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
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012
BCheck if applicable:
CName of organization
Children's Hospital
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
111 Michigan Avenue NW
 
Room/suite
City or town, state or country, and ZIP + 4
Washington, DC20010
D Employer identification number

53-0196580
E Telephone number

G Gross receipts $ 1,005,332,710
F Name and address of principal officer:
KURT DOUGLAS NEWMAN MD
111 Michigan Avenue NW
Washington,DC20010
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.childrensnational.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: 1870
M State of legal domicile: DC
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO IMPROVE HEALTH OUTCOMES FOR CHILDREN, LEAD IN CREATING INNOVATIVE SOLUTIONS TO PEDIATRIC HEALTHCARE PROBLEMS, & EXCEL IN CARE, ADVOCACY, RESEARCH, & EDUCATION, TO MEET NEEDS OF CHILDREN AND THEIR FAMILIES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 16
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 14
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 6,728
6 Total number of volunteers (estimate if necessary) .... 6 956
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 527,776
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -1,280,552
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 30,058,390 27,471,455
9 Program service revenue (Part VIII, line 2g) ......... 820,236,376 884,771,203
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 509,419 -5,372,744
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 2,821,450 3,209,168
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 853,625,635 910,079,082
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) 496,071,639 525,267,158
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).... 302,978,063 342,762,679
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 799,049,702 868,029,837
19 Revenue less expenses. Subtract line 18 from line 12....... 54,575,933 42,049,245
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 940,880,504 908,465,625
21 Total liabilities (Part X, line 26)............. 573,919,237 536,572,770
22 Net assets or fund balances. Subtract line 21 from line 20..... 366,961,267 371,892,855
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 use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
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 IMPROVE HEALTH OUTCOMES FOR CHILDREN REGIONALLY, NATIONALLY, AND INTERNATIONALLY. BE A LEADER IN CREATING INNOVATIVE SOLUTIONS TO PEDIATRIC HEALTHCARE PROBLEMS, AND EXCEL IN CARE, ADVOCACY, RESEARCH, AND EDUCATION TO MEET UNIQUE NEEDS OF CHILDREN, ADOLESCENTS, AND THEIR FAMILIES.
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 organization’s program service accomplishments for each of its three largest program services, as measured 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 $ 639,452,920 including grants of $   ) (Revenue $ 884,771,203 )
CHILDREN'S HOSPITAL OPERATES AN ACUTE CARE PEDIATRIC AND TEACHING FACILITY IN WASHINGTON, DC. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES. CHILDREN'S NATIONAL MEDICAL CENTER (CNMC) IS THE PARENT COMPANY OF THE HOSPITAL. CNMC AND ITS AFFILIATES PROVIDE HEALTHCARE SERVICES TO INFANTS, CHILDREN, AND YOUTH IN WASHINGTON, DC AND THE SURROUNDING METROPOLITAN AREA. SEE SCHEDULE O FOR COMPLETE FY12 COMMUNITY BENEFIT REPORT.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 639,452,920
Form 990 (2011)
Form 990 (2011)
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 IIClick 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 for which 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 IClick 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 IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
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
 
No
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
 
No
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
Yes
 
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, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? 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
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see attachment
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization 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
Yes
 
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......
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................
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.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
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 .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
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..
28c
 
No
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
Yes
 
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
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, 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
35b
Yes
 
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 (2011)
Form 990 (2011)
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
1,756
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
6,728
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
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
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: MediumBulletAE
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 (2011)
Form 990 (2011)
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
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
16
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
14
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
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
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
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete 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
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did 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 15a or 15b, 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,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take 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
DC
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 made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
CORPORATE OFFICERS
111 MICHIGAN AVENUE NW
WASHINGTON,DC20010
(301) 572-6283
Form 990 (2011)
Form 990 (2011)
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 (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) KATHY BARKER
BOARD MEMBER
 1.0 X           0 0 0
(2) DEIDRE ADKINS
BOARD MEMBER
 1.0 X           0 0 0
(3) SHONAY BARNETT-JONES
BOARD MEMBER
 1.0 X           0 0 0
(4) ELIZABETH DUGGAL
BOARD MEMBER
 1.0 X           0 0 0
(5) DEBRA FRIEDMAN
BOARD VICE CHAIRMAN
 2.0 X   X       0 0 0
(6) ALBERTO GOMEZ
BOARD MEMBER
 1.0 X           0 0 0
(7) DAVID WHISTON
BOARD MEMBER
 1.0 X           0 0 0
(8) PETER R HOLBROOK MD
EVP/CHIEF MEDICAL OFFICER
 53.0 X   X       1,544,145 0 97,219
(9) ROBERT KEATING MD
CHIEF OF NEUROSURGERY
 55.0 X           846,080 0 93,999
(10) ROBERT MCDOWELL MD
BOARD MEMBER
 1.0 X           0 0 0
(11) GREGORY O'DELL
BOARD MEMBER
 1.0 X           0 0 0
(12) TERRY CORNWELL RUMSEY
BOARD MEMBER
 1.0 X           0 0 0
(13) IVAN SABEL
SECRETARY/TREASURER
 2.0 X   X       0 0 0
(14) MARY HELEN THOMPSON
BOARD MEMBER
 1.0 X           0 0 0
(15) CAROLYN THORNELL
BOARD CHAIRMAN
 2.0 X   X       0 0 0
(16) KATHIE WILLIAMS
BOARD MEMBER
 1.0 X           0 0 0
(17) MARK BATSHAW MD
EVP/CHIEF ACADEMIC OFFICER
 9.0     X       1,218,937 0 321,598
Form 990 (2011)
Form 990 (2011)
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 (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) JODY BURDELL
EVP/CHIEF OPERATING OFFICER
 54.0     X       1,473,285 0 44,646
(19) MARY ANNE HILLIARD
CHIEF RISK OFFICER
 54.0     X       511,344 0 65,785
(20) DOUGLAS MYERS
EVP & CHIEF FINANCIAL OFFICER
 50.0     X       721,849 0 97,762
(21) NELLIE ROBINSON
EVP/CHIEF NURSING/PATIENT SVCS
 54.0     X       664,582 0 52,662
(22) PAM KING SAMS
EVP/ CHIEF DEVELOPMENT OFFICER
 5.0     X       551,105 0 165,490
(23) RAYMOND SCZUDLO
EVP/ CHIEF LEGAL OFFICER
 53.0     X       1,050,566 0 53,055
(24) MENDEL TUCHMAN MD
CHIEF RESEARCH OFFICER
 5.0     X       614,315 0 97,136
(25) JACQUELINE BOWENS
EVP/EXTERNAL AFFAIRS OFFICER
 53.0       X     773,474 0 28,576
(26) ROBERTA ALESSI
VP OPERATIONS
 54.0       X     371,066 0 61,438
(27) MAX COPPES MD PHD
SVP CENTER OF EXCELLENCE
 53.0       X     776,376 0 103,687
(28) DENICE CORA-BRAMBLE MD
SVP CENTER OF EXCELLENCE
 53.0       X     568,740 0 70,982
(29) RICHARD JONAS MD
CHIEF OF CARDIO SURGERY
 53.0       X     1,771,904 0 152,853
(30) MIRIAM MARKOWITZ
CORP VP STRATEGIC PLANNING
 53.0       X     451,229 0 66,385
(31) GERARD MARTIN MD
SVP CENTER OF EXCELLENCE
 53.0       X     844,228 0 82,223
(32) KURT DOUGLAS NEWMAN MD
SVP CENTER OF EXCELLENCE
 53.0       X     1,137,776 0 276,098
(33) ROGER PACKER MD
SVP CENTER OF EXCELLENCE
 43.0       X     768,454 0 206,551
(34) ANTHONY SANDLER MD
CHIEF OF PEDIATRIC SURGERY
 55.0       X     694,066 0 24,708
(35) CAROLE SCHOR
CORP VP HUMAN RESOURCES
 54.0       X     412,008 0 75,763
(36) DAVID SPARKS
VP FINANCE & CONTROLLER
 54.0       X     444,508 0 80,516
(37) DAVID WESSEL MD
SVP CENTER OF EXCELLENCE
 53.0       X     821,440 0 86,074
(38) JOSEPH WRIGHT MD
SVP CENTER OF EXCELLENCE
 52.0       X     602,187 0 89,066
(39) LAUREL BLAKEMORE MD
CHIEF OF ORTHOPEDIC SURGERY
 55.0         X   634,193 0 50,876
(40) H GIL RUSHTON MD
CHIEF OF UROLOGY
 55.0         X   600,636 0 78,008
(41) JOHN MYSEROS MD
NEUROSURGEON
 55.0         X   636,276 0 22,877
(42) LOUIS M MARMON MD
SURGEON
 55.0         X   538,872 0 24,708
(43) GARY F ROGERS MD
CHIEF OF PLASTIC & RECON SURG
 55.0         X   589,316 0 15,057
(44) EDWIN K ZECHMAN JR
PRESIDENT/CEO
             X 5,206,966 0 173,866
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 27,839,923 0 2,859,664
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet1,248
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
Yes
 
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
NATIONAL NURSES SERVICE
DEPT L-9032
COLUMBUS,OH432609032 		Nursing 3,527,866
COLONIAL PARKING
2145 K STREET NW
WASHINGTON,DC20037 		Parking 3,121,964
ATLANTIC SERVICES GROUP
2131 K STREET NW
WASHINGTON,DC20037 		Parking 2,637,599
HITT CONTRACTING INC
PO BOX 403509
ATLANTA,GA303843509 		Construction 2,635,048
MICROSOFT LICENSING
PO BOX 067
DALLAS,TX752892467 		Licensing 1,887,163
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet136
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 24,325,398
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		3,146,057
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 27,471,455
Program Service Revenue Business Code
2a PATIENT REVENUE 621,400 800,307,241 800,307,241    
b FEES AND CONTRACTS 900,099 9,177,492 9,177,492    
c ALL OTHER PROGRAM SERVICES 900,099 75,286,470 75,286,470    
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 884,771,203
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 1,239,659     1,239,659
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 88,643,889 -2,664
b Less: cost or other basis and sales expenses 88,457,496 6,796,132
c Gain or (loss) 186,393 -6,798,796
d Net gain or (loss)..........MediumBullet -6,612,403     -6,612,403
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 PARTNERSHIP LOSS 621,110 -588,088 -588,088    
b PARKING 812,930 3,269,480     3,269,480
c LAB FEES 621,500 527,776   527,776  
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 3,209,168
12 Total revenue. See Instructions....MediumBullet 910,079,082 884,183,115 527,776 -2,103,264
Form 990 (2011)
Form 990 (2011)
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).
Check if Schedule O contains a response to any question in this Part IX. .........
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 United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. 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 .... 43,770,459   43,770,459  
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 407,683,756 342,028,068 65,655,688  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 15,244,351 8,982,225 6,262,126  
9 Other employee benefits ....... 28,829,828 19,869,253 8,960,575  
10 Payroll taxes ........... 29,738,764 23,130,656 6,608,108  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 1,320,900 145,171 1,175,729  
c Accounting ........... 657,113   657,113  
d Lobbying ........... 351,922   351,922  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 53,369,450 32,491,593 20,877,857  
12 Advertising and promotion .... 1,370,409 190,650 1,179,759  
13 Office expenses ....... 9,852,865 5,887,344 3,965,521  
14 Information technology ...... 13,740,464 1,109,911 12,630,553  
15 Royalties .. 0      
16 Occupancy ........... 25,292,258 16,157,333 9,134,925  
17 Travel ............ 6,877,898 1,981,664 4,896,234  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 278,000 263,568 14,432  
20 Interest ........... 21,566,539 14,311,791 7,254,748  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 52,746,904 34,980,538 17,766,366  
23 Insurance .............. 34,269,419 33,076,838 1,192,581  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL SUPPLIES 73,170,537 69,613,786 3,556,751  
b BAD DEBT EXPENSE 23,187,334 23,187,334    
c REPAIRS AND MAINTENANCE 14,006,309 5,025,031 8,981,278  
d OVERHEAD 2,569,945 2,569,945    
e
f All other expenses 8,134,413 4,450,221 3,684,192  
25 Total functional expenses. Add lines 1 through 24f 868,029,837 639,452,920 228,576,917 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 0 1 0
2 Savings and temporary cash investments ....... 93,509,895 2 72,128,029
3 Pledges and grants receivable, net ......... 4,190,014 3 3,151,413
4 Accounts receivable, net ......... 131,416,855 4 147,548,630
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
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 .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 3,692,052 8 3,546,822
9 Prepaid expenses and deferred charges ............ 6,510,544 9 5,332,847
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 935,436,841
b Less: accumulated depreciation. ..... 10b 402,494,157 520,149,345 10c 532,942,684
11 Investments—publicly traded securities .......... 91,788,843 11 72,988,468
12 Investments—other securities. See Part IV, line 11 ...... 47,142,094 12 32,277,136
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 20,000 14 20,000
15 Other assets. See Part IV, line 11 ........... 42,460,862 15 38,529,596
16 Total assets. Add lines 1 through 15 (must equal line 34)... 940,880,504 16 908,465,625
Liabilities 17 Accounts payable and accrued expenses . 157,541,208 17 128,163,443
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 8,685,472 19 10,798,597
20 Tax-exempt bond liabilities .......... 418,911,526 20 415,069,144
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 514,284 23 428,568
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... -11,733,253 25 -17,886,982
26 Total liabilities. Add lines 17 through 25..... 573,919,237 26 536,572,770
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 ..... 366,961,267 27 371,892,855
28 Temporarily restricted net assets ..... 0 28 0
29 Permanently restricted net assets ..... 0 29 0
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 ..... 366,961,267 33 371,892,855
34 Total liabilities and net assets/fund balances ..... 940,880,504 34 908,465,625
Form 990 (2011)
Form 990 (2011)
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
910,079,082
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
868,029,837
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
42,049,245
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
366,961,267
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-37,117,657
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
371,892,855
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
 
