Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2010 and ending 12-31-2010
BCheck if applicable:
CName of organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
150 NEW PROVIDENCE ROAD
 
Room/suite
City or town, state or country, and ZIP + 4
MOUNTAINSIDE, NJ07092
D Employer identification number

22-1487148
E Telephone number

G Gross receipts $ 107,272,456
F Name and address of principal officer:
AMY B MANSUE
150 NEW PROVIDENCE ROAD
MOUNTAINSIDE,NJ07092
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.childrens-specialized.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1893
M State of legal domicile: NJ
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: TO BE THE PREEMINENT PROVIDER OF SPECIALIZED HEALTHCARE SERVICES FOR INFANTS, CHILDREN AND YOUNG ADULTS.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 26
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 22
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 1,478
6 Total number of volunteers (estimate if necessary) .... 6 414
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 4,944,483 7,385,914
9 Program service revenue (Part VIII, line 2g) ......... 97,351,091 98,463,142
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 1,133,981 178,696
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 742,250 487,339
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 104,171,805 106,515,091
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 70,439,535 71,691,175
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 33,481,707 34,440,852
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 103,921,242 106,132,027
19 Revenue less expenses. Subtract line 18 from line 12...... 250,563 383,064
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 161,794,386 159,003,635
21 Total liabilities (Part X, line 26)............ 80,430,830 76,682,916
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 81,363,556 82,320,719
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signature
Big Right Arrow
Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4
Big Right Arrow




EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: TO BE THE PREEMINENT PROVIDER OF SPECIALIZED HEALTHCARE SERVICES FOR INFANTS, CHILDREN AND YOUNG ADULTS. THE ORGANIZATION PROVIDES MEDICALLY NECESSARY PEDIATRIC HEALTHCARE SERVICES TO ALL CHILDREN IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 35,072,000 including grants of $ 0 ) (Revenue $ 37,845,000 )
EXPENSES INCURRED IN PROVIDING INPATIENT REHABILITATION SERVICES TO ALL CHILDREN IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. THE ORGANIZATION TREATED 478 CHILDREN FOR INPATIENT REHABILITATION FOR A TOTAL OF 365 PATIENT DAYS IN 2010. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.
4b (Code:   ) (Expenses $ 18,680,000 including grants of $ 0 ) (Revenue $ 19,457,000 )
EXPENSES INCURRED IN PROVIDING LONG TERM CARE SERVICES TO ALL CHILDREN IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. THE ORGANIZATION TREATED 87 CHILDREN FOR LONG TERM CARE FOR A TOTAL OF 365 PATIENT DAYS IN 2010. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.
4c (Code:   ) (Expenses $ 9,011,000 including grants of $ 0 ) (Revenue $ 8,032,000 )
EXPENSES INCURRED IN PROVIDING EARLY INTERVENTION PROGRAM SERVICES TO ALL CHILDREN IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. THE ORGANIZATION TREATED 3,550 CHILDREN FOR EARLY INTERVENTION FOR A TOTAL OF 250 PATIENT DAYS IN 2010. PLEASE REFER TO SCHEDULE OF FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.
4d Other program services. (Describe in Schedule O.)
(Expenses $ 4,914,077 including grants of $ 0 ) (Revenue $ 33,129,142 )
4e Total program service expensesMediumBullet$ 67,677,077
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II
Click to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part I
Click to see attachment
.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IV
Click to see attachment
...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
Yes
 
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. .....
20b
 
No
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II
........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV
................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
 
No
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
113
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,478
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletBD
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
26
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
22
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
NJ
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
JOSEPH J DOBOSH JR
150 NEW PROVIDENCE ROAD
MOUNTAINSIDE,NJ07092
(908) 301-5455
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (describe hours for related organizations in Schedule O)
(C)
Position (check all that apply)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) DAVID KOSTINAS
CHAIRMAN - TRUSTEE
3.0 X   X       0 0 0
(2) SISTER JANE FRANCES BRADY
1ST VICE CHAIR - TRUSTEE
3.0 X   X       0 0 0
(3) ROBIN A WALTON
TREASURER - TRUSTEE
3.0 X   X       0 0 0
(4) KISHAN AGARWAL MD
TRUSTEE
3.0 X           0 0 0
(5) BONNIE BALOGA ALTIERI MSN RN
TRUSTEE
3.0 X           0 0 0
(6) FRANK CASTELLO MD
TRUSTEE - MEDICAL DIRECTOR
55.0 X           89,277 0 0
(7) SCOTT CHESNEY
TRUSTEE
3.0 X           0 0 0
(8) TERRANCE FARLEY
TRUSTEE
3.0 X           0 0 0
(9) LAWRENCE GARINELLO
TRUSTEE
3.0 X           0 226,447 17,495
(10) SAVERIO GARRUTO CPA
TRUSTEE
3.0 X           0 0 0
(11) ALEXANDER R GIAQUINTO PHD
TRUSTEE
3.0 X           0 0 0
(12) ELIZABETH HANCE
TRUSTEE
3.0 X           0 0 0
(13) NANCY JACKSON
TRUSTEE
3.0 X           0 0 0
(14) AMY B MANSUE
TRUSTEE - PRESIDENT/CEO
52.0 X   X       549,754 0 127,268
(15) PETER W METZ
TRUSTEE
3.0 X           0 0 0
(16) NANCI D MORRIS
TRUSTEE
3.0 X           0 0 0
(17) GLENN MORTIMER
TRUSTEE
3.0 X           0 0 0
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (describe hours for related organizations in Schedule O)
(C)
Position (check all that apply)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) MARGARET M PEGO
TRUSTEE
3.0 X           0 0 0
(19) STEVEN M ROSENBERG ESQ
TRUSTEE
3.0 X           0 0 0
(20) BARBARA ROTHMAN
TRUSTEE
3.0 X           0 0 0
(21) PHILIP SALERNO
TRUSTEE - PRES/CDO FOUNDATION
3.0 X   X       360,348 0 34,308
(22) VINCENT SERPICO
TRUSTEE
3.0 X           0 0 0
(23) ARVIND SHAH MD
TRUSTEE
3.0 X           0 0 0
(24) GAIL SLOAN
TRUSTEE
3.0 X           0 0 0
(25) VICTORIA WICKS
TRUSTEE
3.0 X           0 0 0
(26) PATRICIA WHITLEY WILLIAMS MD
TRUSTEE
3.0 X           0 0 0
(27) WARREN E MOORE
EVP/COO
55.0     X       466,607 0 72,139
(28) JOSEPH J DOBOSH JR
SENIOR VP/CFO
52.0     X       553,139 0 89,993
(29) KAREN M DEWITT EDD
VP PATIENT CARE
55.0     X       385,501 0 49,463
(30) WILLIAM DWYER
VP HUMAN RESOURCES
55.0     X       356,902 0 43,796
(31) MICHAEL R DRIBBON PHD
VP REHAB SERVICES & PROG. DEV.
55.0     X       286,439 0 54,947
(32) UDAY MEHTA MD
ASSOCIATE MEDICAL DIRECTOR
55.0         X   264,063 0 30,956
(33) MARTIN DIAMOND MD
DIRECTOR; O/P SERVICES
55.0         X   262,128 0 28,824
(34) KRISHAN YALAMANCHI MD
DIRECTOR; BRAIN INJURY
55.0         X   223,051 0 33,295
(35) YVETTE JANVIER MD
DIRECTOR; MEDICAL SERVICES
55.0         X   207,423 0 10,179
(36) THOMAS A RUGINO MD
PHYSIATRIST
55.0         X   191,415 0 38,315
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 4,196,047 226,447 630,978
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet91
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
QUALCARE INC
30 KNIGHTSBRIDGE ROAD
PISCATAWAY,NJ08854
CLAIMS ADMIN. 580,014
MICHAEL REISZ AND COMPANY INC
871 KING GEORGES ROAD
FORDS,NJ08863
CONSTRUCTION 458,823
WM BLANCHARD COMPANY
199 MOUNTAIN AVENUE
SPRINGFIELD,NJ07081
CONSTRUCTION 433,241
ON TIME TRANSPORT INC
111 EAST HIGHLAND PARKWAY
ROSELLE,NJ07203
PATIENT TRANSPORT. 299,967
HEALTHCARE SERVICE GROUP
3220 TILLMAN DRIVE SUITE 300
BENSALEM,PA19020
CLEANING 233,913
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet14
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 4,708,799
e Government grants (contributions)1e 2,412,166
f All other contributions, gifts, grants, and
similar amounts not included above
1f
264,949
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 7,385,914
 Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 541,900 97,409,694 97,409,694    
b OTHER HEALTHCARE RELATED REVENUE 541,900 1,053,448 1,053,448    
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 98,463,142
 Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 91,107     91,107
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 28,620  
b Less: rental expenses    
c Rental income or (loss) 28,620  
d Net rental income or (loss).......MediumBullet 28,620     28,620
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 844,954  
b Less: cost or other basis and sales expenses 757,365  
c Gain or (loss) 87,589  
d Net gain or (loss)..........MediumBullet 87,589     87,589
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CAFETERIA & DIETARY REVENUE 722,210 458,719     458,719
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 458,719
12 Total revenue. See Instructions....MediumBullet 106,515,091 98,463,142 0 666,035
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 3,519,881 0 3,519,881 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 55,484,838 45,400,089 10,084,749  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 1,186,363 925,363 261,000  
9 Other employee benefits ....... 6,860,856 5,666,081 1,194,775  
10 Payroll taxes ........... 4,639,237 3,618,605 1,020,632  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 107,206   107,206  
c Accounting ........... 0      
d Lobbying ........... 95,321   95,321  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 4,701,051 2,125,597 2,575,454  
12 Advertising and promotion .... 85,429 3,337 82,092  
13 Office expenses ....... 5,918,296 3,685,099 2,233,197  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 5,307,823 342,367 4,965,456  
17 Travel ............ 414,905 315,414 99,491  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 151,625 132,327 19,298  
20 Interest ........... 2,333,916   2,333,916  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 7,325,320   7,325,320  
23 Insurance .............. 651,666   651,666  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a PROVISION FOR BAD DEBTS, NET 4,391,132 4,391,132 0 0
b SOFTWARE MAINTENANCE 1,261,330 0 1,261,330 0
c CONTRACTED SERVICES 679,955 474,041 205,914 0
d OTHER EXPENSES 1,015,877 597,625 418,252 0
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 106,132,027 67,677,077 38,454,950 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation
       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year
(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 2,869,918 1 640,410
2 Savings and temporary cash investments ....... 6,820,161 2 10,205,929
3 Pledges and grants receivable, net ......... 2,453,823 3 2,101,537
4 Accounts receivable, net ......... 19,322,462 4 18,241,123
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net ............. 3,864,556 7 5,529,198
8 Inventories for sale or use .............. 435,118 8 418,240
9 Prepaid expenses and deferred charges ............ 3,319,527 9 3,587,821
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 140,689,245
b Less: accumulated depreciation. ..... 10b 54,917,270 88,433,719 10c 85,771,975
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 .. 26,979,868 13 25,432,033
14 Intangible assets ......... 1,180,421 14 1,131,724
15 Other assets. See Part IV, line 11 ........... 6,114,813 15 5,943,645
16 Total assets. Add lines 1 through 15 (must equal line 34)... 161,794,386 16 159,003,635
Liabilities 17 Accounts payable and accrued expenses . 16,631,994 17 16,857,309
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities .......... 51,491,088 20 48,347,432
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 5,749,730 23 4,911,949
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 6,558,018 25 6,566,226
26 Total liabilities. Add lines 17 through 25..... 80,430,830 26 76,682,916
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 60,134,793 27 62,560,251
28 Temporarily restricted net assets ..... 14,916,433 28 13,357,366
29 Permanently restricted net assets ..... 6,312,330 29 6,403,102
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 81,363,556 33 82,320,719
34 Total liabilities and net assets/fund balances ..... 161,794,386 34 159,003,635
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
106,515,091
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
106,132,027
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
383,064
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
81,363,556
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
574,099
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
82,320,719
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization
(ii)
EIN
(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv)
Is the organization in col. (i) listed in your governing document?
(v)
Did you notify the organization in col. (i) of your support?
(vi)
Is the organization in col. (i) organized in the U.S.?
(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Part I
Contributors (see Instructions)
     
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Aggregate contributions
(d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b)
Purpose of gift
(c)
Use of gift
(d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
Organization's
Totals
(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in)
(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e))
         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))
         
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
90,000
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
Yes
 
5,321
i
Other activities? If "Yes," describe in Part IV ..........................
 
No
 
j
Total. lines 1c through 1i ...................................
95,321
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
LOBBYING ACTIVITY EXPLANATION SCHEDULE C, PART II-B; LINES 1G AND 1H CHILDREN'S SPECIALIZED HOSPITAL IS A MEMBER OF THE ROBERT WOOD JOHNSON HEALTH CARE CORPORATION HEALTH SYSTEM ("SYSTEM").CHILDREN'S SPECIALIZED HOSPITAL PAID ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL, A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION, $90,000 FOR ITS PORTION OF THE LOBBYING EXPENSES INCURRED BY THE SYSTEM. ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL PAID AN OUTSIDE INDEPENDENT LOBBYING FIRM TO PROVIDE LOBBYING EFFORTS ON BEHALF OF ALL AFFILIATES WITHIN THE SYSTEM. THE ORGANIZATION IS A MEMBER OF THE NEW JERSEY HOSPITAL ASSOCIATION, THE AMERICAN HOSPITAL ASSOCIATION, NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND THE NEW JERSEY STATE CHAMBER OF COMMERCE WHICH ALL ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS HAS BEEN ALLOCATED TO LOBBYING ACTIVITES PERFORMED ON BEHALF OF THE ORGANIZATION. THIS ALLOCATION AMOUNTED TO $5,321 IN 2010.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 9,145,933 7,904,460 9,312,477
b Contributions ........ 90,772 173,425 174,322
c Investment earnings or losses ... 873,763 1,559,846 -1,562,339
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........
1,745,945 491,798 20,000
f Administrative expenses ....      
g End of year balance ...... 8,364,523 9,145,933 7,904,460
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet76.550 %
c
Term endowment: SchDMd Bullet23.450 %
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   156,400 156,400
b Buildings ................   67,081,801 19,996,092 47,085,709
c Leasehold improvements ............        
d Equipment ................   69,819,996 33,592,685 36,227,311
e Other .................   3,631,048 1,328,493 2,302,555
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 85,771,975
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)
(b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) LIMITED USE 3,451,361 F
(2) LIMITED USE 423,686 F
(3) LIMITED USE 693,980 F
(4) FOUNDATION, INC. 16,779,699 F
(5) EQUIVALENTS; LIMITED USE 407,976 F
(6) EQUIVALENTS; LIMITED USE 3,562,035 F
(7) LIMITED USE 113,296 F


Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet 25,432,033
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
OTHER LIABILITIES 1,717,000
CURRENT 288,360
NON-CURRENT 4,560,866






Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 6,566,226
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 106,515,091
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 106,132,027
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 383,064
4 Net unrealized gains (losses) on investments .......................... 4 317,394
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8 256,705
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 574,099
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 957,163
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 106,832,485
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 317,394
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e 317,394
3 Subtract line 2e from line 1..................... 3 106,515,091
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 106,515,091
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 106,132,027
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3 106,132,027
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 106,132,027
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
ENDOWMENT FUNDS SCHEDULE D, PART V; QUESTION 4 ENDOWMENT FUNDS ARE TO BE USED CONSISTENT WITH INTENT AND IN FURTHERANCE OF THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES.
TEXT OF FIN 48 AUDITED FINANCIAL STATEMENT FOOTNOTE SCHEDULE D, PART X THE ORGANIZATION ENGAGED AN INDEPENDENT BIG FOUR CPA FIRM TO ISSUE AUDITED FINANCIAL STATEMENTS. OUTLINED BELOW IS THE TEXT OF THE FIN 48 DISCLOSURE FOOTNOTE FROM THE ORGANIZATION'S 2010 AUDITED FINANCIAL STATEMENTS: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS EXEMPT FORM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTIONS 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE INCOME TAXES. THE HOSPITAL RECOGNIZES INCOME TAX POSITIONS WHEN IT IS MORE-LIKELY-THAN-NOT THAT THE POSITION WILL BE SUSTAINABLE BASED ON THE MERITS OF THE POSITION. MANAGEMENT HAS CONCLUDED THAT THERE ARE NO MATERIAL TAX LIABILITIES THAT NEED TO BE RECORDED.
RECON. OF CHANGE IN NET ASSETS FROM 990 TO AUDITED FINANCIAL STATEMENTS SCHEDULE D, PART XI; LINE 8 OTHER CHANGES IN FUND BALANCE INCLUDE: - CHANGE IN INTEREST IN RESTRICTED NET ASSETS OF FOUNDATION - $3,460,136 - NET ASSETS RELEASED FROM RESTRICTIONS - ($3,203,431)
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE F
(Form 990)

Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,
Part IV, line 14b, 15, or 16.
Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance? ...................................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside the
United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region
(f) Total
expenditures for region/investments
in region
Central America and the Caribbean 1 1 Program Services FINANCIAL VEHICLE 317,470
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 1 1 317,470
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 1 1 317,470
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)
(c) Region (d) Purpose of
grant
(e) Amount of
cash grant
(f) Manner of
cash
disbursement
(g) Amount of
of non-cash
assistance
(h) Description
of non-cash
assistance
(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant
(e) Manner of cash
disbursement
(f) Amount of
non-cash
assistance
(g) Description
of non-cash
assistance
(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 5
Part V
Supplemental Information
Complete this part to provide the information (see instructions) required in Part I, line 2, and any additional information.
Identifier ReturnReference Explanation
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2010
Additional Data


Software ID:  
Software Version:  



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 See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care 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 discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Does the organization prepare an annual community benefit report?.............
6a
Yes
 
6b
If "Yes," does 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
Charity Care and Certain Other Community Benefits at Cost
Charity Care 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 Charity care at cost (from
Worksheets 1 and 2) ..
  828 674,266 0 674,266 0.660 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) .
           
