN THE PRIMARY DRIVERS OF UNINSURED PATIENTS AT ACUTE CARE HOSPITALS. SECONDLY, CHILDREN, MORE SO THAN ADULTS HAVE GREATER ACCESS TO MEDICAID REIMBURSEMENT AS A PAYER OF LAST RESORT BECAUSE OF STATE CHILD HEALTH PLUS LAWS. THESE TWO FACTORS SIGNIFICANTLY IMPACT THE REPORTED AMOUNT OF CARE CLASSIFIED AS TRUE CHARITY CARE RELATIVE TO FULL SERVICE ACUTE CARE HOSPITALS. FORM 990, PART III, LINE 4B DAY HOSPITAL PROGRAM - BLYTHEDALE OFFERS A DAY HOSPITAL PROGRAM FOR THOSE CHILDREN WHO ARE ABLE TO LIVE AT HOME, BUT STILL REQUIRE A LEVEL OF MEDICAL AND REHABILITATIVE CARE THAT CANNOT BE MET BY THEIR SCHOOL OR OUTPATIENT PROGRAM. IN 2015, 65 % OF THE PROGRAM CAME DIRECTLY FROM THE INPATIENT SETTING, 25 % CAME DIRECTLY FROM REFERRALS IN THE COMMUNITY AND 10% THROUGH THE EARLY INTERVENTION/CPSE PROGRAMS. IN 2015, THE PROGRAM SERVED ON AVERAGE OF 84 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 19,600 VISITS. OVER 80% OF THESE PATIENTS WERE REIMBURSED BY THE MEDICAID PROGRAM. THE DAY HOSPITAL PROGRAM PROVIDES A NURTURING ENVIRONMENT WHERE CHILDREN WITH VARIOUS SPECIAL MEDICAL NEEDS CAN RECEIVE DAILY MEDICAL SUPERVISION, NURSING CARE, AND HAVE THEIR NEEDS FOR PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES MET, ALL WHILE RETURNING HOME AT THE END OF THE DAY. EACH CHILD'S PROGRAM IS INDIVIDUALIZED TO ADDRESS THEIR UNIQUE MEDICAL, PSYCHOLOGICAL AND THERAPEUTIC NEEDS. IN ADDITION, EVERY CHILD IS ASSIGNED A SOCIAL WORKER TO PROVIDE FAMILY SUPPORT AND CASE MANAGEMENT. AS NECESSARY, ONGOING PSYCHOSOCIAL SUPPORT AND COUNSELING, AND CASE MANAGEMENT ARE PROVIDED. SERVICES FOR SCHOOL-AGE CHILDREN ARE PROVIDED IN CONJUNCTION WITH A FULL ACADEMIC PROGRAM UNDER THE AUSPICES OF THE MOUNT PLEASANT-BLYTHEDALE UNION FREE SCHOOL DISTRICT. COMMITTEE ON PRESCHOOL SPECIAL EDUCATION (CPSE PROGRAM) - BLYTHEDALE - CHILDREN'S HOSPITAL PROVIDES EVALUATION AND TREATMENT SERVICES FOR YOUNG CHILDREN BETWEEN THE AGES OF 3 TO 5 YEARS WHO ARE REFERRED THROUGH THEIR LOCAL COMMITTEE ON PRESCHOOL SPECIAL EDUCATION (CPSE). THESE PATIENTS ARE ELIGIBLE FOR ASSESSMENT AT NO COST TO THEIR FAMILIES. THE NEW YORK STATE EDUCATION DEPARTMENT OVERSEES A STATEWIDE PRESCHOOL SPECIAL EDUCATION PROGRAM WITH SCHOOL DISTRICTS, MUNICIPALITIES, APPROVED PROVIDERS, AND PARENTS. EVALUATIONS AND SERVICES ARE PROVIDED TO ELIGIBLE CHILDREN WHO HAVE A DISABILITY THAT AFFECTS THEIR LEARNING. FUNDING FOR EVALUATIONS AND SERVICES IS PROVIDED BY MUNICIPALITIES AND THE STATE. IN 2015, THE PROGRAM SERVED ON AVERAGE OF 19 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 4,125 VISITS. EVALUATION AND TREATMENT PLANNING ARE PERFORMED BY A MULTIDISCIPLINARY TEAM THAT MAY CONSIST OF