 
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
 
 
Form 990 (2011)
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
2011
Open to Public
Inspection
Name of the organization
Children's Hospital
 
Employer identification number

53-0196580
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011

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
2011
Name of organization
Children's Hospital
 
Employer identification number

53-0196580
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 on line H of its
Form 990-EZ or on Part I, 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) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Children's Hospital
  		Employer identification number

53-0196580
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total 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)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




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

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Children's Hospital
  		Employer identification number

53-0196580
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(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) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
Children's Hospital
  		Employer identification number

53-0196580
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total 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 $  
Use duplicate copies of Part III if additional space is needed
(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) (2011)

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
2011
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, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Children's Hospital
 
Employer identification number

53-0196580
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 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 function 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) 2011

Schedule C (Form 990 or 990-EZ) 2011
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 expenses, and share of excess lobbying expenditures).
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) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
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)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(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)? ....
Yes
 
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
 
234,732
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
117,190
j
Total. Add lines 1c through 1i ...............................
351,922
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 carry over 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) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible 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, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
Paid Staff or Management Schedule C, Part II-B, Line 1b FOCUS PRIMARILY ON EFFORTS TO IMPROVE THE LEVEL OF FUNDING FOR SERVICES FOR CHILDREN IN PUBLIC HEALTH PROGRAMS.
Direct Contact Schedule C, Part II-B, Line 1g THE LOBBYING ACTIVITIES ENGAGED IN BY CHILDREN'S HOSPITAL FOCUS PRIMARILY ON EFFORTS TO IMPROVE THE LEVEL OF FUNDING FOR SERVICES FOR CHILDREN IN PUBLIC HEALTH PROGRAMS. THOSE LOBBYING ACTIVITIES INCLUDE CONTINUAL MONITORING OF LEGISLATION VIA DISCUSSIONS WITH LEGISLATIVE STAFF, HOSTING EDUCATIONAL BRIEFING SESSIONS FOR MEMBERS OF CONGRESS, EXECUTIVE BRANCH, STATE AND LOCAL OFFICIALS/STAFF REGARDING CHILD HEALTH ISSUES, AND COORDINATING THE SUBMISSION OF CORRESPONDENCE/WRITTEN COMMENTS ON PROPOSED LEGISLATION AND REGULATIONS, AS WELL AS THE PRESENTATION OF TESTIMONY BEFORE LEGISLATIVE COMMITTEES. CHILDREN'S HOSPITAL ALSO DEVELOPS POLICY POSITIONS IN RESPONSE TO PROBLEMS AND OPPORTUNITIES IN THE PUBLIC SECTOR. EXPENSES TOTALED $234,732.
Other Schedule C, Part II-B, Line 1i THE HOSPITAL IS A MEMBER OF THE NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS (NACH). NACH HAS CHILD ADVOCACY AND LEGISLATIVE ADVOCACY PROGRAMS.
Schedule C (Form 990 or 990EZ) 2011

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, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Children's Hospital
 
Employer identification number

53-0196580
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 can 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 through 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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 (ASC 958), 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 (ASC 958), 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 (ASC 958), 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) 2011

Schedule D (Form 990) 2011
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 ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
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)
 
 
(ii) related organizations ........................
3a(ii)
 
 
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
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   1,440,758 1,440,758
b Buildings ................   645,878,956 261,433,700 384,445,256
c Leasehold improvements ............        
d Equipment ................   248,099,243 139,594,074 108,505,169
e Other .................   40,017,884 1,466,383 38,551,501
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 532,942,684
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
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) must 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








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








Total. (Column (b) must 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) Book value
Federal Income Taxes 0
CAPITAL LEASE OBLIGATIONS 5,334,215
DUE TO AFFILIATES -122,117,164
RESERVE FOR CLAIMS 33,094,874
OTHER LIABILITIES 58,321,063
SETTLEMENTS TO THIRD PARTY PAY 7,480,030




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet -17,886,982
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) 2011

Schedule D (Form 990) 2011
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  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
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  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
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  
3 Subtract line 2e from line 1..................... 3  
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 must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
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  
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 must equal Form 990, Part I, line 18.) ...... 5  
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
Liability for Uncertain Tax Position (ASC 740) Schedule D, Part X, Line 2 FIN 48 FINANCIAL STATEMENT FOOTNOTE FROM CHILDREN'S NATIONAL MEDICAL CENTER (MEDICAL CENTER), OF WHICH CHILDREN'S HOSPITAL IS A SUBSIDIARY, IS AS FOLLOWS: The Medical Center is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. On such basis, the exempt entities will not incur any liability for federal income taxes, except for possible unrelated business income. The Medical Center evaluates uncertain tax positions using a two-step approach for recognizing and measuring tax benefits taken or expected to be taken in an unrelated business activity tax return and disclosures regarding uncertainties in tax positions. There was no impact on the Medical Centers financial statements during the years ended June 30, 2012 and 2011.
Schedule D (Form 990) 2011

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
2011
Open to Public Inspection
Name of the organization
Children's Hospital
 
Employer identification number

53-0196580
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 its grants
and other 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 its grants and other
assistance 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
Middle East and North Africa 1 4 Program Services PATIENTS REFFERALS 717,144
Central America and the Caribbean 0 0 Program Services INSURANCE PREMIUMS 22,096,000
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 1 4 22,813,144
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 1 4 22,813,144
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
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) 2011
Schedule F (Form 990) 2011Page 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) 2011
Schedule F (Form 990) 2011
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) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2011
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
2011
Open to Public Inspection
Name of the organization
Children's Hospital
 
Employer identification number

53-0196580
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did 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 used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    8,846,754   8,846,754 1.020 %
b Medicaid (from Worksheet 3, column a) .....     44,160,814   44,160,814 5.090 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    53,007,568   53,007,568 6.110 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		42 228,272 21,101,656   21,101,656 2.430 %
f Health professions education
(from Worksheet 5) .. 		36 436 22,131,684 6,130,519 16,001,165 1.840 %
g Subsidized health services
(from Worksheet 6) .. 		    16,974,170 12,940,821 4,033,349 0.460 %
h Research (from Worksheet 7)     17,167,177 9,096,983 8,070,194 0.920 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     71,057 7,167 63,890 0.010 %
jTotal Other Benefits ... 78 228,708 77,445,744 28,175,490 49,270,254 5.660 %
kTotal. Add lines 7d and 7j. .. 78 228,708 130,453,312 28,175,490 102,277,822 11.770 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building 2 811 103,961   103,961 0.010 %
7 Community health improvement advocacy            
8 Workforce development 1 5 4,423   4,423  
9 Other            
10 Total 3 816 108,384   108,384 0.010 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
11,672,972
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
 