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs .....
  828 674,266 0 674,266 0.660 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) ....
38 35,416 674,568 0 674,568 0.660 %
f Health professions education
(from Worksheet 5) ..
16 8,204 353,265 0 353,265 0.350 %
g Subsidized health services
(from Worksheet 6) ..
           
h Research (from Worksheet 7)            
i Cash and in-kind contributions
to community groups
(from Worksheet 8) ..
2 2,567 957,039 0 957,039 0.940 %
jTotal Other Benefits ... 56 46,187 1,984,872 0 1,984,872 1.950 %
kTotal. Add lines 7d and 7j. .. 56 47,015 2,659,138 0 2,659,138 2.610 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(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 1 78 397 0 397 0 %
4 Environmental improvements            
5 Leadership development and training for community members 1 250 307,124 0 307,124 0.300 %
6 Coalition building            
7 Community health improvement advocacy 1 0 54,024 0 54,024 0.050 %
8 Workforce development            
9 Other            
10 Total 3 328 361,545 0 361,545 0.350 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
4,391,131
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
0
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
0
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
0
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
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
 
No
Part IV
Management Companies and Joint Ventures
(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) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 PSE&G CHILDREN'S SPECIALIZED HOSPITAL
200 SOMERSET STREET
NEW BRUNSWICK,NJ08901
X   X            
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:PSE&G CHILDREN'S SPECIALIZED HOSPITAL
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires 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?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and 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?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?9
Name and address Type of Facility (Describe)
1 CHILDREN'S SPECIALIZED HOSPITAL
150 NEW PROVIDENCE ROAD
MOUNTAINSIDE,NJ07092
LONG-TERM CARE AND OUTPATIENT CENTER
2 CHILDREN'S SPECIALIZED HOSPITAL
150 NEW PROVIDENCE ROAD
MOUNTAINSIDE,NJ07092
LONG-TERM CARE AND OUTPATIENT CENTER
3 CHILDREN'S SPECIALIZED HOSPITAL
150 NEW PROVIDENCE ROAD
MOUNTAINSIDE,NJ07092
LONG-TERM CARE AND OUTPATIENT CENTER
4 CHILDREN'S SPECIALIZED HOSPITAL
150 NEW PROVIDENCE ROAD
MOUNTAINSIDE,NJ07092
LONG-TERM CARE AND OUTPATIENT CENTER
5 CHILDREN'S SPECIALIZED HOSPITAL
150 NEW PROVIDENCE ROAD
MOUNTAINSIDE,NJ07092
LONG-TERM CARE AND OUTPATIENT CENTER
6 CHILDREN'S SPECIALIZED HOSPITAL
150 NEW PROVIDENCE ROAD
MOUNTAINSIDE,NJ07092
LONG-TERM CARE AND OUTPATIENT CENTER
7 CHILDREN'S SPECIALIZED HOSPITAL
150 NEW PROVIDENCE ROAD
MOUNTAINSIDE,NJ07092
LONG-TERM CARE AND OUTPATIENT CENTER
8 CHILDREN'S SPECIALIZED HOSPITAL
150 NEW PROVIDENCE ROAD
MOUNTAINSIDE,NJ07092
LONG-TERM CARE AND OUTPATIENT CENTER
9 CHILDREN'S SPECIALIZED HOSPITAL
150 NEW PROVIDENCE ROAD
MOUNTAINSIDE,NJ07092
LONG-TERM CARE AND OUTPATIENT CENTER
10
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments 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.
Identifier ReturnReference Explanation
ELIGIBILITY FOR DISCOUNTED CARE PART I, LINE 3C THE INCOME BASED CRITERIA USED TO DETERMINE ELIGIBILITY IS PER NEW JERSEY ADMINISTRATIVE CODE 10:52 SUB CHAPTERS 11, 12 AND 13, AND BASED UPON THE 2010 FEDERAL POVERTY GUIDELINES ("FPG")(DEPARTMENT OF HEALTH AND SENIOR SERVICES) ADJUSTED TO 300% OF THE INCOME PROVERTY GUIDELINE. FPG ARE INCLUDED IN THE CRITERIA FOR DETERMINING ELIGIBILITY FOR CHARITY AND DISCOUNTED CARE.
COMMUNITY BENEFIT REPORT SCHEDULE H, PART I; QUESTION 6A NOT APPLICABLE.
SUBSIDIZED HEALTH SERVICES SCHEDULE H, PART I; QUESTION 7G NO COSTS RELATING TO SUBSIDIZED HEALTHCARE SERVICES ARE ATTRIBUTABLE TO ANY PHYSICIAN CLINICS.
PERCENT OF TOTAL EXPENSE SCHEDULE H, PART I; QUESTION 7 COLUMN (F) THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $4,391,132.
CHARITY CARE AND CERTIAN OTHER COMMUNITY BENEFIT COST SCHEDULE H, PART I, QUESTION 7 WORKSHEET 2 WAS USED FOR THE COST TO CHARGE RATIO.
BAD DEBT EXPENSE SCHEDULE H, PART III, SECTION A; QUESTION 4 BAD DEBT EXPENSE WAS CALCULATED USING THE PROVIDERS' BAD DEBT EXPENSE FROM FINANCIAL STATEMENT, NET OF ACCOUNTS WRITTEN OFF AT CHARGES. THE ORGANIZATION ISSUE AUDITED FINANCIAL STATEMENTS. THE ORGANIZAITON'S ALLOWANCE FOR DOUBTFUL ACCOUNTS (BAD DEBT EXPENSE) METHODOLOGY AND CHARITY CARE POLICIES ARE CONSISTENTLY APPLIED. BELOW DESCRIBES IT IN MORE DETAIL: PATIENT ACCOUNTS RECEIVABLE PATIENT ACCOUNTS RECEIVABLE ARE RECORDED AT THE REIMBURSED OR CONTRACTED AMOUNTS AND DO NOT BEAR INTEREST. THE CORPORATION GRANTS CREDIT TO PATIENTS AND GENERALLY DOES NOT REQUIRE COLLATERAL OR OTHER SECURITY. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS THE HOSPITAL'S BEST ESTIMATE OF PROBABLE CREDIT LOSSES IN THE HOSPITAL'S EXISTING PATIENT ACCOUNTS RECEIVABLE. THE HOSPITAL DETERMINES THE ALLOWANCE BASED ON HISTORICAL COLLECTION EXPERIENCE. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED. CHARITY CARE THE CORPORATION PROVIDES HEALTHCARE SERVICES TO PATIENTS WHO MEET CERTAIN CRITERIA DEFINED BY THE NEW JERSEY DEPARTMENT OF HEALTH AND SENIOR SERVICES WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE CORPORATION MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE AMOUNT OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THE AMOUNT OF CHARITY CARE PROVIDED DURING THE YEAR ENDED DECEMBER 31, 2009, BASED ON THE CORPORATION'S ESTABLISHED CHARGES, WAS APPROXIMATELY $560,286.
COMMUNITY BENEFIT SCHEDULE H, PART III, SECTION B; QUESTION 8 BAD DEBT IS COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THE ORGANIZATION FEELS THAT BAD DEBT SHOULD BE A COMMUNITY BENEFIT AND ASSOCIATED COSTS SHOULD BE INCLUDED ON THE FORM 990, SCHEDULE H, PART I. AS OUTLINED MORE FULLY BELOW THE ORGANIZATION BELIEVES THAT THESE SERVICES AND RELATED COSTS PROMOTE THE HEALTH OF THE COMMUNITY AS A WHOLE AND ARE RENDERED IN CONJUNCTION WITH THE ORGANIZATION'S CHARITABLE TAX-EXEMPT PURPOSES AND MISSION IN PROVIDING MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL INDIVIDUAL'S IN A NON-DISCRIMINATORY MANNER WITHOUT REGARD TO RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY AND CONSISTENT WITH THE COMMUNITY BENEFIT STANDARD PROMULGATED BY THE IRS. THE COMMUNITY BENEFIT STANDARD IS THE CURRENT STANDARD FOR A HOSPITAL FOR RECOGNITION AS A TAX-EXEMPT AND CHARITABLE ORGANIZATION UNDER INTERNAL REVENUE CODE ("IRC") 501(C)(3). THE ORGANIZATION IS RECOGNIZED AS A TAX-EXEMPT ENTITY AND CHARITABLE ORGANIZATION UNDER 501(C)(3) OF THE IRC. ALTHOUGH THERE IS NO DEFINITION IN THE TAX CODE FOR THE TERM "CHARITABLE" A REGULATION PROMULGATED BY THE DEPARTMENT OF THE TREASURY PROVIDES SOME GUIDANCE AND STATES THAT "[T]HE TERM CHARITABLE IS USED IN SECTION 501(C)(3) IN ITS GENERALLY ACCEPTED LEGAL SENSE," AND PROVIDES EXAMPLES OF CHARITABLE PURPOSES, INCLUDING THE RELIEF OF THE POOR OR UNPRIVILEGED; THE PROMOTION OF SOCIAL WELFARE; AND THE ADVANCEMENT OF EDUCATION, RELIGION, AND SCIENCE. NOTE IT DOES NOT EXPLICITLY ADDRESS THE ACTIVITIES OF HOSPITALS. IN THE ABSENCE OF EXPLICIT STATUTORY OR REGULATORY REQUIREMENTS APPLYING THE TERM "CHARITABLE" TO HOSPITALS, IT HAS BEEN LEFT TO THE IRS TO DETERMINE THE CRITERIA HOSPITALS MUST MEET TO QUALIFY AS IRC 501(C)(3) CHARITABLE ORGANIZATIONS. THE ORIGINAL STANDARD WAS KNOWN AS THE CHARITY CARE STANDARD. THIS STANDARD WAS REPLACED BY THE IRS WITH THE COMMUNITY BENEFIT STANDARD WHICH IS THE CURRENT STANDARD. CHARITY CARE STANDARD IN 1956, THE IRS ISSUED REVENUE RULING 56-185, WHICH ADDRESSED THE REQUIREMENTS HOSPITALS NEEDED TO MEET IN ORDER TO QUALIFY FOR IRC 501(C)(3) STATUS. ONE OF THESE REQUIREMENTS IS KNOWN AS THE "CHARITY CARE STANDARD." UNDER THE STANDARD, A HOSPITAL HAD TO PROVIDE, TO THE EXTENT OF ITS FINANCIAL ABILITY, FREE OR REDUCED-COST CARE TO PATIENTS UNABLE TO PAY FOR IT. A HOSPITAL THAT EXPECTED FULL PAYMENT DID NOT, ACCORDING TO THE RULING, PROVIDE CHARITY CARE BASED ON THE FACT THAT SOME PATIENTS ULTIMATELY FAILED TO PAY. THE RULING EMPHASIZED THAT A LOW LEVEL OF CHARITY CARE DID NOT NECESSARILY MEAN THAT A HOSPITAL HAD FAILED TO MEET THE REQUIREMENT SINCE THAT LEVEL COULD REFLECT ITS FINANCIAL ABILITY TO PROVIDE SUCH CARE. THE RULING ALSO NOTED THAT PUBLICLY SUPPORTED COMMUNITY HOSPITALS WOULD NORMALLY QUALIFY AS CHARITABLE ORGANIZATIONS BECAUSE THEY SERVE THE ENTIRE COMMUNITY AND A LOW LEVEL OF CHARITY CARE WOULD NOT AFFECT A HOSPITAL'S EXEMPT STATUS IF IT WAS DUE TO THE SURROUNDING COMMUNITY'S LACK OF CHARITABLE DEMANDS. COMMUNITY BENEFIT STANDARD IN 1969, THE IRS ISSUED REVENUE RULING 69-545, WHICH "REMOVE[D]" FROM REVENUE RULING 56-185 "THE REQUIREMENTS RELATING TO CARING FOR PATIENTS WITHOUT CHARGE OR AT RATES BELOW COST." UNDER THE STANDARD DEVELOPED IN REVENUE RULING 69-545, WHICH IS KNOWN AS THE "COMMUNITY BENEFIT STANDARD," HOSPITALS ARE JUDGED ON WHETHER THEY PROMOTE THE HEALTH OF A BROAD CLASS OF INDIVIDUALS IN THE COMMUNITY. THE RULING INVOLVED A HOSPITAL THAT ONLY ADMITTED INDIVIDUALS WHO COULD PAY FOR THE SERVICES (BY THEMSELVES, PRIVATE INSURANCE, OR PUBLIC PROGRAMS SUCH AS MEDICARE), BUT OPERATED A FULL-TIME EMERGENCY ROOM THAT WAS OPEN TO EVERYONE. THE IRS RULED THAT THE HOSPITAL QUALIFIED AS A CHARITABLE ORGANIZATION BECAUSE IT PROMOTED THE HEALTH OF PEOPLE IN ITS COMMUNITY. THE IRS REASONED THAT BECAUSE THE PROMOTION OF HEALTH WAS A CHARITABLE PURPOSE ACCORDING TO THE GENERAL LAW OF CHARITY, IT FELL WITHIN THE "GENERALLY ACCEPTED LEGAL SENSE" OF THE TERM "CHARITABLE," AS REQUIRED BY TREAS. REG. 1.501(C)(3)-1(D)(2). THE IRS RULING STATED THAT THE PROMOTION OF HEALTH, LIKE THE RELIEF OF POVERTY AND THE ADVANCEMENT OF EDUCATION AND RELIGION, IS ONE OF THE PURPOSES IN THE GENERAL LAW OF CHARITY THAT IS DEEMED BENEFICIAL TO THE COMMUNITY AS A WHOLE EVEN THOUGH THE CLASS OF BENEFICIARIES ELIGIBLE TO RECEIVE A DIRECT BENEFIT FROM ITS ACTIVITIES DOES NOT INCLUDE ALL MEMBERS OF THE COMMUNITY, SUCH AS INDIGENT MEMBERS OF THE COMMUNITY, PROVIDED THAT THE CLASS IS NOT SO SMALL THAT ITS RELIEF IS NOT OF BENEFIT TO THE COMMUNITY. THE IRS CONCLUDED THAT THE HOSPITAL WAS "PROMOTING THE HEALTH OF A CLASS OF PERSONS THAT IS BROAD ENOUGH TO BENEFIT THE COMMUNITY" BECAUSE ITS EMERGENCY ROOM WAS OPEN TO ALL AND IT PROVIDED CARE TO EVERYONE WHO COULD PAY, WHETHER DIRECTLY OR THROUGH THIRD-PARTY REIMBURSEMENT. OTHER CHARACTERISTICS OF THE HOSPITAL THAT THE IRS HIGHLIGHTED INCLUDED THE FOLLOWING: ITS SURPLUS FUNDS WERE USED TO IMPROVE PATIENT CARE, EXPAND HOSPITAL FACILITIES, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH; IT WAS CONTROLLED BY A BOARD OF TRUSTEES THAT CONSISTED OF INDEPENDENT CIVIC LEADERS; AND HOSPITAL MEDICAL STAFF PRIVILEGES WERE AVAILABLE TO ALL QUALIFIED PHYSICIANS. BAD DEBT IS COMMUNITY BENEFIT AND ASSOCIATED COSTS ARE INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THE AMERICAN HOSPITAL ASSOCIATION ("AHA") FEELS THAT MEDICARE UNDERPAYMENTS (SHORTFALL) AND BAD DEBT ARE COMMUNITY BENEFIT AND THUS INCLUDABLE ON THE FORM 990, SCHEDULE H, PART I. THIS ORGANIZATION AGREES WITH THE AHA POSITION THAT BAD DEBT SHOULD BE COMMUNITY BENEFIT. AS OUTLINED IN THE AHA LETTER TO THE IRS DATED AUGUST 21, 2007 WITH RESPECT TO THE FIRST PUBLISHED DRAFT OF THE NEW FORM 990 AND SCHEDULE H, THE AHA FELT THAT THE IRS SHOULD INCORPORATE THE FULL VALUE OF THE COMMUNITY BENEFIT THAT HOSPITALS PROVIDE BY COUNTING BAD DEBT AS QUANTIFIABLE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: - A SIGNIFICANT MAJORITY OF BAD DEBT IS ATTRIBUTABLE TO LOW-INCOME PATIENTS, WHO, FOR MANY REASONS, DECLINE TO COMPLETE THE FORMS REQUIRED TO ESTABLISH ELIGIBILITY FOR HOSPITALS' CHARITY CARE OR FINANCIAL ASSISTANCE PROGRAMS. A 2006 CONGRESSIONAL BUDGET OFFICE ("CBO") REPORT, NONPROFIT HOSPITALS AND THE PROVISION OF COMMUNITY BENEFITS, CITED TWO STUDIES INDICATING THAT "THE GREAT MAJORITY OF BAD DEBT WAS ATTRIBUTABLE TO PATIENTS WITH INCOMES BELOW 200% OF THE FEDERAL POVERTY LINE." - THE REPORT ALSO NOTED THAT A SUBSTANTIAL PORTION OF BAD DEBT IS PENDING CHARITY CARE. UNLIKE BAD DEBT IN OTHER INDUSTRIES, HOSPITAL BAD DEBT IS COMPLICATED BY THE FACT THAT HOSPITALS FOLLOW THEIR MISSION TO THE COMMUNITY AND TREAT EVERY PATIENT THAT COMES THROUGH THEIR EMERGENCY DEPARTMENT, REGARDLESS OF ABILITY TO PAY. PATIENTS WHO HAVE OUTSTANDING BILLS ARE NOT TURNED AWAY, UNLIKE OTHER INDUSTRIES. BAD DEBT IS FURTHER COMPLICATED BY THE AUDITING INDUSTRY'S STANDARDS ON REPORTING CHARITY CARE. MANY PATIENTS CANNOT OR DO NOT PROVIDE THE NECESSARY, EXTENSIVE DOCUMENTATION REQUIRED TO BE DEEMED CHARITY CARE BY AUDITORS. AS A RESULT, ROUGHLY 40% OF BAD DEBT IS PENDING CHARITY CARE. - THE CBO CONCLUDED THAT ITS FINDINGS "SUPPORT THE VALIDITY OF THE USE OF UNCOMPENSATED CARE [BAD DEBT AND CHARITY CARE] AS A MEASURE OF COMMUNITY BENEFITS" ASSUMING THE FINDINGS ARE GENERALIZABLE NATIONWIDE; THE EXPERIENCE OF HOSPITALS AROUND THE NATION REINFORCES THAT THEY ARE GENERALIZABLE. AS OUTLINED BY THE AHA, DESPITE THE HOSPITALS' BEST EFFORTS AND DUE DILIGENCE, PATIENT BAD DEBT IS A PART OF THE HOSPITAL'S MISSION AND CHARITABLE PURPOSES. BAD DEBT REPRESENTS PART OF THE BURDEN HOSPITALS SHOULDER IN SERVING ALL PATIENTS REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. IN ADDITION, THE HOSPITAL INVESTS SIGNIFICANT RESOURCES IN SYSTEMS AND STAFF TRAINING TO ASSIST PATIENTS THAT ARE IN NEED OF FINANCIAL ASSISTANCE.
COLLECTION POLICY SCHEDULE H, PART III, SECTION B; QUESTION 9B ACCOUNTS CONSIDERED TO BE CHARITY CARE ARE NOT INCLUDED IN THE BAD DEBT EXPENSE, BUT RATHER, ACCOUNTED FOR AS AN ALLOWANCE AGAINST REVENUE. IT IS THE POLICY CHILDREN'S SPECIALIZED HOSPITAL TO TREAT ALL PATIENTS EQUALLY REGARDLESS OF INSURANCE AND THEIR ABILITY TO PAY. FOR ACCOUNTS DETERMINED TO BE 'SELF-PAY" AND/OR ACCOUNTS WITH BALANCE AFTER PRIMARY INSURANCE PAYMENTS, THE COLLECTION POLICY REQUIRES: SENDING THREE STATEMENTS, A MINIMUM OF ONE PRE-COLLECTION LETTER, TELEPHONE CONTACT FOR ANY ACCOUNT OVER THE POLICY LIMIT OR AT THE DISCRETION OF THE ACCOUNT REPRESENTATIVE AND/OR SUPERVISOR. THE FACILITY ALSO HAS A CHARITY CARE POLICY TO ASSURE PATIENTS ARE PROVIDED WITH CHARITY CARE ASSISTANCE DETERMINED BY STATE AND FEDERAL REGULATIONS. IT IS THE POLICY TO INFORM ALL PATIENTS DEEMED SELF-PAY OF THE APPROPRIATE ASSISTANCE PROGRAMS AVAILABLE. PATIENTS APPLYING FOR CHARITY CARE ASSISTANCE WILL BE FINANCIALLY SCREENED BY A RESOURCE ADVISOR TO DETERMINE ELIGIBILITY ACCORDING TO STATE AND FEDERAL GUIDELINES AND WILL BE INFORMED OF DOCUMENTATION NEEDED TO COMPLETE A CHARITY CARE APPLICATION. PATIENTS NOT ELIGIBLE FOR CHARITY CARE WILL BE FINANCIALLY COUNSELED FOR ALL OTHER OPTIONS. QUALIFIED PATIENTS WILL BE REFERRED TO ALL APPROPRIATE AGENCIES OR PROGRAMS TO MEET OTHER FINANCIAL NEEDS. AT THE TIME OF THE PATIENT VISIT AND PART OF THE REGISTRATION PROCESS AT THE FACILITY, THE FOLLOWING OPTIONS ARE MADE AVAILABLE TO PATIENTS: - FINANCIAL COUNSELING FOR POSSIBLE ELIGIBILITY FOR MEDICAL ASSISTANCE INCLUDING MEDICAID AND SSI; - FINANCIAL COUNSELING FOR POSSIBLE ELIGIBILITY FOR CHILDRENS SPECIALIZED HOSPITAL CARE PAYMENT ASSISTANCE PROGRAM; AND, - FINANCIAL ARRANGEMENTS INCLUDING: 1. CASH/CREDIT CARD (AMERICAN EXPRESS, DISCOVER, VISA, MASTERCARD), OR 2. FLEXIBLE PAYMENT PLANS. IN ADDITION TO THE ABOVE OPTIONS, THE FACILITY HAS ESTABLISHED A SELF-PAY ASSISTANCE PROGRAM FOR OUR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR MEDICAID OR HOSPITAL'S ASSISTANCE PROGRAM. THE SELF-PAY ASSISTANCE PROGRAM RATES ARE REFLECTIVE OF MEDICAID REIMBURSEMENT.
FACILITY INFORMATION SCHEDULE H, PART V NOT APPLICABLE.
NEEDS ASSESSMENT SCHEDULE H, PART VI; QUESTION 1 THIS ORGANIZATION CONDUCTS A REVIEW OF KEY FACTOR INFORMATION ANNUALLY WHICH INCLUDES: A REVIEW OF HEALTHCARE UTILIZATION OF ITS SERVICE AREA POPULATION BY SERVICES (UROLOGY, CARDIOLOGY, OBSTETRICS, ETC.) FOR DETERMINING INCREASED OR DECREASED HEALTH NEEDS; HEALTHCARE SERVICE ESTIMATES AND FORECASTS (BOTH INPATIENT AND OUTPATIENT); ASSESSMENTS OF LOCAL DEMOGRAPHIC AND SOCIOECONOMIC INFORMATION; AND, A REVIEW OF HEALTH STATUS/NEEDS ASSESSMENTS AND STUDIES CONDUCTED BY EXTERNAL PARTIES (HEALTH RESEARCH AND EDUCATION TRUST OF NEW JERSEY, KID'S COUNT, ETC.). THIS ORGANIZATION CONDUCTS AN EXTENSIVE SERVICE AREA POPULATION PHYSICIAN NEED STUDY (BY PRIMARY AND SPECIALTY) EVERY THREE TO FIVE YEARS. SPECIFIC SPECIALTY NEEDS ARE CONDUCTED FOR IDENTIFIED GAPS IN SERVICE. THESE REVIEWS INFORM MEDICAL STAFF DEVELOPMENT AT THE MEDICAL CENTER TO ASSURE RESPONSIVENESS TO IDENTIFIED COMMUNITY NEEDS. IN ADDITION, THIS ORGANIZATION WORKS WITH LOCAL PROVIDERS TO PLAN AND DISCUSS HEALTH NEEDS OF THE POPULATION.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI; QUESTION 3 CHARITY CARE SIGNS ARE POSTED THROUGHOUT THE FACILITY, MAINLY IN PATIENT REGISTRATION AREAS. SIGNS ARE POSTED IN BOTH ENGLISH AND SPANISH. ALL PATIENTS DEEMED SELF PAY ARE SCREENED FOR FINANCIAL ASSISTANCE BY A RESOURCE ADVISOR ACCORDING TO THE FEDERAL POVERTY GUIDELINES AND REFERRED TO APPROPRIATE AGENCIES OR PROGRAMS.
COMMUNITY INFORMATION SCHEDULE H, PART VI; QUESTION 4 THIS ORGANIZATION IS IN A DIVERSE SUBURBAN LOCATION SERVING DIVERSE COMMUNITIES RANGING FROM INNER CITY COMMUNITIES TO MORE AFFLUENT SUBURBAN AREAS THROUGHOUT THE STATE OF NEW JERSEY. CHILDREN'S HAS NINE LOCATIONS THROUGHOUT THE STATE AND IS COMMITTED TO SERVICE ALL OF ITS COMMUNITIES AND SERVES BOTH INNER CITY AND SUBURBAN AREAS. ABOUT 60% OF ITS INPATIENTS ARE OF MINORITY RACE/ETHNICITY. IN ADDITION, APPROXIMATELY 8% OF ITS PATIENTS ARE OF UNDERINSURED AND UNINSURED PAYER CATEGORIES.
PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI; QUESTION 5 COMMUNITY BUILDING ACTIVITIES UNDERTAKEN BY CHILDRENS SPECIALIZED HOSPITAL IMPROVES THE MEDICAL AND SOCIOECONOMIC WELL-BEING OF THE COMMUNITIES IN OUR CARE. THIS IS ACCOMPLISHED THROUGH SERVICE ON STATE AND REGIONAL ADVOCACY COMMITTEES AND BOARDS, VOLUNTEERISM WITH LOCAL COMMUNITY-BASED NON-PROFIT ADVOCACY GROUPS, AND PARTICIPATION IN CONFERENCES AND OTHER EDUCATIONAL ACTIVITIES TO PROMOTE UNDERSTANDING OF THE ROOT CAUSES OF HEALTH CONCERNS. THIS ORGANIZATION PROVIDES EDUCATIONAL MATERIALS, CONDUCTS COMMUNITY HEALTH FAIRS AND HOLDS HEALTH EDUCATION SEMINARS AND OUTREACH SESSIONS FOR ITS PATIENTS AND FOR COMMUNITY PROVIDERS. PRESENTATIONS ARE PROVIDED BY PHYSICIANS, NURSES AND OTHER HEALTH CARE PROFESSIONALS. CHILDRENS SPECIALIZED HOSPITAL PLANS TO HOLD AN ANNUAL BOARD MEETING OPEN TO THE PUBLIC. THE MAJORITY OF THE BOARD OF TRUSTEES ARE INDIVIDUALS WITH LOCAL BUSINESSES OR WHOM RESIDE IN THE COMMUNITY. HOSPITAL STAFF MEMBERS SERVE ON THE BOARDS OF MANY LOCAL NOT-FOR-PROFIT ORGANIZATIONS AND PROVIDE OTHER FORMS OF SUPPORT (FUNDRAISING, ACTIVITY PARTICIPATION). ALL QUALIFIED PHYSICIANS ARE EXTENDED PRIVILEGES BY THE MEDICAL STAFF OFFICE CREDENTIALING COMMITTEE. UNDER THE DIRECTIVE OF THE ORGANIZATION'S CORPORATE FINANCE OFFICE, SURPLUS FUNDS ARE UTILIZED FOR CAPITAL PROJECTS TO IMPROVE SERVICES OR PURCHASE EQUIPMENT WHICH IN TURN, BENEFIT THE COMMUNITY. PLEASE ALSO REFER TO FORM 990, SCHEDULE O, WHICH CONTAINS THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT AND SUMMARY OF ALL ENTITIES WHICH COMPRISE CHILDRENS SPECIALIZED HOSPITAL.
AFFILIATED HEALTHCARE SYSTEM SCHEDULE H, PART VI; QUESTION 6 THIS ORGANIZATION IS AN AFFILIATE OF THE ROBERT WOOD JOHNSON HEALTH SYSTEM. ALL AFFILIATES ARE COMMITTED TO ENHANCING THE OVERALL HEALTH STATUS OF THE COMMUNITY BY PROVIDING THE HIGHEST QUALITY HEALTHCARE AND RELATED SERVICES. THE ROBERT WOOD JOHNSON HEALTH SYSTEM STRIVES TO EXCEED THE PATIENTS' EXPECTATIONS EMPHASIZING COMMITMENT, COMPETENCE, COLLABORATION, COMMUNICATION, AND COMPASSION. THIS ORGANIZATION SETS OVERALL POLICY REGARDING BILLING AND COLLECTIONS AND THE FACILITY RESPONSES PROVIDED BELOW FOR PART I, LINE 3C; PART I, LINE 6A; PART I, LINE 7G; PART I, LINE 7, COLUMN (F); PART I, LINE 7; PART III, LINE 4; PART III, LINE 8; PART III, LINE 9B ARE REFLECTED OF THAT POLICY. OUTLINED BELOW IS A SUMMARY OF THE ENTITIES WHICH COMPRISE THE ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL NETWORK AND AFFILIATES. Not for Profit Robert Wood Johnson University Hospital Network Entities RWJ Health Care Corporation RWJ Health Care Corporation ("RWJHCC") is the tax-exempt parent of the Robert Wood Johnson University Hospital Network ("Network"). This integrated health care delivery system consists of a group of affiliated health care organizations. The sole member or stockholder of each entity is either RWJHCC or another Network affiliate controlled by RWJCC. Network is an integrated network of healthcare providers throughout the State of New Jersey. RWJ Health Care Corporation is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a supporting organization pursuant to Internal Revenue Code 509(a)(3). RWJ Health Care Corporation strives to continually develop and operate a multi-hospital health care system which provides substantial community benefit through the provision of a comprehensive spectrum of health care services to the residents of New Jersey and surrounding communities. RWJ Health Care Corporation ensures that its system provides medically necessary health care services to all individuals regardless of race, color, creed, sex, national origins or ability to pay. No individuals are denied necessary medical care, treatment or services. Robert Wood Johnson University Hospital Network active hospitals include: Children's Specialized Hospital, Robert Wood Johnson University Hospital, Robert Wood Johnson University Hospital at Hamilton and Robert Wood Johnson University Hospital at Rahway. Each of these hospitals operates consistently with the following criteria outlined in IRS Revenue Ruling 69-545: 1. Each provide medically necessary healthcare services to all individuals regardless of ability to pay, including charity care, self- pay, Medicare and Medicaid patients; 2. Each operate an active emergency room for all persons; which is open 24 hours a day, 7 days a week, 365 days per year; 3. Each maintain an open medical staff, with privileges available to all qualified physicians; and 4. Control of each rests with its board of trustees and the board of trustees of RWJ Health Care Corporation. Both boards are comprised of independent civic leaders and other prominent members of the community. 5. Surplus funds are used to improve the quality of patient care, expand and renovate facilities and advance medical care; programs and activities. Children's Specialized Hospital Children's Specialized Hospital ("CSH") is a 214-bed licensed comprehensive pediatric rehabilitation hospital and pediatric long-term care facility WITH LOCATIONS IN NEW BRUNSWICK, Mountainside AND TOMS RIVER New Jersey. CSH is recognized by the Internal Revenue Service as an internal revenue code section 501(c)(3) tax-exempt organization. Pursuant to its charitable purposes, CSH provides medically necessary health care services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin or ability to pay. Moreover, CSH operates consistently with the criteria outlined in IRS Revenue Ruling 69-545 Robert Wood Johnson University Hospital Robert Wood Johnson University Hospital ("RWJUH") is a 610-bed non-profit academic medical center located in New Brunswick, Middlesex County, New Jersey. RWJUH is recognized by the Internal Revenue Service as an internal revenue code section 501(c)(3) tax-exempt organization. Pursuant to its charitable purposes, RWJUH provides medically necessary health care services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin or ability to pay. Moreover, RWJUH operates consistently with the criteria outlined in IRS Revenue Ruling 69-545 Robert Wood Johnson University Hospital at Hamilton Robert Wood Johnson University Hospital at Hamilton ("RWJUHH") is a 280-bed non-profit acute care medical center located in Hamilton, Mercer County, New Jersey. RWJUHH is recognized by the Internal Revenue Service as an internal revenue code section 501(c)(3) tax-exempt organization. Pursuant to its charitable purposes, RWJUHH provides medically necessary health care services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin or ability to pay. Moreover, RWJUHH operates consistently with the criteria outlined in IRS Revenue Ruling 69-545 Robert Wood Johnson University Hospital at Rahway Robert Wood Johnson University Hospital at Rahway ("RWJUHR") is a 265-bed non-profit acute care medical center located in Rahway, Union County, New Jersey. RWJUHR is recognized by the Internal Revenue Service as an internal revenue code section 501(c)(3) tax-exempt organization. Pursuant to its charitable purposes, RWJUHR provides medically necessary health care services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin or ability to pay. Moreover, RWJUHR operates consistently with the criteria outlined in IRS Revenue Ruling 69-545 Auxiliary of Robert Wood Johnson University Hospital Auxiliary of Robert Wood Johnson University Hospital is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(2). The organization is a supporting organization of Robert Wood Johnson University HOSPITAL; a related Internal Revenue Code 501(c)(3) tax-exempt organization, that provides medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. Children's Specialized Hospital Foundation Children's Specialized Hospital Foundation is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(1). Through fundraising activities the organization supports the charitable purposes, programs and services of Children's Specialized Hospital; a related Internal Revenue Code 501(c)(3) tax-exempt organization, that provides medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. Lakeview Child Care Center, Inc. Lakeview Child Care Center, Inc. is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(2). The organization provides high-quality care operating under the Montessori method and philosophy for the employees of Robert Wood Johnson university Hospital at Hamilton and to the general public. In addition, the center has a drop off program and baby-sitting program used by parents who must go to the hospital for outpatient procedures. Robert Wood Johnson University Hospital at Hamilton Foundation, Inc. Robert Wood Johnson University Hospital at Hamilton Foundation, Inc. is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(1). Through fundraising activities the organization supports the charitable purposes, programs and services of Robert Wood Johnson University Hospital at Hamilton; a related Internal Revenue Code 501(c)(3) tax-exempt organization, that provides medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. Robert Wood Johnson Health Care Corporation at Hamilton Robert Wood Johnson Health Care Corporation at Hamilton is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). The organization is the parent organization of a tax-exempt not for-profit integrated healthcare delivery system in New Jersey which includes Robert W
AFFILIATED HEALTHCARE SYSTEM CONTINUED SCHEDULE H, PART VI; QUESTION 6 Robert Wood Johnson University Hospital at Rahway Auxiliary Robert Wood Johnson University Hospital at Rahway Auxiliary is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). The organization is a supporting organization of Robert Wood Johnson University Hospital at Rahway; a related Internal Revenue Code 501(c)(3) tax-exempt organization, that provides medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. Robert Wood Johnson University Hospital at Rahway Foundation, Inc. Robert Wood Johnson University Hospital at Rahway Foundation, Inc. is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). Through fundraising activities the organization supports the charitable purposes, programs and services of Robert Wood Johnson University Hospital at Rahway; a related Internal Revenue Code 501(c)(3) tax-exempt organization, that provides medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. New Brunswick Affiliated Hospitals, Inc. New Brunswick Affiliated Hospital, Inc.. is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). The organization supports the charitable purposes, programs and services of Robert Wood Johnson University Hospital, Inc.; a related Internal Revenue Code 501(c)(3) tax-exempt organization, that provides medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay Robert Wood Johnson Property Holding Corporation Robert Wood Johnson Property Holding Corporation is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). The organization is a supporting organization of Robert Wood Johnson University Hospital; a related Internal Revenue Code 501(c)(3) tax-exempt organization, that provides medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay, and is primarily responsible for the management and operation of rental space for various affiliates of the Robert Wood Johnson University Hospital Network. Robert Wood Johnson University Hospital Foundation, Inc. Robert Wood Johnson University Hospital Foundation, Inc. is an organization recognized by the Internal Revenue Service as tax-exempt pursuant to Internal Revenue Code 501(c)(3) and as a non-private foundation pursuant to Internal Revenue Code 509(a)(3). Through fundraising activities the organization supports the charitable purposes, programs and services of Robert Wood Johnson University Hospital; a related Internal Revenue Code 501(c)(3) tax-exempt organization, that provides medically necessary healthcare services to all individuals in a non-discriminatory manner regardless of race, color, creed, sex, national origin, religion or ability to pay. For Profit Robert Wood Johnson University Hospital Network Entities Hamilton O/B GYN, P.A. A for-profit entity whose sole shareholder is RWJUHH. The organization is located in Hamilton, Mercer County, New Jersey. The organization provides medical services to individuals. RWJ Diabetes & Endocrinology A for-profit entity whose sole shareholder is RWJUHH. The organization is located in Hamilton, Mercer County, New Jersey. The organization provides medical services to individuals. RWJ Medical Associates at Hamilton A for-profit entity whose sole shareholder is RWJUHH. The organization is located in Hamilton, Mercer County, New Jersey. The organization provides medical services to individuals. RWJ Medical Associates A for-profit entity whose sole shareholder is RWJUH. The organization is located in New Brunswick, Middlesex County, New Jersey. The organization provides medical services to individuals. RWJ Medical Services Organization at Hamilton A for-profit entity whose sole shareholder is Robert Wood Johnson Health Care Corporation at Hamilton. The organization is located in Hamilton, Mercer County, New Jersey. This entity derives income from the receipt of rental income. RWJ Health Network, Inc. A for-profit entity whose sole shareholder is Robert Wood Johnson Health Care Corporation. The organization is located in New Brunswick, Middlesex County, New Jersey. This entity derives income from the operation of a health care system. RWJ Kidney Transplant Association A for-profit entity whose sole shareholder is Robert Wood Johnson University Hospital. The organization is located in New Brunswick, Middlesex County, New Jersey. This entity provides medical services to individuals. RWJ Mutli-Specialty, P.A. A for-profit entity whose sole shareholder is Robert Wood University Hospital. The organization is located in New Brunswick, Middlesex County, New Jersey. This entity provides medical services to individuals. RWJ Surgery Center, Inc. A for-profit entity whose sole shareholder is Robert Wood Health Care Corporation. The organization is located in New Brunswick, Middlesex County, New Jersey. This entity provides surgery services to individuals. System and Affiliate Members, LTD. A controlled foreign corporation by Robert Wood Johnson Health Care Corporation. The organization was formed and operates solely in Bermuda. Vision Healthcare, Inc. A for-profit entity whose sole shareholder is Robert Wood Johnson University Hospital at Rahway. The organization is located in Rahway, Union County, New Jersey. This entity provides investment services to Robert Wood Johnson University Hospital at Rahway.
STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI; QUESTION 7 NOT APPLICABLE. THE ENTITY AND RELATED PROVIDER ORGANIZATIONS ARE LOCATED IN NEW JERSEY. THE STATE OF NEW JERSEY DOES NOT REQUIRE HOSPITALS TO ANNUALLY FILE A COMMUNITY BENEFIT REPORT WITH THE STATE OF NEW JERSEY.
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) LAWRENCE GARINELLO (i)
(ii)
0
194,321
0
29,117
0
3,009
0
7,752
0
9,743
0
243,942
0
0
(2) AMY B MANSUE (i)
(ii)
395,943
0
119,167
0
34,644
0
117,391
0
9,877
0
677,022
0
25,954
0
(3) PHILIP SALERNO (i)
(ii)
284,974
0
62,500
0
12,874
0
9,800
0
24,508
0
394,656
0
0
0
(4) WARREN E MOORE (i)
(ii)
278,436
0
70,127
0
118,044
0
52,301
0
19,838
0
538,746
0
109,380
0
(5) JOSEPH J DOBOSH JR (i)
(ii)
268,753
0
59,949
0
224,437
0
69,968
0
20,025
0
643,132
0
215,493
0
(6) KAREN M DEWITT EDD (i)
(ii)
211,037
0
49,452
0
125,012
0
43,046
0
6,417
0
434,964
0
116,319
0
(7) WILLIAM DWYER (i)
(ii)
191,030
0
42,560
0
123,312
0
36,665
0
7,131
0
400,698
0
115,382
0
(8) MICHAEL R DRIBBON PHD (i)
(ii)
219,856
0
49,816
0
16,767
0
49,594
0
5,353
0
341,386
0
8,366
0
(9) UDAY MEHTA MD (i)
(ii)
237,968
0
0
0
26,095
0
9,800
0
21,156
0
295,019
0
0
0
(10) MARTIN DIAMOND MD (i)
(ii)
252,540
0
0
0
9,588
0
9,800
0
19,024
0
290,952
0
0
0
(11) KRISHAN YALAMANCHI MD (i)
(ii)
203,741
0
0
0
19,310
0
8,592
0
24,703
0
256,346
0
0
0
(12) YVETTE JANVIER MD (i)
(ii)
190,315
0
0
0
17,108
0
8,269
0
1,910
0
217,602
0
0
0
(13) THOMAS A RUGINO MD (i)
(ii)
174,989
0
0
0
16,426
0
6,019
0
32,296
0
229,730
0
0
0



Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 1A THE ORGANIZATION PAID FOR HEALTH CLUB DUES FOR CERTAIN EMPLOYEES. THE HEALTH CLUB DUES ARE TREATED AS TAXABLE WAGES AND ARE INCLUDED ON EACH INDIVIDUAL'S RESPECTIVE 2010 FORM W-2, BOX 5 AS TAXABLE MEDICARE WAGES: AMY B. MANSUE; WARREN E. MOORE; AND JOSEPH J. DOBOSH, JR.; $500 EACH; RESPECTIVELY, AND KAREN M. DEWITT, ED. D., $420.
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 4B THE AMOUNT REFLECTED IN COLUMN B(III) FOR THE FOLLOWING INDIVIDUALS INCLUDES CURRENT YEAR VESTING IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) AS THE AMOUNTS WERE NO LONGER SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THESE AMOUNTS WERE REPORTED AS EMPLOYEE BENEFIT PLAN CONTRIBUTIONS ON PRIOR YEARS FORMS 990. THE AMOUNTS OUTLINED HEREIN WERE INCLUDED IN EACH INDIVIDUAL'S 2010 FORM W-2, BOX 5 AS TAXABLE MEDICARE WAGES: AMY B. MANSUE, $25,954; WARREN E. MOORE, $109,380; JOSEPH J. DOBOSH, JR., $215,493; KAREN M. DEWITT, ED.D., $116,319; WILLIAM DWYER, $115,382 AND MICHAEL R. DRIBBON, PH.D., $8,366. THE DEFERRED COMPENSATION AMOUNT IN COLUMN C FOR THE FOLLOWING INDIVIDUALS INCLUDES UNVESTED BENEFITS IN AN INTERNAL REVENUE CODE SECTION 457(F) PLAN (NON-QUALIFIED DEFERRED COMPENSATION PLAN) WHICH ARE SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. ACCORDINGLY, THE INDIVIDUALS MAY NEVER ACTUALLY RECEIVE THIS UNVESTED BENEFIT AMOUNT. THE AMOUNTS OUTLINED HEREIN WERE NOT INCLUDED IN EACH INDIVIDUAL'S 2010 FORM W-2, AS TAXABLE WAGES: AMY B. MANSUE, $110,041; WARREN E. MOORE, $42,501; JOSEPH J. DOBOSH, JR., $62,618; KAREN M. DEWITT, ED.D., $34,446; WILLIAM DWYER, $28,856 AND MICHAEL R. DRIBBON, PH.D., $40,699.
COMPENSATION INFORMATION SCHEDULE J, PART I; QUESTION 7 THE FOLLOWING INDIVIDUALS RECEIVED A BONUS DURING CALENDAR YEAR 2010 WHICH BONUS AMOUNTS WERE INCLUDED IN COLUMN B (II) HEREIN AND IN EACH INDIVIDUAL'S 2010 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES: LAWRENCE GARINELLO, $29,117; AMY B. MANSUE, $119,167; PHILIP SALERNO, $62,500; WARREN E. MOORE, $70,127; JOSEPH J. DOBOSH, JR., $59,949; KAREN M. DEWITT, ED.D., $49,452; WILLIAM DWYER, $42,560; AND MICHAEL R. DRIBBON, PH.D., $49,816.
COMPENSATION INFORMATION SCHEDULE J, PART II, COLUMN F THE AMOUNT REPORTED IN SCHEDULE J, PART II, COLUMN F REPRESENTS AMOUNTS THAT WERE RECEIVED IN 2010 AND REPORTED ON PRIOR FORMS 990 AS NOT CURRENTLY TAXABLE DEFERRED COMPENSATION BECAUSE THE AMOUNTS WERE SUBJECT TO A SUBSTANTIAL RISK OF COMPLETE FORFEITURE. THESE AMOUNTS WERE TREATED AS TAXABLE INCOME AND REPORTED ON EACH INDIVIDUAL'S 2010 FORM W-2, BOX 5 AS TAXABLE MEDICARE WAGES AS FOLLOWS: AMY B. MANSUE, $25,954; WARREN E. MOORE, $109,380; JOSEPH J. DOBOSH, JR., $215,493; KAREN M. DEWITT, ED.D., $116,319; WILLIAM DWYER, $115,382 AND MICHAEL R. DRIBBON, PH.D., $8,366.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number
22-1487148
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer
(i) Pool
financing
Yes No Yes No Yes No
A NJ HEALTH CARE FACILITIES FINANCING AUTHORITY
 
