SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
SHRINERS HOSPITALS FOR CHILDREN
 
Employer identification number

36-2193608
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    502,829,888 123,099,846 379,730,042 57.310 %
b Medicaid (from Worksheet 3, column a) . . . . .            
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     502,829,888 123,099,846 379,730,042 57.310 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).            
f Health professions education (from Worksheet 5) . . .            
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .     23,545,977   23,545,977 3.550 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .            
j Total. Other Benefits . .     23,545,977   23,545,977 3.550 %
k Total. Add lines 7d and 7j .     526,375,865 123,099,846 403,276,019 60.860 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
 
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
 
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
 
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
 
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
 
No
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

 

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?18
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 SHRINERS HOSPITAL FOR CHILDREN-CHICAGO
2211 NORTH OAK PARK AVENUE
CHICAGO,IL607073392 		X   X X   X       A
2 SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT
3229 BURNET AVENUE
CINCINNATI,OH452293095 		X   X X   X       A
3 SHRINERS HOSPITAL FOR CHILDREN-ERIE
1645 WEST 8TH STREET
ERIE,PA16505 		          X     OUTPATIENT AMBULATORY SURGICAL CENTER & CLINIC A
4 SHRINERS HOSPITAL FOR CHILDREN-GALVESTON
815 MARKET STREET
GALVESTON,TX77550 		X   X X   X       A
5 SHRINERS HOSPITAL FOR CHILDREN-GREENV
950 WEST FARIS ROAD
GREENVILLE,SC29605 		X   X X   X       A
6 SHRINERS HOSPITAL FOR CHILDREN-HONOLULU
1310 PUNAHOU STREET
HONOLULU,HI968261099 		X   X X   X       A
7 SHRINERS HOSPITAL FOR CHILDREN-HOUSTON
6977 MAIN STREET
HOUSTON,TX770303701 		X   X X   X       A
8 SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON
1900 RICHMOND ROAD
LEXINGTON,KY40502 		X   X X   X       A
9 SHRINERS HOSPITAL FOR CHILDREN-LA
3160 GENEVA STREET
LOS ANGELES,CA90020 		X   X X   X       A
10 SHRINERS HOSPITAL FOR CHILDREN-PHILADELP
3551 NORTH BROAD STREET
PHILADELPHIA,PA191404131 		X   X X   X       A
11 SHRINERS HOSPITAL FOR CHILDREN-PORTLAND
3101 SW SAM JACKSON PARK RD
PORTLAND,OR972393095 		X   X X   X       A
12 SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE
FAIRFAX ROAD AT VIRGINIA STREET
SALT LAKE CITY,UT84103 		X   X X   X       A
13 SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR
3100 SAMFORD AVENUE
SHREVEPORT,LA71103 		X   X X   X       A
14 SHRINERS HOSPITAL FOR CHILDREN-SPOKANE
911 WEST 5TH AVENUE
SPOKANE,WA99204 		X   X X   X       A
15 SHRINERS HOSPITAL FOR CHILDREN-ST LOUIS
2001 S LINDBERGH BOULEVARD
ST LOUIS,MO631313597 		X   X X   X       A
16 SHRINERS HOSPITAL FOR CHILDREN-TAMPA
12502 USF PINE DRIVE
TAMPA,FL336129499 		X   X X   X       A
17 SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY
2025 EAST RIVER PARKWAY
MINNEAPOLIS,MN55414 		X   X X   X       A
18 SHRINERS HOSPITAL FOR CHILDREN-N CALI
2425 STOCKTON BOULEVARD
SACRAMENTO,CA95817 		X   X X   X       A
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
SHRINERS HOSPITAL FOR CHILDREN-GROUP A
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		 
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................. 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8   No
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20  
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10    
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

SHRINERS HOSPITAL FOR CHILDREN-GROUP A
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16   No
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17   No
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

SHRINERS HOSPITAL FOR CHILDREN-GROUP A
Name of hospital facility or letter of facility reporting group  
Financial Assistance Policy (FAP) Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21   No
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
PART V, SECTION B FACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: SHRINERS HOSPITAL FOR CHILDREN-CHICAGO, - FACILITY 2: SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT, - FACILITY 3: SHRINERS HOSPITAL FOR CHILDREN-ERIE, - FACILITY 4: SHRINERS HOSPITAL FOR CHILDREN-GALVESTON, - FACILITY 5: SHRINERS HOSPITAL FOR CHILDREN-GREENV, - FACILITY 6: SHRINERS HOSPITAL FOR CHILDREN-HONOLULU, - FACILITY 7: SHRINERS HOSPITAL FOR CHILDREN-HOUSTON, - FACILITY 8: SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON, - FACILITY 9: SHRINERS HOSPITAL FOR CHILDREN-L.A., - FACILITY 10: SHRINERS HOSPITAL FOR CHILDREN-PHILADELP, - FACILITY 11: SHRINERS HOSPITAL FOR CHILDREN-PORTLAND, - FACILITY 12: SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE, - FACILITY 13: SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR, - FACILITY 14: SHRINERS HOSPITAL FOR CHILDREN-SPOKANE, - FACILITY 15: SHRINERS HOSPITAL FOR CHILDREN-ST. LOUIS, - FACILITY 16: SHRINERS HOSPITAL FOR CHILDREN-TAMPA, - FACILITY 17: SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY, - FACILITY 18: SHRINERS HOSPITAL FOR CHILDREN-N. CALI
GROUP A-FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN - CHICAGO PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN - CHICAGO PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 3 -- SHRINERS HOSPITAL FOR CHILDREN-ERIE PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 3 -- SHRINERS HOSPITAL FOR CHILDREN-ERIE PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 4 -- SHRINERS HOSPITAL FOR CHILDREN-GALVESTON PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 4 -- SHRINERS HOSPITAL FOR CHILDREN-GALVESTON PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 5 -- SHRINERS HOSPITAL FOR CHILDREN-GREENV PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 5 -- SHRINERS HOSPITAL FOR CHILDREN-GREENV PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 6 -- SHRINERS HOSPITAL FOR CHILDREN-HONOLULU PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 6 -- SHRINERS HOSPITAL FOR CHILDREN-HONOLULU PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 7 -- SHRINERS HOSPITAL FOR CHILDREN-HOUSTON PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 7 -- SHRINERS HOSPITAL FOR CHILDREN-HOUSTON PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 8 -- SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 8 -- SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 9 -- SHRINERS HOSPITAL FOR CHILDREN-L.A. PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 9 -- SHRINERS HOSPITAL FOR CHILDREN-L.A. PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 10 -- SHRINERS HOSPITAL FOR CHILDREN-PHILADELP PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 10 -- SHRINERS HOSPITAL FOR CHILDREN-PHILADELP PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 11 -- SHRINERS HOSPITAL FOR CHILDREN-PORTLAND PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 11 -- SHRINERS HOSPITAL FOR CHILDREN-PORTLAND PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 12 -- SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 12 -- SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 13 -- SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 13 -- SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 14 -- SHRINERS HOSPITAL FOR CHILDREN-SPOKANE PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 14 -- SHRINERS HOSPITAL FOR CHILDREN-SPOKANE PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 15 -- SHRINERS HOSPITAL FOR CHILDREN-ST. LOUIS PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 15 -- SHRINERS HOSPITAL FOR CHILDREN-ST. LOUIS PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 16 -- SHRINERS HOSPITAL FOR CHILDREN-TAMPA PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 16 -- SHRINERS HOSPITAL FOR CHILDREN-TAMPA PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 17 -- SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 17 -- SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
GROUP A-FACILITY 18 -- SHRINERS HOSPITAL FOR CHILDREN-N. CALI PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY.
GROUP A-FACILITY 18 -- SHRINERS HOSPITAL FOR CHILDREN-N. CALI PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 3C: SHRINERS HOSPITALS FOR CHILDREN OFFERS SPECIALIZED MEDICAL SERVICES PERTAINING TO ORTHOPAEDIC CONDITIONS, BURNS, SPINAL CORD INJURIES AND CLEFT LIP AND PALATE. UPON PATIENT ADMITTANCE FOR ONE OF THESE CONDITIONS, SHRINERS HOSPITALS FOR CHILDREN REVIEWS THE PATIENT'S "ABILITY TO PAY" USING THE FEDERAL POVERTY GUIDELINES SPECIFIED IN SCHEDULE H, PART I, LINES 3A AND 3B, AND PROVIDES FREE OR DISCOUNTED CARE PURSUANT TO THESE GUIDELINES. NEVERTHELESS, SHRINERS HOSPITALS FOR CHILDREN WILL ALWAYS SERVE THESE SPECIALIZED NEEDS FOR ALL OF ITS PATIENTS, REGARDLESS OF THEIR "ABILITY TO PAY". AS SUCH, SHRINERS HOSPITALS FOR CHILDREN DID NOT APPLY ANY INCOME-BASED CRITERIA, ASSET TEST, OR OTHER MEANS TEST OR THRESHOLD FOR PROVIDING FREE CARE TO PATIENTS IN 2014.
PART I, LINE 7: A GENERAL LEDGER ACCOUNTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7. THE SYSTEM ADDRESSES ALL PATIENT SEGMENTS (INPATIENT AND OUTPATIENT). A COST-TO-CHARGE RATIO IS NOT PART OF THE SYSTEM.
PART III, LINE 4: BAD DEBT EXPENSE IS NOT APPLICABLE TO SHRINERS HOSPITALS FOR CHILDREN, AND AS SUCH, IS NOT PART OF THE FOOTNOTES IN ITS FINANCIAL STATEMENTS. SHRINERS HOSPITALS FOR CHILDREN PROVIDES PATIENT CARE REGARDLESS OF THEIR ABILITY TO PAY. AS SUCH, THERE ARE NO REVENUES AGAINST WHICH A BAD DEBT COULD ARISE.
PART III, LINE 9B: SHRINERS HOSPITALS FOR CHILDREN PROVIDES PATIENT CARE REGARDLESS OF THEIR ABILITY TO PAY. AS SUCH, THERE IS NO DEBT COLLECTION POLICY.
PART VI, LINE 2: SHRINERS HOSPITALS FOR CHILDREN PROVIDES PEDIATRIC, ORTHOPAEDIC, AND BURN CARE REGARDLESS OF THEIR ABILITY TO PAY.
PART VI, LINE 3: SHRINERS HOSPITALS FOR CHILDREN POSTS ITS CHARITY CARE POLICY IN ADMISSION AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT, AND PROVIDES A COPY OF ITS POLICY TO PATIENTS AS PART OF THE INTAKE PROCESS AND WITH DISCHARGE MATERIALS.
PART VI, LINE 4: SHRINERS HOSPITALS FOR CHILDREN (THROUGH THIS ENTITY AND ITS RELATED ENTITY) SERVE CHILDREN IN NEED OF SPECIALIZED ORTHOPAEDIC AND BURN CARE ACROSS THE UNITED STATES AND WORLD-WIDE.
Schedule H (Form 990) 2014
Additional Data


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