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
2,348,950
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
2,702,944
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-353,994
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size 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 CHILDREN'S HOSPITAL
111 MICHIGAN AVE NW
WASHINGTON,DC20010 		X X X X X X X X  
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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)
CHILDREN'S HOSPITAL
Name of Hospital Facility:  
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 2011)
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 the community health 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 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 Participation in the development of a community-wide community benefit plan
d Participation in the execution of a 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 Needs Assessment
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 and 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 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
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 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted 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 (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 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 patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
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 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
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)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
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   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?17
Name and address Type of Facility (describe)
1 CHILDREN'S OUTPATIENT CTR OF MONTGOMERY
SHADY GROVE MEDICAL PARK
ROCKVILLE,MD20850 		REGIONAL OUTPATIENT CENTER
2 CHILDREN'S OUTPATIENT CTR OF NORTHERN VA
8501 ARLINGTON BOULEVARD STE 200
FAIRFAX,VA22031 		REGIONAL OUTPATIENT CENTER
3 CHILDREN'S OUTPATIENT CTR IN LAUREL
13922 BALTIMORE AVE
LAUREL,MD20707 		REGIONAL OUTPATIENT CENTER
4 CHILDREN'S HEALTH CENTER - ADAMS MORGAN
1630 EUCLID STREET NW
WASHINGTON,DC20009 		HEALTH CENTERS
5 CHILDREN'S HEALTH CENTER - GOOD HOPE RD
2501 GOOD HOPE ROAD SE
WASHINGTON,DC20020 		HEALTH CENTERS
6 CHILDREN'S HEALTH CENTER - MLK JR AVE
3029 MARTIN LUTHER KING JR AVE SE
WASHINGTON,DC20032 		HEALTH CENTERS
7 CHILDREN'S OUTPATIENT CTR - UPR MARLBORO
9440 PENNSYLVANIA AVENUE
UPPER MARLBORO,MD20772 		REGIONAL OUTPATIENT CENTER
8 MOBILE VAN - HEALTH CARE
N/A
NA,DC20010 		MOBILE HEALTH CARE
9 CHILDREN'S OUTPATIENT CTR IN ANNAPOLIS
888 BESTGATE ROAD STE 320
ANNAPOLIS,MD21401 		REGIONAL OUTPATIENT CENTER
10 CHILDREN'S HEALTH CENTER - SHAW
2220 11TH STREET NW
WASHINGTON,DC20001 		HEALTH CENTERS
11 CHILDREN'S OUTPATIENT CTR SPRING VALLEY
4900 MASSACHUSETTS AVENUE NW
WASHINGTON,DC20016 		REGIONAL OUTPATIENT CENTER
12 CHILDREN'S NAT'L AMBULATORY SURGERY CTR
9850 KEY WEST AVENUE
ROCKVILLE,MD20850 		REGIONAL OUTPATIENT CENTER
13 CHILDREN'S OUTPATIENT CTR IN FREDERICK
5910 FREDERICK CROSSING LANE STE 1
FREDERICK,MD21704 		REGIONAL OUTPATIENT CENTER
14 MOBILE VAN - DENTAL
N/A
NA,DC20010 		MOBILE HEALTH CARE
15 CHILDREN'S HEALTH CENTER AT THEARC
1901 MISSISSIPPI AVE SE
WASHINGTON,DC20020 		HEALTH CENTERS
16 CHILDREN'S OUTPATIENT CTR MONTGOMERY CTY
15245 SHADY GROVE ROAD STE 350
ROCKVILLE,MD20858 		REGIONAL OUTPATIENT CENTER
17 CHILDREN'S NATIONAL IMAGING CENTER
9850 KEY WEST AVENUE Suite 110
ROCKVILLE,MD20850 		REGIONAL OUTPATIENT CENTER
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions 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, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any 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
community benefit report   Please see Schedule O for an executive summary of the community benefit report. criteria for free or discounted care schedule h, part i, line 3c CHildren's Hospital and its parent, Childrens National Medical Center, is committed to provide quality pediatric health care for all patients regardless of their ability to meet the associated financial obligations and without discrimination on the grounds of race, color, national origin or creed. Last year, our administrators and staff focused their exceptional skills, talents, and energy on expanding already successful programs to reach more at-risk families and communities, while launching new ones with the promise of addressing unmet needs. Our community benefit report highlights a few of these accomplishments, including the: -DC Pediatric Oral Health Coalition, a group comprised of stakeholders across organizations and disciplines that share best practices and develop solutions to improve the state of pediatric oral health in the District; -Healthy Teeth Fluoride Varnish Program, where over 1,400 parents in underserved communities received an education in good oral health habits, while establishing a dental home for their children; -Congenital Heart Disease Screening Program, which promotes the value of early screening to prevent the risks created by delayed diagnosis; -Health Education Program at the Children's National ED at United Medical Center, a program that provides much needed education on the top five ambulatory care sensitive (ACS) conditions, and the proper use of the emergency department; -Focus on Youth with ImPACT, a CDC funded project, that serves both youth ages 12-15 and their parents with education on preventing HIV, as well as the risks of early sexual activity, and lastly -Sickle Cell Adolescent Transition Program, which empowers and prepares kids with sickle cell anemia to successfully transition from pediatric to adult care. The Children's National family is proud of our contribution to creating and maintaining healthier communities in the District of Columbia. Working together, we can make sure that every child has the opportunity to grow up healthy!
Children's National Medical Center Annual Report Schedule H, Part I, Line 6a CHILDREN'S NATIONAL MEDICAL CENTER PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT FOR MASS PUBLIC DISTRIBUTION which includes information about Children's Hospital. THE REPORT IS POSTED TO OUR WEBSITE. IN ADDITION, AN EXECUTIVE SUMMARY INCLUDING THE LINK TO THE REPORT IS DISTRIBUTED TO THE HOSPITAL'S KEY STAKEHOLDERS AND GENERAL PUBLIC. Schedule H, Part I, Line 7 A COST ACCOUNTING SYSTEM HAS BEEN UTILIZED TO CALCULATE AMOUNTS REPORTED IN THE TABLE IN PART I, LINE 7A-D. THE COST ACCOUNTING SYSTEM INCLUDES CHARITY, MEDICAID SHORTFALLS, SELF-PAY, AND PUBLIC PROGRAMS. A COST TO CHARGE RATIO WAS NOT USED TO CALCULATE ANY OF THE FIGURES REPORTED IN THE TABLE IN PART I. THE AMOUNTS WERE PULLED FROM FINANCIAL DATABASES MANAGED BY THE CHILDREN'S NATIONAL Medical Center ACCOUNTING AND FINANCE DEPARTMENT.
Bad Debt Expense Schedule H, Part I, Line 7, column (f) Children's Hospitals Net Community Benefit expense does not include the organizations bad debt expense for the FYE June 30, 2012 of $23,187,334.
Cost Attributable to a Physical Clinic Schedule H, Part I, Line 7g AS DESCRIBED BY DEFINITION, SUBSIDIZED HEALTH SERVICES ARE CLINICAL PROGRAMS THAT ARE PROVIDED DESPITE A LOSS SO SIGNIFICANT THAT NEGATIVE MARGINS REMAIN AFTER REMOVING THE EFFECTS OF CHARITY CARE, BAD DEBT AND MEDICAID SHORTFALLS. THE SERVICES ARE PROVIDED DESPITE THE FINANCIAL LOSS TO MEET THE NEEDS OF THE COMMUNITY. IF THE SERVICES WERE NOT PROVIDED, THEY WOULD NOT BE AVAILABLE TO THE AREA OR WOULD RESULT IN THE GOVERNMENT OR ANOTHER NOT-FOR- PROFIT ORGANIZATION PROVIDING THE SERVICES. THE SUBSIDIZED HEALTH SERVICES AMOUNT IN PART I, LINE 7G INCLUDES $4,033,349 WHICH IS ATTRIBUTED TO THE PRIMARY CLINICAL SERVICES PROVIDED VIA CHILDREN'S Hospital'S SIX CHILDREN'S HEALTH CENTERS LOCATED IN THE DISTRICT OF COLUMBIA. CHILDREN'S HEALTH CENTERS PROVIDE PROGRAM AND INITIATIVES INCLUDING COMPREHENSIVE AND HIGH QUALITY PREVENTIVE SERVICES, IMPROVEMENT OF IMMUNIZATION RATES, AND COORDINATION OF CARE FOR CHILDREN WITH SPECIAL HEALTH CARE NEEDS. THE AMOUNT INCLUDES SALARY, FRINGE, DIRECT, AND INDIRECT COSTS EXPENDED TO PROVIDE THE CLINICAL SERVICES. OUR CHILDREN'S HEALTH CENTERS ARE ESTABLISHING BEST PRACTICES IN COMMUNITY HEALTH.
Community Building Activities Schedule H, Part II As reported in Part II and defined, community-building activities include programs that address the root causes of health problems, such as homelessness, poverty, and environmental problems. Each program included in Part II meets the definition of community benefit including meeting one or more of the community benefit objectives: improving access to health services, enhancing health, advancing generalizable knowledge, or relief of government burden. The primary purpose of the programming is to improve the health of the community. Programs accounted for as community building activities fall into the subcategories of coalition building, community support, and workforce development. Our Injury Prevention Coalition program falls under the category of community building as it is comprised of Safe Kids World Wide and the Injury Free Coalition for Kids DC Chapter. The Injury Prevention Coalition is dedicated to the prevention of intentional and unintentional childhood injuries and strives to prioritize injury prevention for children and their families, caregivers, public officials, residents and visitors in the metropolitan area. These two organizations began as a result of two physicians responding to a need in their respective communities. Through both organizations coalitions such as The Injury Prevention Coalition have formed and grown to address issues surrounding injury prevention and safety. Today, Safe Kids USA is one of the 19 member countries of Safe Kids Worldwide, with more than 600 local coalitions and chapters in communities across the U.S. Injury is the leading cause of morbidity and mortality for children and young adults living in the United States and children living in poverty have a higher rate of injury than children of more substantial means. The Injury Prevention Coalition at Childrens National Medical Center includes collaboration between local stakeholders including: the Poison Control Center, Metropolitan Police Department, Fire and EMS, Washington Area Bicyclist Association, and other community groups with the goal of providing educational services and resources regarding the prevention of unintentional and intentional injuries to include: child passenger safety; bike safety; pedestrian safety; fire safety, and youth violence. The Coalition strives to decrease the number of injuries experienced among children and equip children and parents with proper knowledge of prevention, thereby enhancing the public health of the community. Will there be enough doctors to care for the growing health care concerns in America? Organizations like the Association of American Medical Colleges say not likely. They predict that by 2015 the US will experience a shortage of 65,000 doctors and that number is expected to more than double by 2025. Childrens National is answering the call to promote early interest in the medical profession by offering 10-week summer internships for pre-med college students. The program is housed in the division of Trauma and Burn and gives interns opportunities to observe patient care, a mentorship with attending surgeons in Trauma, Ortho, Neurosurgery and General Surgery and training and experience in clinical research. Research projects are selected from the Trauma and Burn research portfolio and focuses primarily on studying the early management of injured patients, using human factors and technology approaches to improve the efficiency and reduce errors in the care of injured children. The student interns also gain practical experience in data entry and analysis. Childrens National also sponsors weekly seminars where faculty members present on their specialty area and the educational path for their profession. The summer internship program not only encourages students to pursue medical training in a pediatric specialty, but the experience also assists them in gaining admission to medical school. Most of the program participants expected to pursue pediatric specialty training by the completion of the internship. Additionally, two activities conducted by our Orthopedic Surgery and Sports Medicine department fall into the community support subcategory of community building. Members of our medical faculty were on site during sporting events to provide any necessary physician/medical services. During the events, medical faculty worked to ensure that there was safe participation. Faculty also provided services during a two day basketball tournament that raised funds for adaptive sports.
Bad Debt Expense Schedule H, Part III, Line 4 BAD DEBT IS ACCOUNTED FOR IN THE FOOTNOTES FOR ACCOUNTS RECEIVABLE IN THE ORGANIZATION'S FINANCIAL STATEMENTS. ACCOUNTS RECEIVABLE FOR PATIENT SERVICES CONSIST OF AMOUNTS DUE DIRECTLY FROM PATIENTS OR PATIENTS' THIRD PARTY PAYORS SUCH AS INSURANCE COMPANIES, MANAGED CARE PROGRAMS, AND MEDICAID PROGRAMS FOR SERVICES RENDERED. PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE FINANCIAL STATEMENTS OF THE ORGANIZATION IS SHOWN NET OF RECOVERIES ON AMOUNTS PREVIOUSLY WRITTEN OFF. THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTIMATED BASED ON PRIOR EXPERIENCE AND MANAGEMENT'S JUDGMENT AND IS, THEREFORE, SUSCEPTIBLE TO CHANGE. THE PROCESS OF DETERMINING BAD DEBT MAY ALSO INCLUDE THE REDUCTION OF AN ACCOUNT BASED ON PROCEDURES ASSOCIATED WITH INSURANCE CONTRACTUAL AGREEMENTS, GUARANTOR CHARITY EVALUATION, AND GUARANTOR BAD DEBT EVALUATION. THE COST-TO-CHARGE RATIO METHODOLOGY WAS USED TO DETERMINE THE AMOUNTS REPORTED ON LINE 2. BAD DEBT IS NOT INCLUDED IN COMMUNITY BENEFIT.
Medicare Cost Report Schedule H, Part III, Line 8 SHORTFALLS ARE NOT INCLUDED AS COMMUNITY BENEFIT. ANY SHORTFALL IS EVENTUALLY PAID IN FULL BY MEDICARE AS SETTLEMENT. THERE IS THEREFORE NO SHORTFALL. THE FY 2012 SETTLED COST REPORT- WORKSHEET E-3 PART IV WAS USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6.
Collection Practices Schedule H, Part III, Line 9b THE COLLECTION POLICY DOES NOT CONTAIN SPECIFIC PROVISIONS FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY. ALL PATIENTS ARE TREATED THE SAME. CHILDREN'S NATIONAL IS COMMITTED TO PROVIDING QUALITY HEALTHCARE TO ALL PATIENTS WHILE MAINTAINING RESPONSIBLE AND EFFECTIVE FINANCIAL PROGRAMS WHICH ENSURE THAT THIS COMMITMENT CAN CONTINUE. CHILDREN'S NATIONAL SUPPORTS FAMILIES IN CARRYING OUT THEIR RESPONSIBILITY FOR OBTAINING MEDICAL CARE FOR THEIR CHILDREN. CHILDREN'S HOSPITAL, THEREFORE, WILL ASSIST FAMILIES IN VERIFYING THEIR ABILITY TO MEET THEIR FINANCIAL OBLIGATIONS TO THE HOSPITAL OR IN SECURING THE RESOURCES NECESSARY TO DO SO. THE PURPOSE OF THIS POLICY IS TO ESTABLISH GUIDELINES FOR EFFECTIVE AND RESPONSIBLE FISCAL PROGRAM, WHICH ASSURES THE FINANCIAL VIABILITY OF THE INSTITUTION AND MAINTAINS THE DIGNITY OF THE FAMILY. COLLECTION EFFORTS ARE THEREFORE THE SAME FOR ALL PATIENT RESPONSIBLE BALANCES ONCE THE APPROVED CHARITY ADJUSTMENT HAS BEEN MADE.