22-1487148 64579FGL1 11-01-2005 56,895,000 CONSTRUCTION   X X     X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . . 9,135,000      
2 Amount of bonds defeased . . . . 0      
3 Total proceeds of issue . . . . 56,895,000      
4 Gross proceeds in reserve funds . . 2,474,925      
5 Capitalized interest from proceeds. 743,756      
6 Proceeds in refunding escrow. . . . . 0      
7 Issuance costs from proceeds . . . 1,169,455      
8 Credit enhancement from proceeds. 0      
9 Working capital expenditures from proceeds . . 0      
10 Capital expenditures from proceeds . . 56,895,000      
11 Other spent proceeds . . 0      
12 Other unspent proceeds. . . 0      
13 Year of substantial completion . . . 2007
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue?   X            
15 Were the bonds issued as part of an advance refunding issue?   X            
16 Has the final allocation of proceeds been made? . . X              
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .   X            
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use?   X            
b Are there any research agreements that may result in private business use of bond-financed property? . .   X            
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .   X            
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 0 %      
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 %      
6 Total of lines 4 and 5 . . .. . . . . . 0 %      
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X            
2 Is the bond issue a variable rate issue? X              
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X            
b Name of provider .  
 
 
 
 
 
 
 
c Term of hedge . .        
d Was the hedge superintegrated? .                
e Was a hedge terminated? .                
4a Were gross proceeds invested in a GIC? .   X            
b Name of provider .  
 
 
 
 
 
 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X            
6 Did the bond issue qualify for an exception to rebate? . . .   X            
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
TAX-EXEMPT BOND ISSUES SCHEDULE K, PART I THE TAX-EXEMPT BOND ISSUANCE INCLUDED IN SCHEDULE K, PART I INCLUDES CUSIP NUMBERS IN ADDITION TO THE ONE DISCLOSED IN SCHEDULE K, PART I, COLUMN (C). THESE ARE THE FOLLOWING: 64579FGM9; 64579FGN7; 64579FGP2; 64579FGQ0; 64579FGR8; 64579FGS6; 64579FGT4; 64579FGU1 & 64579FGV9
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) UMDNJ FRANK CASTELLO,MD-TRUSTEE 417,971 REIMB.OF PHYS. COMP & MALPR.   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS SCHEDULE L; PART IV AS REFLECTED IN CORE FORM, PART VII, THE ORGANIZATION PAID DR. CASTELLO $89,277 DIRECTLY FOR SERVICES RENDERED. IN ADDITION, THE ORGANIZATION PAID UMDNJ $417,971 WHICH REPRESENTED REIMBURSEMENT ATTRIBUTABLE TO DR. CASTELLO'S EMPLOYEE COMPENSATION, BENEFITS AND MALPRACTICE INSURANCE RECEIVED BY DR. CASTELLO AS A UMDNJ EMPLOYEE.
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