THERAPISTS, SPECIAL EDUCATION TEACHERS, AUDIOLOGISTS, PHYSIATRISTS (REHABILITATION DOCTORS), NEUROLOGISTS, PSYCHIATRISTS, PSYCHOLOGISTS, SOCIAL WORKERS, NURSES, NUTRITIONISTS, AND OTHER SPECIALTY CONSULTANTS. AT BLYTHEDALE, WE PROVIDE INDIVIDUALIZED RELATED SERVICES TO ELIGIBLE CHILDREN AGE'S THREE TO FIVE THROUGH OUR OUTPATIENT DEPARTMENT. WE SERVE CHILDREN WITH A WIDE RANGE OF NEEDS INCLUDING DIFFICULTIES THAT MAY INTERFERE WITH THEIR LEARNING AND FUNCTIONING IN PRESCHOOL. CHILDREN WITH THE FOLLOWING DIFFICULTIES ARE MOST COMMON IN THE PROGRAM: - DELAYS OR LAGS IN COGNITIVE, LANGUAGE, MOTOR OR SOCIAL EMOTIONAL DEVELOPMENT - CONGENITAL OR ACQUIRED ABNORMALITIES - DIAGNOSED MEDICAL CONDITIONS SUCH AS CEREBRAL PALSY, NEUROMUSCULAR OR OTHER NEUROLOGICAL DISORDERS FORM 990, PART III, LINE 4C EARLY INTERVENTION - THE EARLY INTERVENTION PROGRAM IS A STATEWIDE PROGRAM THAT PROVIDES MANY DIFFERENT TYPES OF EARLY INTERVENTION SERVICES TO CHILDREN BETWEEN THE AGES OF BIRTH TO THREE YEARS WITH DEVELOPMENT DELAY OR DIAGNOSED DISABILITIES AND TO THEIR FAMILIES. IN NEW YORK STATE, THE DEPARTMENT OF HEALTH IS THE LEAD STATE AGENCY RESPONSIBLE FOR THE EARLY INTERVENTION PROGRAM. IN 2015, THE PROGRAM SERVED ON AVERAGE OF 23 PATIENTS PER SCHOOL DAY FOR A TOTAL OF 5,700 VISITS. THE HOSPITAL ALSO PROVIDED 2,600 OUTPATIENT THERAPY AND CLINIC VISITS TO PATIENTS IN THE PROGRAM. BLYTHEDALE CHILDREN'S HOSPITAL IS WELL SUITED TO PROVIDE EVALUATION AND TREATMENT SERVICES FOR YOUNG CHILDREN. AS THE REGION'S PREMIERE HOSPITAL OFFERING REHABILITATIVE SERVICES TO CHILDREN, WE HAVE THE LARGEST DEPARTMENTS OF SPEECH THERAPY, OCCUPATIONAL THERAPY AND PHYSICAL THERAPY. THE EXPERTISE OF OUR HIGHLY SKILLED, MULTIDISCIPLINARY STAFF ENABLES US TO PROVIDE COORDINATED, COMPREHENSIVE, INDIVIDUALIZED PROGRAMS FOR THE CHILDREN AND FAMILIES WE SERVE. PARENTS AND STAFF WORK CLOSELY TOGETHER TO DEVELOP GOALS AND IMPATIENT PLANS. EVALUATION AND TREATMENT PLANNING ARE PERFORMED BY A MULTI-DISCIPLINARY TEAM THAT MAY CONSIST OF THERAPISTS, PHYSIATRISTS (REHABILITATION DOCTORS), NEUROLOGISTS, PSYCHIATRISTS, PSYCHOLOGISTS, SPECIAL EDUCATION, TEACHERS, AUDIOLOGISTS, SOCIAL WORKERS, NURSES, NUTRITIONISTS, AND OTHER SPECIALTY CONSULTANTS. WHILE NOT LIMITED TO THE FOLLOWING, THE PROGRAM TREATS A WIDE ARRAY OF ISSUES AND DIAGNOSES: - DELAYS OR LAGS IN REACHING THEIR DEVELOPMENTAL MILESTONES - CONGENITAL OR ACQUIRED ABNORMALITIES SUCH AS VISION OR HEARING IMPAIRMENTS - DIAGNOSED MEDICAL CONDITIONS SUCH AS CEREBRAL PALSY, NEUROMUSCULAR OR OTHER NEUROLOGICAL DISORDERS BLYTHEDALE CHILDREN'S HOSPITAL OFFERS VARIOUS OUTPATIENT THERAPY AND SUB SPECIALTY MEDICAL CLINICS TO SPECIAL NEEDS CHILDREN