Community Health Care Needs Assessment Schedule H, Part VI, Line 2 Children's National Medical Center through Children's Hospital commits to conducting a community health needs assessment (CHNA) every three years to understand the health and health care status of the pediatric population in our community. The assessment will guide the hospital in targeting its resources to achieve the greatest impact on child health and wellness at a population-level. In compliance with IRC Section 501(r), Childrens Hospital is in process of completing a community health needs assessment and plan during FYE June 30, 2013, including Board approval of the plans implementation. Our most recent CHNA was completed and released in October 2009 (FY 2010). The assessment was a first-of-its-kind study conducted in collaboration with RAND Health and is an in-depth study of the health and health care of the 100,000 plus youth who reside in the District of Columbia. The assessment was a unique blend of both quantitative data and qualitative interviews which led to a comprehensive and grassroots view of the actual state of our pediatric community. The 2009 CHNA highlighted several pressing public health issues, namely striking health disparities, across our local communities. In addition to identifying health care needs, a key finding was the lack of data infrastructure to monitor and track local health indicators. In response to this finding, Children's National has embarked on a large data infrastructure project to develop a web-based platform to aggregate, display, track, and disseminate health metrics in the District of Columbia: the DC Health Matters web portal. This innovative, community driven portal will rely on both primary and secondary sources of data and serve as the foundation for our next needs assessment. Children's National believes strongly in the power of collaboration. We have reached out to our peer DC hospitals to work with us in development of the DC Health Matters web portal, as well as a citywide CHNA and implementation plan. We have proposed that all DC hospitals partner in this effort by forming the District of Columbia Healthy Communities Collaborative (DCHCC). This Collaborative will conduct a citywide community health needs assessment (CHNA) and implementation strategy that is responsive to the needs and priorities identified by the CHNA. Community representatives will be engaged continually in all aspects of the project. The overarching objective of this ambitious collective endeavor is to improve population health and health equity by devising and executing a citywide community health improvement plan. Comparable to how we utilized the 2009 CHNA findings, the next set of CHNA findings will assist Children's National in decision making for infrastructure development and data collection priorities; health promotion and disease prevention program planning, development, and monitoring; budget justifications and allocation of advocacy funds; influence on public policy initiatives; and, identification of advocacy-based research and education priorities. Once the next citywide CHNA is complete, Children's National will partake in continued education to external and internal stakeholders on the findings of needs assessment. Internally, the Children's National Advocacy and Public Policy, Inc. will have the responsibility and function to identify and make recommendations of Children's National's priority agenda based on the incorporation and integration of findings from the needs assessment along with Children's National strategic plan. The recommended priority agenda will be reviewed and officially approved by the Children's Hospital Board of Directors. This effort will be guided by our "prioritization tool." The prioritization tool was developed within Children's National's Advocacy and Community Affairs Department which houses the community benefit operations staff. The tool assesses the feasibility and overall impact of health programs. Once Children's National has developed its prioritization focal areas, we will work with the DCHCC to represent our areas of focus within the larger citywide implementation plan. Internally, ongoing evaluation and monitoring of the implementation plan will take place by the Advocacy and Community Affairs and Child Health Data Lab departments of Children's National. The DC Health Matters portal will be used as a platform to track progress of the implementation plan.
Eligibility Education Schedule H, Part VI, Line 3 THE FOLLOWING PROCESSES TAKE PLACE FOR FAMILIES WHO DO NOT HAVE INSURANCE OR WHO CANNOT PAY. 1. AN APPLICATION IS MADE FOR MEDICAL ASSISTANCE AND FINANCIAL ASSISTANCE PROGRAM (FAP) STAFFED BY CONTRACTED COMPANIES, MED LAW & DECO IN THE FINANCIAL INFORMATION CENTER (FIC). ELIGIBILITY IS CONSIDERED FOR ALL APPROPRIATE PUBLIC PROGRAMS. WE WOULD LIKE THIS PROCESS TO TAKE PLACE PRIOR TO THE MEDICAL VISIT. FAP APPLICATIONS ARE MAILED TO SELF PAY PATIENTS WHEN THEY MAKE AN APPOINTMENT. 2. WHILE THE APPLICATION IS IN PROCESS, THE PATIENT IS REGISTERED AS MEDICAID PENDING AND THE MEDICAL VISIT TAKES PLACE (CITIZENS ONLY). NON CITIZENS ARE REGISTERED AS SELF PAY. 3. IF MEDICAID ELIGIBLE, THE PATIENT REGISTRATION IS CONVERTED TO THE MEDICAID PLAN. 4. IF NOT ELIGIBLE, THE PATIENT'S CHARITY CARE APPLICATION IS FURTHER EVALUATED FOR CN CHARITY CARE BY CNMC CUSTOMER SERVICE IN THE FIC. 5. IF FAP IS APPROVED, ACCOUNTS NOTES ARE UPDATED AND THE FAMILY IS NOTIFIED OF THEIR STATUS AND RESPONSIBILITY. THE ACCOUNTS ARE MANAGED BY CUSTOMER SERVICE STAFF. ONLY EXPECTED BALANCES REMAIN ON THE ACCOUNT AND FAMILIES RECEIVE STATEMENTS SHOWING THEIR RESPONSIBILITY. 6. IF FAP IS NOT APPROVED, ACCOUNTS NOTES ARE UPDATED AND THE FAMILY IS NOTIFIED OF THEIR STATUS AND RESPONSIBILITY. FAMILIES CAN SET UP PAYMENT PLANS TO RESOLVE THEIR ACCOUNT BALANCES 7. FOR INSURED FAMILIES: MEDICALLY INDIGENT STATUS CAN APPLY. THIS STATUS CAN BE EVALUATED AT ANY TIME IF A FAMILY'S REMAINING BALANCE (EXCLUDING ANY DEDUCTIBLES) AFTER 3RD PARTY PAYER IS GREATER THAN 30% OF ANNUAL INCOME LESS HOUSING EXPENSES. - WHENEVER APPLICABLE, IT IS ENCOURAGED THAT FAMILIES REVIEW THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE BEFORE THE APPOINTMENT DATE. APPOINTMENTS ARE TYPICALLY MADE WITH THE FIC OFFICE WHEN FAMILIES MAKE THEIR MEDICAL APPOINTMENTS. THEY CAN GO DIRECTLY TO THE FIC OFFICE AT CN AT ANY OTHER TIME. - FAMILIES ARE ENCOURAGED TO COOPERATE WITH OUR STAFF BY SUPPLYING ALL NECESSARY INFORMATION FOR THE MEDICAID AND FAP APPLICATIONS.
Description of Community Served Schedule H, Part VI, Line 4 As the only exclusive provider of pediatric care center in the Nation's capital, Children's National Medical Center has the privilege of serving a diverse and broad community, spanning from the District of Columbia to Maryland and Virginia and beyond. Our community is filled with an array of ethnic groups and vibrant cultures. Population figures for the region are estimated at approximately 632,323 for the District of Columbia; 5,884,563 in Maryland; and 8,185,867 in Virginia. In the District of Columbia, children 18 years old and under make up 17 percent of the population and about 23 percent of the population in Maryland and Virginia. Children age five and under are 5.9 percent of the population in the District and represent a little more than 6 percent of the population in Maryland and Virginia. In the DC metropolitan area, 14.52 percent of the population age five and older report speaking a language other than English at home; 9.5 percent are Hispanic, less than 4 percent are Asian/Pacific Islander, less than 1 percent are Indian, nearly 50 percent are African American, and 42.45 percent are White. Each year Children's National provides services to over 360,000 of our youngest residents from near and far offering services throughout the area via seven Children's Health Centers, which provide primary care programs including mobile units all centered in the District of Columbia; our eight regional outpatient centers that provide specialty care in Maryland, Virginia and the District of Columbia; the Sheikh Zayed Campus which features 303 beds, of which 54 our designated for level IIIC Newborn Intensive Care Unit bassinets and Children's National Health Network with more than 750 affiliated pediatricians. Children's National is the largest provider of pediatric care in the District of Columbia. In addition, serving as the regional referral center for pediatric emergency, trauma, cancer, cardiac and critical care, neonatology, orthopedic surgery, neurology, and neurosurgery. Additionally, Children's National has programs focusing in the areas of school health services, mobile health services, community partnerships and safety campaigns. Since our early beginnings in 1870, our mission has been and remains improving the health status of our communities and providing care to our most vulnerable children. While the median incomes for the metropolitan area range from $61,835 in the District; $63,302 in Virginia and $72,419 in Maryland, 18 percent of persons in the District of Columbia live below the poverty line, while 9 percent in Maryland and 10.7 percent in Virginia live below the poverty line. Approximately 74,000 children in the District are enrolled in Medicaid. The state of Maryland has just over 370,000 enrolled and Virginia has an estimated 475,000 children enrolled in the program. In FY 2012, 76% of all District of Columbia hospital inpatients are Medicaid beneficiaries, 51% of all Maryland admissions are Medicaid beneficiaries, and about 31% of Virginia inpatients are Medicaid beneficiaries. Children's National strives every day to improve upon our commitment to improve the health of our children. In FY 2012, Children's National provided $18,162,343 in charity care. Our commitment to improve health status of children extends beyond our local and regional area. Through our international program we are able to extend our community and provide care to families from around the world seeking care for their children at our institution. Families from 30 countries seek care for their children at Children's National. Because the hospital is located in the heart of the nation's capital, Children's National has the unique advantage of resources, such as embassies and three major airports to welcome our international families. We contact embassies, provide interpreters and coordinate all medical appointments to ease the stay of families from abroad. In addition, Children's National Center and Washington Hospital Center recently opened a medical office in the United Arab Emirates in the city of Abu Dhabi. The new office serves as a liaison office for Children's National Medical Center and Washington Hospital Center in the Gulf Region. The office coordinates conferences and continuing medical education courses for medical staff and facilitates second opinion services via the internet and telemedicine, bringing the expertise offered at the two Washington, DC -based hospitals to the citizens of the UAE and other Gulf countries. Children's National is also known internationally as a leader in research. Children's Research Institute spearheads research at Children's National Medical Center. Located on the top floor of the Sheikh Zayed Campus for Advanced Children's Medicine building, our research concentrates on all translational, clinical and community studies that lead to improved understanding, prevention, treatment, and care of childhood diseases. The institute is divided into specialty research centers that include: Center for Cancer and Immunology Research, Center for Translational Science Research, Center for Genetic Medicine Research, and the Center for Neuroscience Research, overseeing more than 250 research projects. Children's Research Institute also oversees the educational activities and academic affairs of Children's and the Department of Pediatrics at the George Washington University School of Medicine and Health Sciences and also has frequent partnerships with many other research institutions regionally and nationally. Additionally, Children's National recently launched the Shiekh Zayed Institute for Pediatric Surgical Innovation redefining what is possible in surgery through innovative, integrated research. The Institute's physician -scientists are applying their expertise in their specialized fields to pursue the common goal to make pediatric surgery more precise, less invasive, and pain-free. Children's National is dedicated to providing high quality educational opportunities for internal and external physicians, nurses, and allied health professionals through internships, residency, fellowships, graduate medical education, and continuing medical education. Each year, pediatric training is provided for approximately 180 third-year medical students from George Washington University (GWU), 45 third-year medical students from Howard University, and 100 fourth-year students from GWU and other medical schools. Clinical training is provided to 84 pediatric residents and 115 fellows and other graduate trainees each year.
Promoting the Health of the Community Schedule H, Part VI, Line 5 For more than 140 years, Children's National Medical Center has been committed to serving the community by promoting and improving the health of children and supporting the health improvements in their homes, schools, neighborhoods, and broader community. This commitment is evidenced from the governing boards to community health initiatives to collaborative citywide forums. Children's Hospital, the 501(c)(3) not-for-profit organization, is governed by board of directors representing the diversity of the local, regional, national, and international communities that we serve. The majority of our board of directors resides within the primary service area of the Washington, DC metropolitan area, including the District of Columbia, Maryland, and Virginia. Children's National is a pioneer in innovative programs that move beyond awareness to targeted interventions that improve the lives of children and their families, locally, regionally, nationally, and internationally The Children's National Advocacy and Public Policy, Inc. (CNAPPI) governs the Advocacy component of our Care Advocacy Research and Education (CARE) mission as a charitable organization. The CNAPPI is comprised of leaders from throughout the region with vast experience in policy, advocacy, leadership and strategic planning and serves as a leading voice on child health for the Children's National enterprise, reaching beyond the boundaries of the institution to advocate for all children regardless of their circumstance or location. The CNAPPI serves as Children's National's designated clearinghouse for prioritizing and guiding official policy statements and action, government relations, community benefit outreach and other relevant issues. Children's National was able to implement a program linking families to medical homes for comprehensive care as well and educate families on the proper use of the Emergency Department for ambulatory care sensitive issues, a health priority determined by the findings from our 2009 Community Needs Assessment. The Community Education program at Children's National Satellite Emergency Department at United Medical Center was able to provide health education on the top five ambulatory care sensitive issues: fever, gastro intestinal illness, upper respiratory infections, ear infections and asthma to over 2675 families in fiscal year 2012. In addition, the program was able to schedule 4003 appointments, with 70.3% of the families attending their scheduled follow up appointment. Both the IMPACT DC and IDEAL clinics and other programs received nearly 200 referrals and approximately 60 appointments with specialists were made. The health education program develops and maintains partnerships with area primary care physicians and other community-based programs in the region serving the health needs of children. Findings from Children's National's 2009 Community Health Needs Assessment also highlighted the need to address pediatric oral health care in the District of Columbia. Children's National is leading the charge by helping to establish the District of Columbia Pediatric Oral Health Coalition. The coalition is comprised of stakeholders across organizations and disciplines that share best practices and develop solutions to improve the state of pediatric oral health in the District of Columbia. The mission of the coalition is to advocate for improved oral health access and care for all children in the District of Columbia. Children's National endorses the Coalition's Action Plan to achieve its' goals which includes utilizing collaborative public and private partnerships of health, social services and educational systems to improve oral health literacy to create behavioral change in oral health care for the District of Columbia children and families. These are just a few examples of the many ways Children's National is working to promote the health of our community.
Affiliated Health Care System Roles Schedule H, Part VI, Line 6 Children's Hospital is part of an affiliated health care system comprised of the following entities: - Children's Hospital Foundation - 501(c)(3), fundraising - Children's National Medical Center - 501(c)(3), oversight and financial responsiblity for health care system - Safe Kids Worldwide - 501(c)(3), injury prevention for children - Children's Hospital Self-Insurance Trust - 501(c)(3), provision of insurance to system - Brainy Camps Association - 501(c)(3), provision of camps for children - Children's National Advocacy & Public Policy Inc - 501(c)(3), advocating for children's health issues -Children's research Institute - 501(c)(3), conducting clinical medical research and education programs Each entity participates in the Children's National Medical Center's ability to deliver pediatric health care services on an integrated basis.
STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI DC,
Schedule H (Form 990) 2011
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
2011
Open to Public Inspection
Name of the organization
Children's Hospital
 