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 to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Identifier Return Reference Explanation
COMMUNITY BENEFIT STATEMENT CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS BACKGROUND ========== CHILDREN'S SPECIALIZED HOSPITAL ("CSH"), AN AFFILIATE MEMBER OF THE ROBERT WOOD JOHNSON HEALTH SYSTEM, IS A NOT FOR-PROFIT LICENSED COMPREHENSIVE PEDIATRIC REHABILITATION HOSPITAL AND PEDIATRIC LONG-TERM CARE FACILITY. CSH IS ALSO LICENSED AND OPERATES A PEDIATRIC MEDICAL DAY CARE AND A PEDIATRIC PRACTICE FOR CHILDREN WITH DISABILITIES. CSH HAS BEEN PROVIDING SERVICES TO THE CHILDREN OF NEW JERSEY AND SURROUNDING STATES FOR 120 YEARS. OUR TALENTED AND CARING STAFF PROVIDES A WIDE ARRAY OF MEDICAL, DEVELOPMENTAL, EDUCATIONAL AND REHABILITATIVE SERVICES FOR INFANTS, CHILDREN, ADOLESCENTS, AND YOUNG ADULTS. CSH'S HEALTHCARE PROFESSIONALS ARE COMMITTED TO PROVIDING EXPERT AND COMPASSIONATE CARE TO CHILDREN WITH CHRONIC ILLNESSES AND DISABILITIES. EVALUATION AND TREATMENT IS AVAILABLE FOR A VARIETY OF REHABILITATION NEEDS, INCLUDING BUT NOT LIMITED TO BRAIN INJURIES, SPINAL CORD DYSFUNCTION, RESPIRATORY ISSUES, AUTISM, ORTHOPEDIC PROBLEMS, SPORTS INJURIES, LEARNING, LANGUAGE OR HEARING PROBLEMS, DEVELOPMENTAL DELAYS, AND BEHAVIOR OR ATTENTION PROBLEMS AT HOME OR IN SCHOOL. COMPREHENSIVE, COORDINATED CARE IS PROVIDED FOR CHILDREN WITH CHRONIC ILLNESSES AND DISABILITIES WHO MAY HAVE MULTIPLE AND COMPLEX THERAPY NEEDS. CHARITABLE PURPOSES, CHARITY CARE AND COMMUNITY ACTIVITIES ========================================================== CSH PROVIDES HEALTH CARE SERVICES TO ALL NJ CHILDREN WHO CAN BENEFIT FROM REHABILITATIVE CARE AND WHO ARE LEGAL RESIDENTS OF NEW JERSEY IN A NON-DISCRIMINATORY MANNER REGARDLESS OF ABILITY TO PAY. CSH PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN IT'S ESTABLISHED RATES AND MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. CSH DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE; THEREFORE, THESE AMOUNTS ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. CSH DOES NOT RECEIVE ANY DISTRIBUTION OF FEDERAL OR STATE SUBSIDIES FOR CHARITY CARE SERVICES RENDERED. AWARDS AND ACKNOWLEDGEMENTS =========================== CSH IS ACCREDITED BY THE JOINT COMMISSION OF ACCREDITATION OF HEALTHCARE ORGANIZATIONS. MISSION STATEMENT ================= THE MISSION OF CHILDREN'S SPECIALIZED HOSPITAL IS TO BE THE PREEMINENT PROVIDER OF SPECIALIZED HEALTHCARE SERVICES FOR INFANTS, CHILDREN AND YOUNG ADULTS. CHILDREN'S SPECIALIZED HOSPITAL CORPORATE VALUES ================================================ THE VALUES OF CSH ARE COMPASSION, INTEGRITY, EXCELLENCE, FUN, INNOVATION, AND TEAMWORK. COMPASSION: WE WILL PROVIDE A LOVING, CARING ENVIRONMENT FOR THE CHILDREN, FAMILIES, AND EACH OTHER. INTEGRITY: WE ARE COMMITTED TO ORGANIZATIONAL AND FINANCIAL ACCOUNTABILITY, TRANSPARENCY, RESPECT FOR ALL AND ETHICAL PRACTICES. EXCELLENCE: WE WILL BE THE BEST AT OUR JOBS AND PROVIDE THE HIGHEST QUALITY CARE TO OUR CHILDREN, CONSTANTLY STRIVING TO IMPROVE AND BE THE BEST. FUN: WE WILL PROVIDE A CHILD-FRIENDLY ENVIRONMENT. IF WE HAVE FUN DOING OUR JOBS, IT WILL REFLECT IN HOW WE DEAL WITH THE CHILDREN AND EACH OTHER. INNOVATION: WE WILL BE CREATIVE IN PROVIDING CARE AND PROBLEM SOLVING. TEAMWORK: CSH IS A TEAM WHERE EVERY PERSON IS NEEDED TO PROVIDE THE QUALITY CARE FOR WHICH WE ARE KNOWN. WE MUST WORK TOGETHER TO BE SUCCESSFUL. PATIENT-AND-FAMILY-CENTERED CARE AND CHILDREN'S SPECIALIZED HOSPITAL ==================================================================== PATIENT-AND-FAMILY CENTERED CARE IS AN APPROACH TO HEALTHCARE THAT SHAPES HEALTHCARE POLICIES, PROGRAMS, FACILITY DESIGN, AND DAY TO DAY INTERACTIONS AMONG PATIENTS AND THEIR FAMILIES, PHYSICIANS AND OTHER HEALTHCARE PROFESSIONALS. HEALTHCARE PROFESSIONALS WHO PRACTICE PATIENT-AND-FAMILY CENTERED CARE RECOGNIZE THE VITAL ROLE THAT FAMILIES PLAY IN ENSURING THE HEALTH AND WELL-BEING OF CHILDREN AND FAMILY MEMBERS OF ALL AGES. THESE PRACTITIONERS ACKNOWLEDGE THAT EMOTIONAL, SOCIAL AND DEVELOPMENTAL SUPPORTS ARE INTEGRAL COMPONENTS OF HEALTHCARE. THEY RESPECT EACH CHILD AND FAMILY'S INNATE STRENGTHS AND VIEW THE HEALTHCARE EXPERIENCE AS AN OPPORTUNITY TO BUILD ON THESE STRENGTHS AND SUPPORT FAMILIES IN THEIR CARE-GIVING AND DECISION-MAKING ROLES. PATIENTAND FAMILY CENTERED APPROACHES LEAD TO BETTER HEALTH OUTCOMES AND WISER ALLOCATIONS OF RESOURCES, AS WELL AS GREATER PATIENT AND FAMILY SATISFACTION. PATIENT-AND-FAMILY CENTERED CARE IN PEDIATRICS IS BASED ON THE UNDERSTANDING THAT THE FAMILY IS THE CHILD'S PRIMARY SOURCE OF STRENGTH AND SUPPORT AND THAT THE CHILD'S AND FAMILY'S PERSPECTIVES AND INFORMATION ARE IMPORTANT IN CLINICAL DECISION MAKING. PATIENT-AND-FAMILY CENTERED PRACTITIONERS ARE KEENLY AWARE THAT HEALTHCARE EXPERIENCES CAN ENHANCE PARENTS' CONFIDENCE IN THEIR ROLES AND, OVER TIME, INCREASE THE COMPETENCE OF CHILDREN AND YOUNG ADULTS TO TAKE RESPONSIBILITY FOR THEIR OWN HEALTHCARE, PARTICULARLY IN ANTICIPATION OF THE TRANSITION TO ADULT SERVICE SYSTEMS. PATIENT-AND-FAMILY-CENTERED CARE IS GROUNDED IN COLLABORATION AMONG PATIENTS, FAMILIES, AND ALL HOSPITAL PERSONNEL FOR THE PLANNING, DELIVERY, AND EVALUATION OF THE DELIVERY OF HEALTH CARE TO THE CHILDREN WE SERVE, AS WELL AS IN THE EDUCATION OF HEALTH CARE WORKERS. CONTINUING OUR GOAL TO BE RECOGNIZED AS A CENTER OF EXCELLENCE IN PEDIATRIC CARE, CSH IS COMMITTED TO THE INTEGRATION OF PATIENT-AND-FAMILY-CENTERED PRINCIPLES INTO OUR HEALTH CARE POLICIES AND PRACTICES ACROSS THE CONTINUUM OF CARE PROVIDED BY OUR INSTITUTION. IN PLACING THE NEEDS OF THE CHILD AND FAMILY AT THE CENTER OF ALL ACTIVITIES, WE WILL FULFILL OUR MISSION AND EMBODY THE VALUES OF PATIENT-AND-FAMILY-CENTERED CARE AND CHILDREN'S SPECIALIZED HOSPITAL BY: RESPECTING EACH CHILD AND HIS OR HER FAMILY AS PARTNERS IN CARE, HONORING DIVERSITY AND ITS EFFECT ON THE FAMILY'S EXPERIENCE AND THE PERCEPTION OF CARE THROUGH RECOGNIZING THAT EACH FAMILY IS UNIQUE IN THEIR STRUCTURE, VALUES, CULTURE, ETHNIC, ORIENTATION, SPIRITUAL BELIEFS, SOCIAL-ECONOMICS, EDUCATIONAL, AND GEOGRAPHIC DIVERSITY. BUILDING ON THE STRENGTHS OF EACH CHILD AND FAMILY, EVEN IN DIFFICULT AND CHALLENGING SITUATIONS, BY ACKNOWLEDGING EACH FAMILY'S PRIORITIES AND LEVEL OF EXPERTISE RECOGNIZING AND RESPECTING DIFFERENT METHODS OF COPING IMPLEMENTING COMPREHENSIVE SERVICES THAT PROVIDE DEVELOPMENTAL, EDUCATIONAL, EMOTIONAL, ENVIRONMENTAL, AND FINANCIAL SUPPORTS SUPPORTING AND FACILITATING CHOICE FOR THE CHILD AND FAMILY ABOUT APPROACHES TO CARE AND SUPPORT ENSURING FLEXIBILITY IN ORGANIZATIONAL POLICIES, PROCEDURES AND PROVIDER PRACTICES TO REFLECT DIVERSITY AND MEET THE NEEDS, BELIEFS, PERSONALITIES, LIFE EXPERIENCES, SPIRITUAL AND CULTURAL VALUES OF EACH CHILD AND FAMILY PROVIDING FORMAL AND INFORMAL SUPPORT FOR EACH CHILD AND FAMILY - COLLABORATING WITH FAMILIES AT ALL LEVELS OF HEALTHCARE, IN THE CARE OF THE INDIVIDUAL CHILD AND IN PROFESSIONAL EDUCATION, POLICY MAKING AND PROGRAM DEVELOPMENT, THROUGH THE EXCHANGE OF HONEST AND UNBIASED INFORMATION ON AN ONGOING BASIS AND IN WAYS THAT ARE USEFUL AND AFFIRMING. EMPOWERING CHILDREN AND FAMILIES TO DISCOVER THEIR OWN STRENGTHS, BUILD CONFIDENCE AND MAKE CHOICES AND DECISIONS ABOUT THEIR HEALTH THROUGH THE CREATION OF TRUE PARTNERSHIPS WITH HEALTHCARE PROFESSIONALS. WORKING WITH LOCAL COMMUNITIES, SCHOOLS AND HEALTH OFFICIALS TO ENSURE THAT COMMUNITY SERVICES AND SUPPORT SYSTEMS FOR CHILDREN AND THEIR FAMILIES ARE FLEXIBLE, ACCESSIBLE AND COMPREHENSIVE. ====================================================================== CSH MAINTAINS INPATIENT PROGRAMS FOR BRAIN INJURY, SPINAL CORD DYSFUNCTION, INFANTS WITH PULMONARY AND CONGENITAL DISORDERS, AND GENERAL REHABILITATION. OUTPATIENT PROGRAMS EXIST AT VARYING LEVELS OF DEVELOPMENT INCLUDING THE AUTISM PROGRAM AND THE COMPREHENSIVE FEEDING PROGRAM. THESE ARE JUST A FEW OF OUR MANY PROGRAMS AND SPECIALTY SERVICE AREAS THAT COMBINE CUTTING-EDGE TECHNOLOGY WITH CLINICAL EXPERTISE AND COMPASSIONATE CARE IN A PATIENT-AND-FAMILY-CENTERED ENVIRONMENT AT FACILITIES IN NEW BRUNSWICK, MOUNTAINSIDE, TOMS RIVER, FANWOOD, HAMILTON, BAYONNE, CLIFTON AND ROSELLE PARK. ADDITIONALLY, CSH'S STAFF PROVIDES EXPERTISE AT VARIOUS SCHOOLS, CENTERS, AND PROGRAMS FOR CHILDREN WITH SPECIAL NEEDS THROUGHOUT NEW JERSEY. BRAIN INJURY ------------ HELPING A CHILD RECOVER FROM A BRAIN INJURY PRESENTS COMPLEX CHALLENGES. WHILE THE CHILD NEEDS HELP IN RECOVERING FROM HIS INJURIES, HE ALSO IS STILL DEVELOPING PHYSICALLY, EMOTIONALLY, AND INTELLECTUALLY. THE BRAIN INJURY PROGRAM AT CSH MEETS THESE CHALLENGES AND THE UNIQUE NEEDS OF CHILDREN BY PROVIDING INNOVATIVE, EXPERT AND LOVING CARE FOR THE PATIENT WITH A BRAIN INJURY ON HIS OR HER ROAD TO INDEPENDENCE. THE BRAIN INJURY PROGRAM, WHICH WAS ESTABLISHED IN 1981, IS DESIGNED TO MEET THE NEEDS OF BRAIN-INJURED, AGE APPROPRIATE PATIENTS AT ALL LEVELS OF COGNITIVE AWARENESS.
COMMUNITY BENEFIT STATEMENT; CONT'D CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS THE REHABILITATION PROCESS IS THE FOUNDATION FOR LONG TERM RECOVERY. CHILDREN ARE BEST TREATED BY PEDIATRIC SPECIALISTS IN AN ENVIRONMENT ESPECIALLY GEARED TO THEIR NEEDS. CSH PROVIDES SPECIALIZED CARE FOR EACH CHILD'S UNIQUE NEEDS DURING THEIR RECOVERY IN A COMPREHENSIVE MEDICAL AND REHABILITATION SETTING. A FULL CONTINUUM OF CARE FROM COMA TO RE-ENTRY TO THE COMMUNITY IS PROVIDED FOR EACH CHILD. THE BRAIN INJURY PROGRAM IS GEARED TOWARD MAXIMAL PROGRESS THROUGH REHABILITATION WHILE EMPHASIZING THE ACHIEVEMENT OF NORMAL PEDIATRIC DEVELOPMENTAL MILESTONES. CSH'S PROFESSIONAL STAFF, WHO ARE EXPERIENCED WITH BRAIN INJURIES AND THE DEVELOPMENTAL NEEDS OF CHILDREN, INCORPORATE EACH CHILD AND FAMILY WITHIN THE REHABILITATION TEAM TO ENCOURAGE OPTIMAL PROGRESS. EACH CHILD'S INDIVIDUALIZED PROGRAM FOCUSES ON HIS OR HER MEDICAL, PHYSICAL, COGNITIVE, AND PSYCHOSOCIAL NEEDS. IN ADDITION TO INDIVIDUAL THERAPY, GROUP THERAPY PROVIDES COMPREHENSIVE STRUCTURED STIMULATION SESSIONS FOR PATIENTS IN ORDER TO ENHANCE AND ACCELERATE AROUSAL, ALERTNESS, ORIENTATION, AND SOCIALIZATION. THE BRAIN INJURY PROGRAM ADDRESSES: - MEDICAL MANAGEMENT - SPECIALIZED NURSING CARE - PHYSICAL THERAPY - OCCUPATIONAL THERAPY - SPEECH THERAPY - AUDITORY EVALUATION - COGNITIVE STATUS - NUTRITIONAL STATUS - FAMILY SUPPORT - CASE MANAGEMENT - PSYCHOLOGICAL STATUS - CORTICAL FUNCTIONING - RE-ENTRY TO HOME, SCHOOL, AND COMMUNITY ONE OUTPATIENT COMPONENT OF THE BRAIN INJURY PROGRAM IS THE NEURO-REHABILITATION PROGRAM. THE NEURO-REHABILITATION GROUP PROGRAM IS AN INTENSIVE TREATMENT PROGRAM FOR CHILDREN AND ADOLESCENTS WHO HAVE SUSTAINED AN ACQUIRED OR TRAUMATIC BRAIN INJURY, OR WHO ARE EXPERIENCING COGNITIVE DYSFUNCTION AS A RESULT OF NEUROLOGICAL OR OTHER CHRONIC ILLNESS. THIS FAMILY-CENTERED PROGRAM PROVIDES THERAPEUTIC INTERVENTIONS DESIGNED TO HELP CHILDREN AND ADOLESCENTS REGAIN COGNITIVE SKILLS AND LEARN COMPENSATORY STRATEGIES THAT ARE NEEDED FOR SCHOOL AND SOCIAL FUNCTIONING. THE PROGRAM ALSO ADDRESSES MOTOR IMPAIRMENTS THAT MAY ACCOMPANY ACQUIRED BRAIN INJURY OR ILLNESS. THE GROUP PROGRAM IS DELIVERED PRIMARILY IN SMALL GROUP SETTINGS. INDIVIDUAL PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES MAY ALSO BE PROVIDED AS INDICATED. INVOLVEMENT IN THE GROUP PROGRAM PREPARES THE YOUNGSTER FOR RETURN TO A LARGER GROUP SETTING, USUALLY SCHOOL, AND PROVIDES HIM OR HER WITH IMPROVED SKILLS FOR PEER INTERACTION AND SOCIALIZATION. CHILDREN MAY ALSO BE SEEN THROUGH THE NEURO-REHABILITATION INDIVIDUAL PROGRAM. CHILDREN IN THE INDIVIDUAL PROGRAM ARE PRESENTLY INVOLVED IN SCHOOL AND COMMUNITY ACTIVITIES BUT REQUIRE ADDITIONAL INTERVENTION TO BETTER REGAIN OR DEVELOP COMPENSATORY SKILLS TO IMPROVE OR MAINTAIN AGE APPROPRIATE WAYS OF THINKING AND BEHAVING. SPINAL CORD PROGRAM ------------------- THE SPINAL CORD PROGRAM PROVIDES INTENSIVE AND COMPREHENSIVE REHABILITATION SERVICES FOR CHILDREN AND ADOLESCENTS WITH ACQUIRED AND CONGENITAL SPINAL CORD PROBLEMS. THE PROGRAM TREATS PATIENTS WITH ALL LEVELS OF PEDIATRIC SPINAL CORD DYSFUNCTION, FROM THE CHILD DEPENDENT ON A VENTILATOR TO THE INDIVIDUAL WITH THE LOWEST LEVEL OF SPINAL CORD INJURY. PATIENTS ARE PROVIDED WITH AN AGGRESSIVE REHABILITATION TREATMENT PROGRAM COUPLED WITH COMPREHENSIVE MEDICAL AND NURSING CARE. THE PROGRAM'S TEAM APPROACH RESULTS IN A COORDINATED TREATMENT PLAN DESIGNED TO MEET THE COMPLEX NEEDS OF EACH PATIENT AND HIS OR HER FAMILY. WHILE AN EMPHASIS IS PLACED ON ACHIEVING NORMAL DEVELOPMENTAL MILESTONES, THE TREATMENT PLAN TAKES INTO ACCOUNT THE PATIENT'S LEVEL OF INJURY, AGE, AND DEVELOPMENTAL ABILITIES IN CREATING REALISTIC EXPECTATIONS FOR PERFORMING ACTIVITIES. THE TEAM IS ADEPT AT DEVELOPING TREATMENT PLANS TO ACCOMMODATE PATIENTS WITH HIGH SPINAL CORD INJURIES (TETRA(QUADRA)PLEGIA) WHO REQUIRE A TREMENDOUS AMOUNT OF SUPPORT, SPECIAL EQUIPMENT, AND VENTILATOR ASSISTANCE, AS WELL AS THOSE PATIENTS WITH LOW LEVEL SPINAL CORD INJURIES (PARAPLEGIA) WHO CAN GAIN VIRTUAL INDEPENDENCE. INTENSIVE MEDICAL NEEDS CAN BE SAFELY ACCOMMODATED AT CSH BY VIRTUE OF THE EXTENSIVE MEDICAL COVERAGE PROVIDED TO THE PATIENTS. PATIENTS WITH TRACHEOTOMIES, SPECIAL FEEDING NEEDS, AND INTRAVENOUS AND CENTRAL LINES, FOR EXAMPLE, CAN BE MANAGED WHILE RECEIVING THE NECESSARY REHABILITATION THERAPY. FAMILIES AND PATIENTS ARE INTEGRALLY INVOLVED IN THE COMPREHENSIVE TREATMENT PLANNING. FAMILIES AND PATIENTS ALSO RECEIVE INSTRUCTION FROM THE STAFF IN OVERALL CARE AND THE USE OF SPECIAL EQUIPMENT. THE TEAM THOROUGHLY EDUCATES THE PATIENT AND HIS OR HER FAMILY REGARDING THE PHYSICAL CONSEQUENCES OF A SPINAL CORD INJURY AND THE REQUIRED CARE AND TREATMENT. SOME OF THE DIAGNOSTIC AND SPECIAL SERVICES AVAILABLE TO PATIENTS IN THE SPINAL CORD PROGRAM INCLUDE: - ELECTRODIAGNOSTIC TESTING - VENTILATOR ASSISTANCE PROGRAM - REFERRALS FOR EVALUATIONS FOR DIAPHRAGMATIC PACING - A FULL RANGE OF DIAGNOSTIC UROLOGIC TESTING - REFERRAL FOR BACLOFEN PUMP PLACEMENT - ORTHOTICS AND PROSTHETICS - REHABILITATION TECHNOLOGY SERVICES INCLUDING: - SEATING AND POSITIONING - MOBILITY AND ENVIRONMENTAL ACCESS - AUGMENTATIVE AND ALTERNATIVE COMMUNICATION - COMPUTER ACCESS GENERAL REHABILITATION PROGRAM ------------------------------ THE GENERAL REHABILITATION PROGRAM AT CHILDREN'S SPECIALIZED HOSPITAL OFFERS HABILITATIVE AND REHABILITATIVE SERVICES TO PATIENTS AGED 0-21 WITH, BUT NOT LIMITED TO, NEUROLOGIC, ORTHOPEDIC, DEVELOPMENTAL, CARDIOPULMONARY DISORDERS AND/OR OTHER ACQUIRED INJURIES AND ILLNESSES, THROUGH AN INTERDISCIPLINARY TEAM APPROACH. THE PROGRAM PROVIDES ASSESSMENT, TREATMENT, AND/OR SUPPORT TO THE PATIENT AND FAMILY FROM THE ACUTE INPATIENT PHASE OF REHABILITATION THROUGH THE COMMUNITY, VOCATIONAL, AND EDUCATIONAL RE-ENTRY PHASE. IN ORDER TO OFFER A CONTINUUM OF COMPREHENSIVE TRANSDISCIPLINARY SERVICE TO THESE CHILDREN AND THEIR FAMILIES, IN A COMPASSIONATE, PROFESSIONAL AND HOLISTIC FASHION, SERVICES ARE PROVIDED THROUGH BOTH INPATIENT AND OUTPATIENT PHASES OF REHABILITATIVE CARE. PATIENTS ADMITTED TO THE PROGRAM INCLUDE CHILDREN THROUGH YOUNG ADULTS 0-21 YEARS OF AGE. THEY ARE REQUIRED TO MEET THE FOLLOWING CRITERIA REGARDING THEIR MEDICAL STABILITY. INITIAL DIAGNOSTIC AND SURGICAL PROCEDURES MUST BE COMPLETED. MEDICATION REGIMEN, FLUID AND ELECTROLYTE BALANCE, AND LIFE SUPPORT SERVICES MUST BE STABILIZED. THE PATIENTS SERVED MAY HAVE IMPAIRMENTS IN AREAS INCLUDING THOSE OF, COGNITION, MOBILITY, SELF-CARE, COMMUNICATION, SOCIAL EMOTIONAL FUNCTIONING, SENSORY PROCESSING, ACADEMIC FUNCTIONING, AND FEEDING. THE PROGRAM ADDRESSES BEHAVIORAL, FUNCTIONAL, PHYSICAL, COGNITIVE, PSYCHOSOCIAL, VOCATIONAL, EDUCATIONAL, LEISURE, AND RECREATIONAL NEEDS OF EACH PATIENT. EVERY EFFORT IS MADE TO ACCOMMODATE THE PATIENT AND FAMILIES UNIQUE CULTURAL AND SPIRITUAL NEEDS. THE GOAL OF THE PROGRAM IS TO REDUCE THE BARRIERS, WHICH LIMIT A CHILD'S ABILITY TO PARTICIPATE IN DEVELOPMENTALLY APPROPRIATE ACTIVITIES OF HIS OR HER LIFE. TO FACILITATE A SMOOTH TRANSITION AND OPTIMIZE THE PATIENT'S ABILITY TO FULLY INTEGRATE INTO THE COMMUNITY, OUTREACH, AND EDUCATION ARE PROVIDED TO THE INTENDED DISCHARGE ENVIRONMENT (E.G. SCHOOL, HOME, COMMUNITY ORGANIZATIONS). IN ADDITION, PATIENTS ARE PROVIDED DEVELOPMENTALLY APPROPRIATE LIFE SKILL TRAINING THROUGH GROUP AND INDIVIDUAL THERAPY AS WELL AS COMMUNITY OUT-TRIPS. SOME CHILDREN AND ADOLESCENTS SEEN THROUGH THESE PROGRAMS REQUIRE INTENSIVE MEDICAL, NURSING, AND RESPIRATORY THERAPY SUPPORT FOR RESPIRATORY PROBLEMS. THESE CHILDREN MAY HAVE CONGENITAL OR ACQUIRED RESPIRATORY PROBLEMS INCLUDING BRONCHOPULMONARY DYSPLASIA, CONGENITAL MUSCULAR PROBLEMS, AND CONGENITAL AND ACQUIRED AIRWAY AND RESPIRATORY ABNORMALITIES. INFANT/TODDLER PROGRAM ---------------------- THE INFANT TODDLER PROGRAM PROVIDES INTENSIVE AND COMPREHENSIVE REHABILITATION SERVICES FOR INFANTS AND YOUNG CHILDREN WITH MEDICAL DIFFICULTIES RELATED TO PREMATURITY AND A RANGE OF DISORDERS PRESENTING AT BIRTH. THE PROGRAM TREATS CHILDREN WHO REQUIRE ALL LEVELS OF NEONATAL CARE. PATIENTS ARE TREATED WITH A COMPREHENSIVE, THERAPEUTIC PROGRAM, COUPLED WITH EXCELLENT MEDICAL AND NURSING CARE. BECAUSE OF THIS TEAM APPROACH, A COORDINATED TREATMENT PLAN CAN BE DESIGNED TO MEET THE COMPLEX NEEDS OF EACH PATIENT AND HIS OR HER FAMILY. WHILE EMPHASIZING AGE-APPROPRIATE SKILLS, THE TEAM CUSTOMIZES GOALS BASED ON EACH INFANT'S OR TODDLER'S MEDICAL STABILITY, AGE, AND DEVELOPMENTAL LEVEL TO MAXIMIZE HIS OR HER UNIQUE POTENTIAL. THE MULTISPECIALTY STAFF IS HIGHLY TRAINED IN WORKING WITH THESE CHILDREN WHO REQUIRE SPECIAL EQUIPMENT AND VENTILATOR ASSISTANCE. THE TEAM USES SPECIAL TECHNIQUES TO ENCOURAGE CHILDREN'S INTERACTION WITH THEIR ENVIRONMENT DURING THERAPY DAYS. TO OFFER THIS SPECIALIZED TREATMENT, OUR STAFF IS COMMITTED TO PURSUING ONGOING EDUCATION AND TRAINING IN STATE-OF-THE-ART TECHNIQUES USED TO TREAT THIS SPECIAL POPULATION.
