TY 2013 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) WILLIAM J ABRAHAM JR........................................................................ DIRECTOR	1.00 .......................1.00	X
(2) MICHAEL W ALTSCHAEFL........................................................................ DIRECTOR	1.00 .......................1.00	X
(3) THOMAS M BOLGER........................................................................ DIRECTOR	1.00 .......................1.00	X
(4) ELIZABETH BRENNER........................................................................ DIRECTOR	1.00 .......................1.00	X
(5) CURT S CULVER........................................................................ DIRECTOR	1.00 .......................1.00	X
(6) BETH DALEY-ULLEM........................................................................ DIRECTOR	1.00 .......................1.00	X
(7) DAVID J DRURY........................................................................ DIRECTOR/CHAIR	1.00 .......................1.00	X	X
(8) DAVID H GILBERT........................................................................ DIRECTOR	1.00 .......................1.00	X
(9) MARK R HOGAN........................................................................ DIRECTOR	1.00 .......................1.00	X
(10) PAUL W JONES........................................................................ DIRECTOR	1.00 .......................1.00	X
(11) JOSEPH KERSCHNER MD........................................................................ DIRECTOR	1.00 .......................1.00	X
(12) KEVIN MANSELL........................................................................ DIRECTOR	1.00 .......................1.00	X
(13) LINDA T MELLOWES........................................................................ DIRECTOR	1.00 .......................1.00	X
(14) C DAVID MYERS........................................................................ DIRECTOR	1.00 .......................1.00	X
(15) ALBERT S ORR III........................................................................ DIRECTOR	1.00 .......................1.00	X
(16) MICHAEL T PEPKE........................................................................ DIRECTOR	1.00 .......................1.00	X
(17) J JOEL QUADRACCI........................................................................ DIRECTOR	1.00 .......................1.00	X

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) JAY O ROTHMAN........................................................................ DIRECTOR	1.00 .......................1.00	X					0	0	0
(19) JOHN E SCHLIFSKE........................................................................ DIRECTOR	1.00 .......................1.00	X					0	0	0
(20) PETER M SOMMERHAUSER........................................................................ DIRECTOR/VICE CHAIR	1.00 .......................1.00	X	X				0	0	0
(21) PAUL W SWEENEY........................................................................ DIRECTOR	1.00 .......................1.00	X					0	0	0
(22) OWEN J SULLIVAN........................................................................ DIRECTOR	1.00 .......................1.00	X					0	0	0
(23) PHOEBE W WILLIAMS........................................................................ DIRECTOR	1.00 .......................1.00	X					0	0	0
(24) MARK C WITT........................................................................ DIRECTOR	1.00 .......................1.00	X					0	0	0
(25) MARGARET TROY........................................................................ DIRECTOR/CHHS PRESIDENT	0.00 .......................40.00	X	X				0	1,231,779	318,154
(26) THOMAS ARENBERG........................................................................ DIRECTOR	1.00 .......................1.00	X					0	0	0
(27) MICHAEL LOVELL........................................................................ DIRECTOR	1.00 .......................1.00	X					0	0	0
(28) PAUL KNOEBEL........................................................................ DIRECTOR	1.00 .......................1.00	X					0	0	0
(29) ELIZABETH BEDWELL........................................................................ VP RESEARCH ADMINISTRATION	0.00 .......................40.00		X				0	191,296	26,422
(30) CINTHIA S CHRISTENSEN........................................................................ PRESIDENT & COO	40.00 .......................0.00		X				654,973	0	108,969
(31) WELDON GAGE........................................................................ TREASURER / CFO	0.00 .......................40.00		X				0	510,566	69,978
(32) MICHAEL GUTZEIT MD........................................................................ VP, CHW / CHIEF MEDICAL OFFICER	40.00 .......................0.00		X				458,794	0	90,086
(33) BARBARA JOERS........................................................................ VICE PRESIDENT, CHW	40.00 .......................0.00		X				248,347	0	14,573
(34) JULIET KERSTEN........................................................................ VICE PRESIDENT, CHW	40.00 .......................0.00		X				297,952	0	41,797
(35) NANCY KOROM........................................................................ VP, CHW / CHIEF NURSING OFFICER	40.00 .......................0.00		X				387,890	0	81,904
(36) MARGARET NEIMER........................................................................ VP CHW	14.00 .......................26.00		X				260,241	49,487	73,808
(37) SHEILA REYNOLDS........................................................................ SECRETARY	0.00 .......................40.00		X				0	383,091	82,165
(38) MARK SHIP........................................................................ VP REVENUE CYCLE	40.00 .......................0.00		X				0	321,195	20,839
(39) MARC GORELICK MD........................................................................ EXECUTIVE VP CHHS	40.00 .......................0.00		X				96,585	0	28,234
(40) DONNA JAMIESON........................................................................ EXECUTIVE DIR, PATIENT CARE	40.00 .......................0.00			X			179,870	0	44,501
(41) TOM LAUSTEN........................................................................ DIRECTOR, PHARMACY SVS	40.00 .......................0.00			X			168,232	0	38,253
(42) ERIN YALE........................................................................ DIR, DIAG IMAGING & EMERGENCY	40.00 .......................0.00			X			175,377	0	34,407
(43) SUZAN BUCHAKLIAN........................................................................ DIR, SURGICAL SERVICES	40.00 .......................0.00			X			186,949	0	28,356
(44) LORI BARBEAU DDS........................................................................ MEDICAL DIRECTOR DENTAL PROGRAM	40.00 .......................0.00				X		251,843	0	45,441
(45) ANDREW SCHMITT MD........................................................................ HOSPITALIST	40.00 .......................0.00				X		251,256	0	32,431
(46) MARYLYN RANTA MD........................................................................ DIR, CHW PHYSICIAN AFFAIRS	40.00 .......................0.00				X		249,582	0	50,649
(47) SHANE FISHER DDS........................................................................ PEDIATRIC DENTIST	40.00 .......................0.00				X		239,512	0	24,399
(48) A CHARLES POST DDS........................................................................ PROGRAM ADMIN DENTAL RESIDENCY	40.00 .......................0.00				X		217,469	0	27,732
(49) MARC CADIEUX........................................................................ FORMER INTERIM TREASURER	0.00 .......................40.00					X	0	199,061	20,997