Employer identification number

53-0196580
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 or provision 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. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
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
Yes
 
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
 
No
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 Regulations 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) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) PETER R HOLBROOK MD (i)
(ii)		 716,289
0 		564,457
0 		263,399
0 		12,250
0 		84,969
0 		1,641,364
0 		0
0
(2) ROBERT KEATING MD (i)
(ii)		 714,781
0 		129,781
0 		1,518
0 		81,541
0 		12,458
0 		940,079
0 		0
0
(3) EDWIN K ZECHMAN JR (i)
(ii)		 482,614
0 		0
0 		4,724,352
0 		110,467
0 		63,399
0 		5,380,832
0 		0
0
(4) MARK BATSHAW MD (i)
(ii)		 620,547
0 		477,757
0 		120,633
0 		262,250
0 		59,348
0 		1,540,535
0 		0
0
(5) JACQUELINE BOWENS (i)
(ii)		 364,276
0 		290,068
0 		119,130
0 		12,250
0 		16,326
0 		802,050
0 		0
0
(6) JODY BURDELL (i)
(ii)		 614,425
0 		477,620
0 		381,240
0 		12,250
0 		32,396
0 		1,517,931
0 		0
0
(7) MARY ANNE HILLIARD (i)
(ii)		 276,062
0 		227,943
0 		7,339
0 		42,696
0 		23,089
0 		577,129
0 		0
0
(8) DOUGLAS MYERS (i)
(ii)		 431,230
0 		282,278
0 		8,341
0 		76,740
0 		21,022
0 		819,611
0 		0
0
(9) NELLIE ROBINSON (i)
(ii)		 319,771
0 		212,948
0 		131,863
0 		12,250
0 		40,412
0 		717,244
0 		0
0
(10) PAM KING SAMS (i)
(ii)		 317,524
0 		226,685
0 		6,896
0 		144,711
0 		20,779
0 		716,595
0 		0
0
(11) RAYMOND SCZUDLO (i)
(ii)		 447,425
0 		351,854
0 		251,287
0 		12,250
0 		40,805
0 		1,103,621
0 		0
0
(12) MENDEL TUCHMAN MD (i)
(ii)		 340,962
0 		264,270
0 		9,083
0 		64,389
0 		32,747
0 		711,451
0 		0
0
(13) ROBERTA ALESSI (i)
(ii)		 244,345
0 		119,210
0 		7,511
0 		37,057
0 		24,381
0 		432,504
0 		0
0
(14) LAUREL BLAKEMORE MD (i)
(ii)		 486,460
0 		146,128
0 		1,605
0 		37,251
0 		13,625
0 		685,069
0 		0
0
(15) MAX COPPES MD PHD (i)
(ii)		 438,441
0 		329,796
0 		8,139
0 		79,095
0 		24,592
0 		880,063
0 		0
0
(16) DENICE CORA-BRAMBLE MD (i)
(ii)		 311,047
0 		249,872
0 		7,821
0 		44,542
0 		26,440
0 		639,722
0 		0
0
(17) RICHARD JONAS MD (i)
(ii)		 1,076,603
0 		681,821
0 		13,480
0 		98,222
0 		54,631
0 		1,924,757
0 		0
0
(18) MIRIAM MARKOWITZ (i)
(ii)		 180,614
0 		222,817
0 		47,798
0 		37,555
0 		28,830
0 		517,614
0 		0
0
(19) GERARD MARTIN MD (i)
(ii)		 479,802
0 		355,538
0 		8,888
0 		51,583
0 		30,640
0 		926,451
0 		0
0
(20) KURT DOUGLAS NEWMAN MD (i)
(ii)		 639,687
0 		456,702
0 		41,387
0 		220,761
0 		55,337
0 		1,413,874
0 		0
0
(21) ROGER PACKER MD (i)
(ii)		 422,094
0 		336,813
0 		9,547
0 		163,934
0 		42,617
0 		975,005
0 		0
0
(22) H GIL RUSHTON MD (i)
(ii)		 443,679
0 		153,947
0 		3,010
0 		57,249
0 		20,759
0 		678,644
0 		0
0
(23) ANTHONY SANDLER MD (i)
(ii)		 586,945
0 		105,603
0 		1,518
0 		12,250
0 		12,458
0 		718,774
0 		0
0
(24) CAROLE SCHOR (i)
(ii)		 272,154
0 		130,999
0 		8,855
0 		39,839
0 		35,924
0 		487,771
0 		0
0
(25) DAVID SPARKS (i)
(ii)		 292,398
0 		143,029
0 		9,081
0 		42,015
0 		38,501
0 		525,024
0 		0
0
(26) DAVID WESSEL MD (i)
(ii)		 451,446
0 		360,649
0 		9,345
0 		58,318
0 		27,756
0 		907,514
0 		0
0
(27) JOSEPH WRIGHT MD (i)
(ii)		 327,086
0 		267,466
0 		7,635
0 		63,356
0 		25,710
0 		691,253
0 		0
0
(28) JOHN MYSEROS MD (i)
(ii)		 525,706
0 		109,580
0 		990
0 		12,250
0 		10,627
0 		659,153
0 		0
0
(29) LOUIS M MARMON MD (i)
(ii)		 347,790
0 		188,244
0 		2,838
0 		12,250
0 		12,458
0 		563,580
0 		0
0
(30) GARY F ROGERS MD (i)
(ii)		 442,640
0 		145,686
0 		990
0 		2,538
0 		12,519
0 		604,373
0 		0
0
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
First-class or charter travel Schedule J, Part I, Line 1a FIRST CLASS OR CHARTER TRAVEL/TRAVEL FOR COMPANIONS THE CEO PER HIS EMPLOYMENT CONTRACT IS ENTITLED TO (A) USE FIRST CLASS TRAVEL (WHERE BUSINESS CLASS IS NOT AVAILABLE) FOR TRIPS OF MORE THAN 4 HOURS, AND (B) TAKE HIS SPOUSE ON UP TO 7 TRIPS PER YEAR FOR CONFERENCES WHERE HER PRESENCE BENEFITS THE HOSPITAL AND ITS BUSINESS RELATIONS. IN ADDITION, UPON PRIOR APPROVAL OF THE CEO, AND IN LIMITED CIRCUMSTANCES, TRAVEL FOR AN EXECUTIVE'S SPOUSE MAY BE AUTHORIZED WHERE HER PRESENCE BENEFITS THE HOSPITAL AND ITS BUSINESS RELATIONS. HOSPITAL POLICY PERMITS BUSINESS CLASS FOR INTERNATIONAL TRAVEL. THERE IS NO CHARTER TRAVEL.
TAX INDEMNIFICATION AND GROSS UP PAYMENTS   CERTAIN SUPPLEMENTAL RETIREMENT BENEFITS, UPON APPROVAL OF THE COMPENSATION COMMITTEE, ARE INCREASED BY A TAX EQUALIZATION AMOUNT, WHICH IS SIGNIFICANTLY LESS THAN THE AMOUNT THAT WOULD BE DETERMINED BY A TAX GROSS UP OR INDEMNIFICATION METHOD. THIS IS TREATED AS TAXABLE COMPENSATION TO THE RECIPIENT.
HEALTH OR SOCIAL CLUB   CERTAIN EXECUTIVES, THROUGH THEIR EMPLOYMENT AGREEMENTS, ARE REIMBURSED FOR HEALTH CLUB OR SOCIAL CLUB DUES. THIS IS TREATED AS TAXABLE COMPENSATION TO THE RECIPIENT.
PERSONAL SERVICES   CERTAIN EXECUTIVES, THROUGH THEIR EMPLOYMENT AGREEMENTS, ARE REIMBURSED FOR TAX, FINANCIAL AND ESTATE PLANNING, AND HEALTH COSTS. THIS IS TREATED AS TAXABLE COMPENSATION TO THE RECIPIENT. THERE ARE NO EXPENDITURES FOR MAIDS, CHAUFFEURS OR CHEFS.
Severance or Change of Control Payment Schedule J, Part I, Line 4a During calendar year 2011, the organization transitioned its key leadership position from Mr. Edwin Zechman, who had served Children's National Medical Center as CEO for 16 years, to a new CEO. As part of his contract, Mr. Zechman was paid additional compensation at the close of his tenure. The organization's Board has and maintains a previously established process for determining the reasonableness of the executive compensation of the organization's CEO. As part of its typical process, the Executive Compensation Committee of the Board obtains the services of an independent, third-party compensation specialist. That specialist relies on comparability data to establish a range of what is "reasonable" compensation for the CEO's position in the current market. The compensation specialist presents its findings to the Board via a written report. The Executive Compensation Committee, comprised of members independent to the transactions at hand, discuss the contents of the report and, using that report, determine what compensation should be paid to the CEO. This process of determining the reasonable compensation is recorded in contemporaneous written minutes of the Committee meeting. As an extension of this process, the Board determined that it was reasonable to provide Mr. Zechman the compensation which is reported on Form 990, Part VII and further detailed on Schedule J. The compensation reported here represents compensation which was paid to Mr. Zechman in 2011. Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b THE FOLLOWING OFFICERS AND KEY EMPLOYEES PARTICIPATED IN A SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN. THE CONTRIBUTIONS TO THE SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C) AS PART OF DEFERRED COMPENSATION: ROBERT KEATING, MD - $69,291 MARK L BATSHAW, MD - $250,000 MARY ANNE HILLIARD - $30,446 DOUGLAS MYERS - $64,490 PAM KING SAMS - $132,461 MENDAL TUCHMAN, MD - $52,139 ROBERT ALESSI - $24,808 LAUREL BLAKEMORE, MD - $25,001 MAX COPPES, MD - $66,845 DENICE CORA-BRAMBLE, MD - $32,292 MIRIAM MARKOWITZ - $25,305 GERARD MARTIN, MD - $39,333 KURT D NEWMAN, MD - $208,511 ROGER PACKER, MD - $151,684 H GIL RUSHTON, MD - $44,999 CAROL SCHOR - $27,589 DAVID SPARKS - $29,765 DAVID WESSEL, MD - $46,068 JOSEPH WRIGHT, MD - $51,106 RICHARD JONAS, MD - $85,972
Schedule J (Form 990) 2011