COMMUNITY BENEFIT STATEMENT; CONT'D CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS THOSE INFANT TODDLER PATIENTS WHO NEED SPECIAL MEDICAL CARE CAN BE SAFELY ACCOMMODATED WITH CHILDREN'S SPECIALIZED HOSPITAL'S EXTENSIVE MEDICAL COVERAGE. THESE PATIENTS MAY BE TRACHEOTOMY DEPENDENT, OXYGEN DEPENDENT, OR VENTILATOR DEPENDENT, REQUIRING CLOSE MONITORING AND FREQUENT CHANGES IN MANAGEMENT. THESE PATIENTS, AS WELL AS THOSE INFANTS AND TODDLERS WITH SPECIAL FEEDING NEEDS, INTRAVENOUS AND CENTRAL LINES, CAN BE MANAGED WHILE RECEIVING REHABILITATION THERAPY. INFANTS WHO ARE RECOVERING FROM NEONATAL ABSTINENCE ARE TREATED WITH A MEDICATION AND A HOLISTIC APPROACH, WHICH ALLOWS THEIR SAFE TRANSITION TO HOME. FAMILY INVOLVEMENT IS VITAL TO A CHILD'S OVERALL DEVELOPMENT. WE STRONGLY ENCOURAGE FAMILY PARTICIPATION IN TREATMENT SESSIONS. OUR TEAM INSTRUCTS FAMILIES IN CARING FOR THEIR CHILDREN AND USING SPECIAL EQUIPMENT. FAMILIES LEARN ABOUT THERAPEUTIC INTERVENTIONS THAT PROMOTE GROWTH AND DEVELOPMENT. INFANT TODDLER MEDICAL SPECIALTIES: A NEONATOLOGIST/PEDIATRICIAN, A PHYSICIAN WHO SPECIALIZES IN NEONATAL CARE AND PEDIATRICS, HEADS THE INFANT TODDLER PROGRAM TEAM. OTHER MULTIDISCIPLINARY PEDIATRIC PROFESSIONALS PROVIDE MEDICAL SUPPORT, REHABILITATION SERVICES, AND ADDRESS DEVELOPMENTAL NEEDS WHILE AIMING TOWARD MAXIMIZING RESPIRATORY INDEPENDENCE. WHILE UPON ADMISSION MANY OF THE CHILDREN REQUIRE INTENSIVE RESPIRATORY CARE, THE GOAL FOR EACH IS TO BE TRANSITIONED BACK TO HIS OR HER HOME AND COMMUNITY. OTHER MEDICAL SPECIALISTS FOR THE INFANT TODDLER PROGRAM ARE ALSO AVAILABLE FOR CONSULTATION: EAR, NOSE, AND THROAT NEUROLOGY OPHTHALMOLOGY ORTHOPEDICS PHYSIATRY RADIOLOGY UROLOGY THE AUTISM PROGRAM ------------------ THE AUTISM PROGRAM AT CHILDREN'S SPECIALIZED HOSPITAL WORKS WITH CHILDREN THROUGH 21 YEARS OF AGE, WHO HAVE AN AUTISM SPECTRUM DISORDER (AUTISM, ASPERGER'S SYNDROME, PERVASIVE DEVELOPMENTAL DISORDER, CHILDHOOD DISINTEGRATIVE DISORDER OR RETT'S SYNDROME). THE PROGRAM IS DEDICATED TO IMPROVING THE LIVES OF CHILDREN, ADOLESCENTS AND FAMILIES WITH AUTISM SPECTRUM DISORDERS BY PROVIDING COMPREHENSIVE EVALUATIONS, TREATMENT, COMMUNITY EDUCATION AND RESEARCH. WE ARE ONE OF THE FEW PROGRAMS IN NEW JERSEY TO PROVIDE COORDINATED, MULTIDISCIPLINARY CARE FOR CHILDREN, ADOLESCENTS AND FAMILIES AFFECTED BY AN AUTISM SPECTRUM DISORDER COMPREHENSIVE FEEDING PROGRAM ----------------------------- THE COMPREHENSIVE FEEDING PROGRAM IS AN OUTPATIENT PROGRAM THAT SERVICES INFANTS, TODDLERS, AND YOUNG CHILDREN WHO ARE UNABLE OR REFUSE TO MAINTAIN AN ADEQUATE ORAL INTAKE OF FOOD. PROBLEMS MAY BE MEDICAL/PHYSIOLOGICAL, DEVELOPMENTAL, BEHAVIORAL, PSYCHOSOCIAL, INDIVIDUAL OR FAMILY RELATED. THIS TEAM UTILIZES A MULTIDISCIPLINARY APPROACH TO HAVE CHILDREN EAT PROPER FOODS AND IMPROVE NUTRITIONAL STANDING. BASED ON A PREDICTED INCIDENCE OF 25% OF INFANTS AND YOUNG CHILDREN WITH FEEDING PROBLEMS, THERE ARE THOUSANDS OF CHILDREN WHO CAN BENEFIT FROM THIS SERVICE. EACH CHILD IS PROVIDED WITH A COMPREHENSIVE EVALUATION THAT COVERS MEDICAL, PHYSIOLOGICAL, DEVELOPMENTAL, BEHAVIORAL, AND PSYCHOSOCIAL ISSUES. THE TEAM COMBINES THE EXPERTISE OF A MULTIDISCIPLINARY TEAM OF PROFESSIONALS WHOSE PRIMARY GOAL IS TO ESTABLISH FEEDING PATTERNS THAT CAN BE MAINTAINED IN THE CHILD'S NATURAL ENVIRONMENT. THE TEAM INCLUDES THE FOLLOWING: - SPEECH PATHOLOGIST - CHILD PSYCHOLOGIST - PEDIATRIC DIETITIAN - DEVELOPMENTAL PEDIATRICIAN - OCCUPATIONAL THERAPIST - PHYSICAL THERAPIST - PATIENT CARE COORDINATOR THE PROGRAM AND ITS TEAM MEMBERS EMPOWER PARENTS AND CAREGIVERS BY PROVIDING KNOWLEDGE AND TECHNIQUES, WHICH WILL ALLOW THEM TO ENGAGE THEIR CHILD IN POSITIVE THERAPEUTIC FEEDING EXPERIENCES AND INTERACTIONS. THE PROGRAM ALSO PROVIDES SUPPORT AND KNOWLEDGE TO OTHER PROFESSIONALS IN THE COMMUNITY, SUCH AS CHILDCARE PROVIDERS, WHO PARTICIPATE IN THE CHILD'S FEEDING EXPERIENCES. ATTENTION-DEFICIT HYPERACTIVITY DISORDERS (AD/HD) ------------------------------------------------- CHILDREN'S SPECIALIZED HOSPITAL ALSO PROVIDES COMPREHENSIVE SERVICES FOR CHILDREN WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDERS (AD/HD). CSH IS A SERVICE PROVIDER DEDICATED TO IMPROVING THE LIVES OF CHILDREN AND ADOLESCENTS WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDER AND ASSOCIATED DISABILITIES. PROGRAMS AND SERVICES INFORMATION ================================= INPATIENT PROGRAMS ------------------ INPATIENT SERVICES ARE LICENSED FOR 90 PEDIATRIC REHABILITATION BEDS. INPATIENT REHABILITATION CARE PROVIDED INCLUDES MEDICAL AND NURSING CARE, COMPREHENSIVE THERAPY SERVICES, PSYCHOLOGICAL AND NEUROPSYCHOLOGICAL SERVICES, ACADEMICS, SOCIAL SERVICES, AND NUTRITIONAL SERVICES. INCLUDED IN THE THERAPY SERVICES ARE PHYSICAL THERAPY, HYDROTHERAPY, REHABILITATION TECHNOLOGY, EDUCATIONAL TECHNOLOGY/AUGMENTATIVE COMMUNICATION, OCCUPATIONAL THERAPY, ACTIVITIES OF DAILY LIVING, SPEECH AND HEARING, RESPIRATORY THERAPY, RECREATIONAL THERAPY AND CHILD LIFE. THESE CSH SERVICES ARE PROVIDED TO ALLOW THE CHILDREN TO ATTAIN THEIR GREATEST POTENTIAL - MEDICALLY, SOCIALLY, ACADEMICALLY, AND EMOTIONALLY. THEIR FAMILIES ARE PROVIDED WITH SUPPORT AND EDUCATIONAL SERVICES TO ENSURE THEIR CHILD CAN RETURN TO THEIR HOME AND COMMUNITY. THERE ARE TWO LICENSED LONG-TERM CARE FACILITIES. A 42 BED UNIT IN MOUNTAINSIDE WITH THE CAPACITY TO EXPAND AN ADDITIONAL 8 WAIVER BEDS AND A 26 BED FACILITY IN TOMS RIVER. OUTPATIENT PROGRAMS AND SERVICES -------------------------------- CSH PROVIDES A NUMBER OF OUTPATIENT SERVICES RELATED TO PEDIATRIC REHABILITATION AND EDUCATION. OUTPATIENT PROGRAMS OFFERED BY CSH INCLUDE SERVICES IN ASSESSMENT AND THERAPY FROM PEDIATRIC MEDICAL SPECIALISTS AND SUB-SPECIALISTS, AS WELL AS VARIOUS THERAPY DEPARTMENTS. IN ADDITION, THE FOLLOWING SPECIALTY PROGRAMS AND CLINICS ARE OFFERED: ORTHOPEDICS, UROLOGY, OPHTHALMOLOGY, NEUROLOGY, PHYSIATRY AND DEVELOPMENTAL PEDIATRICS. THE EARLY INTERVENTION IS DESIGNED TO MEET THE EDUCATIONAL, THERAPEUTIC, SOCIAL, AND EMOTIONAL NEEDS OF CHILDREN FROM BIRTH TO AGE FIVE WITH PHYSICAL HANDICAPS OR DEVELOPMENTAL DELAYS. THE EIP PROGRAM IS FUNDED BY A FEE SCHEDULE FROM THE STATE OF NEW JERSEY. VARIOUS COMMUNITY EVENTS AND OUTPATIENT PROGRAMS AND SERVICES ARE OFFERED BY CSH. LISTED BELOW IS A BRIEF LIST OF EVENTS AND PROGRAMS: CHILDREN'S REGIONAL SWIM MEET + INVITATIONAL TRACK AND FIELD MEET CLUB SIB GUPPIES I AND II SHARKS I AND II INTERACTIVE ORAL SENSORY - MOTOR THERAPY IN AUTISM? PEDIATRIC TRAUMATIC BRAIN INJURY - THE JOURNEY CAMP OPEN ARMS DAY CAMP PALS PARADISE OVERNIGHT CAMP CAMP CHATTERBOX NEURO-REHABILITATION PROGRAM PEDIATRIC PRACTICE PARENT RESOURCE CENTER TOYS-TO-GO PROGRAM "LIGHTNING WHEELS" WHEELCHAIR & AMBULATORY SPORTS TEAM FOR INDIVIDUALS WITH PHYSICAL DISABILITIES "FRIDAY NIGHT FEVER - MOUNTAINSIDE AND TOMS RIVER" PROFESSIONAL TRAINING --------------------- CSH IS COMMITTED TO PROVIDING AN EDUCATIONAL SETTING, WHICH WILL LEAD TO CONTINUOUS ADVANCEMENT IN PROFESSIONAL KNOWLEDGE AND SKILLS FOR THOSE INTERESTED IN PEDIATRIC REHABILITATION. CSH PROVIDES CLINICAL TRAINING AND EXPERIENCE IN THE FIELD OF PEDIATRIC REHABILITATION AND CARE OF THE DISABLED CHILD FOR RESIDENT PHYSICIANS IN THE AREAS OF PEDIATRICS AND PHYSIATRY THROUGH SCHOOLS, WHICH AFFILIATE WITH THE HOSPITAL. IN ADDITION, THE HOSPITAL TRAINS FELLOWS, NURSES, AND THERAPISTS ENROLLED IN SCHOOLS AND COLLEGES THAT ARE ALSO AFFILIATED WITH THE HOSPITAL. TO ADVANCE THE STATE OF PEDIATRIC REHABILITATION, CHILDREN'S SPECIALIZED ALSO CONDUCTS AND SUBSIDIZES PROGRAMS AND SEMINARS TO EDUCATE INTERESTED HEALTHCARE PROFESSIONALS. ACCESSIBILITY PLAN ================== EACH YEAR CHILDREN'S SPECIALIZED HOSPITAL LOOKS AT HOW TO IMPROVE ACCESS TO CARE AND THE COMMUNITY FOR OUR PATIENTS AND FAMILIES. WE REVIEW ANY BARRIERS THAT MAY EXIST AND HOW TO BEST REMOVE THEM. OUR APPROACH AND OUTCOMES ARE OUTLINED BELOW: REVIEW PLAN FOR PROMOTING ACCESSIBILITY TO ORGANIZATION-WIDE SERVICES FOR PERSONS SERVED, PERSONNEL & OTHER STAKEHOLDERS. IDENTIFY & REMOVE POTENTIAL BARRIERS TO OUR PROGRAMS & SERVICES FOR PERSONS SERVED, PERSONNEL & OTHER STAKEHOLDERS. IDENTIFY & REMOVE EXISTING BARRIERS AND MAKE PROGRAMS AND SERVICES ACCESSIBLE FOR PERSONS SERVED, PERSONNEL & OTHER STAKEHOLDERS AS SOLICITED & IDENTIFIED THROUGH AN ANNUAL ACCESSIBILITY SURVEY, AS WELL AS MONTHLY ENVIRONMENT OF CARE ROUNDS. INITIATE AND IMPLEMENT NECESSARY STEPS TO DECREASE OR REMOVE IDENTIFIED BARRIER(S) FOR PERSONS SERVED, PERSONNEL & OTHER STAKEHOLDERS WITH A SPECIFIED TIMELINE. INTEGRATION: ADVOCACY & EDUCATION TO ELIMINATE & REDUCE BARRIERS IN THE COMMUNITIES OF PERSONS SERVED. PROVIDE A REVIEW MECHANISM FOR "REASONABLE ACCOMMODATION" REQUESTS MADE BY PERSONS SERVED AND/OR PERSONNEL. ON AN ANNUAL BASIS, HOSPITAL LEADERSHIP REVIEWS THE PLAN FOR PROMOTING ACCESSIBILITY TO ORGANIZATION-WIDE SERVICES FOR PERSONS SERVED AND POTENTIAL PERSONS SERVED, AS WELL AS THE FINDINGS FROM THE ANNUAL ACCESSIBILITY SURVEY THAT IS CONDUCTED BY A REHABILITATION PROFESSIONAL & A PERSON SERVED.
COMMUNITY BENEFIT STATEMENT; CONT'D CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS THIS REVIEW TAKES PLACE AT THE HOSPITAL'S ENVIRONMENT OF CARE, OPERATIONS, AND PI STEERING COMMITTEE(S). COMMUNICATION AND FOLLOW THROUGH IS DONE WITHIN THE EXISTING HOSPITAL-WIDE PERFORMANCE IMPROVEMENT STRUCTURE. BELOW IS THE 2010 ACCESSIBILITY SURVEY FINDINGS: 2010 ACCESSIBILITY SURVEY FACILITY SUMMARY STEVENS ROAD - MICHELLE TOMAINO - 12/08/2010 -------------------------------------------- BARRIER: DESCRIPTION ARCHITECTURAL: NONE CITED DURING SURVEY ENVIRONMENTAL: - GYM: MULTIPLE ACTIVITIES IN THE GYM BLOCKING FIRE EXIT PATH AND LIMITING WHEELCHAIR ACCESS TO THE MATS. THERE IS A MAT IN FRONT OF BREAKOUT ROOM 5 WHICH WOULD RESTRICT WHEELCHAIR ACCESS. - STAFF BATHROOM: SEVERAL SHEETS OF TOILET PAPER ON THE FLOOR AS A RESULT TOILET PAPER DISPENSER. - ALL AREAS: PAPER TOWEL DISPENSERS DIFFICULT FOR OUR PATIENTS WITH HEMI-PARESIS TO UTILIZE. ATTITUDINAL: NONE CITED DURING SURVEY FINANCIAL: ONGOING ISSUE FOR FAMILIES WHO CANNOT QUALIFY FOR STATE FUNDING TO SUPPLEMENT NEEDS FOR SERVICES. EMPLOYMENT: NONE CITED DURING SURVEY COMMUNICATION: NONE CITED DURING SURVEY TRANSPORTATION: NONE CITED DURING SURVEY COMMUNITY INTEGRATION: NONE CITED DURING SURVEY OTHER BARRIERS: - PARKING LOT: FIRE LANE BLOCKED, DUE TO CONSTRUCTION/WATER MAIN DIG. - PARKING LOT: RESTRICTED ACCESS TO PARKING BECAUSE OF BLOCKED AREA OVER WATER MAIN: IF NO SPACES ARE AVAILABLE AT OUR MAIN ENTRANCE, FAMILIES HAVE TO TURN AROUND TO GO TO THE PARKING AVAILABLE AT THE BACK OF THE BUILDING NEW BRUNSWICK - PAT O'HANLON - 12/15/10 --------------------------------------- BARRIER: DESCRIPTION ARCHITECTURAL: NONE CITED DURING SURVEY ENVIRONMENTAL: NONE CITED DURING SURVEY ATTITUDINAL: NONE CITED DURING SURVEY FINANCIAL: NONE CITED DURING SURVEY EMPLOYMENT: NONE CITED DURING SURVEY COMMUNICATION: NONE CITED DURING SURVEY TRANSPORTATION: NONE CITED DURING SURVEY COMMUNITY INTEGRATION: NONE CITED DURING SURVEY OTHER BARRIERS: NONE CITED DURING SURVEY MOUNTAINSIDE - PAT O'HANLON - 12/15/10 -------------------------------------- BARRIER: DESCRIPTION ARCHITECTURAL: NONE CITED DURING SURVEY ENVIRONMENTAL: NONE CITED DURING SURVEY ATTITUDINAL: NONE CITED DURING SURVEY FINANCIAL: NONE CITED DURING SURVEY EMPLOYMENT: NONE CITED DURING SURVEY COMMUNICATION: NONE CITED DURING SURVEY TRANSPORTATION: NONE CITED DURING SURVEY COMMUNITY INTEGRATION: NONE CITED DURING SURVEY OTHER BARRIERS: NONE CITED DURING SURVEY 310 MAIN STREET - MICHELLE TOMAINO - 12/08/10 --------------------------------------------- BARRIER: DESCRIPTION ARCHITECTURAL: NONE CITED DURING SURVEY ENVIRONMENTAL: NONE CITED DURING SURVEY ATTITUDINAL: NONE CITED DURING SURVEY FINANCIAL: NONE CITED DURING SURVEY EMPLOYMENT: NONE CITED DURING SURVEY COMMUNICATION: NONE CITED DURING SURVEY TRANSPORTATION: NONE CITED DURING SURVEY COMMUNITY INTEGRATION: NONE CITED DURING SURVEY OTHER BARRIERS: NONE CITED DURING SURVEY HAMILTON - MEGAN FENNELLY - 12/10/10 ------------------------------------ BARRIER: DESCRIPTION ARCHITECTURAL: NONE CITED DURING SURVEY ENVIRONMENTAL: NONE CITED DURING SURVEY ATTITUDINAL: NONE CITED DURING SURVEY FINANCIAL: NONE CITED DURING SURVEY EMPLOYMENT: NONE CITED DURING SURVEY COMMUNICATION: NONE CITED DURING SURVEY TRANSPORTATION: NONE CITED DURING SURVEY COMMUNITY INTEGRATION: NONE CITED DURING SURVEY OTHER BARRIERS: NONE CITED DURING SURVEY FANWOOD PLAZA - PAT O'HANLON - 12/15/10 --------------------------------------- BARRIER: DESCRIPTION ARCHITECTURAL: - IN THE PROCESS OF MOVING ACROSS THE HALL, DID THE BEST I COULD. - BUMP IN THE FLOOR IN LOBBY AREA OUTSIDE OF FAMILY WAITING AREA. ENVIRONMENTAL: EXTREME "CLUTTER" THROUGHOUT SITE. EX: CLASSROOM ALTERNATES USING DESKS AND TABLES. DESKS NOT IN USE ARE PILED IN THE MIDDLE OF ROOM. WAITING AREAS HAVE CHAIRS STACKED, VERY MESSY LOOKING FOR FAMILIES WHO MAY BE CONSIDERING PROGRAM FOR CHILD. DOES NOT REPRESENT THE GREAT WORK DONE BY STAFF AT SITE ATTITUDINAL: NONE CITED DURING SURVEY FINANCIAL: NONE CITED DURING SURVEY EMPLOYMENT: NONE CITED DURING SURVEY COMMUNICATION: - LACK OF APPROVED RESOURCES IN LOBBY FOR FAMILIES. - NO LOBBY MONITOR. - NO COMPUTER ACCESS FOR FAMILIES TRANSPORTATION: 70-80% OF CHILDREN ARE BUSED UNDER MEDICAID/LOGISTICS CARE WHO IN MOST CASES WILL NOT ESCORT CHILDREN TO LOBBY UPON ARRIVAL ACCORDING TO CSH POLICYARRANGING TRANSPORTATION FOR CHILDREN IS A NIGHTMARE CURRENT PROCESS TAKES MAJOR TIME AND PATIENCE, CAN DELAY CHILDREN IN RECEIVING SERVICES COMMUNITY INTEGRATION: LACK OF CHILDREN'S SPECIALIZED HOSPITAL RESOURCES IE: OUTPATIENT GUIDE, AQUATIC PROGRAM, POCKET PAL, (THE APPROVED LIST) FOR CLIENTS. OTHER BARRIERS: NONE CITED DURING SURVEY ROSELLE - PAT O'HANLON - 12/08/10 --------------------------------- BARRIER: DESCRIPTION ARCHITECTURAL: NONE CITED DURING SURVEY ENVIRONMENTAL: - LITTLE GATED AREAS DO NOT ALLOW ACCESS OF STROLLERS. CRIBS, ETC, IN THE EVENT OF A FIRE ACCESS WOULD BE DIFFICULT. - AREA BEFORE ENTRANCE TO DECK PLAY AREA, CLUTTERED WITH BIGGER, NECESSARY EQUIPMENT (I.E.: STANDER) AND TOYS. NEED STORAGE SHED ATTITUDINAL: NONE CITED DURING SURVEY FINANCIAL: NONE CITED DURING SURVEY EMPLOYMENT: NONE CITED DURING SURVEY COMMUNICATION: - LACK OF RESOURCES (APPROVED), FOR DISTRIBUTION TO FAMILIES. - LACK OF APPROVED RESOURCES AVAILABLE TO FAMILIES IN AREA WHERE THEY DROP OFF CHILDREN TRANSPORTATION: NONE CITED DURING SURVEY COMMUNITY INTEGRATION: NONE CITED DURING SURVEY OTHER BARRIERS: NONE CITED DURING SURVEY CLIFTON - PAT O'HANLON - 12/08/10 --------------------------------- BARRIER: DESCRIPTION ARCHITECTURAL: NONE CITED DURING SURVEY ENVIRONMENTAL: NO DESIGNATED PRIVATE AREA WHERE OLDER, BIGGER CHILD COULD BE CHANGED, CATHETERIZED, ETC ATTITUDINAL: NONE CITED DURING SURVEY FINANCIAL: NONE CITED DURING SURVEY EMPLOYMENT: NONE CITED DURING SURVEY COMMUNICATION: LACK OF APPROVED RESOURCE MATERIAL AVAILABLE IN LOBBY/WAITING AREA TRANSPORTATION: NONE CITED DURING SURVEY COMMUNITY INTEGRATION: NONE CITED DURING SURVEY OTHER BARRIERS: - SIGNAGE IN PARKING LOT AND/OR ON ROAD LEADING TO LOCATION. - COMPUTER AVAILABLE FOR FAMILY USE TO ACCESS RESOURCES OUR WEBSITE, LIBRARIAN, ETC. - NO PRIVACY AT REGISTRATION DESK. BAYONNE - PAT O'HANLON - 12/08/10 --------------------------------- BARRIER: DESCRIPTION ARCHITECTURAL: NONE CITED DURING SURVEY ENVIRONMENTAL: NONE CITED DURING SURVEY ATTITUDINAL: NONE CITED DURING SURVEY FINANCIAL: NONE CITED DURING SURVEY EMPLOYMENT: NONE CITED DURING SURVEY COMMUNICATION: LACK OF APPROVED RESOURCES IN LOBBY/WAITING AREAS TRANSPORTATION: NONE CITED DURING SURVEY COMMUNITY INTEGRATION: NONE CITED DURING SURVEY OTHER BARRIERS: - LACK OF COMPUTER AND WIRELESS ACCESS FOR FAMILIES ADMISSION TO HOSPITAL PROGRAM: ------------------------------ GRANT ADMISSION TO PROGRAM SERVICES & ACTIVITIES TO THOSE WITH AN IDENTIFIED NEED THAT IS VALIDATED BY MEETING PRE-ESTABLISHED ADMISSION CRITERIA/SCREENING. MEASURE: PATIENT REFERRALS THAT MEET PRE-ESTABLISHED ADMISSION CRITERIA/SCREENING ARE OFFERED RELEVANT SERVICES/ADMISSION DATA SOURCE: PRE-ADMISSION DEPT. LOG. 2010 FINDINGS: 100% OF ALL ADMISSIONS MEETING CRITERIA/SCREENING ARE OFFERED ADMISSION. IF PATIENT NOT OFFERED ADMISSION, APPROPRIATE REFERRALS MADE. EMPLOYMENT: ----------- RECRUIT QUALIFIED EMPLOYEES WITH "REASONABLE ACCOMMODATIONS" FOR PERSONS WITH ACTIVITY LIMITATIONS IN ORDER TO PROMOTE EQUAL EMPLOYMENT/PARTICIPATION OPPORTUNITIES THROUGHOUT ALL ORGANIZATIONAL LEVELS. MEASURE: ADHERENCE TO STATE/FEDERAL REGULATIONS RE: EMPLOYMENT WITHOUT REGARD TO ACTIVITY LIMITATIONS, RACE, COLOR, NATIONAL ORIGIN OR AGE & PARTICIPATE IN COMMUNITY EFFORTS TO PROMOTE OPPORTUNITIES FOR PERSONS WITH ACTIVITY LIMITATIONS DATA SOURCE: HUMAN RESOURCE DEPT. FILES. 2010 FINDINGS: 100% OF ALL JOB APPLICANTS FOLLOWED "STANDARD" PROCEDURES FOR EMPLOYMENT APPLICATION PROCESS AND ONGOING EMPLOYMENT. OTHER: ------ REMAIN ACTIVELY INVOLVED IN COMMITTEES AT THE LOCAL, STATE & NATIONAL LEVEL WHERE POLICIES, REGULATIONS AND PROGRAM PLANNING IMPACT PEDIATRIC SERVICES & THEIR ACCESSIBILITY & DELIVERY. MEASURE: CONTINUED CHILDREN'S PRESENCE AT LOCAL, STATE, FEDERAL LEVEL PROGRAM PLANNING RE: SERVICE DELIVERY FOR PERSONS SERVED, ACTING AS AN ADVOCATE FOR PERSONS SERVED. DATA SOURCE: ADVOCACY ACTIVITIES. 2010 FINDINGS: SEVERAL ADVOCACY ACTIVITIES FOR PERSONS SERVED. LEADERSHIP ---------- - HOSPITAL STAFF, SENIOR LEADERSHIP BOARD REPRESENTATION ON THE ALLIANCE FOR THE BETTERMENT OF CITIZENS WITH DISABILITIES (ABCD). INVOLVED WITH ADVOCATING FOR EARLY INTERVENTION THROUGH THIS ORGANIZATION. - LEADERSHIP SERVES ON THE MAYOR'S ADVISORY COUNCIL ON BEHALF OF CHILDREN AND YOUNG ADULTS WITH DEVELOPMENTAL DISABILITIES IN THE TOWNSHIP OF DOVER. - CEO APPOINTED NJHA BOARD OF DIRECTORS - CEO APPOINTED TO NACHRI BOARD OF DIRECTORS AND PUBLIC POLICY COUNCIL
COMMUNITY BENEFIT STATEMENT; CONT'D CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS - CEO SERVES ON NJ STATE CHAMBER OF COMMERCE BOARD OF DIRECTORS - PARTICIPANT IN THE HEALTH CARE TASK FORCE THAT IS DEVELOPING A PLAN TO ADDRESS CRITICAL HEALTH CARE ISSUES IN THE STATE INCLUDING COST OF HEALTH INSURANCE, EXPANSION OF MEDICAID, AND THE NEED FOR WORKFORCE TO BE TRAINED TO BE ABLE TO MEET OUR NEEDS. - CEO ON VITALE WORKGROUP - CHAIRMAN OF STATE SENATE HEALTH COMMITTEE ESTABLISHED A TASK FORCE TO EXAMINE WAYS TO EXPAND MEDICAID AND A YEARLONG PROGRAM ON CRITICAL ISSUES IN NJ - PRESENTED ON THE NEEDS OF CHILDREN, AND KIDCARE TO COVER ALL CHILDREN IN NJ. - CEO CHAIRS FOR THE NJ CHAMBER A WORKGROUP ON EMPLOYMENT OF PEOPLE WITH DISABILITIES. - CEO, CDO AND VP-HUMAN RESOURCES ARE GRADUATES OF LEADERSHIP NJ - COO IS A MEMBER OF THE STATE INTERAGENCY COORDINATING COUNCIL WHICH OVERSEES THE DELIVERY OF EARLY INTERVENTION SERVICES THROUGHOUT THE STATE. MEMBERS ARE APPOINTED BY THE GOVERNOR AND CURRENTLY SERVES AS THE VICE CHAIR AND ACTING CHAIRMAN OF THIS COUNCIL - RESIDENCY, INTERN, STUDENT, AND FELLOW PROGRAMS FOR ADMINISTRATION, MEDICINE, NURSING, PHARMACY, THERAPIES. - PARTNERSHIP WITH THE EDUCATION SUPERVISOR FROM THE COMMISSION OF SPECIAL EDUCATION TO COORDINATE EDUCATIONAL AND CLINICAL REHABILITATION SERVICES TO ENSURE POSITIVE TRANSITIONS TO SCHOOL AND COMMUNITY. -FOUNDING MEMBER OF THE INTERNATIONAL PEDIATRIC REHABILITATION COLLABORATIVE - A GROUP TO ADVANCE BEST PRACTICES IN PEDIATRIC REHABILITATION. - DONATE EQUIPMENT TO THE UNITED SPINAL ORGANIZATION THAT HELPS DISTRIBUTE ADAPTIVE EQUIPMENT TO THE NEEDY AND THIRD WORLD COUNTRIES. - MEMBER, NEW JERSEY HOSPITAL ASSOCIATION (NJHA). - ADMINISTER A LIST SERVE FOR THE SIG (SPECIAL INTEREST GROUP)-17 OF RESNA REGARDING INTERNATIONAL APPROPRIATE TECHNOLOGY. THIS IS A FORUM FOR PEOPLE AROUND THE WORLD TO DISCUSS VARIOUS ADAPTIVE EQUIPMENT ISSUES. - COMMUNITY POLICING ALLIANCE IN FANWOOD - WORKS TO IMPROVE THE SAFETY OF INDIVIDUALS IN TOWN. - CLINICAL CONSORTIUM FOR REHABILITATION TECHNOLOGY WITH AREA HOSPITALS, CLINICS AND DEVELOPMENTAL CENTERS. - PAST PRESIDENT OF THE NJ CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS. - BOARD MEMBER, NEW JERSEY'S PEDIATRIC COUNCIL ON RESEARCH AND EDUCATION (PCORE) AND NEW JERSEY AAP CHAPTER. - NATIONAL INSTITUTE ON DISABILITY AND REHABILITATION RESEARCH (NIDRR) GRANT WITH NEW JERSEY INSTITUTE OF TECHNOLOGY. - MEDICAID PHYSICIAN GROUP MEETINGS TO ENSURE UNDERSTANDING OF REHABILITATION TECHNOLOGY SERVICES AND EQUIPMENT. - HUMANISM IN HEALTHCARE AWARD RECIPIENTS - HEALTHCARE FOUNDATION OF NEW JERSEY. - NASW-NJ CONFERENCE AND BY-LAWS REVISION COMMITTEES. - TOP DOCS NAMED BY NEW JERSEY MONTHLY. - ONE OF TOP 5 CHILDREN'S HOSPITALS IN NATIONAL EMPLOYEE OPINION SURVEY. - SECOND PLACE - TRAILBLAZER AWARD FOR INNOVATION PRACTICE (HOSPITAL DIVISION). - FAMILY AND PATIENT REPRESENTATIVES PRESENTED ON CAPITOL HILL WITH NACHRI. - TARGETED EARLY INTERVENTION PROGRAM EVALUATION TEAM FOR MERCER COUNTY, NJ. - REPRESENTATION ON THE DIVISION OF DEVELOPMENTAL DISABILITIES COMMITTEE THAT MAKE RECOMMENDATIONS TO THE STATE OF NJ AND FEDERAL GOVERNMENT WITH REGARD TO THE IDEA AND HOW LAWS IMPACT CHILDREN WE SERVE. - SERVE ON THE ADVOCACY AND PUBLIC AFFAIRS COMMITTEE TO THE BRAIN INJURY ASSOCIATION OF NEW JERSEY (BIANJ). - PARTNERED WITH YMCA TO PROVIDE AQUATICS PROGRAM TO CHILDREN WITH DISABILITIES. - MEMBER OF THE GOVERNOR'S COMMISSION ON RECREATIONAL OPPORTUNITIES FOR INDIVIDUALS WITH DISABILITIES. - MEMBERS OF THE CHILD AND ADOLESCENT TASK FORCE OF THE