SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
Children's Hospital Corporation
 
Employer identification number

04-2774441
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) . . . 		    29,169,390 19,664,814 9,504,576 0.480 %
b Medicaid (from Worksheet 3, column a) . . . . .     422,205,842 276,657,126 145,548,716 7.410 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     451,375,232 296,321,940 155,053,292 7.890 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     5,970,054 283,503 5,686,551 0.290 %
f Health professions education (from Worksheet 5) . . .     40,738,107 6,960,068 33,778,039 1.720 %
g Subsidized health services (from Worksheet 6) . . . .     33,883,903 26,869,789 7,014,114 0.360 %
h Research (from Worksheet 7) .     438,494,402 420,994,923 17,499,479 0.890 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     8,085,405   8,085,405 0.410 %
j Total. Other Benefits . .     527,171,871 455,108,283 72,063,588 3.670 %
k Total. Add lines 7d and 7j .     978,547,103 751,430,223 227,116,880 11.560 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
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 31   1,514,683   1,514,683 0.080 %
4 Environmental improvements            
5 Leadership development and
training for community members		            
6 Coalition building            
7 Community health improvement advocacy 12   753,517   753,517 0.040 %
8 Workforce development            
9 Other            
10 Total 43   2,268,200   2,268,200 0.120 %
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 Healthcare 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
2,761,795
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
0
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
10,246,785
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
10,570,703
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-323,918
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
Yes
 
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

Yes

 
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 %
11 None
  		       
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
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?1Name, 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 Boston Children's Hospital
300 Longwood Avenue
Boston,MA02115
www.childrenshospital.org
MA LICENSE #2139 		X X X X   X X      
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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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)
Boston Children's Hospital
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): 		1
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 19
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  
6 a 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   No
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 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): childrenshospital.org/about-us/community-mission/community-needs-assessment
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" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on 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) 2019
Page 5
Schedule H (Form 990) 2019
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
Boston Children's Hospital
Name of hospital facility or letter of facility reporting group  
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 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
www.childrenshospital.org/financialassistance
b
www.childrenshospital.org/financialassistance
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
Page 6
Part VFacility Information (continued)

Billing and Collections
Boston Children's Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
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 nonpayment?.................................. 17 Yes  
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
f
19 Did the hospital facility or other authorized 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
e
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 19. (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 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
Boston Children's Hospital
Name of hospital facility or letter of facility reporting group  
Yes No
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) 2019
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Schedule H (Form 990) 2019
Page 8
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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
Boston Children's Hospital Part V, Section B, Line 5: Boston Children's 2019 assessment used a participatory, collaborative approach and examined health in its broadest context. The assessment draws on data collected for the larger Boston CHNA that includes data from the Massachusetts Department of Public Health, vital records, and surveillance systems. In addition, a community-wide survey was conducted for the Boston CHNA that engaged over 2,400 residents including 548 parents/caregivers of children 18 or younger and 201 youth under 18. Seven of the 13 focus groups conducted for the Boston CHNA emphasized parent and family experiences, and there was one youth specific focus group. Forty-five key informant interviews were conducted for the Boston CHNA, 18 of which focused on issues related to parents, families, or children in Boston. To understand experiences and needs of those served by Boston Children's satellite locations outside Boston, 11 key informant interviews were conducted with clinic staff such as nurses, social workers, and administrators, as well as staff of community-based partner organizations.