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 Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
Children's Hospital
 
Employer identification number
53-0196580
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 DISTRICT OF COLUMBIA
  		53-6001131 254764GN7 10-26-2005 50,000,000 CONSTRUCT AND RENOVATE FACILITIES   X   X   X
B DISTRICT OF COLUMBIA
  		53-6001131 254764GP2 10-26-2005 50,000,000 CONSTRUCT AND RENOVATE FACILITIES   X   X   X
C DISTRICT OF COLUMBIA
  		53-6001131 254764GQ0 10-26-2005 50,000,000 CONSTRUCT AND RENOVATE FACILITIES   X   X   X
D DISTRICT OF COLUMBIA
  		53-6001131 254764GX5 04-10-2008 3,555,193 CONSTRUCT AND RENOVATE FACILITIES   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 50,000,000 50,000,000 50,000,000 3,555,193
4 Gross proceeds in reserve funds . . . . . . . . 3,738,181 3,738,181 3,738,181 233,255
5 Capitalized interest from proceeds . . . . . . . . . . 12,645,266 12,645,267 12,645,267 511,928
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 889,291 889,291 889,291 63,310
8 Credit enhancement from proceeds . . . . . . . . . . 2,909,809 2,909,809 2,909,809 198,654
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 29,817,453 29,817,453 29,817,453 2,548,046
11 Other spent proceeds . . . . . . . . . . . 0 0 0 0
12 Other unspent proceeds . . . . . . . . . . . 0 0 0 0
13 Year of substantial completion . . . . . . . . . . . 2009 2009 2009 2012
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . .   X   X   X   X
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X   X   X     X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   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   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X   X
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
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 of bond-financed property? . . . . . . . . .   X   X   X   X
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .   X   X X   X  
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X   X   X   X
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? . X   X   X   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% 0% 0% 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   %   %   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . .   %   %   %   %
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X   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   X   X   X
2 Is the bond issue a variable rate issue? X   X   X     X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X   X   X     X
b Name of provider . . . . . . . . UBS
  		UBS
  		UBS
  		 
 
c Term of hedge . . . . . . . . 29.75 29.75 29.75  
d Was the hedge superintegrated? . . . . X   X   X     X
e Was a hedge terminated? . . . . .   X   X   X   X
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X   X
b Name of provider . . . . . . 0
  		0
  		0
  		0
 
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   X   X   X
6 Did the bond issue qualify for an exception to rebate? .   X   X   X   X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X   X   X   X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2011

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
2011
Open to Public
Inspection
Name of the organization
Children's Hospital
 