BIANJ. - RECREATION FOR INDIVIDUALS WITH DISABILITIES GRANT TO IMPLEMENT ADAPTIVE AQUATICS PROGRAM. - ADJUNCT PROFESSOR - DOMINICAN COLLEGE. - PSYCHOLOGY STAFF ARE MEMBERS OF VARIOUS GROUPS INCLUDING ASPERGER SYNDROME EDUCATION NETWORK (ASPEN) AND CENTER FOR OUTREACH AND SERVICES FOR THE AUTISM COMMUNITY (COSAC). - COMMUNITY AGENCY REPRESENTATIVE TO SCOTCH PLAINS-FANWOOD SCHOOLS AS PART OF THEIR SELF-MONITORING FOR NJ DEPT OF EDUCATION. - SERVICE ON MERCER COUNTY PROFESSIONAL ADVISORY COMMITTEE. - OFFICERS NEW JERSEY NEUROPSYCHOLOGICAL SOCIETY. - NATIONAL TASK FORCE MEMBER FOR FAMILY-CENTERED CARE SURVEY INITIATIVE. - FULL ACCREDITATION THROUGH THE COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES (CARF) AND THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS (JCAHO). -PARTNER WITH THE COSAC TO PROVIDE EDUCATION AND SUPPORT SERVICES TO FAMILIES OF CHILDREN WITH AUTISM. - MEMBER OF THE GRANTS REVIEW COMMITTEE FOR NIDRR. - "BRIDGES" PROGRAM TO HELP CHILDREN TRANSITION BACK TO SCHOOL. - FAMILY FACULTY A PART OF ORGANIZATION WIDE WORK GROUPS AND COMMITTEES, AS WELL AS SUPPORTS FOR FAMILIES ON INPATIENT UNITS. - LIGHTNING WHEELS - INTERNATIONAL REPRESENTATION FOR OUR WHEELCHAIR SPORTS TEAM. - EXPANDED OUTREACH TO THE SPANISH SPEAKING COMMUNITY THROUGH EDUCATION ON SPANISH LANGUAGE TELEVISION, RADIO STATIONS AND NEWSPAPERS. - PROFESSOR - UNION COUNTY COLLEGE PTA PROGRAM. - ORGANIZED A VISION CLINIC MODEL FOR "THE COMMISSION FOR THE BLIND". - HOSTED NEW JERSEY SPEECH AND HEARING ASSOCIATION (NJSHA) 50TH ANNIVERSARY CONFERENCE. - NATIONAL INSTITUTE OF HEALTH RESEARCH PROGRAM EXAMINING REGRESSION IN AUTISM. - MEDICATION TRIALS RESEARCH - AUTISM. - REPRESENTATION ON THE BOARD OF COSAC. - BEST PRACTICES TASKFORCE - AUTISM, AMERICAN SPEECH AND HEARING ASSOCIATION (ASHA). - FACILITATED CLOSURE OF THE NJ RECYCLING PROGRAM FOR ADAPTIVE EQUIPMENT PROGRAM. - MEMBER, EDUCATION AND TRAINING COMMITTEE - GOVERNOR'S CONFERENCE ON RECREATION FOR INDIVIDUALS WITH DISABILITIES. - FAMILY-CENTERED CARE NATIONAL TASK FORCE TO DEVELOP QUESTIONS FOR PRESS, GANEY. - CARF PARENT LIAISON FOR ACCREDITATION SURVEY TEAM. - SECRETARY, EXECUTIVE COMMITTEE OF BRAIN INJURY INTERDISCIPLINARY SPECIAL INTEREST GROUP (BI-ISIG) OF THE AMERICAN CONGRESS OF REHABILITATION MEDICINE (ACRM). - CFO IS A PAST PRESIDENT IN THE NEW JERSEY CHAPTER OF HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION (HFMA). CURRENTLY SERVES ON THE ADVISORY COUNCIL OF THE NJ CHAPTER. -CFO IS A MEMBER OF THE HFMA NATIONAL ADVISORY COUNCIL-REIMBURSEMENT AND PAYMENT GROUP - CHAIR, IMPLEMENTATION OF THE FEDERAL HEALTH INFORMATION TECHNOLOGY (HIT) COMMITTEE - CHAMBER OF COMMERCE EXECUTIVE COMMITTEE - MEDICAL ADVISOR, STAY FOCUSED INC., A PROGRAM DEVOTED TO HELPING SPECIAL NEEDS KIDS BECOME CERTIFIED IN SCUBA DIVING - MEDICAL ADVISOR, PEAK POTENTIAL INC., AN ADAPTIVE ROCK CLIMBING PROGRAM FOR SPECIAL NEEDS CHILDREN AND ADOLESCENTS - APPOINTED TO THE NEW JERSEY STATE COMMITTEE ON PEDIATRIC EMERGENCY SERVICES - "SPECIAL RECOGNITION AWARD" FROM THE AAP FOR SERVICE AND ADVOCACY FOR CHILDREN AND PEDIATRICIANS - RECEIVED GOVERNOR'S COUNCIL ON AUTISM GRANT - PAST CHAIR OF THE STATE PERFORMANCE PLAN COMMITTEE FOR THE STATE INTERAGENCY COORDINATING COUNCIL - VOLUNTEER WAS RECIPIENT OF THE "NJ BIZ HEALTHCARE HEROES AWARD" - STEERING COMMITTEE - INTERNATIONAL PEDIATRIC REHABILITATION COLLABORATIVE - MEMBER OF THE MAYOR'S ADVISORY COUNCIL ON DEVELOPMENTAL DISABILITIES, TOMS RIVER - MEMBER OF SAFE KIDS COMMUNITY PROGRAM COMMITTEE - PEDIATRIC LIAISON SERVICE TO PROVIDE TRAINING TO COMMUNITY PEDIATRICIANS REGARDING DEVELOPMENTAL SURVEILLANCE/SCREENING IN THE MEDICAL HOME - APPOINTED BY THE SECRETARY OF HEALTH AND HUMAN SERVICES TO INTERAGENCY AUTISM COORDINATING COUNCIL (IACC) - MEMBER, NJ GOVERNOR'S COUNCIL ON MEDICAL RESEARCH AND TREATMENT OF AUTISM - AUTISM FAMILY SERVICES OF NJ AWARD FOR EXCELLENCE AND DEDICATION TO FAMILIES OF KIDS WITH AUTISM - GOVERNOR'S WYNONA LIPMAN AWARD FOR ACHIEVEMENTS ON BEHALF OF WOMEN AND FAMILIES - NJ ADVISORY COMMISSION ON THE STATUS OF WOMEN AWARD - ESTABLISHED AND PARTICIPATED IN RESNA OCCUPATIONAL THERAPY ASSISTIVE TECHNOLOGY COMPETENCY TASK FORCE. - PRESIDENT OF THE SOMERSET AND HUNTERDON COUNTY PSYCHOLOGICAL ASSOCIATION - MEMBER, PLANNING COMMITTEE FOR NATIONAL SUMMIT ON VIOLENCE AND ABUSE IN RELATIONSHIPS - MEMBER - REVIEW TEAM FOR WHITE PAPER FOR SIBLING LEADERSHIP NETWORK -RECOMMENDATIONS FOR RESEARCH, ADVOCACY AND SUPPORT RELATED TO SIBLINGS OF PEOPLE WITH DEVELOPMENTAL DISABILITIES - PARTNERSHIP WITH RUTGERS UNIVERSITY FOR NEW JERSEY SIBLING LEADERSHIP NETWORK - SERVED ON THE CHILD LIFE NATIONAL PROFESSIONAL RESOURCE COUNCIL - MEMBER, BOARD OF DIRECTORS NEW JERSEY SPEECH AND HEARING ASSOCIATION (NJSHA) - NJSHA BOARD LIAISON TO THE AAC COMMITTEE - NJSHA CLINICAL FORUM CHAIR - NJSHA AAC WEBSITE DESIGN COORDINATOR - MEMBER, INTERNATIONAL COMMITTEE EUROPEAN SEATING SYMPOSIUM - REPRESENTATION ON THE LEADERSHIP OF THE DIVISION OF DEVELOPMENTAL DISABILITIES - SPECIAL RECOGNITION FROM NACHRI FOR FEDERAL ADVOCACY FOR CHILDREN - CO-CHAIR OF THE UNION COUNTY HEALTHCARE EMERGENCY MANAGEMENT COMMITTEE - MEMBER, MERCER COUNTY PROFESSIONAL ADVISORY COMMITTEE - MEMBER, BOARD OF TRUSTEES FOR NATIONAL ASSOCIATION FOR THE MENTALLY ILL (NAMI)-NJ - REVIEWER FOR THE SOCIETY OF PEDIATRIC PSYCHOLOGY STUDENT RESEARCH AWARDS - MEMBER, PLANNING COMMITTEE FOR NATIONAL SUMMIT ON VIOLENCE AND
COMMUNITY BENEFIT STATEMENT; CONT'D CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS - PROFESSORS/LECTURERS AT VARIOUS LOCAL UNIVERSITIES. - PRESIDENT OF THE NJ CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS - RECEIVED GRANT FROM KOHL'S KIDS ABILITIES PROGRAM TO RAISE AUTISM AWARENESS COMMUNITY INTEGRATION INTERNATIONALLY - SPONSORED FOUR DISABILITY AWARENESS CARNIVALS AT DIFFERENT LOCATIONS THROUGHOUT NJ, ATTENDED BY OVER 1,500 FAMILIES - MEMBER, PHILANTHROPY LEADERSHIP COUNCIL - ASSOCIATION OF FUNDRAISING PROFESSIONALS - APPOINTED TO THE NEW JERSEY GOVERNOR'S COUNCIL FOR MEDICAL RESEARCH AND TREATMENT OF AUTISM. - RECEIVED THE NJ COMMUNITY SERVICE AWARD PRESENTED BY AUTISM FAMILY SERVICES. - LONG TERM CARE RECOGNIZED IN THE OCTOBER 5TH "US NEWS & WORLD REPORT" ARTICLE, "AMERICA'S BEST NURSING HOMES" - RECEIVED HEALTHCARE FACILITY EMERGENCY PREPAREDNESS GRANT FOR FIRST TIME (ALSO APPROVED FOR 2010 GRANT) - FOUNDATION PRESIDENT IS TRUSTEE, LEADERSHIP NJ - MEMBER, U.S. SECRETARY OF HEALTH AND HUMAN SERVICES INTERAGENCY AUTISM COORDINATING COUNCIL - ACHIEVED AMERICAN COLLEGE OF GRADUATE MEDICAL EDUCATION ACCREDITATION FOR OUR DEVELOPMENTAL-BEHAVIOR PEDIATRICS FELLOWSHIP (FIRST AND ONLY ONE IN NEW JERSEY) - MULTIPLE PRESENTATIONS AT NATIONAL MEETINGS - MEMBER OF THE UNITED STATES INTERAGENCY AUTISM COORDINATING COUNCIL - MEMBER OF EDUCATIONAL ACCREDITATION SURVEY TEAM, MEDICAL SOCIETY OF NEW JERSEY - MEMBER OF NEW JERSEY GOVERNOR'S COUNCIL ON TRAUMATIC BRAIN INJURY - MEMBER OF THE ADVISORY COUNCIL, ELIZABETH BOGGS CENTER, NEW BRUNSWICK - PRESIDENT, NEW JERSEY ASSOCIATION OF NEURODEVELOPMENTAL PEDIATRICIANS - VICE CHAIR FOR NEW JERSEY'S CATASTROPHIC RELIEF FUND FOR CHILDREN - COMPLETED TENURE AS PRESIDENT OF THE NEW JERSEY CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS AND SERVES ON THE EXECUTIVE BOARD AS IMMEDIATE PAST PRESIDENT - VICE CHAIR OF THE OCCUPATIONAL THERAPY SPECIAL INTEREST GROUP AT REHABILITATION ENGINEERING SOCIETY OF NORTH AMERICA - MEMBER, NATIONAL TASK FORCE FOR DEVELOPING OCCUPATIONAL THERAPY COMPETENCIES - INITIALLY ACCEPTED BY THE AMERICAN OCCUPATIONAL THERAPY ASSOCIATION (AOTA) AS STANDARDS OF PRACTICE NATIONALLY - ESTABLISHED RESEARCH COLLABORATIONS WITH VARIOUS UNIVERSITIES NATIONALLY -PARTICIPATE ON STATEWIDE EVIDENCE BASED PRACTICE IN CHILDREN'S MENTAL HEALTH TASK FORCE -PROVIDED TRAINING WORKSHOPS FOR EARLY CHILDHOOD EDUCATORS ON RED FLAGS FOR AUTISM FAMILY REPRESENTATIVE ON NJ BRAIN INJURY ASSOCIATION CHILD AND ADOLESCENT COMMITTEE - MEMBER APTANJ PRACTICE COMMITTEE; NJ REPRESENTATIVE TO NATIONAL - SECRETARY APTA PEDIATRIC SECTION HOSPITAL BASED SPECIAL INTEREST GROUP - APPOINTED INCOMING NJ STATE REPRESENTATIVE FOR THE REGION OF APTA SECTION ON PEDIATRICS
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENT CORE FORM, PART III; QUESTION 4D EXPENSES INCURRED IN PROVIDING VARIOUS OTHER MEDICALLY NECESSARY PEDIATRIC HEALTHCARE SERVICES TO ALL CHILDREN IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN, RELIGION OR ABILITY TO PAY. PLEASE REFER TO THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT INCLUDED IN SCHEDULE O.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7 ROBERT WOOD JOHNSON HEALTHCARE CORPORATION IS THE SOLE MEMBER OF THIS ORGANIZATION. ROBERT WOOD JOHNSON HEALTHCARE CORPORATION HAS THE RIGHT TO ELECT THE MEMBERS OF THIS ORGANIZATION'S BOARD OF TRUSTEES AND HAS CERTAIN RESERVED POWERS AS DEFINED IN THIS ORGANIZATION'S BYLAWS.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 11A THE ORGANIZATION'S FEDERAL FORM 990 WAS PROVIDED TO AND MADE AVAILABLE TO EACH VOTING MEMBER OF THE ORGANIZATION'S GOVERNING BODY PRIOR TO ITS FILING WITH THE IRS AFTER REVIEW BY THE ORGANIZATION'S AUDIT AND COMPLIANCE COMMITTEE. THE ORGANIZATION'S BOARD OF TRUSTEES HAS ASSUMED THE RESPONSIBILITY TO OVERSEE, REVIEW AND APPROVE THE FEDERAL FORM 990, INCLUDING THE PREPARATION, REVIEW AND FILING PROCESS. AS PART OF THE TAX RETURN PREPARATION PROCESS THE ORGANIZATION HIRED A PROFESSIONAL CPA FIRM WITH EXPERIENCE AND EXPERTISE IN BOTH HEALTHCARE AND NOT-FOR-PROFIT TAX RETURN PREPARATION TO PREPARE THE FEDERAL FORM 990. THE CPA FIRM'S TAX PROFESSIONALS WORKED CLOSELY WITH THE ORGANIZATION'S FINANCE PERSONNEL AND VARIOUS OTHER INDIVIDUALS OF THE ORGANIZATION TO OBTAIN THE INFORMATION NEEDED IN ORDER TO PREPARE A COMPLETE AND ACCURATE TAX RETURN. THE CPA FIRM PREPARED A DRAFT FEDERAL FORM 990 AND FURNISHED IT TO THE ORGANIZATION'S FINANCE PERSONNEL AND OTHER INDIVIDUALS FOR THEIR REVIEW. THE ORGANIZATION'S FINANCE PERSONNEL AND OTHER INDIVIDUALS REVIEWED THE DRAFT FEDERAL FORM 990 AND DISCUSSED QUESTIONS AND COMMENTS WITH THE CPA FIRM. REVISIONS WERE MADE TO THE DRAFT FEDERAL FORM 990 WHERE NECESSARY AND A FINAL DRAFT WAS FURNISHED BY THE CPA FIRM TO THE ORGANIZATION'S FINANCE PERSONNEL AND VARIOUS OTHER INDIVIDUALS FOR FINAL REVIEW AND APPROVAL PRIOR TO PRESENTATION OF THE FEDERAL FORM 990 TO THE MEMBERS OF THE CHILDREN'S SPECIALIZED HOSPITAL AUDIT AND COMPLIANCE COMMITTEE. THE CHILDREN'S SPECIALIZED HOSPITAL BOARD OF TRUSTEES HAS DELEGATED TO THE AUDIT COMMITTEE THE RESPONSIBILITY TO OVERSEE, REVIEW AND APPROVE OF THE FEDERAL FORM 990, INCLUDING THE PREPARATION, REVIEW AND FILING PROCESS.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 12 THE ORGANIZATION REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. ANNUALLY ALL MEMBERS OF THE BOARD OF TRUSTEES, OFFICERS AND SENIOR MANAGEMENT PERSONNEL ARE REQUIRED TO REVIEW THE EXISTING CONFLICT OF INTEREST POLICY AND COMPLETE A QUESTIONNAIRE. THE COMPLETED QUESTIONNAIRES ARE RETURNED TO THE ORGANIZATION'S CHIEF COMPLIANCE OFFICER FOR REVIEW. THEREAFTER THE CHIEF COMPLIANCE OFFICER PREPARES A SUMMARY OF THE COMPLETED QUESTIONNAIRES WHICH CONTAINS INFORMATION DISCLOSED ON AN INDIVIDUAL BY INDIVIDUAL BASIS. THEREAFTER, THE CHIEF COMPLIANCE OFFICER OF THE ORGANIZATION PRESENTS THIS SUMMARY TO THE ORGANIZATION'S AUDIT AND COMPLIANCE COMMITTEE FOR THEIR REVIEW AND DISCUSSION.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION B; QUESTION 15 THE ORGANIZATION'S BOARD OF TRUSTEES HAS AN EXECUTIVE COMPENSATION COMMITTEE ("COMMITTEE"). THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS AND APPROVES OF THE COMPENSATION AND BENEFITS OF THE ORGANIZATION'S SENIOR MANAGEMENT, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. THE COMMITTEE REVIEWS THE "TOTAL COMPENSATION" OF THE INDIVIDUALS WHICH IS INTENDED TO INCLUDE BOTH CURRENT AND DEFERRED COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED. THE COMMITTEE'S REVIEW IS DONE ON AT LEAST AN ANNUAL BASIS AND ENSURES THAT THE "TOTAL COMPENSATION" OF SENIOR MANAGEMENT OF THE ORGANIZATION IS REASONABLE. THE ACTIONS TAKEN BY THE COMMITTEE ENABLE THE ORGANIZATION TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE SECTION 4958 WITH RESPECT TO THE TOTAL COMPENSATION OF CERTAIN MEMBERS OF THE SENIOR MANAGEMENT TEAM, INCLUDING THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. THE THREE FACTORS WHICH MUST BE SATISFIED IN ORDER TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS ARE THE FOLLOWING: 1. THE COMPENSATION ARRANGEMENT IS APPROVED IN ADVANCE BY AN "AUTHORIZED BODY" OF THE APPLICABLE TAX-EXEMPT ORGANIZATION WHICH IS COMPOSED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A "CONFLICT OF INTEREST" WITH RESPECT TO THE COMPENSATION ARRANGEMENT; 2. THE AUTHORIZED BODY OBTAINED AND RELIED UPON "APPROPRIATE DATA AS TO COMPARABILITY" PRIOR TO MAKING ITS DETERMINATION; AND 3. THE AUTHORIZED BODY "ADEQUATELY DOCUMENTED THE BASIS FOR ITS DETERMINATION" CONCURRENTLY WITH MAKING THAT DETERMINATION. THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES EACH OF WHO ARE INDEPENDENT AND ARE FREE FROM ANY CONFLICTS OF INTEREST. THE COMMITTEE RELIED UPON APPROPRIATE COMPARABLE DATA; SPECIFICALLY THE COMMITTEE OBTAINED A WRITTEN COMPENSATION STUDY FROM AN INDEPENDENT FIRM WHICH SPECIALIZES IN THE REVIEWING OF HOSPITAL AND HEALTHCARE SYSTEM EXECUTIVE COMPENSATION AND BENEFITS THROUGHOUT THE UNITED STATES. THIS STUDY USED COMPARABLE GEOGRAPHIC AND DEMOGRAPHIC MARKET DATA INCLUDING BUT NOT LIMITED TO SIMILAR SIZED HOSPITALS, # OF LICENSED BEDS AND NET PATIENT SERVICE REVENUE. THE COMMITTEE ADEQUATELY DOCUMENTED ITS BASIS FOR ITS DETERMINATION THROUGH THE TIMELY PREPARATION OF WRITTEN MINUTES OF THE COMPENSATION COMMITTEE MEETINGS DURING WHICH THE EXECUTIVE COMPENSATION AND BENEFITS WAS REVIEWED AND SUBSEQUENTLY APPROVED. THE ACTIONS OUTLINED ABOVE WITH RESPECT TO THE COMMITTEE AND THE ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS ONLY APPLIES TO CERTAIN SENIOR MANAGEMENT PERSONNEL, INCLUDING BUT NOT LIMITED TO THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER. THE COMPENSATION AND BENEFITS OF THE OTHER INDIVIDUALS CONTAINED IN THIS FORM 990 IS REVIEWED ANNUALLY BY THE PRESIDENT/CHIEF EXECUTIVE OFFICER WITH ASSISTANCE FROM ORGANIZATION'S HUMAN RESOURCES DEPARTMENT IN CONJUNCTION WITH THE INDIVIDUAL'S JOB PERFORMANCE DURING THE YEAR AND IS BASED UPON OTHER OBJECTIVE FACTORS DESIGNED TO ENSURE THAT REASONABLE AND FAIR MARKET VALUE COMPENSATION IS PAID BY THE ORGANIZATION. OTHER OBJECTIVE FACTORS INCLUDE MARKET SURVEY DATA FOR COMPARABLE POSITIONS, INDIVIDUAL GOALS AND OBJECTIVES, PERSONNEL REVIEWS, EVALUATIONS, SELF-EVALUATIONS AND PERFORMANCE FEEDBACK MEETINGS.
DISCLOSURE INFORMATION CORE FORM, PART VI, SECTION C; QUESTION 19 THE ORGANIZATION HAS ISSUED TAX-EXEMPT BONDS TO FINANCE VARIOUS CAPITAL IMPROVEMENT PROJECTS, RENOVATIONS AND EQUIPMENT. IN CONJUNCTION WITH THE ISSUANCE OF THESE TAX-EXEMPT BONDS, THE ORGANIZATION'S FINANCIAL STATEMENTS WERE INCLUDED WITH THE TAX-EXEMPT BOND PROSPECTUS WHICH WAS MADE AVAILABLE TO THE GENERAL PUBLIC FOR REVIEW. IN ADDITION, THE ORGANIZATION'S FILED CERTIFICATE OF INCORPORATION AND ANY AMENDMENTS CAN BE OBTAINED AND REVIEWED THROUGH THE STATE OF NEW JERSEY SECRETARY OF STATE.
COMPENSATION INFORMATION CORE FORM, PART VII AND SCHEDULE J LAWRENCE GARINELLO IS A MEMBER OF THIS ORGANIZATION'S BOARD OF TRUSTEES BUT WORKS ON A FULL-TIME BASIS 50 HOURS PER WEEK AS THE VICE PRESIDENT OF PLANNING FOR ROBERT WOOD JOHNSON UNIVERSITY HOSPITAL; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. PHILIP SALERNO IS A MEMBER OF THIS ORGANIZATION'S BOARD OF TRUSTEES BUT WORKS ON A FULL-TIME BASIS 50 HOURS PER WEEK AS THE PRESIDENT AND CHIEF DEVELOPMENT OFFICER OF CHILDREN'S SPECIALIZED HOSPITAL FOUNDATION; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION.
OTHER CHANGES IN NET ASSETS CORE FORM, PART XI; QUESTION 5 OTHER CHANGES IN NET ASSETS OR FUND BALANCE INCLUDE: - NET CHANGE IN UNREALIZED GAINS ON INVESTMENTS OTHER THAN TRADING SECURITIES - $317,394 - CHANGE IN INTEREST IN RESTRICTED NET ASSETS OF FOUNDATION - $3,460,136 - NET ASSETS RELEASED FROM RESTRICTIONS - ($3,203,431)
AUDITED FINANCIAL STATEMENTS CORE FORM, PART XII; QUESTION 2 A BIG FOUR INDEPENDENT CPA FIRM AUDITED THE FINANCIAL STATEMENTS OF THE TAXPAYER FOR THE YEARS ENDED DECEMBER 31, 2010 AND DECEMBER 31, 2009; RESPECTIVELY, AND ISSUED A CERTIFIED AUDITED FINANCIAL STATEMENT. AN UNQUALIFIED OPINION WAS ISSUED BY THE BIG FOUR INDEPENDENT CPA FIRM EACH YEAR. THE TAXPAYER'S AUDIT AND COMPLIANCE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID KOSTINAS TITLE:CHAIRMAN - TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SISTER JANE FRANCES BRADY TITLE:1ST VICE CHAIR - TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBIN A WALTON TITLE:TREASURER - TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KISHAN AGARWAL MD TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BONNIE BALOGA ALTIERI MSN RN TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:FRANK CASTELLO MD TITLE:TRUSTEE - MEDICAL DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SCOTT CHESNEY TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TERRANCE FARLEY TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LAWRENCE GARINELLO TITLE:TRUSTEE HOURS:52
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SAVERIO GARRUTO CPA TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ALEXANDER R GIAQUINTO PHD TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELIZABETH HANCE TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NANCY JACKSON TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:AMY B MANSUE TITLE:TRUSTEE - PRESIDENT/CEO HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PETER W METZ TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NANCI D MORRIS TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GLENN MORTIMER TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARGARET M PEGO TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:STEVEN M ROSENBERG ESQ TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BARBARA ROTHMAN TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PHILIP SALERNO TITLE:TRUSTEE - PRES/CDO FOUNDATION HOURS:52
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:VINCENT SERPICO TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ARVIND SHAH MD TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GAIL SLOAN TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:VICTORIA WICKS TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PATRICIA WHITLEY WILLIAMS MD TITLE:TRUSTEE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WARREN E MOORE TITLE:EVP/COO HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOSEPH J DOBOSH JR TITLE:SENIOR VP/CFO HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KAREN M DEWITT EDD TITLE:VP PATIENT CARE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM DWYER TITLE:VP HUMAN RESOURCES HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL R DRIBBON PHD TITLE:VP REHAB SERVICES & PROG. DEV. HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:UDAY MEHTA MD TITLE:ASSOCIATE MEDICAL DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARTIN DIAMOND MD TITLE:DIRECTOR; O/P SERVICES HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KRISHAN YALAMANCHI MD TITLE:DIRECTOR; BRAIN INJURY HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:YVETTE JANVIER MD TITLE:DIRECTOR; MEDICAL SERVICES HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS A RUGINO MD TITLE:PHYSIATRIST HOURS:
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
CHILDREN'S SPECIALIZED HOSPITAL
 
Employer identification number

22-1487148
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income



(e)
End-of-year assets


(f)
Direct controlling
entity



















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section



(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled organization
Yes No
(1) CHILDRENS SPECIALIZED HOSPITAL FDN

150 NEW PROVIDENCE ROAD

MOUNTAINSIDE,NJ07092
13-6844298
FUNDRAISING NJ 501(C)(3) 509(A)(1) RWJHCC
 
 
 
(2) LAKEVIEW CHILD CARE CENTER INC

ONE HAMILTON HEALTH PLACE

HAMILTON,NJ08690
22-2627639
CHILD CARE NJ 501(C)(3) 509(A)(2) RWJHCCH
 
 
 
(3) RWJ UNIV HOSPITAL HAMILTON

ONE HAMILTON HEALTH PLACE

HAMILTON,NJ08690
21-0634572
HLTHCARE SVC NJ 501(C)(3) HOSPITAL RWJHCCH
 
 
 
(4) RWJ UNIV HOSP HAMILTON FDN INC

ONE HAMILTON HEALTH PLACE

HAMILTON,NJ08690
22-2552329
FUNDRAISING NJ 501(C)(3) 509(A)(1) RWJHCCH
 
 
 
(5) RWJ HEALTH CARE CORPORATION AT HAMILTON

ONE HAMILTON HEALTH PLACE

HAMILTON,NJ08690
22-2566863
HOLDING CO. NJ 501(C)(3) 509(A)(3) RWJHCC
 
 
 
(6) RWJ UNIV HOSP AT RAHWAY AUXILIARY

865 STONE STREET

RAHWAY,NJ07065
22-0012205
SUPPORTING NJ 501(C)(3) 509(A)(3) RWJUHR
 
 
 
(7) RWJ UNIV HOSP AT RAHWAY FOUNDATION

865 STONE STREET

RAHWAY,NJ07065
22-2405094
FUNDRAISING NJ 501(C)(3) 509(A)(3) RWJUHR
 
 
 
(8) RWJ UNIVERSITY HOSPITAL AT RAHWAY

865 STONE STREET

RAHWAY,NJ07065
22-1487305
HLTHCARE SVC NJ 501(C)(3) HOSPITAL RWJHCC
 
 
 
(9) NEW BRUNSWICK AFFILIATED HOSPITALS INC

120 ALBANY STREET SUITE 750

NEW BRUNSWICK,NJ08901
22-1946837
HLTHCARE SVC NJ 501(C)(3) 509(A)(3) RWJHCC
 
 
 
(10) RWJ PROPERTY HOLDING CORPORATION

120 ALBANY STREET SUITE 750

NEW BRUNSWICK,NJ08901
22-2474955
PROPERTY NJ 501(C)(3) 509(A)(3) RWJHCC
 
 
 
(11) RWJ HEALTH CARE CORPORATION

120 ALBANY STREET SUITE 750

NEW BRUNSWICK,NJ08901
22-2568905
HOLDING CO. NJ 501(C)(3) 509(A)(3) NA
 
 
 
(12) RWJ UNIV HOSPITAL FOUNDATION INC

120 ALBANY STREET SUITE 750

NEW BRUNSWICK,NJ08901
22-2378007
FUNDRAISING NJ 501(C)(3) 509(A)(3) RWJHCC
 
 
 
(13) RWJ UNIVERSITY HOSPITAL

ONE ROBERT WOOD JOHNSON PLACE

NEW BRUNSWICK,NJ08903
22-1487243
HLTHCARE SVC NJ 501(C)(3) HOSPITAL RWJHCC
 
 
 
(14) AUXILIARY OF RWJ UNIVERSITY HOSPITAL

120 ALBANY STREET SUITE 750

NEW BRUNSWICK,NJ08901
22-6014339
SUPPORTING NJ 501(C)(3) 509(A)(2) RWJUH
 
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No Yes No
(1) NONE

 
 
     
                 












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



(b)
Primary activity



(c)
Legal domicile
(state or
foreign
country)
(d)
Direct controlling
entity


(e)
Type of entity
(C corp, S corp,
or trust)

(f)
Share of total income



(g)
Share of
end-of-year
assets

(h)
Percentage
ownership


(1) HAMILTON OB GYN PA
ONE HAMILTON HEALTH PLACE
HAMILTON,NJ08690
20-0218248
HEALTHCARE SVCS. NJ NA
 
C CORP.      
(2) RWJ DIABETES & ENDOCRINOLOGY
ONE HAMILTON HEALTH PLACE
HAMILTON,NJ08690
26-1447574
HEALTHCARE SVCS. NJ NA
 
C CORP.      
(3) RWJ MED ASSOC AT HAMILTON
ONE HAMILTON HEALTH PLACE
HAMILTON,NJ08690
22-3454267
PROF. SVCS. NJ NA
 
C CORP.      
(4) RWJ MED SVCS ORG AT HAMILTON
ONE HAMILTON HEALTH PLACE
HAMILTON,NJ08690
22-3454270
RENTAL REAL EST. NJ NA
 
C CORP.      
(5) VISION HEALTHCARE INC
865 STONE STREET
RAHWAY,NJ07065
20-4285005
INVESTMENT NJ NA
 
C CORP.      
(6) RWJ HEALTH NETWORK INC
120 ALBANY STREET SUITE 750
NEW BRUNSWICK,NJ08901
22-3420314
HEALTHCARE SVCS. NJ NA
 
C CORP.      
(7) RWJ KIDNEY TRANSPLANT ASSOC
120 ALBANY STREET SUITE 750
NEW BRUNSWICK,NJ08901
03-0382501
HEALTHCARE SVCS. NJ NA
 
C CORP.      
(8) RWJ MULTI-SPECIALTY PA
120 ALBANY STREET SUITE 750
NEW BRUNSWICK,NJ08901
03-0382492
HEALTHCARE SVCS. NJ NA
 
C CORP.      
(9) RWJ MEDICAL ASSOCIATES PA
120 ALBANY STREET SUITE 750
NEW BRUNSWICK,NJ08901
22-3586872
HEALTHCARE SVCS. NJ NA
 
C CORP.      
(10) RWJ SURGERY CENTER INC
120 ALBANY STREET SUITE 750
NEW BRUNSWICK,NJ08901
22-3698431
HEALTHCARE SVCS. NJ NA
 
C CORP.      
(11) SYSTEM AND AFFILIATE MEMBERS
CRAIG APPIN HOUSE 8 WESLEY STREET
HAMILTON,BDHM JX
BD
98-0656382
FINANCIAL VEHICLE BD NA
 
FOREIGN CORP.      
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization
(b)
Transaction
type(a-r)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
(2)

(3)

(4)

(5)

(6)

Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Are all
partners
section
501(c)(3)
organizations?
(e)
Share of
end-of-year
assets
(f)
Disproprtionate allocations?
(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065)
(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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