Boston Children's Hospital Part V, Section B, Line 7d: A comprehensive report on Boston Children's CHNA is available on the hospital's website. In addition, a special report on the CHNA was created to share the process, top findings and Boston Children's plan to address community-identified concerns. The special report was distributed by mail and by email to key stakeholders and all external participants involved in the community process. Boston Children's also distributed the report widely to internal staff. The complete assessment and special report can be found on our website at Bostonchildrens.org/community
Boston Children's Hospital Part V, Section B, Line 11: Boston Children's addresses the health and social needs identified in a comprehensive community health assessment process through our clinical care, services and programs and in collaboration with community partners. Below is a summary of the needs identified and Boston Children's efforts. For the complete Community Health and Benefits Plan, visit bostonchildrens.org/community.Behavioral health and issues related to substance abuse- Offering training and education for school and health center staff- Providing education and direct services in schools and community health locations for children and families- Advocating for changes to improve systems of care - Asthma management, education and treatment- Improving health and quality of life outcomes for children with asthma through home visiting and case management services- Developing cost-effective program models that help families to better control asthma- Advocating for changes to improve asthma care Obesity with a focus on healthy eating and access to physical fitnessopportunities- Offering prevention and treatment efforts- Supporting children and families and connecting them to community resources.- Building capacity in community settings to help children improve nutrition and increase physical activity Impact of violence and trauma on children, families and communities- Utilizing clinical expertise to provide prevention, treatment and advocacy services- Supporting efforts to help children and families affected by violenceSupport for early childhood/child development- Building community capacity to identify and help children and families with behavioral health concerns- Supporting efforts to create integrated systems of care for families with children starting at birth- Partnering with community organizations that provide families with support and treatment servicesPrograms and opportunities for youth including workforce development efforts- Continuing support for programming related to youth-identified needs and interests- Working with partners to provide education support and recreation for youthHealth education for children and families- Building upon the health education opportunities currently provided through community programs and services- Coordinating these resources to better meet the need for health education in the communityOther issues that affect the health of children and families such as housing, jobs, food and safety- Supporting, funding and working closely with partners and coalitions working on these issues
Boston Children's Hospital Part V, Section B, Line 15e: The Financial Assistance Policy provides as follows:Patient/Parent will be referred to a Hospital Financial counselor for determination of eligibility for public assistance or Hospital financial assistance programs. For patients not qualifying for public assistance, information collected will be provided to the Director, Financial Clearance and Financial Counseling, for determination of eligibility in the Hospital Financial Assistance Program. Patients who potentially qualify for financial assistance will be approved by the Hospital Chief Financial Officer, Vice President of Patient Financial Services and/or Director, Financial Clearance and Financial Counseling, with consultation and approval of the appropriate Foundation Chief or a designee as appropriate.
Boston Children's Hospital Part V, Section B, Line 16j: Children's takes the following additional steps to make patients aware of the availability of financial assitance:- Posting of signage in all patient care admission areas of the availability of financial assitance,- All billing correspondence includes language regarding the availability of financial assistance,- The Hospital web-site provides contact information for Hospital Financial Counselors who can help assist patients with applying for programs to cover medical expenses.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
Page 9
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?6
Name and address Type of Facility (describe)
1 1 - Boston Children's at Waltham
9 Hope Ave
Waltham,MA02453 		Outpatient Satellite Facility
2 2 - Boston Children's at Lexington
482 Bedford Street
Lexington,MA02173 		Outpatient Satellite Facility
3 3 - Martha Eliot Health Center
75 Bickford Street
Boston,MA02130 		Outpatient Community Health Center
4 4 - Boston Children's at Peabody
1 Essex Center Drive
Peabody,MA01960 		Outpatient Satellite Facility
5 5 - Boston Children's at North Dartmouth
500 Faunce Corner Road
North Dartmouth,MA02747 		Outpatient Satellite Facility
6 6 - Boston Children's at 333 Longwood Ave
333 Longwood Avenue
Boston,MA02115 		Outpatient Pediatric Clinic
7
8
9
10
Schedule H (Form 990) 2019
Page 10
Schedule H (Form 990) 2019
Page 10
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: Children's, based on its participation in the state of Massachusetts Health Safety Net, utilizes Federal Poverty Guidelines for determining eligibility for free care and discounted care to low income individuals. For purposes of discounted care, Children's offers discounts to individuals, regardless of income, who are uninsured and are ineligible for free care or other public programs.
Part I, Line 7: Children's used an internal cost accounting system for purposes of reporting certain amounts on Part I, line 7. The system is designed to address all segments of patient care (inpatient, outpatient and emergency) and assigns costs to patients from all payer sources (Medicaid, Medicare, managed care, commercial, uninsured and self-pay). The cost of charity care was determined based on the overall relationship of hospital costs as a percentage of hospital charges, applied to charges that qualified as charity care.Children's provides charity care to all children in need who meet the hospital's charity care standards, which are in alignment with all state mandated regulations. Nearly 30% of children who receive their care at Children's are insured through Medicaid programs in a number of states including Massachusetts. In aggregate, Medicaid programs do not reimburse the hospital for the total costs of providing care to these children. Children's has a strong commitment to improving the health status of the children in our local community. Based on a tri-annual community needs assessment, Children's supports a variety of programs and partners both internal and external that are addressing the needs of Boston children. Children's has also identified four major health focus areas in which it concentrates its efforts. For children in Boston, asthma, mental health, obesity and child development are major concerns. Children's has community based programs in each of these issue areas. The hospital alsohas an Office of Child Advocacy that provides support to these programs.Children's is a leader in education and training for healthcare professionals.Children's subsidizes services that are either limited or unavailable in the broader community. Examples include psychiatry, primary care, and dental care.Recognizing that Children's does not have the capacity to meet all the needs of the children of Boston, it supports through financial contributions and in kind services) a large number of community based organizations who are providing these important services. Beneficiaries range from full service community health centers to Head Start programs for pre-school children.For more information, visit www.childrenshospital.org/community.
Part I, Line 7g: Children's does not subsidize physician services; thus there are none reported in the dollar amount for subsidized health services.
Part I, Ln 7 Col(f): The total bad debt expense of $23,877,752 is included in Form 990, Part IX, line 25 column (A), but subtracted for purposes of calculating the percentage in this column.
Part I, Line 6a Children's files an annual community benefits report with the Attorney General's Office (AG) in Massachusetts. There are significant differences between the AG and IRS requirements for reporting community benefits expenditures. The IRS counts the following as community benefits while the AG does not: Medicaid shortfalls, indirect costs, health professions education, and research funded by tax-exempt and government sources. Children's AG Report is publicly available and can be accessed directly on the AG's web site, www.mass.gov/AG and Children's web site, www.childrenshospital.org.
Part II, Community Building Activities: In FY20, Children's reported two types of community building activities: $1,514,683 for 31 community support programs and $753,517 for community health improvement advocacy. Children's community building activities are designed specifically to address health disparities and improve the health of children, families and communities. According to public health literature (see Ambulatory Pediatrics and Health Affairs), initiatives that address disparities for children across four different levels: the individual, systemic, community and society can lead to meaningful improvements in health.As described in Form 990, Part III Program Service Accomplishments, Children's takes a multi-pronged approach to tackle the most pressing health issues facing Boston children. At the same time, Children's addresses non-health or social determinants of health issues such as violence, workforce development and education, which also impact a child's health. Therefore, Children's directs its community building activities in the following areas:- Children's public policy advocacy efforts help to improve access to health care for all individuals and ensure high-quality pediatric services.- As a major employer in Massachusetts and civic leader in Boston, Children's supports efforts to ensure a diverse and culturally competent health care workforce as well as promotes economic health in thesurrounding communities. - To improve life in local neighborhoods, Children's has targeted support towards community based organizations that do not focus specifically on health, but rather on the vibrancy of the community. Contributions to groups such as the Fenway Community Development Corporation and Sociedad Latina are as important as partnerships with community health centers. For more information, visit http://www.childrenshospital.org/about-us/community-mission.
Part III, Line 2: Bad debt expense reflects patient charges that have been deemed uncollectible, converted to cost based on the ratio of patient care cost to charges from Worksheet 2.
Part III, Line 3: There is not any amount of bad debt reflected as charity care, because it can't be quantified accurately at this time. However, some bad debts would be charity care.
Part III, Line 4: Children's Medical Center and Subsidiaries' Audited Financial Statements does not contain any footnotes describing bad debt.
Part III, Line 8: Medicare allowable costs are obtained directly from the Medicare Cost Report and are determined in accordance with Medicare principles of reimbursement.
Part III, Line 9b: Children's makes reasonable and diligent efforts to collect each patient's insurance and other information and to verify coverage for health care services. Children's applies collection actions to all patients in the same manner, irrespective of their insurance status. Children's does not (and does not permit its agents to) engage in collection action of any kind, including billing, with respect to patients/guarantors that are exempt from collection action under Children's Credit and Collection Policy and under Massachusetts regulations governing the Health Safety Net program. All patients/guarantors who are not exempt from collection action are advised in all billing-related communications of the availability of free care and financial assistance, including assistance in applying for public programs and the availability of charity care. Children's does not (and does not permit its agents to) engage in legal action against patients/guarantors, including liens, wage garnishments, or lawsuits, or report patients/guarantors to credit bureaus or credit agencies without specific, case-by-case authorization by Children's Board of Directors. No legal action occurred during the year. Children's Credit and Collection Policy is filed with the Massachusetts Division of Health Care Finance and Policy. That policy and related policies are also available to patients upon request and on the Hospital's website.
Part VI, Line 2: Boston Children's assesses the community needs on an ongoing basis through continuous dialogue with the community, participation on committees, working groups, and task forces, as well as input from Community Advisory Board and partners.For more information, visit www.childrenshospital.org/community-health/community-health-needs
Part VI, Line 3: Children's provides patients with information about financial assistance programs that are available through the Commonwealth of Massachusetts or through the hospital's own financial assistance program.For those patients that request financial assistance, Children's assists patients by screening them for eligibility in an available public program and assisting them in applying for the program. All patients/guarantors who are not exempt from collection action are advised in all billing-related communications of the availability of free care and financial assistance, including assistance in applying for public programs and the availability of charity care. The screening and application process for a financial assistance programs is done through either the Virtual Gateway (which is an internet portal designed by the Massachusetts Executive Office of Health and Human Services to provide an online application for the programs offered by the state) or through a standard paper application. All Virtual Gateway and paper applications are reviewed and processed by the Massachusetts Office of Medicaid. Hospitals have no role in the determination of program eligibility made by the state, but at the patient's request may take a direct role in appealing or seeking information related to the coverage decisions.
Part VI, Line 4: Boston Children's conducted a community health needs assessment to ensure that it was addressing the most pressing health concerns across Boston and its four priority neighborhoods- Roxbury, Mission Hill, Fenway and Jamaica Plain.FINDINGS:The residents of Boston Children's priority neighborhoods are ethnically and linguistically diverse, with wide variations in socioeconomic levels. Minority and low-income residents are disproportionately affected by the social and economic context in which they live. Demographic Characteristics: Residents and stakeholders commented on the variety of cultures represented in the communities served by Boston Children's. Quantitative data illustrate that racial and ethnic diversity varies across Boston Children's priority neighborhoods and citywide. While the majority of residents in Roxbury/Mission Hill self-identify as Black (60.9%), Fenway and Jamaica Plain have a larger proportion of White residents (70.2% and 62.0%, respectively) compared to the city (53.9%). Poverty, Income, and Employment: Economic data demonstrate that among the priority neighborhoods, a greater proportion of families in Roxbury/Mission Hill (31.0%) were living in poverty compared to families citywide (16.0%). Additionally, nearly half of female headed households with children under five years of age in Boston were living in poverty (46.7%).Education: Quantitative data show that educational attainment across the priority neighborhoods ranges from 71.0% of Fenway residents with abachelor's degree or higher to 25.0% of Roxbury/Mission Hill adults. Additionally, Black and Hispanic students graduate at lower rates than their White and Asian counterparts.Housing: Housing concerns disproportionately affect renters, who represent the majority in Boston; 42.4% of renters in Boston contribute 35% or more of their income to housing costs. Neighborhood Crime and Perceptions of Safety: Quantitative data validate residents' concerns; between January and June 2013, Boston Children's priority neighborhoods collectively accounted for approximately 40% of thetotal crimes reported citywide during this time period, the majority of which were classified as larceny or attempted larceny. Furthermore, over half of all homicides occurred in Roxbury/Mission Hill.There are 4 hospitals and 7 community health centers serving our priority neighborhoods. There are 22 Census Tracks that fall under 2 different MUA/P areas that are within the Boston Children's Hospital priority areas. Massachusetts has a low rate of uninsured children.0-5 years 1.1% uninsured - 35.9% on Medicaid6-18 years 1.5% uninsured - 30.6% on Medicaid19-25 yrs-7% uninsured - 18.9% on Medicaid
Part VI, Line 5: As the only free-standing children's hospital in the state, Children's treats 90% of the sickest kids in Massachusetts and offers a range of services that are unavailable elsewhere in the region, including pediatric transplants, critical care transport services, a level 1 Pediatric Trauma Unit and a level 3 Neonatal Intensive Care Unit. Children's also qualifies for DSH payments as the state's largest provider of pediatric care to low-income families. Approximately 30% of its patients are covered by Medicaid, including patients insured by out-of-state Medicaid programs. In addition, Children's has an open medical staff model.Children's is also a leader in education and training for healthcare professionals. It sponsors 38 Accreditation Council for Graduate Medical Education-accredited training programs, one American Dental Association accredited training program and 15 non-accredited subspecialty fellowships with 512 residents/clinical fellows enrolled in these programs. Children's partners with 27 schools of nursing throughout Massachusetts and New England to provide clinical experiences in pediatrics.Children's offers a variety of continuing education courses designed for health care professionals in pediatric practice. The courses are accredited by the Office of Continuing Education at Harvard Medical School and each hour of instruction is approved for Category 1 credits towards the AMA Physician's Recognition Award. Topics include autism, eating disorders, sports injuries, endometriosis, substance abuse, concussions, strabismus, Type II Diabetes and vascular anomalies. Children's also offers half-day programs titled Pediatric Health Care Summits that are held at local hospitals, such as Beverly Hospital, Lawrence General and South Shore Hospital (Weymouth). Additionally, Children's partners with area community hospitals such as Good Samaritan Medical Center, Holy Family, Lawrence General, South Shore, St. Anne's and St. Joseph's to sponsor Community Hospital Pediatrics Grand Rounds with monthly lectures provided by faculty in medical and surgical sub-specialties.Children's also operates "Career Opportunity Advancement Children's Hospital", a seven-week program for Boston youth to explore health care careers while having a safe and meaningful summer and the program "Student Career Opportunity Outreach Program", designed by Children's nurses to introduce young people to nursing career opportunities.Children's is home to the world's largest and most active research enterprise at a pediatric center. Children's research mission encompasses basic research, clinical research, community service programs and the postdoctoral training of new scientists.Children's has a twenty-one person voluntary Board of Directors. Eighteen of the Board members are not direct employees of the hospital and all of them live in the hospital's service area. The Board oversees the Hospital's endowment and follows a 4% spending rule in keeping with the industry standard of the responsible management of assets. Reserves are invested back into patient care, teaching, research, patient safety andquality initiatives, equipment, facilities, community benefits and to subsidize vital services that run a deficit.
Part VI, Line 6: Although Children's does not have true affiliates as defined by the IRS, it does have other affiliations.As the largest pediatric referral center in the region, Children's maintains a variety of relationships with community hospitals and other smaller pediatric programs throughout New England. These relationships include seven community hospitals in eastern Massachusetts where Children's physicians have formal arrangements to provide on-site emergency medicine, inpatient, neonatal and/or outpatient pediatric specialty services. Children's also owns and operates five outpatient facilities in Waltham, Lexington, Peabody, North Dartmouth and Jamaica Plain that offer access to pediatric specialty care in a wide array of subspecialties. Children's provides assistance to other pediatric facilities (Hasbro, RI, Dartmouth Hitchcock, NH, and Boston Medical Center) in the region through training, recruitment, consultations, on-site care and referrals for care that is not otherwise available.In addition, the Pediatric Physicians Organization at Children's brings together pediatricians, pediatric medical groups and pediatric specialists at Children's.
Part VI, Line 7, Reports Filed With States MA
501(r) Reporting under IRS Revenue Procedure 2015-21 In June 2020, outside counsel reviewed the processes and procedures implemented by Boston Children's Hospital (BCH) in connection with its Financial Assistance Policy, Credit & Collection Policy, Plain Language Summary and Community Health Needs Assessment, to determine compliance with 501(r) requirements. As a result of these reviews, a number of apparent omissions, errors and other failures to meet requirements, as described below, were discovered. BCH promptly took steps to correct these omissions, errors and failures, as described below. Processes and procedures were also put in place to ensure that these omissions, errors and failures do not recur. Financial Assistance Policy ("FAP"): Publicizing FAP and Related Documents:Plain Language Summary While BCH has historically posted the plain language summary of its FAP on its public website, it has not consistently offered to patients a copy of the plain language summary as part of the intake or discharge process. As of July 18, 2020, the plain language summary has been offered during the discharge process for patients treated in the Emergency Department. As of October 1, 2020, the plain language summary has also been offered as part of the intake process by hospital based clinics, and offering of the plain language summary has been incorporated into the pre-admissions and admissions intake processes. A prompt in Epic to offer the plain language summary appears in Epic during the intake process for outpatient visits, inpatient admissions, and day surgery and during the discharge process for patients who presented in the ED and for inpatients who were not offered the plain language summary during the intake process.BCH is not aware of any individuals affected by this error and believes there were no individuals adversely affected because any individual applying for financial assistance or expressing concern regarding ability to pay for care was provided with financial counseling and made aware of the availability of financial assistance and the process for applying for financial assistance. In addition, the plain language summary is and has been available on BCH's public website. Website Address on Billing StatementWhile BCH has historically included a conspicuous written notice on its billing statements of the telephone number for its financial counseling office, which includes staff who are available to help identify financial assistance available, BCH had not included on its billing statements the direct website address where copies of the Financial Assistance Policy (FAP), FAP Application form and plain language summary could be accessed. BCH added the direct website address to billing statements as of July 20, 2020. BCH does not believe that any individuals have been adversely affected as result of this oversight, since the contact information of the department able to provide information about the FAP and able to assist with the FAP application process was provided on the billing statements. Updating the billing statement addressed the failure to comply with these requirements, so no additional practices or procedures were necessary to minimize the likelihood of such failures recurring. This omission would have impacted all patients who received billing statements prior to July 20, 2020, when the error was corrected. It is not reasonably feasible for BCH to restore individuals to the position they would have been in had this information not been omitted, as this would require sending billing statements to all individuals who received them prior to correction of the error, which would likely cause confusion for individuals who have settled their bills with BCH. Translations of FAP and Related Documents While BCH had provided translations of its FAP, FAP application form and plain language summary for ten (10) limited English proficiency groups, based on an update of its analysis of the limited English proficiency groups in the community served by BCH and the population likely to be affected or encountered by BCH, BCH needed to make available translations of these documents in three additional languages: Russian, Italian and Somali. BCH made available translations of these documents in Somali as of June 20, 2020, and in Russian and Italian as of August 4, 2020. BCH is unaware of any individuals being adversely affected as a result of this omission and believes there were no individuals adversely affected because BCH provides any individual with limited English proficiency access to an interpreter to assist in any financial assistance matters. In addition, BCH has implemented a process to (a) review data related to limited English proficiency groups annually; (b) update the list of languages into which the FAP, FAP Application form and plain language summary need to be translated; (c) obtain translations needed in any additional languages; and (d) make those translations available to our patients and their families. It is not reasonably feasible for BCH to restore individuals to the position they would have been in had the failure not occurred. This would require identifying all patients who accessed these documents and who might have needed translations of these documents in one of these three additional languages, which is likely not possible. Provider ListBCH discovered in May, 2020 that, while BCH has historically posted its FAP provider list, the provider list had not been updated at least every 90 days. BCH updated its provider list on May 20, 2020, and has implemented a process to ensure that it is updated at least quarterly thereafter. BCH is not aware of any individuals being adversely affected as a result of this error.BCH has assigned to a supervisor and a manager the responsibility to update the provider list on a quarterly basis. These staff members will review a report generated by BCH's Credentialing and Enrollment department, which includes all providers who have been granted medical staff privileges by BCH. If BCH has added any new practices or providers that/who were not on the provider list posted, the revised provider list will be sent for translation and the revised provider list, along with all required translations will be posted on BCH's external website. It is not reasonably feasible for BCH to restore individuals to the position they would have been in had the failure not occurred. This would require identifying all patients who accessed the provider list, and providing the updated list to those patients, which would include many who are not in active treatment and may cause confusion. Methodology for Calculating AGB:While BCH had posted and otherwise made available a methodology for calculating amounts generally billed ("AGB"), BCH had in practice used a different methodology to calculate the AGB applied to bills of individuals eligible for financial assistance. The methodology used was more favorable (i.e., the discount applied was greater than the discount that would have been applied using the posted AGB methodology). BCH updated the AGB methodology to reflect the methodology it uses to calculate AGB, and posted and otherwise made available the updated methodology on May 20, 2020. Following the close of each fiscal year (which usually occurs by the end of each calendar year), BCH's Finance and Reimbursement department will gather the information necessary to calculate the AGB, and calculate AGB. Patient Financial Services will make any changes to the AGB document required, based on such annual calculation. The updated AGB will then be posted on BCH's external website. BCH does not believe any individual was adversely affected by this error, as the methodology used was favorable to patients. Therefore, BCH has not attempted to restore individuals to the position they would have been in had the failure not occurred.
Schedule H (Form 990) 2019
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