Employer identification number

53-0196580
Identifier Return Reference Explanation
Members or Stockholders Form 990, Part VI, Lines 6, 7a, and 7b CHILDREN'S NATIONAL MEDICAL CENTER ("CNMC") IS THE SOLE MEMBER OF CHILDREN'S HOSPITAL AND HAS THE RIGHT TO ELECT DIRECTORS OF CHILDREN'S HOSPITAL. THE ARTICLES AND BY-LAWS OF CHILDREN'S HOSPITAL DESCRIBE CERTAIN RIGHTS RESERVED TO THE SOLE MEMBER.
Form 990 Review Process Form 990, Part VI, Line 11b THE RELEVANT COMMITTEES OF THE ORGANIZATION AND ITS PARENT ORGANIZATION, CNMC, REVIEW APPLICABLE PORTIONS OF THE FORM 990: THE LEGAL AFFAIRS AND AUDIT COMMITTEE REVIEW THE FINANCIAL DISCLOSURES, THE NOMINATING AND GOVERNANCE COMMITTEE REVIEW THE GOVERNANCE SECTIONS AND THE PUBLIC BENEFIT SECTIONS, AND THE EXECUTIVE COMPENSATION COMMITTEE REVIEW THE COMPENSATION DISCLOSURES. THE COMPLETED FORM 990 IS THEN MADE AVAILABLE TO THE ENTIRE GOVERNING BOARD OF CHILDREN'S HOSPITAL BEFORE FILING.
Conflict of Interest Policy Monitoring & Enforcement Form 990, Part VI, Line 12c CHILDREN'S HOSPITAL REQUIRES THAT EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE COMPLETE A CONFLICT OF INTEREST FORM AT LEAST EVERY YEAR. IN ADDITION EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE IS INSTRUCTED AND REQUIRED TO AMEND THE CONFLICT OF INTEREST FORM IMMEDIATELY UPON A CHANGE IN STATUS OF ANY OF THE QUESTIONS ON THE FORM. THESE FORMS ARE REVIEWED ANNUALLY BY THE CHIEF LEGAL OFFICER AND CONFLICTS AND INTERESTS ARE NOTED. THE CHILDREN'S HOSPITAL BOARD MAKES A DETERMINATION, BASED ON THE RECOMMENDATION OF THE CHIEF LEGAL OFFICER AS TO WHICH PERSONS SHOULD BE CONSIDERED "INTERESTED PARTIES" BASED ON THE CRITERIA SET FORTH IN THE BOARD'S GOVERNANCE POLICY. Governing Policies PART VI, LINES 13 & 14: CHILDREN'S HOSPITAL IS GOVERNED BY THE POLICIES OF ITS PARENT, CNMC. THESE POLICIES INCLUDE A WRITTEN WHISTLEBLOWER POLICY AND A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY.
Process for Determining Compensation Form 990, Part VI, Line 15a THE EXECUTIVE COMPENSATION COMMITTEE OF THE CNMC BOARD OF DIRECTORS IS COMPRISED WHOLLY OF DISINTERESTED, INDEPENDENT BOARD MEMBERS. THE COMMITTEE HAS RETAINED INDEPENDENT OUTSIDE CONSULTANTS EXPERT ON COMPENSATION MATTERS. THE COMMITTEE DETERMINES ADJUSTMENTS IN COMPENSATION, INCLUDING BASE PAY, INCENTIVES, AND OTHER FORMS OF COMPENSATION FOR EACH PERSON DEEMED BY THE COMPENSATION COMMITTEE TO BE A "DISQUALIFIED PERSON" AS THAT TERM IS USED IN THE INTERMEDIATES SANCTION REGULATIONS OF THE IRS. THE COMMITTEE IS INFORMED IN ITS DECISION-MAKING BY COMPENSATION STUDIES AND COMPARISONS DONE BY THE INDEPENDENT CONSULTANT, AND RELIES UP "REASONABLENESS" OPINIONS FOR SUCH CONSULTANTS PRIOR TO OR CONTEMPORANEOUS WITH MAKING COMPENSATION DECISIONS. THE COMMITTEE MEETS 4-6 TIMES PER YEAR TO CONSIDER SUCH MATTERS.
How Documents are Made Available to the Public Form 990, Part VI, Line 19 CHILDREN'S HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED ON REQUEST.
Other Changes in Net Assets or fund balances PART XI, LINE 5: Derivative losses $ (22,180,306) Unrealized gains $ 644,879 Derivative interest expense $ (5,708,352) Bearacuda Funding $ (9,814,392) Partnership adjustment $ (59,486) ---------------- Total other changes in net Assets : $ (37,117,657)
Program Services Part III, Line 4a Children's Mission Statement As the nation's children's hospital, the mission of Children's National Medical Center is to excel in Care, Advocacy, Research and Education. We accomplish this through: - Providing a quality health care experience for our patients and families. - Improving health outcomes for children regionally, nationally, and internationally. - Leading the creation of innovative solutions to pediatric health challenges. Children's Vision Statement As the nation's children's hospital, we will set the standard of excellence for the care of children. - We will serve as the voice for the most vulnerable among us: our children. - We will lead the quest to cure some of childhood's most devastating diseases. - We will prepare the nation's future leaders in child health. - We will be the children's hospital against which all others are measured. Children's Child-Centered Vision By incorporating feedback from our families, we have developed our first child-centered vision, which looks at the hospital experience through a child's eyes. Healing a child's body, mind and spirit takes more than medicine: it takes a team to fulfill a family's dream. - My hospital is a bright and happy place that feels like home. - My providers, my family, and I are a team, and everyone's job is important. - The way my hospital works is built around me. - My providers don't all look alike. - My hospital is my family's connection to everything I need for my health, whether they provide it or blaze trail it. About Children's National Children's National Medical Center is the premier provider of pediatric care in the Washington, DC, metropolitan area and is the only freestanding children's hospital between Philadelphia, Pittsburgh, Norfolk, and Atlanta. Serving the nation's children for 140 years, Children's National is a proven leader in the development and application of innovative new treatments for childhood illness and injury. Children's internationally recognized team of pediatric healthcare professionals care for more than 360,000 patients each year who come from throughout the region, nation and world. Serving as an advocate for all children, Children's is the largest non-governmental provider of pediatric care in the District of Columbia, providing more than $50 million in uncompensated care. In addition, Children's serves as the regional referral center for pediatric emergency, trauma, cancer, cardiac and critical care as well as neonatology, orthopedic surgery, neurology, and neurosurgery. Children's National is proudly ranked consistently among the best pediatric hospitals in America by US News & World Report and the Leapfrog Group, and has received Magnet designation by the ANCC. SCIENCE EDUCATION PARTNERSHIP AWARD (SEPA) A HOLISTIC HEALTH MODEL AIMS AT SERVING ALL AREAS OF A CHILD'S DEVELOPMENT, INCLUDING THOSE THAT CAN BE IMPACTED BY THE SURROUNDING COMMUNITY. THE "BEING ME" INITIATIVE IS A SCIENCE EDUCATION PARTNERSHIP AWARD (SEPA) PROGRAM THAT USES THIS INTEGRATIVE APPROACH TO BUILDING A CHILD'S PHYSICAL, COGNITIVE, AND SOCIAL SKILLS, WHILE SUPPORTING COLLABORATIVE LEARNING AND PARTICIPATION FROM FAMILIES, FRIENDS, AND TEACHERS. THE GOAL: TO EMPLOY HANDS-ON, INQUIRY-BASED LEARNING, AND TO PROMOTE AWARENESS OF HEALTH-RELATED ISSUES BY BLENDING SCIENCE AND ART. "BEING ME" WAS PILOTED LAST YEAR IN TWO URBAN SCHOOL SYSTEMS WITH MOSTLY LOWER-INCOME, MINORITY, AND IMMIGRANT STUDENTS - A DEMOGRAPHIC WITH RELATED DISPARITIES IN BOTH ACCESS TO HEALTH CARE AND HEALTH OUTCOMES. THE PROGRAM, SUPPORTED BY THE NATIONAL SCIENCE CONTENT STANDARDS, USES AN ART-BASED, SCIENCE CURRICULUM AROUND FIVE CONDITIONS OR ISSUES: ASTHMA, OBESITY, SLEEP, BULLYING, AND SICKLE CELL DISEASE. HOWEVER, THE TRUE INNOVATION IS THE PROGRAM'S GOAL TO MAKE CHILDREN CREATIVE EXPERTS IN UNDERSTANDING THE SCIENTIFIC PROCESS IN TERMS OF THEIR OWN HEALTH AND WELL-BEING. "BEING ME" INCLUDES INSTRUCTION WITH STUDENTS AND ALSO INVOLVES PARENTS AND HEALTH AIDS THROUGH FAMILY LEARNING EVENTS AND A SPECIAL SUMMER SCIENCE CAMP EXPERIENCE. TEACHERS BENEFIT FROM REGULAR TARGETED PROFESSIONAL DEVELOPMENT IN BOTH CLINICAL AND RESEARCH SETTINGS. "BEING ME" IS A PARTNERSHIP BETWEEN CHILDREN'S NATIONAL MEDICAL CENTER, THE NATIONAL CHILDREN'S MUSEUM, AND GEORGE WASHINGTON UNIVERSITY SCHOOL OF EDUCATION. MARK THORNE, DIRECTOR OF THE NATIONAL CHILDREN'S MUSEUM WITHOUT WALLS, SEES THE BENEFIT OF THIS NOVEL EFFORT: "THE PROGRAM IS SO IMPORTANT BECAUSE IT REACHES CHILDREN AND FAMILIES IN UNDERSERVED COMMUNITIES WITH THE BASICS OF SCIENCE AND HEALTH, WHILE ALLOWING FOR CREATIVITY THROUGH ART. IMPORTANTLY, IT ALSO EDUCATES FAMILIES - AND TEACHERS - ABOUT THOSE HEALTH DISPARITIES THAT TEND TO HIT OUR COMMUNITIES HARDEST." TEENS AGAINST THE SPREAD OF AIDS (TASA) TEENS AGAINST THE SPREAD OF AIDS (TASA) IS A PROGRAM FOR HIGH SCHOOL STUDENTS AGES 16 - 18 FROM THE WASHINGTON, DC AREA. USING THEATER, POETRY, AND HIP HOP, TASA MEMBERS EDUCATE THEIR PEERS, PARENTS, AND HEALTH PROFESSIONALS ABOUT IMPORTANT TEEN HEALTH CONCERNS, INCLUDING HIV, SEXUALITY, AND VIOLENCE. THE PROGRAM WAS CREATED BECAUSE THE DISTRICT OF COLUMBIA HAS THE HIGHEST RATE OF HIV INFECTION IN THE COUNTRY AND MANY PEOPLE DON'T EVEN KNOW THEY EVEN HAVE IT. THROUGH THE PROGRAM, TEENS BECOME PEER AND PUBLIC EDUCATORS ABOUT THE RISKS OF GETTING THE DISEASE, HOW TO BE TESTED, AND HOW TO FIND MEDICAL CARE AND HELP. TASA CONDUCTED 10 EVENTS AND WORKSHOPS REACHING 395 YOUTH AND EDUCATED 40 YOUTH ON COMMUNICATING WITH HEALTH CARE PROVIDERS AND HEALTH CARE RIGHTS. FOCUS ON YOUTH WITH IMPACT HIV REMAINS A PREVENTABLE DISEASE, AND WITH EDUCATION AND AWARENESS THE RATES OF INFECTION CAN DRAMATICALLY DECREASE. THE FOCUS ON YOUTH IMPACT PROJECT (INFORMED PARENTS AND CHILDREN TOGETHER) - A CENTERS FOR DISEASE CONTROL AND PREVENTION-FUNDED INITIATIVE - AIMS TO EDUCATE CHILDREN ABOUT THE RISKS OF UNSAFE SEXUAL ACTIVITY, AND HELP PARENTS DISCUSS SEXUAL BEHAVIOR WITH THEIR CHILDREN. OVER EIGHT SESSIONS THE IMPACT PROGRAM TEACHES YOUTH AGES 12 - 15 THE IMPORTANCE OF RESPECTING THEIR VALUES AND MORALS, AND THE BENEFITS OF ABSTAINING FROM EARLY SEXUAL ACTIVITY. IT ALSO EQUIPS PARENTS, THROUGH A MANDATORY ADULT EDUCATIONAL CURRICULUM, WITH THE KNOWLEDGE AND COMMUNICATION TOOLS NECESSARY TO KEEP THEIR FAMILIES HEALTHY, AND IN THE LONG RUN, TO HELP STEM THE HIV EPIDEMIC. OVER 60 CHILDREN PARTICIPATED IN THE PROGRAM. HEALTH EDUCATION PROGRAM DATA SHOWS THAT MANY PARENTS OPT TO USE THE EMERGENCY ROOM RATHER THAN WAIT FOR AN APPOINTMENT WITH THEIR CHILD'S PRIMARY CARE PHYSICIAN. CHILDREN'S EMERGENCY DEPARTMENT HEALTH EDUCATION PROGRAM WAS ESTABLISHED WITH THE GOAL OF EDUCATING AT-RISK FAMILIES ON THE PROPER USE OF THE EMERGENCY DEPARTMENT AND THE IMPORTANCE OF FINDING A MEDICAL HOME FOR THEIR CHILD. THE HEALTH EDUCATORS NOT ONLY EDUCATE, THEY ALSO LOCATE A PRIMARY CARE PROVIDER AND SCHEDULE AN APPOINTMENT. IN 2011 OVER 300 COMMUNITY MEMBERS WERE REACHED BY THE PROGRAM. HEALTHY TEETH FLUORIDE VARNISH PROGRAM HEALTHY TEETH AMOUNT TO MORE THAN JUST A GREAT SMILE. UNTREATED DENTAL DECAY CAN AFFECT A CHILD'S ABILITY TO EAT, SLEEP, CONCENTRATE AND YES, PERFORM IN SCHOOL. IN FACT, A STAGGERING 51 MILLION SCHOOL HOURS ARE LOST EACH YEAR DUE TO DENTAL-RELATED ILLNESS. THE HEALTHY TEETH FLUORIDE VARNISH PROGRAM INITIATED BY CHILDREN'S NATIONAL GIVES KIDS IN UNDERSERVED AREAS THE OPPORTUNITY TO RECEIVE PREVENTIVE ORAL CARE AT THEIR HEAD START PROGRAM, SCHOOL, OR PRIMARY PROVIDER'S OFFICE, AND IT EDUCATES PARENTS ABOUT GOOD ORAL HEALTH PRACTICES, AS WELL. THIS COMPREHENSIVE APPROACH SERVES TWO IMPORTANT PURPOSES: TO ELIMINATE DENTAL DECAY BY MAKING GOOD ORAL HYGIENE A DAILY ROUTINE FOR EVERY CHILD, AND A STANDARD COMPONENT OF PREVENTIVE HEALTH CARE. IN 2011 1,493 INDIVIDUALS RECEIVED ORAL HEALTH EDUCATION, 1,926 FLUORIDE APPLICATIONS WERE PROVIDED, AND 128 CHILDREN WERE REFERRED TO A DENTAL HOME THROUGH THE HEALTHY TEETH PROGRAM. CHILDREN'S SCHOOL SERVICES SCHOOL NURSING PROGRAM INCREASINGLY, SCHOOLS ARE CALLED UPON TO OFFER MUCH MORE THAN AN ENRICHING ACADEMIC EXPERIENCE. IN MANY COMMUNITIES, SCHOOLS ARE ON THE FRONT LINES OF CONNECTING FAMILIES WITH THE SOCIAL SUPPORTS SO CRITICAL TO OPTIMAL LEARNING. RECOGNIZING THAT SCHOOL NURSES ARE UNIQUELY QUALIFIED AND POSITIONED TO HELP, CHILDREN'S SCHOOL SERVICES SCHOOL HEALTH NURSING PROGRAM -ARMED WITH A SPECIALLY-DESIGNED HEALTH PROMOTION CURRICULUM - WORKS ONSITE WITH PERSONNEL, FAMILIES, AND COMMUNITY RESOURCES TO MINIMIZE AND ELIMINATE HEALTH-RELATED BARRIERS TO LEARNING. IN 2011, 177 SCHOOLS BENEFITTED FROM INITIATIVES FOCUSED ON PREVENTION, EARLY IDENTIFICATION AND INTERVENTIONS FOR VARIOUS HEALTH PROBLEMS. REFERRALS TO CASE MANAGEMENT INCREASED BY AN ASTONISHING 166 PERCENT OVER THE PREVIOUS YEAR, AND THE NUMBER OF STUDENTS LINKED TO CARE AS A RESULT OF THOSE REFERRALS INCREASED EXPONENTIALLY. ACTIVITIES PROVIDED MORE THAN $50 MILLION IN COMMUNITY BENEFIT IN FISCAL YEAR 2011, INCLUDING THOSE HIGHLIGHTED IN THE NARRATIVES:
Program Services Continued Part III, Line 4a - ADVANCED PROFESSIONAL PRACTICE EXPERIENCE - ALLIANCE FOR SAFE CHILDREN AND YOUTH - CAR SEAT INSPECTION STATION - CHILDREN'S HEALTH PROJECT OF DC MOBILE HEALTH PROGRAM - CLINICAL AND COMMUNITY RESEARCH STUDIES - COMMUNITY BENEFIT OPERATIONS - COMMUNITY HEALTH INITIATIVE - COMMUNITY PHYSICIAN AND MEDICAL STAFF LECTURES - COMMUNITY WORKFORCE DEVELOPMENT ROTATIONS - CONGENITAL HEART DISEASE SCREENING PROGRAM - DC PEDIATRIC ORAL HEALTH COALITION - EMERGENCY MEDICAL SERVICES FOR CHILDREN NATIONAL RESOURCE CENTER - HAITI EARTHQUAKE RELIEF - HEALTH EDUCATION WORKSHOPS AND CLASSES OFFERED AT CHILDREN'S HEALTH CENTERS - HEALTH PROFESSIONS EDUCATION (MEDICAL STUDENTS, NURSES, RESIDENTS, AND FELLOWS) - HEALTHY START HEALTHY FAMILIES - HEMOPHELIA TREATMENT CENTER NEW PARENT BREAKFAST - INJURY PREVENTION COALITION - LA FERIA DE LA FAMILIA - LAB HEALTH PROFESSIONALS ROTATION - LUPUS FOUNDATION MEETING - MEETING THE MENTAL HEALTH NEEDS OF CHILDREN AND ADOLESCENT VICTIMS OF MALTREATMENT - OCCUPATIONAL THERAPY STUDENT FIELDWORK PROGRAM - NBC 4 HEALTH & FITNESS EXPO - PHYSICAL THERAPY STUDENT AFFILIATION PROGRAM - PRIMARY CARE PROVIDED AT CHILDREN'S HEALTH CENTERS - RESPONSE TO CHILD AND ADOLESCENT VICTIMIZATION - SCIENTIFIC SYMPOSIUM OF HEMOSTATSIS & THROMBOSIS RESEARCH SOCIETY - SICKLE CELL ADOLESCENT TRANSITION PROGRAM - SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC) - SUBPOENAS AND MEDICAL CONSULTATION - SUPER H RACE - TEEN LIFE CLUBS (TLC) - VOICES - WHEELCHAIR BASKETBALL INVITATIONAL TOURNAMENT PARTNERS INCLUDE: - ADVENTURE DENTAL - ADVISORY NEIGHBORHOOD COMMISSIONERS (ANCS) - BOSTON UNIVERSITY - BOYS AND GIRLS CLUBS OF GREATER WASHINGTON - CALVARY HEALTH CARE INC. - CATHOLIC UNIVERSITY - COMMUNITY OF HOPE - DC ACTION FOR CHILDREN - DC DEPARTMENT OF HEALTH CARE FINANCE - DC PRIMARY CARE ASSOCIATION - DENTAQUEST - DISTRICT OF COLUMBIA DEPARTMENT OF HEALTH - DISTRICT OF COLUMBIA DEPARTMENT OF TRANSPORTATION - DISTRICT OF COLUMBIA FIRE AND EMERGENCY MEDICAL SERVICES - DISTRICT OF COLUMBIA FIRE FIGHTER BURN FOUNDATION - DISTRICT OF COLUMBIA PUBLIC SCHOOLS - DUKE UNIVERSITY - GEORGETOWN UNIVERSITY - GEORGE WASHINGTON UNIVERSITY - HOLY CROSS HOSPITAL - HOWARD UNIVERSITY - JOB CORPS - KIDS SMILES OF DC - MARYMOUNT UNIVERSITY - MARY'S CENTER FOR MATERNAL AND CHILD HEALTH - METROPOLITAN POLICE DEPARTMENT - MONTGOMERY COMMUNITY COLLEGE - NATIONAL REHABILITATION HOSPITAL - NATIONAL INSTITUTES OF HEALTH (NIH) - OFFICE OF EARLY CHILDHOOD DEVELOPMENT - POISON CONTROL CENTER - PRINCE GEORGE'S COMMUNITY COLLEGE - SMALL SMILES - STREETWISE FOUNDATION - TELEMUNDO - TRINITY UNIVERSITY - UNITY HEALTH CARE - UNIVERSITY OF MARYLAND - WASHINGTON AREA BICYCLIST ASSOCIATION - WASHINGTON HOSPITAL CENTER - UNIVERSITY OF MARYLAND - WASHINGTON AREA BICYCLIST ASSOCIATION - WASHINGTON HOSPITAL CENTER - MONTGOMERY COMMUNITY COLLEGE - NATIONAL REHABILITATION HOSPITAL - NATIONAL INSTITUTES OF HEALTH (NIH) - OFFICE OF EARLY CHILDHOOD DEVELOPMENT - POISON CONTROL CENTER - PRINCE GEORGE'S COMMUNITY COLLEGE - SMALL SMILES - STREETWISE FOUNDATION - TELEMUNDO - TRINITY UNIVERSITY - UNITY HEALTH CARE - UNIVERSITY OF MARYLAND - WASHINGTON AREA BICYCLIST ASSOCIATION - WASHINGTON HOSPITAL CENTER - UNIVERSITY OF MARYLAND - WASHINGTON AREA BICYCLIST ASSOCIATION - WASHINGTON HOSPITAL CENTER Community Benefit Report Children's National Medical Center is committed to meeting its mission of Care, Advocacy, Research, and Education by growing healthy kids! In 2011, this goal was the motivation behind a number of programs and initiatives aimed at educating, treating, and preventing a wide range of diseases, as well as breaking the racial, ethnic, and socioeconomic boundaries that can be barriers to impactful health care. Because the Washington, DC metropolitan area is comprised of communities with unique and diverse medical needs, we are continually challenged to determine where the need for care is greatest, and identify key partnerships to bring meaningful services to children and their families. Last year, our administrators and staff focused their exceptional skills, talents, and energy on expanding already successful programs to reach more at-risk families and communities, while launching new ones with the promise of addressing unmet needs. The community benefit report highlights a few of these accomplishments, including the: DC Pediatric Oral Health Coalition, a group comprised of stakeholders across organizations and disciplines that share best practices and develop solutions to improve the state of pediatric oral health in the District; Healthy Teeth Fluoride Varnish Program, where over 1,400 parents in underserved communities received an education in good oral health habits, while establishing a dental home for their children; Congenital Heart Disease Screening Program, which promotes the value of early screening to prevent the risks created by delayed diagnosis; Health Education Program at the Children's National ED at United Medical Center, a program that provides much needed education on the top five ambulatory care sensitive (ACS) conditions, and the proper use of the emergency department; Focus on Youth with ImPACT, a CDC funded project, that serves both youth ages 12-15 and their parents with education on preventing HIV, as well as the risks of early sexual activity, and lastly Sickle Cell Adolescent Transition Program, which empowers and prepares kids with sickle cell anemia to successfully transition from pediatric to adult care. The Children's National family is proud of our contribution to creating and maintaining healthier communities in the District of Columbia. Working together, we can make sure that every child has the opportunity to grow up healthy.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KATHY BARKER TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PETER R HOLBROOK MD TITLE:EVP/CHIEF MEDICAL OFFICER HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TERRY CORNWELL RUMSEY TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CAROLYN THORNELL TITLE:BOARD CHAIRMAN HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARK BATSHAW MD TITLE:EVP/CHIEF ACADEMIC OFFICER HOURS:46
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JODY BURDELL TITLE:EVP/CHIEF OPERATING OFFICER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARY ANNE HILLIARD TITLE:CHIEF RISK OFFICER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DOUGLAS MYERS TITLE:EVP & CHIEF FINANCIAL OFFICER HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NELLIE ROBINSON TITLE:EVP/CHIEF NURSING/PATIENT SVCS HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PAM KING SAMS TITLE:EVP/ CHIEF DEVELOPMENT OFFICER HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RAYMOND SCZUDLO TITLE:EVP/ CHIEF LEGAL OFFICER HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MENDEL TUCHMAN MD TITLE:CHIEF RESEARCH OFFICER HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JACQUELINE BOWENS TITLE:EVP/EXTERNAL AFFAIRS OFFICER HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERTA ALESSI TITLE:VP OPERATIONS HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MAX COPPES MD PHD TITLE:SVP CENTER OF EXCELLENCE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DENICE CORA-BRAMBLE MD TITLE:SVP CENTER OF EXCELLENCE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD JONAS MD TITLE:CHIEF OF CARDIO SURGERY HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MIRIAM MARKOWITZ TITLE:CORP VP STRATEGIC PLANNING HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GERARD MARTIN MD TITLE:SVP CENTER OF EXCELLENCE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KURT DOUGLAS NEWMAN MD TITLE:SVP CENTER OF EXCELLENCE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROGER PACKER MD TITLE:SVP CENTER OF EXCELLENCE HOURS:12
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CAROLE SCHOR TITLE:CORP VP HUMAN RESOURCES HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID SPARKS TITLE:VP FINANCE & CONTROLLER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID WESSEL MD TITLE:SVP CENTER OF EXCELLENCE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOSEPH WRIGHT MD TITLE:SVP CENTER OF EXCELLENCE HOURS:3
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
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
2011
Open to Public Inspection
Name of the organization
Children's Hospital
 