THROUGHOUT THE REGION. IN 2015 THE HOSPITAL PROVIDED OVER 2,750 ENCOUNTERS TO CHILDREN REQUIRING THESE SERVICES (THESE SERVICES INCLUDE AUDIOLOGY, NEUROLOGY, ORTHOPEDICS, SPINA BIFIDA CLINIC, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, BRACE AND EQUIPMENT MODIFICATION AND FITTING). FORM 990, PART VI, SECTION A, LINE 2 JOHN FURTH AND OWEN GUTFREUND (BOARD MEMBERS) HAVE A FAMILY RELATIONSHIP. DAVID PEDOWITZ HAS A BUSINESS RELATIONSHIP WITH PATRICIA STANLEY, LARRY COHEN, AND PEGGY TANNER (BOARD MEMBERS, AND FORMER BOARD MEMBER, RESPECTIVELY). FRANK STERN HAS A BUSINESS RELATIONSHIP WITH BOTH DAVID PEDOWITZ AND JOHN BARKER (BOARD MEMBERS). FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 IS PROVIDED TO EACH MEMBER OF THE BLYTHEDALE CHILDREN'S HOSPITAL'S BOARD OF TRUSTEES PRIOR TO ITS FILING WITH THE INTERNAL REVENUE SERVICE. THE FORM 990 IS REVIEWED BY THE BLYTHEDALE FINANCE DEPARTMENT AS WELL AS BY DELOITTE TAX, LLP, BEFORE IT IS PRESENTED TO THE BOARD'S EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE THEN PROVIDES AN OVERVIEW OF THE FORM 990 TO THE FULL BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS, SENIOR MANAGEMENT AND KEY EMPLOYEES OF BLYTHEDALE CHILDREN'S HOSPITAL MUST COMPLETE A STATEMENT ANNUALLY AND WHENEVER NEW INFORMATION ARISES, WHICH DISCLOSES ANY POTENTIAL CONFLICT OF INTEREST, AS REQUIRED BY THE HOSPITAL'S CONFLICT OF INTEREST POLICY. THESE STATEMENTS ARE REVIEWED BY THE HOSPITAL'S COMPLIANCE OFFICER WHO PREPARES A REPORT ON DISCLOSURES FOR THE BOARD'S EXECUTIVE COMMITTEE. HOSPITAL BOARD MEMBERS AND STAFF ARE TRAINED AND EDUCATED ON THEIR OBLIGATIONS UNDER THIS POLICY, INCLUDING ITS GIFT AND GRATUITIES PROVISIONS. FORM 990, PART VI, SECTION B, LINE 15 BLYTHEDALE CHILDREN'S HOSPITAL MAINTAINS A RIGOROUS APPROACH AND A THOROUGH AND TRANSPARENT PROCESS TO EVALUATE EXECUTIVE COMPENSATION. EVERY 2 YEARS, BLYTHEDALE FORMALLY ENGAGES SULLIVAN, COTTER AND ASSOCIATES TO PROVIDE THE COMPENSATION COMMITTEE WITH A THOROUGH REVIEW AND ASSESSMENT OF ALL ELEMENTS OF EXECUTIVE COMPENSATION. THIS IS DONE TO ENSURE THE OVERALL REASONABLENESS OF THE TOTAL COMPENSATION PROVIDED TO ITS CHIEF EXECUTIVE OFFICER AND ALL OTHER CHIEF OFFICERS. MOREOVER, ON AN ANNUAL BASIS BLYTHEDALE ENGAGES SULLIVAN, COTTER AND ASSOCIATES TO REVIEW BOTH THE NATIONAL AND REGIONAL HEALTHCARE MARKETPLACE TO DETERMINE BASE PAY INCREASE PROJECTIONS FOR ALL MAIN EMPLOYEE CATEGORIES INCLUDING EXECUTIVES. SULLIVAN, COTTER AND ASSOCIATES IS A WELL REGARDED COMPENSATION CONSULTING FIRM WITH REGIONAL AND NATIONAL EXPERTISE. THE FIRM COMPARES BLYTHEDALE'S EXECUTIVE COMPENSATION TO A PRIMARY COMPARATOR MARKET THAT INCLUDES REGIONAL CHILDREN'S AND REHABILITATION NOT-FOR-PROFIT HOSPITALS; NOT-FOR-PROFIT HOSPITALS IN THE METROPOLITAN NEW YORK AREA; AND NOT-FOR-PROFIT HOSPITALS IN THE HUDSON VALLEY REGION. IN OCTOBER 2015, SULLIVAN, COTTER AND ASSOCIATES, INC PROVIDED TO THE BOARD'S COMPENSATION COMMITTEE AN ASSESSMENT OF THE COMPETITIVENESS OF THE TOTAL COMPENSATION PROVIDED TO BLYTHEDALE'S EXECUTIVES RELATIVE TO PREVALENT AND COMPARABLE MARKETPLACE PRACTICES. FUTHERMORE, SULLIVAN COTTER ASSISTED THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES IN REVIEWING BLYTHEDALE'S EXECUTIVE COMPENSATION PHILOSOPHY STATEMENT. IN ADDITION TO ANALYZING THE DATA PROVIDED BY SULLIVAN, COTTER AND ASSOCIATES, THE COMPENSATION COMMITTEE OF THE BOARD OF TRUSTEES CONSIDERS A NUMBER OF FACTORS WHEN REVIEWING AND ESTABLISHING COMPENSATION FOR THE CEO AND ALL OTHER CHIEF OFFICERS INCLUDING BUT NOT LIMITED TO THE FOLLOWING: DEVELOPMENT OF NEW PROGRAMS; MOBILIZING THE HOSPITAL TO STRIVE FOR EXCELLENT RESULTS IN PATIENT CARE; MANAGEMENT PERFORMANCE AND COMPLIANCE WITH ALL PROFESSIONAL AND REGULATORY STANDARDS; AND INITIATIVES AND FACILITIES TO SUPPORT AND ADVANCE BLYTHEDALE'S MISSION WHILE EFFECTIVELY ALLOCATING AND MANAGING THE HOSPITAL'S RESOURCES. BY REVIEWING THE COMPENSATION DATA FROM INDEPENDENT SOURCES FOR FUNCTIONALLY COMPARABLE POSITIONS IN ORGANIZATIONS COMPARABLE TO BLYTHEDALE AND BY ANALYZING THE INTERNAL PERFORMANCE DATA, THE COMPENSATION COMMITTEE DETERMINES THAT IT PROVIDES A "REBUTTABLE PRESUMPTION OF REASONABLENESS" THAT THE TOTAL COMPENSATION PROVIDED TO BLYTHEDALE EXECUTIVES IS REASONABLE AND CONSISTENT WITH MARKET PRACTICES. IN DECEMBER 2015, WITHOUT INPUT OR VOTING PARTICIPATION BY THE INDIVIVDUALS WHOSE COMPENSATION WAS APPROVED, THE COMPENSATION COMMITTEE APPROVED INCENTIVE COMPENSATION AWARDS FOR THE CEO AND EXECUTIVE MANAGEMENT TEAM AND APPROVED THE PROPOSED 2016 EXECUTIVE BASE COMPENSATION. THE FINAL DETEMINATION OF THE COMMITTEE WAS DOCUMENTED AND AN OVERVIEW WAS PROVIDED TO THE FULL BOARD OF TRUSTEES TO ENSURE FULL DISCLOSURE AND TRANSPARENCY OF EXECUTIVE COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 BLYTHEDALE CHILDREN'S HOSPITAL MAKES ITS FORM 990 AND FORM 1023 AVAILABLE TO THE PUBLIC BY RETAINING A COPY OF EACH AT THE ADDRESS LISTED ON PAGE 1 OF THIS RETURN. THE ORGANIZATION' S FORM 990 IS ALSO AVAILABLE FOR PUBLIC INSPECTION ON WWW.GUIDESTAR.ORG. THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND AT MANAGEMENT'S DISCRETION. FORM 990, PART XI, LINE 9: CHANGE IN PENSION LIABILITY 237,251. REASON FOR FILING AMENDED TAX RETURN THE TAX YEAR 2015 RETURN FOR BLYTHEDALE CHILDREN'S HOSPITAL HAS BEEN AMENDED TO SEPARATELY STATE AN UNREALIZED LOSS.