TY 2015 Form 990 Schedule O

efile Public Visual Render ObjectId: 201730739349300503 - Submission: 2017-03-14 TIN: 13-1739922

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

BLYTHEDALE CHILDREN'S HOSPITAL

Employer identification number

13-1739922

Return Reference	Explanation
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.

Return Reference

Explanation

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.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

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