Employer identification number

53-0196580
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







(1) CHILDREN'S NATIONAL SPECIALISTS OF VA
111 MICHIGAN AVENUE NW
WASHINGTON,DC20010
26-4571100 		HEALTH CARE DC -1,311,834 0 NA
 










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) CHILDREN'S RESEARCH INSTITUTE

111 MICHIGAN AVENUE NW

WASHINGTON,DC20010
52-1654453 		RESEARCH DC 501(C)(3) 9 CNMC
 
 
No
(2) CHILDREN'S NATIONAL MEDICAL CENTER

111 MICHIGAN AVENUE NW

WASHINGTON,DC20010
52-1640403 		HEALTH CARE DC 501(C)(3) 11B, II NA
 
 
No
(3) SAFE KIDS WORLDWIDE

1301 PENNSYLVANIA AVENUE NW

WASHINGTON,DC20004
52-1627574 		INJURY PRVNTN DC 501(C)(3) 11A, I CNMC
 
 
No
(4) CHILDREN'S HOSPITAL SELF-INSURANCE TRUST

111 MICHIGAN AVENUE NW

WASHINGTON,DC20010
52-1640399 		INSURANCE DC 501(C)(3) 11C, III-FI cnmc
 
Yes
 
(5) CHILDREN'S HOSPITAL FOUNDATION

111 MICHIGAN AVENUE NW

WASHINGTON,DC20010
52-1640402 		FUNDRAISING DC 501(C)(3) 7 CNMC
 
 
No
(6) BRAINY CAMPS ASSOCIATION

111 MICHIGAN AVENUE NW

WASHINGTON,DC20010
27-1547370 		CHILD CAMPS DC 501(C)(3) 11A, I CH
 
Yes
 
(7) CHILDREN'S NAT'L ADVOC & PUBLIC POLICY

111 MICHIGAN AVENUE NW

WASHINGTON,DC20010
27-1564354 		ADVOCACY DC 501(C)(3) 11B, II CNMC
 
 
No
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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) CHILDREN'S PEDIATRICIANS ASSOC

111 MICHIGAN AVENUE NW
WASHINGTON,DC20010
52-2072589 		HEALTH CARE DC NA
  		  -588,088 5,249,938   No 0   No 50.000 %












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) CHILDREN'S NATIONAL HEALTH NETWORK
111 MICHIGAN AVENUE NW
WASHINGTON,DC20010
52-1996521 		HEALTH CARE DC NA
  		C Corp 0 0  
(2) SAFE KIDS WORLDWIDE LTD
PO BOX 916
ROAD TOWN TORTOLA    
VQ
INJURY PREVEN VQ NA
  		C Corp 0 0  
(3) BEARACUDA RE
PO BOX 69 KY1-1102
GRANDCAYMAN    
CJ
REINSURANCE CJ NA
  		C Corp 0 0  
(4) BEAR CUB REINSURANCE LTD
PO BOX 69 KY1-1102
GRANDCAYMAN    
CJ
REINSURANCE CJ NA
  		C Corp 0 0  






Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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 related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
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) BRAINY CAMPS ASSOCIATION

 O 333,570 CASH
(2) BRAINY CAMPS ASSOCIATION

 P 295,802 CASH
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(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 Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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


Software ID:  
Software Version: