2013-05-14T11:42:58-05:00 2012-06-30 ERNST & YOUNG US LLP 111 MONUMENT CIRCLE SUITE 2600 INDIANAPOLIS IN 46204 990 2011-07-01 310672132 Children's Medical Center % DAVID T MILLER CHIL 9376413338 One Childrens Plaza Dayton OH 454041815 DAVID T MILLER 2013-05-06 3176817000 2011 2016-02-24 21:20:13Z DEBORAH FELDMAN ONE CHILDRENS PLAZA DAYTON OH 454041815 340251312 false X www.childrensdayton.org X 1967 OH TO IMPROVE THE HEALTH STATUS OF ALL CHILDREN THROUGH SERVICE, EDUCATION, RESEARCH AND ADVOCACY. 19 14 1940 893 -5607 -5607 10540270 13792546 194695740 202208573 8188402 11154342 2687349 5350065 216111761 232505526 100525 216288 0 0 101995746 104630679 0 0 1073749 74336688 80844055 176432959 185691022 39678802 46814504 410865595 428519704 38047015 45942566 372818580 382577138 X TO IMPROVE THE HEALTH STATUS OF ALL CHILDREN THROUGH SERVICE, EDUCATION, RESEARCH AND ADVOCACY. false false 207790860 216288 202208573 SEE SCHEDULE O. 207790860 true true false true false false false false false true true true false false true false false true false false true false false false true false true true true true true false false false false false false true false true false false false false true true true false false true 102 1 true 1940 true false true BD false false false true true false false false false X 19 14 false false false false false false false true true false false true true true true true true true true true true OH X X DAVID T MILLER 9376413338 ONE CHILDRENS PLAZA DAYTON OH 454041815 X EMILY CHAMBERS 1.0 X 0 0 0 JEFFREY CHRISTIAN MD 1.0 X 0 502294 51900 ELIZABETH H EY MD 1.0 X 130682 0 0 JEAN IRELAND 1.0 X 0 0 0 ROBERT P MYERS DO 1.0 X 0 0 0 TIMOTHY G PEPPER 1.0 X 0 0 0 ARTHUR PICKOFF 1.0 X 107280 0 0 COLLEEN RYAN 1.0 X 0 0 0 GREGORY SAMPLE 1.0 X 0 0 0 BEVERLY SHILLITO 1.0 X 0 0 0 ROSIE GOFORTH 1.0 X 0 0 0 SCOTT KELLY 1.0 X 0 0 0 THERESE MCNEA-WILEY 1.0 X 0 0 0 MICHAEL SHANE 1.0 X 0 0 0 JERAD M BARNETT 1.0 X X 0 0 0 CHARLES M FOLEY 1.0 X X 0 0 0 LAURENCE KLABEN 1.0 X X 0 0 0 NEIL A MCLACHLAN 1.0 X X 0 0 0 VISHAL SOIN 1.0 X X 0 0 0 MARLA VICHICH 1.0 X X 0 0 0 DEBBIE WATTS ROBINSON 1.0 X X 0 0 0 DAVID KINSAUL 40.0 X X 586287 0 363120 THOMAS MURPHY MD 40.0 X X 335704 0 168281 DAVID T MILLER 40.0 X 301050 0 54631 MATTHEW GRAYBILL 40.0 X 236228 0 102363 LISA COFFEY 40.0 X 183160 0 38802 RENAE PHILLIPS 40.0 X 237478 0 96504 GREGORY RAMEY 40.0 X 230840 0 105423 VICKI GIAMBRONE 40.0 X 229806 0 38367 MARGARET HEMMEN 40.0 X 183468 0 13030 GREGORY HUFF 40.0 X 159085 0 36161 ELIZABETH FREDETTE 40.0 X 145501 0 32150 CYNTHIA BURGER 40.0 X 144382 0 32348 3210951 502294 1133080 14 false true true CHILDREN'S CARE GROUP 1 CHILDRENS PLAZA DAYTON OH 45404 PHYSICIAN SERVICES 11419992 WRIGHT STATE PHYSICIANS PO BOX 1144 DAYTON OH 45401 PHYSICIAN SERVICES 1813488 DAYTON CHILDREN'S CARDIOLOGY 1 CHILDRENS PLAZA DAYTON OH 45404 PHYSICIAN SERVICES 1716612 WRIGHT STATE UNIVERSITY PO BOX 927 DAYTON OH 45401 PHYSICIAN SERVICES 1302399 ORTHOPAEDIC CENTER FOR SPINAL PED 1 CHILDRENS PLAZA DAYTON OH 45404 PHYSICIAN SERVICES 409178 5 39817 19320 822952 12910457 65433 13792546 PATIENT SERVICES REVENUE 624100 117284224 117284224 MEDICARE/MEDICAID 624100 84929956 84929956 SURGERY CENTER 621400 -5607 -5607 202208573 8800547 8800547 0 0 351346 827450 -476104 -476104 -476104 108753598 23196 106402721 20278 2350877 2918 2353795 2353795 335692 19320 86203 249489 249489 0 610174 409134 201040 201040 HITECH MED RECORDS 900099 3060596 3060596 CAFETERIA/KIDS CARE 722210 1360697 1360697 DAY CARE CENTER 812930 692094 692094 262253 262253 5375640 232505526 207790860 -5607 10927727 20000 20000 196288 196288 0 0 3116386 3116386 0 79816942 75241695 3953364 621883 4465406 4209441 221173 34792 11596986 11042773 462942 91271 5634959 5311953 279102 43904 0 258042 258042 240000 240000 183016 183016 0 0 14910618 14626882 283736 738723 738723 10972135 9913804 888991 169340 3958910 3958910 0 2551772 2442562 99728 9482 723225 343458 346471 33296 0 150480 150480 0 0 14844856 14319692 472694 52470 1327803 1327803 MEDICAL SUPPLIES 20108023 20108023 PURCHASED SERVICES 6266846 4629307 1620228 17311 STATE HOSPITAL ASSESSMENT 3620514 3620514 MISCELLANEOUS -10908 -10908 185691022 172385324 12231949 1073749 14910 15010 29801992 44977390 1738641 1581244 22926911 27615433 0 0 0 0 98419 39836 1474060 1755147 787044 565886 185414204 85508860 102432828 99905344 217666263 221218098 20694184 24091921 2071712 2223611 0 0 11158631 4530784 410865595 428519704 28833376 30218758 0 0 1415 1415 0 0 0 0 0 0 0 0 0 0 9212224 15722393 38047015 45942566 X 371563718 380726993 1254862 1850145 0 0 372818580 382577138 410865595 428519704 X 46814504 -37055946 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true false false false true 162728 true 16286 true 18534 false 197548 false false SCHEDULE C SUPPLEMENTAL INFORMATION SCHEDULE C, PART II-B LINE 1F: OHIO HOSPITAL ASSOCIATION $3,084 OHIO CHILDREN'S HOSPITAL ASSOCIATION $141,611 NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS $18,033 TOTAL: $162,728 LINE 1G: MANAGEMENT TIME $13,513 NACH 2012 FAMILY ADVOCACY DAYS $2,773 TOTAL: $16,286 LINE 1H: MANAGEMENT TIME $1,019 CONSULTING EXPENSE $17,265 PRINTING AND SUPPLIES $250 TOTAL: $18,534 TOTAL LINE 1J: $197,548 123741717 7937991 434441 4446180 0 0 127667969 97132791 7689808 22325672 3402441 4113 0 123741717 71668979 19617386 8980654 2900616 233612 0 97132791 87947632 1194204 -14186547 3254832 31478 0 71668979 1.00000 0.00000 0.00000 false true true 3965938 3965938 49032544 20690265 28342279 126751028 63322450 63428578 5664694 1496145 4168549 99905344 HIRTLE CALLAGHAN-OFFSHORE 11328041 F HIRTLE CALLAGHAN-COMMODITIES 10501353 F HIRTLE CALLAGHAN-REAL ESTATE 2262527 F 24091921 0 RESERVE FOR PROFESSIONAL LIABILITY 5658596 ESTIMATED REIMB/MEDICAID PROGRAMS 251075 PENSION LIABILITY 1345904 DEFERRED COMPENSATION PAYABLE 1677810 SERP PENSION ACCRUAL 3947547 REINSURANCE 2841461 15722393 SUPPLEMENTAL INFORMATION Part V, Line 4 The endowments are held by the Children's Medical Center Foundation, a subsidiary of Children's Medical Center. The funds are used exclusively to support Children's Medical Center and its subsidiaries. The intended use of the funds is to support medical research, the child life program and the medical chairs of specific hospital departments. 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OUTPATIENT CARE CENTER SPRINGBORO OUTPATIENT CARE CENTER

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OUTPATIENT CARE CENTER DIAGNOSTIC CENTER SPRINGBORO URGENT CARE CENTER

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OUTPATIENT CARE CENTER Schedule H Part VI PART I, LINE 7G DAYTON CHILDREN'S INCLUDED $14,409,850 OF PHYSICIAN CLINIC COSTS IN THE SUBSIDIZED HEALTH SERVICES CATEGORY. PART I. LINE 7 THE FOLLOWING COSTING METHODOLOGIES WERE USED IN PREPARATION OF SCHEDULE H PART I, LINE 7: -CHARITY CARE AT COST WAS CALCULATED USING THE COST TO CHARGE RATIO. -UNREIMBURSED MEDICAID WAS CALCULATED USING THE COST TO CHARGE RATIO. -COMMUNITY HEALTH IMPROVEMENT SERVICES WERE VALUED AT THE ACTUAL CASH COSTS, INCLUDING DIRECTLY ASSIGNABLE PAYROLL COSTS, RELATED TO THESE ACTIVITIES. NO OVERHEAD ALLOCATION WAS CHARGED TO ANY AMOUNT INCLUDED IN THIS COMPUTATION. -HEALTH PROFESSIONS EDUCATION COSTS WERE DETERMINED USING THE FACILITY'S MEDICARE COST REPORTED, SUPPLEMENTED BY THE ACTUAL CASH COSTS, INCLUDING DIRECTLY ASSIGNABLE PAYROLL COSTS, RELATED TO THESE ACTIVITIES. -SUBSIDIZED HEALTH SERVICES COSTS WERE DETERMINED USING THE FACILITY'S INTERNAL COST ACCOUNTING SYSTEM. THE COST OF THESE SERVICES INCLUDES DIRECT COSTS ATIRIBUTABLE TO HEALTH SERVICES OPERATIONS, TOGETHER WITH AN ALLOCATION OF FACILITY DIRECT AND INDIRECT OVERHEAD USING A COST FINDING METHODOLOGY PATTERNED AFTER THE MEDICARE COST REPORT. -CASH AND IN KIND CONTRIBUTIONS WERE VALUED AT THE ACTUAL CASH COSTS, INCLUDING DIRECTLY ASSIGNABLE PAYROLL COSTS, RELATED TO THESE ACTIVITIES. NO OVERHEAD ALLOCATION WAS CHARGED TO ANY AMOUNT INCLUDED IN THIS COMPUTATION. PART III, LINE 4: THE COSTING METHODOLOGY USED IN PREPARATION OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS IS THE COST TO CHARGE RATIO, RATIO OF PATIENT COST-TO-CHARGE. THE CHILDREN'S MEDICAL CENTER'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE DISCUSSING BAD DEBT EXPENSE. A PROVISION FOR BAD DEBT EXPENSE IS SHOWN ON THE PROFIT AND LOSS STATEMENT. THE CALCULATION OF BAD DEBT EXPENSE IS IN CONFORMITY WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES REQUIRING MANAGEMENT TO MAKE ESTIMATES AND ASSUMPTIONS BASED ON HISTORICAL DATA THAT AFFECT THE REPORTED AMOUNTS OF REVENUE AND EXPENSES DURING THE REPORTD PERIOD. LIKEWISE, AN ALLOWANCE FOR BAD DEBT IS SHOWN ON THE BALANCE SHEET UNDER THE SAME PRINCIPLE AFFECTING THE REPORTED AMOUNTS OF ASSETS AND LIABILITIES DURING THE REPORTED PERIOD. PART III, LINE 8: THE COSTS REPORTED FOR SERVICES PROVIDED TO MEDICARE PATIENTS COME FROM SCHEDULE E OF THE FACILITY'S COST REPORT AS FILED. SINCE CHILDREN'S MEDICAL CENTER IS REIMBURSED FOR MEDICARE SERVICES UNDER A TEFRA METHODOLOGY, THERE IS NORMALLY NO SHORTFALL, AS ALLOWED COSTS AND PAYMENTS DUE ARE EQUAL. PART III, LINE 9B: THE HOSPITAL'S POLICIES ON BILLING AND COLLECTIONS ARE POSTED ON OUR WEBSITE UNDER THE "FINANCIAL MATTERS" TAB. IT IS THE HOSPITAL'S POLICY TO PUBLICIZE THE AVAILABILITY OF FREE CARE, GOVERNMENT, AND OTHER FINANCIAL ASSISTANCE PROGRAMS BEFORE SERVICES ARE PROVIDED THROUGH MEANS SUCH AS ONSITE FINANCIAL COUNSELORS AND BROCHURES PROVIDED IN THE REGISTRATION AREAS. EACH OF THESE AVENUES OF COMMUNICATION INCLUDES DETAILED INSTRUCTIONS ON HOW PATIENTS AND FAMILIES MAY APPLY FOR ASSISTANCE. THE HOSPITAL'S POLICIES ON BILLING AND COLLECTIONS SPECIFY WHEN COLLECTION ACTION MAY BE TAKEN AND MAKES IT CLEAR THAT THESE MEASURES WILL ONLY OCCUR AFTER DAYTON CHILDREN'S HAS MADE REASONABLE EFFORTS TO CONTACT A FAMILY ABOUT ITS BILL AND THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAMS. THESE PRACTICES APPLY TO ALL PATIENTS IN GENERAL, NOT ONLY PATIENTS WHO MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE. IN ADDITION, PATIENTS ARE INFORMED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAMS THROUGH SIGNS DISPLAYED IN REGISTRATION AREAS AND THROUGH MESSAGES APPEARING ON BILLING STATEMENTS MAILED BY THE HOSPITAL. FINALLY, THE HOSPITAL EMPLOYS ON-SITE FINANCIAL COUNSELORS WHO CONTACT PATIENTS WITHOUT COVERAGE IN ORDER TO DISCUSS THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS VIA PHONE OR THROUGH FACE-TO-FACE INTERVIEWS. THESE FINANCIAL COUNSELORS WILL ASSIST FAMILIES IN APPLYING FOR FINANCIAL ASSISTANCE PROGRAMS IF DESIRED. PART V: SECTION B, LINE 19D ALL PATIENTS ARE CHARGED THE SAME FOR SERVICES RECEIVED. HOWEVER, CHARGES BILLED TO ALL FAP ELIGIBLE PATIENTS ARE DISCOUNTED BASED ON THE HOSPITAL'S SLIDING FEE SCALE FOR DISCOUNTED CARE. THIS IS BASED ON CURRENT FEDERAL POVERTY LEVELS. PART V: DAYTON CHILDREN'S HAS 10 HEALTH CARE FACILITIES OTHER THAN THOSE REQUIRED TO BE LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED AS A HEALTH CARE FACILITY UNDER STATE LAW. WE HAVE 5 TESTING CENTERS, 4 OFFSITE CLINICS, AND 1 URGENT CARE CENTER (50 % OWNED). #2. NEEDS ASSESSMENT DESCRIBE HOW THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. IMPROVING THE HEALTH STATUS OF CHILDREN IS A KEY COMPONENT OF THE CHILDREN'S MEDICAL CENTER OF DAYTON'S MISSION. TO HELP DEVELOP MEANINGFUL STRATEGIES IN THIS AREA, DAYTON CHILDREN'S EVALUATES THE STATUS OF OUR REGION'S PEDIATRIC HEALTH THROUGH A REGIONAL PEDIATRIC HEALTH ASSESSMENT CONDUCTED EVERY THREE YEARS. THE FIRST ASSESSMENT WAS CONDUCTED IN 2002, THE SECOND IN 2005, THIRD IN 2008. OUR FOURTH AND CURRENT ASSESSMENT WAS COMPLETED IN MARCH 2011. WE WORKED WITH SCHWARTZ CONSULTING PARTNERS AND COMMUNITY HEALTH ADVOCATES, SUCH AS THE WRIGHT STATE SCHOOL OF MEDICINE, CARESOURCE, READYSETSOAR AND PUBLIC HEALTH DAYTON & MONTGOMERY COUNTY TO DEVELOP THE QUESTIONNAIRE. THE SURVEY WAS ADMINISTERED ONLINE AND VIA TELEPHONE TO 600 PARENTS WITH CHILDREN UNDER 14 YEARS OF AGE IN OUR SERVICE AREA TO REPRESENT THE COMMUNITY SERVED BY THE HOSPITAL. NOTE: PREVIOUS WAVES OF THE ASSESSMENT HAVE BEEN CONDUCTED EXCLUSIVELY USING RANDOM TELEPHONE INTERVIEWING. HOWEVER IN RECENT YEARS THE PROPORTION OF FAMILIES WHO RELY EXCLUSIVELY ON MOBILE PHONES HAS INCREASED DRAMATICALLY, LEADING TO DECLINES IN TELEPHONE SURVEY RESPONSES, ESPECIALLY AMONG PARENTS OF YOUNG CHILDREN. THIS HAS LED HEALTH AND EPIDEMIOLOGICAL ORGANIZATIONS SUCH AS THE NATIONAL CENTER FOR HEALTH STATISTICS TO RECOMMEND MIXED ONLINE AND TELEPHONE SAMPLING METHODS. THE COMBINATION OF ONLINE AND TELEPHONE SAMPLING METHODS, COUPLED WITH DEMOGRAPHIC WEIGHTING, ALLOWED THIS STUDY TO COME WITHIN ONE OR TWO PERCENTAGE POINTS OF THE MOST RECENT CENSUS FIGURES FOR KEY DEMOGRAPHIC STATISTICS FOR THE MIAMI VALLEY AREA (BASED ON 2009 U.S. CENSUS RESULTS FOR 13 COUNTIES SERVED BY DAYTON CHILDREN'S ). THE HOSPITAL USES THE INSIGHT FROM THE ASSESSMENT TO LEARN MORE ABOUT THE HEALTH STATUS OF THE REGION'S CHILDREN, TO DETERMINE A COURSE OF ACTION TO MEET THEIR NEEDS, AND TO IMPROVE CHILDREN'S QUALITY OF LIFE AND GIVE CHILDREN A VOICE REGARDING THEIR HEALTH AND SAFETY. OUR 2011 STUDY REVEALS THREE AREAS REQUIRING GREATER ATTENTION: 1. MANAGING COLDS AND FLU 2. DEALING WITH DIET AND NUTRITION/CHILDHOOD OBESITY, AND 3. PREVENTING INJURIES AND IMPROVING SAFETY. THESE AREAS SUGGEST A FOCUS FOR THE REGION'S PEDIATRIC HEALTH AGENDA FOR THE COMING YEARS, PARTICULARLY IN AREAS WHERE WE ARE ABLE TO PREVENT THE PREVENTABLE. THESE FINDINGS ARE USED TO PLAN MUCH OF OUR COMMUNITY HEALTH AND OUTREACH PROGRAMMING. WHEN THIS STUDY WAS FIRST PUBLISHED IN 2011, WE HELD A PRESS CONFERENCE TO DISSEMINATE THE INFORMATION. IN ADDITION, WE CREATED A SUMMARY REPORT AND WHITE PAPERS OUTLINING THE NEXT STEPS FOR THE KEY ISSUES. FINALLY, OUR HEALTH ASSESSMENT WAS PUBLISHED ON OUR HOSPITAL WEBSITE AND AVAILABLE UPON REQUEST FOR ANY INVESTED PARTY. DAYTON CHILDREN'S ALSO WORKS WITH PARTNERS SUCH AS LOCAL HEALTH DEPARTMENTS AND CHILD-SERVING ORGANIZATIONS TO GAIN ADDITIONAL INFORMATION REGARDING THESE NEEDS IN ORDER TO CREATE COMPREHENSIVE ACTION PLANS. USING DATA FROM THE REGIONAL PEDIATRIC HEALTH ASSESSMENT, OUR INJURY DATABASE, INPUT FROM OUR PEDIATRIC EXPERTS, OTHER LOCAL AND NATIONAL STUDIES, DAYTON CHILDREN'S SETS A ROBUST AGENDA OF INJURY PREVENTION, HEALTH PROMOTION AND ADVOCACY TO ADDRESS THE HEALTH CARE NEEDS FACING OUR REGION'S CHILDREN. BECAUSE THE 2011 REGIONAL PEDIATRIC HEALTH ASSESSMENT TAKES A LOOK AT A VARIETY OF ISSUES FACING THE STATUS OF CHILDREN'S HEALTH IN OUR COMMUNITY, THERE ARE MANY ISSUES WE ARE UNABLE TO ADDRESS FOR A VARIETY OF REASONS. FOR INSTANCE, WE KNOW MENTAL HEALTH ISSUES ARE A KEY CONCERN IN OUR COMMUNITY, BUT GIVEN OUR RESOURCE THIS AN ISSUE WE ARE CURRENTLY UNABLE TO ADDRESS. DENTAL HEALTH IS ALSO A CONCERN, BUT CURRENTLY THIS IS ANOTHER AREA WITH LIMITED RESOURCES. THIS SURVEY IS VERY ROBUST AND ONE OF THE FEW ASSESSMENTS THAT DIRECTLY ADDRESSES CHILDREN'S HEALTH NEEDS AND PARENT PERCEPTIONS IN OUR COMMUNITY. DAYTON CHILDREN'S SHARES THE DATA WITH COMMUNITY LEADERS AND POTENTIAL PARTNERS SO THAT ADDITIONAL PROGRAMMING CAN BE DEVELOPED THROUGHOUT OUR REGION. THE ASSESSMENT IS INTENDED TO PROVIDE COMMUNITY HEALTH ADVOCATES WITH A GUIDE TO THE HEALTH ISSUES IMPACTING THE REGION'S CHILDREN AND TO SUGGEST SOME AREAS OF FOCUS FOR FUTURE PROGRAMMING AND EDUCATION BEYOND THE WALLS OF DAYTON CHILDREN'S. #3: THE HOSPITAL'S POLICIES ON BILLING AND COLLECTIONS ARE POSTED ON OUR WEBSITE UNDER THE "FINANCIAL MATTERS" TAB. IT IS THE HOSPITAL'S POLICY TO PUBLICIZE THE AVAILABILITY OF FREE CARE, GOVERNMENT, AND OTHE false GOODWILL EASTER SEALS 1511 KUNTZ RD DAYTON OH 45404 370537112 501(C)(3) 10000 CAR SEAT PROGRAM DAYTON SOCIETY OF NATURAL HISTORY 2600 DEWEESE PKWY DAYTON OH 45414 310585917 501(C)(3) 10000 FOOD FITNESS & FUN 2 0 PHARMACY 273 59845 MEALS/FOOD 459 51010 TRANSPORTATION 929 42404 RENT/UTILITIES 34 24438 SPECIAL EQUIPMENT 59 15376 OTHER 10 3214 SUPPLEMENTAL INFORMATION SCHEDULE I, PART I, LINE 2 THE FINANCE COMMITTEE AND COMMUNITY RELATIONS MANAGER APPROVE ALL GRANTS AND CHARITABLE DONATIONS. X true true X X X X X false true false false false false false false false JEFFREY CHRISTIAN MD 0 426926 0 300 0 75068 0 29873 0 22027 0 554194 0 0 DAVID KINSAUL 366999 0 150645 0 68643 0 341496 0 21624 0 949407 0 0 0 THOMAS MURPHY MD 227136 0 53456 0 55112 0 151631 0 16650 0 503985 0 0 0 DAVID T MILLER 202001 0 49725 0 49324 0 32474 0 22157 0 355681 0 0 0 LISA COFFEY 144089 0 30256 0 8815 0 20143 0 18659 0 221962 0 0 0 RENAE PHILLIPS 190421 0 39564 0 7493 0 77946 0 18558 0 333982 0 0 0 GREGORY RAMEY 155163 0 44084 0 31593 0 82723 0 22700 0 336263 0 0 0 VICKI GIAMBRONE 154579 0 37212 0 38015 0 28452 0 9915 0 268173 0 0 0 MATTHEW GRAYBILL 187893 0 37060 0 11275 0 81114 0 21249 0 338591 0 0 0 MARGARET HEMMEN 181584 0 300 0 1584 0 12726 0 304 0 196498 0 0 0 GREGORY HUFF 134417 0 7124 0 17544 0 11260 0 24901 0 195246 0 0 0 ELIZABETH FREDETTE 128054 0 6113 0 11334 0 10421 0 21729 0 177651 0 0 0 CYNTHIA BURGER 130745 0 6465 0 7172 0 10202 0 22146 0 176730 0 0 0 SUPPLEMENTAL INFORMATION SCHEDULE J, PART I, QUESTION 4B PARTICIPANTS IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND THE INCREASE IN ACTUARIAL VALUE: DAVID KINSAUL 336,738 DAVID MILLER 27,753 THOMAS MURPHY 146,783 GREGORY RAMEY 79,115 VICKI GIAMBRONE 24,687 MATTHEW GRAYBILL 77,241 RENAE PHILLIPS 74,087 LISA COFFEY 17,096 0 CARRELL PICKOFF SPOUSE OF TRUSTEE 16494 EMPLOYMENT false X 3 63521 SELLING PRICE false true true SUPPLEMENTAL INFORMATION ALL STOCK DONATIONS ARE TRANSFERRED TO EITHER MORGAN STANLEY/SMITH BARNEY OR CHILDREN'S MEDICAL CENTER KEY BANK TRUST ACCOUNT TO SELL STOCK. MORGAN STANLEY/SMITH BARNEY SENDS CHECK FOR CASH RECEIVED TO CHILDREN'S. KEY BANK DIRECTLY DEPOSITS PROCEEDS INTO CHILDREN'S CHECKING ACCOUNT. SUPPLEMENTAL INFORMATION FORM 990, PART III, LINE 4A The Children's Medical Center is a pediatric hospital located in downtown Dayton, Ohio. The Medical Center and its staff are committed to serving as an advocate for the children and their families in the Miami Valley through a variety of different programs. It offers inpatient, outpatient and ancilliary services to the children in the surrounding 20 counties. Services are provided to patients without regard to their ability to pay. For the fiscal year ending June 30, 2012, the hospital's mix of patients was 53.1% Medicaid, 39.0% Commercial, 6.7% Other Government Programs and 1.2% Self Pay. The hospital provides a Level III neonatal nursery for premature newborns as well as critical care and general pediatric inpatient beds. A 24 hour emergency department is available to all children in the area. Some of the specialities offered at the hospital are neurosurgery, hematology/oncology, pulmonary, gastroenterology, neurology, developmental disorders, psychology, endocrinology, genetics, cardiology, and general surgery. Without Children's Medical Center, many children in the area would have to travel a good distance to receive these services. The Medical Center also offers a Pediatric Residency Program that trains new pediatricians who will care for the next generation of children. Children's also sponsors many community events where children's health and safety are promoted. Some statistics for the fiscal year ending June 30, 2012 are as follows: # of beds: 155, Inpatient days: 28,868, Admissions: 6,952, Average length of stay: 4.26 days. Average daily census: 81 Occupancy rate: 52%, Surgeries performed: 11,488, X-Ray studies: 66,872, Lab Test: 865,750, Respiratory therapy procedures: 101,177, Pharmacy doses dispensed: 3,525,382 cardiology procedures: 37,471 Neurology procedures: 3,472, Urgent care visits: 14,630, Emergency department visits: 71,360, Outpatient clinics: 75,442. Form 990, Part VI, Lines 11a The CFO reviews key disclosures with appropriate committees of the Board of Trustees. Then prior to filing, the Form 990 is electronically loaded to a secure website for the entire Board of Trustees to review. An email is sent to all members notifying them that the form is available for their review and that it will be filed on or before 05/15/13. Form 990, Part VI, Line 12c - Monitoring Conflict of Interest At the beginning of each meeting, the chairman of the board asks each member to identify and disclose any potential conflicts of interest based on the agenda or any changes in their business practice that might be relevant. If there are any conflicts, the member(s) recuse themselves and not participate in the discussion and do not vote on the item. This then is noted in the minutes of that meeting. Board Members annually agree to abide by written conflict of interest and confidentiality policies. Board members also work to represent and balance the interests of Children's Medical Center's many constituents. The board annually evaluates its own performance. Form 990, Part VI, line 15a & 15b Compensation for the hospital's Chief Executive Officer (CEO) is set by an Executive Compensation Committee (the Committee) made up of three independent trustees who are also officers of the Board. This Committee also approves compensation levels, incentive plan payouts and executive benefits for each executive employed by the hospital. The Committee operates under a formal charter and keeps contemporaneous minutes of its proceedings. The Committee uses a total compensation philosophy to guide all decisions related to executive compensation at Dayton Children's Medical Center (DCMC), and as such determines and approves all aspects of the CEO's total compensation package, including benefits and expense allowances. These are detailed in a written employment agreement for the CEO. The Committee uses an outside consultant to conduct periodic reviews of the executive compensation levels of the organization versus those of similarly sized and situated organizations using published surveys. These survey results are used by the Committee in setting executive levels and the CEO's compensation in particular. The Committee follows a formal calendar of meetings and the chairman of the Committee reports to the Board of Trustees at least annually on the Committee's activities and on details of the CEO's compensation and benefits package. The Committee also reviews and approves disclosures related to executive compensation made as part of IRS Form 990. Part VI, Line 19 Availability of Financial, Conflict of interest, organizing documents Children's Medical Center's Conflict of Interest Policy is made available on our website. The financial statements and the organizing documents are made available as required by the extent of the law. Form 990, Part VII - Jeffrey Christian MD works 40 hours per week for the subsidiary, Children's Care Group. -Elizabeth EY MD is employed by dayton pediatric imaging. Children's Medical Center contracts with dayton pediatric imaging for Dr. EY to provide services at Children's Medical Center as the medical director of radiology. - Arthur Pickoff MD is employed by Wright State University. Children's Medical Center contracts with Wright State University for Dr. Pickoff to provide services at Children's Medical Center as the Chairman of the Department of Pediatrics. Form 990 Part XI Total Adjustment Unrealized gain on investment (10,388,607) Transfer to Children's Medical Center Foundation (7,681,015) Net assets released from restrictions used for purchase of property & equipment 824,045 Net assets released from ristrictions -temporarily restricted net assets (2,892,891) Change in pension benefit obligation and plan assets (16,917,478) Total (37,055,946) CHILDREN'S HOME CARE OF DAYTON ONE CHILDRENS PLAZA DAYTON OH 45404 311356037 HOME CARE OH 501(c)(3) 9 CMC true CHILDREN'S MEDICAL CENTER FOUNDATION ONE CHILDRENS PLAZA DAYTON OH 45404 311045247 SUPPORT OH 501(c)(3) 11a CMC true MIDDLETOWN SURGERY CENTER LLC 5950 INNOVATION DRIVE MIDDLETOWN OH 45005 205160579 SURGERY CENTER OH NA RELATED -5607 0 false 0 false 0.10000 CHILDREN'S CARE GROUP ONE CHILDRENS PLAZA DAYTON OH 45404 311411364 SPEC PHYS GROUP OH CMC C-CORP 12353599 6202168 1.00000 CHILDREN'S ANESTHESIA GROUP ONE CHILDRENS PLAZA DAYTON OH 45404 260887231 ANESTHESIA SVCS OH CMC C-CORP 3610042 1819526 1.00000 PEDIATRIC ASSURANCE COMPANY LTD BUTTERFIELD BANK BLDG 6TH FLOOR HAMILTON BERMUDA BD HM12 980478183 SELF-INSURANCE BD CMC N/A 1247779 38415976 1.00000 DAYTON CHILDREN'S ORTHOPAEDIC CENTER ONE CHILDRENS PLAZA DAYTON OH 45404 453934418 ORTHO SERVICES OH CMC C-CORP 1753109 430302 1.00000 false true true false false false false false true false false true false true false true true false CHILDRENS MEDICAL CENTER FOUNDATION B 7681016 FMV CHILDRENS MEDICAL CENTER FOUNDATION C 5423329 CASH CHILDRENS HOME CARE OF DAYTON L 424907 CASH CHILDRENS MEDICAL CENTER FOUNDATION L 71953 CASH CHILDRENS CARE GROUP L 9340553 CASH CHILDRENS ANESTHESIA GROUP L 3610042 CASH CHILDRENS CARE GROUP N 121476 FMV CHILDRENS ANESTHESIA GROUP N 536479 FMV CHILDRENS HOME CARE OF DAYTON P 9914196 CASH CHILDRENS CARE GROUP P 1889624 CASH DAYTON ORTHOPAEDICS P 212234 CASH CHILDRENS ANESTHESIA GROUP Q 165000 FMV CHILDRENS HOME CARE OF DAYTON Q 89059 FMV DAYTON ORTHOPAEDICS Q 1810000 FMV DAYTON ORTHOPAEDICS I 60839 CASH