(A) Name and business address	(B) Description of services	(C) Compensation
MEDICAL COLLEGE OF WISCONSIN INC8701 WATERTOWN PLANK ROADMILWAUKEEWI53226	HEALTHCARE PROF/ACADEMIC/ADMIN	28,353,936
MEDICAL COLLEGE OF WISCONSIN AFFILIATED8701 WATERTOWN PLANK ROADMILWAUKEEWI53226	RESIDENT SERVICES	10,756,898
BLOOD CENTER OF WISCONSIN INC638 N 18TH STMILWAUKEEWI53233	BLOOD PRODUCTS/LAB SERVICES	7,928,693
THEDA CARE122 E COLLEGE AVEAPPLETONWI54912	ANCILLIARY SERV/OTHER SERV	5,109,659
MILWAUKEE REGIONAL MEDICAL CENTER - FFL2661 AVIATION ROADWAUKESHAWI53188	AIR TRANSPORTATION SERVICES	1,723,380
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 35

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	16,816,637	16,816,637
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	5,086,062	1,511,874	3,574,188
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	156,126,728	133,863,956	22,262,772
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	9,803,452	8,373,378	1,430,074
9	Other employee benefits .......	26,952,626	22,985,950	3,966,676
10	Payroll taxes ...........	11,702,649	10,001,382	1,701,267
11	Fees for services (non-employees):
a	Management ......	82,342,000		82,342,000
b	Legal .........
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	921,022		921,022
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........	67,178,475	62,144,715	5,033,760
12	Advertising and promotion ....	8,156	2,743	5,413
13	Office expenses .......	424,714	373,114	51,600
14	Information technology ......	194,915	153,219	41,696
15	Royalties ..
16	Occupancy ...........	20,151,997	14,050,345	6,101,652
17	Travel ............	643,129	270,063	373,066
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	260,867	130,339	130,528
20	Interest ...........	14,111,623	15,115	14,096,508
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	47,442,802	47,442,802
23	Insurance ..............	1,615,800	20,459	1,595,341
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	59,331,243	59,331,243
b	HOSPITAL ASSESSMENT TAX	11,945,382	11,945,382
c
d
e	All other expenses	18,987,787	14,864,518	4,123,269
25	Total functional expenses. Add lines 1 through 24e	552,048,066	404,297,234	147,750,832	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 if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	20,934,534	1	73,284,774
2	Savings and temporary cash investments .........		2
3	Pledges and grants receivable, net ...........	1,890,349	3	1,519,728
4	Accounts receivable, net .............	78,401,999	4	79,560,551
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
		10,000	5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............	511,460	7	613,001
8	Inventories for sale or use ..............	4,089,825	8	4,627,972
9	Prepaid expenses and deferred charges ..........	5,162,899	9	5,096,354
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	713,455,935
b	Less: accumulated depreciation .....	10b	290,099,745	444,556,620	10c	423,356,190
11	Investments—publicly traded securities ..........	298,749,648	11	271,668,117
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	416,488,570	15	479,229,710
16	Total assets. Add lines 1 through 15 (must equal line 34)......	1,270,795,904	16	1,338,956,397
	17	Accounts payable and accrued expenses .........	73,260,669	17	66,523,306
18	Grants payable .................		18
19	Deferred revenue ................	1,157,530	19	1,308,172
20	Tax-exempt bond liabilities .............	269,599,134	20	266,060,711
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ....		24
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....................	112,670,213	25	29,906,242
26	Total liabilities. Add lines 17 through 25.........	456,687,546	26	363,798,431
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	649,591,292	27	779,256,568
28	Temporarily restricted net assets ...........	36,839,166	28	51,344,554
29	Permanently restricted net assets ...........	127,677,900	29	144,556,844
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	814,108,358	33	975,157,966
34	Total liabilities and net assets/fund balances ........	1,270,795,904	34	1,338,956,397

- TIN:

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.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.
right arrow

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

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

CHILDREN'S HOSPITAL OF WISCONSIN INC

Employer identification number

39-0812532

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Non-functionally integrated

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of 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)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(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 monetary support
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of monetary support


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2013

Page 2

Part II

Support Schedule for Organizations Described in Sections 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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here................................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2012 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2013. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2012. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2012. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 3

Part III

Support Schedule for Organizations Described in Section 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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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) 2009	(b) 2010	(c) 2011	(d) 2012	(e) 2013	(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.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2012 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2012 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2013. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........ right arrow

33 1/3% support tests—2012. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ..... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2013

Page 4

Part IV

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

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

OMB No. 1545-0047

2013

Name of the organization

CHILDREN'S HOSPITAL OF WISCONSIN INC

Employer identification number

39-0812532

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year ......................... 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 its Form 990PF, Part I, line 2, 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 2

Name of organization CHILDREN'S HOSPITAL OF WISCONSIN INC

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, RESTRICTEDRESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 3

Name of organization CHILDREN'S HOSPITAL OF WISCONSIN INC

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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Page 4

Name of organization
CHILDREN'S HOSPITAL OF WISCONSIN INC

Employer identification number

39-0812532

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

(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

(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

(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

(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) (2013)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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. SchDMd Bullet

Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL OF WISCONSIN INC

Employer identification number

39-0812532

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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, 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.

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 XIII, the text of the footnote to its financial statements that describes these items.

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

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:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

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

Cat. No. 52283D

Schedule D (Form 990) 2013

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?........

Yes No

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.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:

			Amount
c	Beginning balance .................................	1c	379,800
d	Additions during the year ..............................	1d	201,531
e	Distributions during the year .............................	1e	148,585
f	Ending balance ...................................	1f	432,746

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....	337,517,064	320,201,015	319,718,349	301,025,999	246,110,966
b	Contributions ........	20,430,025	12,951,629	8,809,809	13,508,585	12,400,322
c	Net investment earnings, gains, and losses	20,149,400	13,134,597	501,862	13,344,633	48,806,039
d	Grants or scholarships .....	8,024,840	7,676,552	7,914,215	7,310,168	6,291,328
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....	1,170,250	1,093,625	914,790	850,700
g	End of year balance ......	368,901,399	337,517,064	320,201,015	319,718,349	301,025,999

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

46.900 %

Permanent endowment SchDMd Bullet

39.200 %

Temporarily restricted endowment SchDMd Bullet

13.900 %

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

Yes

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................
b	Buildings ................	488,171,708	197,359,364	290,812,344
c	Leasehold improvements ............	6,637,613	2,832,707	3,804,906
d	Equipment ................	202,749,640	87,590,456	115,159,184
e	Other .................	15,896,974	2,317,218	13,579,756
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				423,356,190

Schedule D (Form 990) 2013

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(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.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) DUE FROM AFFILIATES				44,784,177
(2) BENEFICIAL INTEREST IN NET ASSETS OF CHILDREN'S HOSPITAL OF WISCONSIN FOUND.				428,586,598
(3) 457 PLAN ASSETS				999,516
(4) INVESTMENT IN CATALPA				140,879
(5) PENSION ASSET				4,718,540




Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				479,229,710

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
RESERVE FOR MEDICAL EDUCATION GRANT SETTLEMENTS		3,073,670
CAPITAL AND OTHER LEASE OBLIGATIONS		1,356,171
FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS		21,176,218
457 PLAN LIABILITY		999,516
ESTIMATED THIRD PARTY PAYER SETTLEMENTS		3,300,667




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		29,906,242
2. Liability for uncertain tax positions In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................

Schedule D (Form 990) 2013

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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 XIII.) ............	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 XIII.) ...........	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 XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
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 XIII.) ............	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 XIII.) ............	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 XIII

Supplemental Information

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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART IV, LINE 1B:	CERTAIN EMPLOYEES OF THE ORGANIZATION HAVE SIGNING AUTHORITY FOR THE CHILDREN'S HOSPITAL OF WISCONSIN MEDICAL STAFF FUNDS MONEY MARKET AND CHECKING ACCOUNT. AN EMPLOYEE OF THE ORGANIZATION ALSO PROVIDES ALL MONTHLY ACCOUNTING FUNCTIONS.
PART V, LINE 4:	CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION, INC., A RELATED ENTITY, HOLDS ENDOWMENT FUNDS ON BEHALF OF CHILDREN'S HOSPITAL OF WISCONSIN, INC. INTENDED USES OF THE FUNDS INCLUDE VARIOUS HEALTH-RELATED SERVICES, CAPITAL PROJECTS AND RESEARCH.
PART X, LINE 2:	CHHS EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS, AND THERE HAVE BEEN NO UNCERTAIN TAX POSITONS RECORDED FOR THE YEARS ENDED DECEMBER 31, 2013 AND 2012.

Schedule D (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL OF WISCONSIN INC

Employer identification number

39-0812532

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining 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, as a factor in determining eligibility for free or discounted care.

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"? ..............

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

Yes

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? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) ..	905,333		905,333	0.160 %
b	Medicaid (from Worksheet 3, column a) ....	238,967,029	188,150,341	50,816,688	9.210 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	239,872,362	188,150,341	51,722,021	9.370 %
Other Benefits		4,816,019	1,065,849	3,750,170	0.680 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	4,816,019	1,065,849	3,750,170	0.680 %
f	Health professions education (from Worksheet 5) ..	28,959,940	7,707,317	21,252,623	3.850 %
g	Subsidized health services (from Worksheet 6) ..	7,066,535	3,448,063	3,618,472	0.660 %
h	Research (from Worksheet 7)	6,821,162		6,821,162	1.240 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8)	481,934		481,934	0.090 %
j	Total. Other Benefits ..	48,145,590	12,221,229	35,924,361	6.520 %
k	Total. Add lines 7d and 7j .	288,017,952	200,371,570	87,646,382	15.890 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013

Schedule H (Form 990) 2013

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.

		(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	45,650		45,650	0.010 %
3	Community support	1,034,743	3,970	1,030,773	0.190 %
4	Environmental improvements
5	Leadership development and training for community members	26,425		26,425	0 %
6	Coalition building	1,902,016	14,776	1,887,240	0.340 %
7	Community health improvement advocacy	5,433		5,433	0 %
8	Workforce development	28,394		28,394	0.010 %
9	Other
10	Total	3,042,661	18,746	3,023,915	0.550 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

3,551,190

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

986,465

Enter Medicare allowable costs of care relating to payments on line 5.....

1,282,760

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-296,295

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2013

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?2 Name, address, primary website address, and state license number
1	CHILDREN'S HOSPITAL OF WISCONSIN INC 9000 W WISCONSIN AVE MILWAUKEE,WI53201 CHW.ORG 135	X	X	X	X	X	X
2	CHILDREN'S HOSPITAL OF WI-FOX VALLEY 130 S 2ND STREET NEENAH,WI54956 CHW.ORG 1005	X	X	X

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	CHILDREN'S HOSPITAL OF WISCONSIN INC
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ....................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Yes

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.CHW.ORG

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 350.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	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	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	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 website
b	The policy was attached to 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 on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	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?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	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 individual’s eligibility under the facility’s FAP?..........	17		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 Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

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?..........

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	CHILDREN'S HOSPITAL OF WI-FOX VALLEY
Name of hospital facility or facility reporting group

If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)

Yes

Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Part VI)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................

Did the hospital facility make its CHNA report widely available to the public? .............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.CHW.ORG

Other website (list url):

Available upon request from the hospital facility

Other (describe in Part VI)

If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):

Adoption of an implementation strategy that addresses each of the community health needs identified through the CHNA

Execution of the implementation strategy

Participation in the development of a community-wide plan

Participation in the execution of a community-wide plan

Inclusion of a community benefit section in operational plans

Adoption of a budget for provision of services that address the needs identified in the CHNA

Prioritization of health needs in its community

Prioritization of services that the hospital facility will undertake to meet health needs in its community

Other (describe in Part VI)

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ......

If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Financial Assistance Policy			Yes	No
9	Did the hospital facility have in place during the tax year a written financial assistance policy that:
	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?	9	Yes
10	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........	10	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
11	Used FPG to determine eligibility for providing discounted care?.................	11	Yes
	If "Yes," indicate the FPG family income limit for eligibility for discounted care: 350.000000000000% If "No," explain in Part VI the criteria the hospital facility used.
12	Explained the basis for calculating amounts charged to patients?.................	12	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	Residency
i	Other (describe in Part VI)
13	Explained the method for applying for financial assistance?...................	13	Yes
14	Included measures to publicize the policy within the community served by the hospital facility?.......	14	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 website
b	The policy was attached to 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 on admission to the hospital facility
f	The policy was available upon request
g	Other (describe in Part VI)
Billing and Collections
15	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?.......	15	Yes
16	Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a	Reporting to credit agency
b	Lawsuits
c	Liens on residences
d	Body attachments
e	Other similar actions (describe in Section C)
17	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 individual’s eligibility under the facility’s FAP?..........	17		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 Section C)

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)

Other (describe in Part VI)

Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)

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.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Part VI)

If "Yes," explain in Part VI.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? .........................

If "Yes," explain in Part VI.

Schedule H (Form 990) 2013

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference	Explanation
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 3: IN 2011, CHILDREN'S HOSPITAL INITIATED A COMMUNITY-BASED EFFORT TO IMPROVE CHILD HEALTH THAT RECOGNIZES THE INFLUENCE OF SOCIAL, CULTURAL AND ENVIRONMENTAL FACTORS ON HEALTH AND THE IMPACT SUCH INFLUENCES MAY HAVE WHEN THEY OCCUR DURING CRITICAL PERIODS OVER ONE'S LIFE, LIKE CHILDHOOD.CHILDREN'S HOSPITAL SELECTED THREE MILWAUKEE NEIGHBORHOODS WHICH HAVE HISTORICALLY BEEN UNDERSERVED FOR INITIAL ENGAGEMENT EFFORTS. THESE NEIGHBORHOODS - METCALFE PARK, FRANKLIN HEIGHTS/AMANI NEIGHBORHOOD, AND LINDSAY HEIGHTS - WERE IDENTIFIED BECAUSE 1) THEY HAD A HIGH CONCENTRATION OF PEDIATRIC-AGE RESIDENTS; 2) THERE WERE SIGNIFICANT CHALLENGES TO CHILD HEALTH OUTCOMES; AND 3) THEY HAD AN EXISTING TRUSTED COMMUNITY RESOURCE(S) THAT WAS WILLING TO PARTNER WITH CHILDREN'S HOSPITAL IN ENGAGING THE COMMUNITY IN NEW WAYS TO IMPROVE CHILD HEALTH OUTCOMES.THE INITIATIVE BEGAN WITH COMMUNITY CAFES, WHICH WERE LISTENING SESSIONS. AT THE COMMUNITY CAFES, RESIDENTS WERE ASKED OPEN-ENDED QUESTIONS AND ENGAGED IN TABLE CONVERSATIONS PROVIDING INPUT ON WHAT CONCERNS AND NEEDS EXIST WITHIN EACH OF THE THREE NEIGHBORHOODS. RESIDENTS IDENTIFIED THEMSELVES OR THEIR NEIGHBORS TO SERVE ON NEIGHBORHOOD ADVISORY COMMITTEES THAT THEY LEAD AND INVITE PARTNERS TO PARTICIPATE IN DISCUSSIONS AND ACTION AROUND PRIORITIES. RESIDENT FEEDBACK MADE CLEAR THAT PRIMARY CARE WAS NEEDED FOR BOTH CHILDREN AND THEIR CAREGIVERS IN THESE UNDERSERVED COMMUNITIES. THESE COMMUNITY CAFES PROVIDED CHILDREN'S HOSPITAL WITH A GOOD FOUNDATION TO INITIATE A MORE DETAILED LOOK AT THE HEALTH OF THE BROADER MILWAUKEE COMMUNITY.IN 2013, CHILDREN'S HOSPITAL AND FOUR OTHER HEALTH SYSTEMS IN MILWAUKEE (THE MILWAUKEE HEALTH CARE PARTNERSHIP) COMMISSIONED A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT IN COLLABORATION WITH THE MILWAUKEE HEALTH DEPARTMENT AND OTHER MUNICIPAL HEALTH DEPARTMENTS. THE ASSESSMENT CONSISTS OF THREE NARROWER REPORTS MEANT TO PROVIDE A HOLISTIC PICTURE OF HEALTH IN MILWAUKEE: - MILWAUKEE COUNTY COMMUNITY HEALTH SURVEY. THE PURPOSE OF THE MCCHS IS TO ASSESS THE HEALTH STATUS OF RESIDENTS. PRIMARY OBJECTIVES WERE TO (A) GATHER SPECIFIC DATA ON BEHAVIORAL AND LIFESTYLE HABITS OF THE ADULT POPULATION; (B) GATHER DATA ON THE PREVALENCE OF RISK FACTORS AND DISEASE CONDITIONS EXISTING WITHIN THE ADULT POPULATION; (C) COMPARE, WHERE APPROPRIATE, HEALTH DATA OF RESIDENTS TO PREVIOUS HEALTH STUDIES; AND (D) COMPARE, WHERE APPROPRIATE AND AVAILABLE, HEALTH DATA OF RESIDENTS TO STATE AND NATIONAL MEASUREMENTS. APPROXIMATELY 1,200 MILWAUKEE COUNTY RESIDENTS WERE SAMPLED USING RANDOM LANDLINE AND CELL PHONE-ONLY SAMPLES. COMBINED, POST-STRATIFICATION WAS CONDUCTED BY SEX AND AGE TO REFLECT THE 2010 CENSUS PROPORTION OF THESE CHARACTERISTICS IN THE AREA. - KEY INFORMANT REPORT. THE KEY INFORMANT REPORT IS A SUMMARY OF FINDINGS FROM POLICYMAKERS, HEALTH CARE PROVIDERS, LOCAL EXPERTS AND COMMUNITY MEMBERS CONDUCTED AS A PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE SURVEY ASKED RESPONDENTS TO RANK UP TO FIVE PUBLIC HEALTH ISSUES, BASED ON THE FOCUS AREAS PRESENTED IN WISCONSIN'S STATE HEALTH PLAN. - SECONDARY DATA REPORT. THE SECONDARY DATA REPORT IS A SUPPLEMENT TO THE PRIMARY DATA COLLECTION CONDUCTED IN THE MILWAUKEE COUNTY COMMUNITY HEALTH SURVEY AND THE KEY INFORMANT REPORT. THE REPORT SUMMARIZES THE DISTRIBUTION OF HEALTH INDICATORS AMONG SOCIOECONOMIC GROUPS WITHIN THE CITY OF MILWAUKEE AND MILWAUKEE COUNTY. THE REPORT USES PUBLICLY AVAILABLE DATA SOURCES FROM LOCAL, STATE AND NATIONAL LEVELS. WHILE THESE REPORTS PROVIDE RICH DATA AND A HOLISTIC VIEW OF HEALTH IN MILWAUKEE, THE PRIMARY FOCUS WAS THE ADULT POPULATION. GIVEN THIS LIMITATION, THE FOLLOWING DATA SOURCES WERE USED TO SUPPLEMENT THE FINDINGS OF THE MILWAUKEE HEALTH CARE PARTNERSHIP'S COMMUNITY HEALTH NEEDS ASSESSMENT TO ENSURE CHILDREN'S HOSPITAL'S HIGHEST PRIORITY - CHILDREN - ARE WELL REPRESENTED: - KIDS COUNT! DATA. KIDS COUNT IS A NATIONAL AND STATE-BY-STATE EFFORT TO TRACK WELL-BEING INDICATORS FOR CHILDREN IN THE UNITED STATES. FUNDED BY THE ANNIE E. CASEY FOUNDATION, KIDS COUNT OFFERS HIGH-QUALITY DATA AND TRENDS ANALYSIS. - KAISER STATE HEALTH FACTS. KAISER STATE HEALTH FACTS, FUNDED BY THE HENRY J. KAISER FAMILY FOUNDATION, PROVIDES FREE DATA ON MORE THAN 800 HEALTH INDICATORS AT THE STATE, NATIONAL AND COUNTY LEVEL. DATA, COMPILED FROM A VARIETY OF PUBLIC, PRIVATE AND GOVERNMENT SOURCES, ALLOWS USERS TO MAP, RANK, TREND OR DOWNLOAD INFORMATION. - UNITED STATES CENSUS BUREAU. IN ADDITION TO CONDUCTING A CENSUS DECENNIALLY, THE U.S. CENSUS BUREAU COLLECTS AND DISSEMINATES DATA ACROSS A VARIETY OF TOPICS. SOURCES FOR THIS INFORMATION INCLUDE THE POPULATION AND HOUSING CENSUS, NATIONAL HEALTH INTERVIEW SURVEY, ECONOMIC CENSUS, THE AMERICAN COMMUNITY SURVEY, CURRENT POPULATION SURVEY AND OTHER RELATED SURVEYS. - OTHER PUBLIC AND GOVERNMENT SOURCES. ADDITIONAL PUBLIC AND GOVERNMENT DATA SOURCES INCLUDE THE CENTER FOR DISEASE CONTROL, WISCONSIN INSTITUTE ON POVERTY AND UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE. TOGETHER, THESE SOURCES PROVIDE BOTH EXPERT AND BROAD PUBLIC INPUT INTO THE HEALTH NEEDS OF THE COMMUNITY.
CHILDREN'S HOSPITAL OF WI-FOX VALLEY	PART V, SECTION B, LINE 3: THE REPORT FOR CHW FOX VALLEY USED DATA AND INFORMATION FROM THE FOX CITIES LIFE STUDY. CHILDREN'S HOSPITAL WORKED WITH UNITED WAY FOX CITIES, THE FOX CITIES CHAMBER OF COMMERCE, THE COMMUNITY FOUNDATION FOR THE FOX VALLEY REGION AND THE FOX CITIES OF WISCONSIN ECONOMIC DEVELOPMENT PARTNERSHIP IN SPONSORING THIS REPORT.CHILDREN'S HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS FOR THE FOX VALLEY COMMUNITY RELIED HEAVILY ON THE LEADING INDICATORS FOR EXCELLENCE STUDY, OR LIFE STUDY. THE LIFE STUDY IS A MULTIFACETED ASSESSMENT OF LIFE IN 10 KEY AREAS IN THE FOX CITIES. IT EXAMINES WHAT "EXCELLENCE" WOULD LOOK LIKE FOR THE FOX CITIES REGION AND IDENTIFIED OPPORTUNITIES FOR THE FOX CITIES IN THE FOLLOWING AREAS:- ARTS AND CULTURE - LEISURE- COMMUNITY - NATURAL ENVIRONMENT- HEALTH - SAFETY- HOME - SELF-SUFFICIENCY- LEARNING - WORKOF PARTICULAR USE WAS THE "HEALTHY LIFE" REPORT, A SECTION OF THE LIFE STUDY FOCUSED ON THE COMPONENTS OF A HEALTHY LIFESTYLE, INCLUDING INDICATORS RELATED TO ACCESS TO MEDICAL CARE, HEALTH STATUS, MENTAL HEALTH STATUS, PREVENTION EFFORTS, QUALITY OF MEDICAL CARE AND RISKY BEHAVIORS. PRIMARY DATA FOR THE REPORT WAS COLLECTED THROUGH A VARIETY OF METHODS. A COMMUNITY SURVEY WAS CONDUCTED OF RANDOMLY SAMPLED RESIDENTS OF THE FOX CITIES METRO AREA AND OF AREA LEADERS REPRESENTING GOVERNMENT, FAITH, BUSINESS, MEDIA, NONPROFITS AND FOUNDATIONS, HEALTH CARE, EDUCATION AND THE COMMUNITY AT LARGE. COMMUNITY FOCUS GROUPS WITH IMPORTANT SUBGROUPS OF THE COMMUNITY - OLDER ADULTS, YOUTH, WORKING PARENTS AND MEMBERS OF THE MULTICULTURAL COMMUNITY - WERE CONVENED TO GAUGE THEIR PERCEPTIONS OF QUALITY OF LIFE. EXPERT SECTOR PANELS WERE CONVENED AND ONE-ON-ONE INTERVIEWS WERE CONDUCTED WITH PROFESSIONALS WITHIN EACH OF THE 10 SECTIONS OF THE LIFE STUDY.IN ADDITION TO THE SURVEYS, FOCUS GROUPS AND INTERVIEWS, A NUMBER OF SECONDARY DATA SOURCES WERE USED TO COMPLETE THE PICTURE. THESE SOURCES INCLUDE:- UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE COUNTY HEALTH RANKINGS- WISCONSIN DEPARTMENT OF HEALTH SERVICES- BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM- YOUTH RISK BEHAVIOR SURVEY- WISCONSIN INTERACTIVE STATISTICS ON HEALTH- U.S. CENSUS BUREAU- ANNIE E. CASEY FOUNDATION "KIDS COUNT"- CHILDREN'S HOSPITAL OF WISCONSIN PROGRAM DATA
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 4: THE FOLLOWING INSTITUTIONS WERE INTEGRAL TO THE COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT: AURORA HEALTH CARE, COLUMBIA ST. MARY'S HEALTH SYSTEM, FROEDTERT HEALTH, WHEATON FRANCISCAN HEALTHCARE AND PUBLIC HEALTH OFFICIALS IN THE CITY OF MILWAUKEE AND OTHER MILWAUKEE COUNTY MUNICIPALITIES
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 7: BECAUSE CHILDREN'S HOSPITAL IS A PEDIATRIC SPECIALTY HOSPITAL, OUR ATTENTION AND RESOURCES ARE FOCUSED ON AREAS IDENTIFIED IN THE MILWAUKEE HEALTH CARE PARTNERSHIP'S COMMUNITY HEALTH NEEDS ASSESSMENT WHERE WE CAN MAKE THE BIGGEST IMPACT ON THE HEALTH OF CHILDREN.THE FOLLOWING ISSUES WERE IDENTIFIED AS THE HIGHEST HEALTH NEEDS OF THE PEDIATRIC COMMUNITY AND THEREFORE, THE HIGHEST PRIORITIES FOR CHILDREN'S HOSPITAL OF MILWAUKEE:- ACCESS TO MENTAL, ORAL AND PRIMARY HEALTH CARE- OBESITY AND WEIGHT MANAGEMENT- INFANT MORTALITY- SEXUAL HEALTH- COMMUNITY AND HOME SAFETYTHE NEEDS IDENTIFIED BY THE CHNA WHICH MORE DIRECTLY IMPACT ADULT HEALTH AND THEREFORE WERE NOT ADDRESSED BY CHILDREN'S WERE BEHAVIORAL HEALTH, CHRONIC DISEASE, HEALTH ILLITERACY, AND DISPARATE IMPACT.
CHILDREN'S HOSPITAL OF WI-FOX VALLEY	PART V, SECTION B, LINE 7: BECAUSE CHILDREN'S HOSPITAL FOX VALLEY IS A PEDIATRIC SPECIALTY HOSPITAL, ITS ATTENTION AND RESOURCES ARE FOCUSED ON AREAS IDENTIFIED IN THE LIFE STUDY WHERE WE COULD MAKE THE BIGGEST IMPACT FOR THE HEALTH OF CHILDREN. THE FOLLOWING ISSUES WERE ESTABLISHED AS THE HIGHEST HEALTH PRIORITIES FOR CHILDREN'S HOSPITAL IN FOX VALLEY:- ACCESS TO MENTAL HEALTH CARE SERVICES- LIFESTYLE AND HEALTH- HEALTHY DEVELOPMENT OF ALL YOUTH- SUPPORT FOR CHILDRENTHE NEEDS THAT WERE NOT ADDRESSED BY CHILDREN'S BECAUSE THEY MORE DIRECTLY IMPACT ADULTS WERE AFFORDABLE HOUSING, CARE FOR ELDERLY AND PERSONS WITH A DISABILITY, FINANCIAL AND OTHER SUPPORT FOR QUALITY-OF-LIFE ACTIVITIES, INVESTMENT IN ENVIRONMENT, NEED FOR BETTER PAYING JOBS, PERSONAL SAFETY OF ADULTS, SELF-SUFFICIENCY CHALLENGES, AND SUPPORT FOR EDUCATION.
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 11: ALTHOUGH THE HOSPITAL'S FAP LIMITS ELIGIBILITY AT 350 PERCENT OF THE FPG, THE HOSPITAL MAY PROVIDE FINANCIAL ASSISTANCE FOR FAMILIES ABOVE 350 PERCENT OF THE FPG SINCE THE HOSPITAL MAKES ADDITIONAL CONSIDERATIONS FOR THE MEDICALLY INDIGENT.
CHILDREN'S HOSPITAL OF WI-FOX VALLEY	PART V, SECTION B, LINE 11: ALTHOUGH THE HOSPITAL'S FAP LIMITS ELIGIBILITY AT 350 PERCENT OF THE FPG, THE HOSPITAL MAY PROVIDE FINANCIAL ASSISTANCE FOR FAMILIES ABOVE 350 PERCENT OF THE FPG SINCE THE HOSPITAL MAKES ADDITIONAL CONSIDERATIONS FOR THE MEDICALLY INDIGENT.
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 14G: THE HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE CHILDREN'S FAP VIA ITS WEBSITE, BILLING INVOICES, AND AT VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES HAVE ACCESS TO THE FAP IN THE PATIENT HANDBOOK UPON ADMISSION. THE FULL WRITTEN POLICY IS AVAILABLE ON OUR WEBSITE AND UPON REQUEST. A PLAIN LANGUAGE SUMMARY IS INCLUDED IN BILLING INVOICES AND AVAILABLE IN WAITING AREAS.
CHILDREN'S HOSPITAL OF WI-FOX VALLEY	PART V, SECTION B, LINE 14G: THE HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE CHILDREN'S FAP VIA ITS WEBSITE, BILLING INVOICES, AND AT VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES HAVE ACCESS TO THE FAP IN THE PATIENT HANDBOOK UPON ADMISSION. THE FULL WRITTEN POLICY IS AVAILABLE ON OUR WEBSITE AND UPON REQUEST. A PLAIN LANGUAGE SUMMARY IS INCLUDED IN BILLING INVOICES AND AVAILABLE IN WAITING AREAS.
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 18E: THE HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE CHILDREN'S FAP VIA ITS WEBSITE, BILLING INVOICES, AND AT VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES HAVE ACCESS TO THE FAP IN THE PATIENT HANDBOOK UPON ADMISSION. PRIOR TO REFERRING AN ACCOUNT TO A COLLECTION AGENCY OR UNDERTAKING ANY EXTRAORDINARY COLLECTION ACTIONS, CHILDREN'S WILL MAKE EFFORTS TO COLLECT AMOUNTS DUE, INCLUDING REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER CHILDREN'S FAP. AT LEAST 3 BILLING STATEMENTS INCLUDING A PLAIN LANGUAGE SUMMARY OF THE FAP ARE SENT OVER A PERIOD OF 120 DAYS. THE HOSPITAL MAKES EXTENSIVE EFFORTS TO PROVIDE FACE-TO-FACE DIALOGUE, AS WELL AS COMMUNICATION VIA TELEPHONE, E-MAIL AND OTHER MEANS, AS NECESSARY TO ENSURE THAT FAMILIES ARE PROVIDED WITH SUFFICIENT INFORMATION REGARDING ALTERNATIVES FOR OBTAINING FREE OR DISCOUNTED CARE, AS WELL AS THE BILLING AND COLLECTION PROCESS GENERALLY. THE COMMUNICATION PROCESS IS SUPPORTED BY INTERPRETER SERVICES AS NEEDED.
CHILDREN'S HOSPITAL OF WI-FOX VALLEY	PART V, SECTION B, LINE 18E: THE HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE CHILDREN'S FAP VIA ITS WEBSITE, BILLING INVOICES, AND AT VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES HAVE ACCESS TO THE FAP IN THE PATIENT HANDBOOK UPON ADMISSION. PRIOR TO REFERRING AN ACCOUNT TO A COLLECTION AGENCY OR UNDERTAKING ANY EXTRAORDINARY COLLECTION ACTIONS, CHILDREN'S WILL MAKE EFFORTS TO COLLECT AMOUNTS DUE, INCLUDING REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER CHILDREN'S FAP. AT LEAST 3 BILLING STATEMENTS INCLUDING A PLAIN LANGUAGE SUMMARY OF THE FAP ARE SENT OVER A PERIOD OF 120 DAYS. THE HOSPITAL MAKES EXTENSIVE EFFORTS TO PROVIDE FACE-TO-FACE DIALOGUE, AS WELL AS COMMUNICATION VIA TELEPHONE, E-MAIL AND OTHER MEANS, AS NECESSARY TO ENSURE THAT FAMILIES ARE PROVIDED WITH SUFFICIENT INFORMATION REGARDING ALTERNATIVES FOR OBTAINING FREE OR DISCOUNTED CARE, AS WELL AS THE BILLING AND COLLECTION PROCESS GENERALLY. THE COMMUNICATION PROCESS IS SUPPORTED BY INTERPRETER SERVICES AS NEEDED.
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 20D: THE MAXIMUM AMOUNT THE HOSPITAL CHARGES PATIENTS IS DETERMINED BY APPLYING FINANCIAL ASSISTANCE DISCOUNTS TO CHILDREN'S GROSS CHARGES, BUT IN NO EVENT WILL THE AMOUNT BILLED TO A FAMILY QUALIFIED FOR FINANCIAL ASSISTANCE EXCEED THE AMOUNTS GENERALLY BILLED (AGB) BY CHILDREN'S TO INSURED PATIENTS. THE AGB IS CALCULATED ANNUALLY BASED ON THE LOOK-BACK METHOD AS PRESCRIBED UNDER THE IRS REGULATIONS AND IS BASED ON CHW'S OVERALL MEDICARE AND COMMERCIAL REIMBURSEMENT RATE.
CHILDREN'S HOSPITAL OF WI-FOX VALLEY	PART V, SECTION B, LINE 20D: THE MAXIMUM AMOUNT THE HOSPITAL CHARGES PATIENTS IS DETERMINED BY APPLYING FINANCIAL ASSISTANCE DISCOUNTS TO CHILDREN'S GROSS CHARGES, BUT IN NO EVENT WILL THE AMOUNT BILLED TO A FAMILY QUALIFIED FOR FINANCIAL ASSISTANCE EXCEED THE AMOUNTS GENERALLY BILLED (AGB) BY CHILDREN'S TO INSURED PATIENTS. THE AGB IS CALCULATED ANNUALLY BASED ON THE LOOK-BACK METHOD AS PRESCRIBED UNDER THE IRS REGULATIONS AND IS BASED ON CHW'S OVERALL MEDICARE AND COMMERCIAL REIMBURSEMENT RATE.

Schedule H (Form 990) 2013

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?5
Name and address		Type of Facility (describe)
1	CHW FOX VALLEY BEHAVIORAL HEALTH 1820 N APPLETON RD MENASHA,WI54952	PATIENT CARE SERVICES
2	CHILD ADVOCACY CENTER - FOX VALLEY 325 N COMMERCIAL ST SUITE 400 NEENAH,WI54956	PATIENT CARE SERVICES
3	CHILD ADVOCACY CENTER - RACINE 2405 NORTHWESTERN AVE SUITE 2058 RACINE,WI53404	PATIENT CARE SERVICES
4	CHILD ADVOCACY CENTER - WAUKESHA 101 W BROADWAY 2ND FLOOR WAUKESHA,WI53186	PATIENT CARE SERVICES
5	DOWNTOWN HEALTH CENTER 1020 N 12TH ST MILWAUKEE,WI53233	URBAN HEALTH CENTER
6
7
8
9
10

Schedule H (Form 990) 2013

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 3: IN 2011, CHILDREN'S HOSPITAL INITIATED A COMMUNITY-BASED EFFORT TO IMPROVE CHILD HEALTH THAT RECOGNIZES THE INFLUENCE OF SOCIAL, CULTURAL AND ENVIRONMENTAL FACTORS ON HEALTH AND THE IMPACT SUCH INFLUENCES MAY HAVE WHEN THEY OCCUR DURING CRITICAL PERIODS OVER ONE'S LIFE, LIKE CHILDHOOD.CHILDREN'S HOSPITAL SELECTED THREE MILWAUKEE NEIGHBORHOODS WHICH HAVE HISTORICALLY BEEN UNDERSERVED FOR INITIAL ENGAGEMENT EFFORTS. THESE NEIGHBORHOODS - METCALFE PARK, FRANKLIN HEIGHTS/AMANI NEIGHBORHOOD, AND LINDSAY HEIGHTS - WERE IDENTIFIED BECAUSE 1) THEY HAD A HIGH CONCENTRATION OF PEDIATRIC-AGE RESIDENTS; 2) THERE WERE SIGNIFICANT CHALLENGES TO CHILD HEALTH OUTCOMES; AND 3) THEY HAD AN EXISTING TRUSTED COMMUNITY RESOURCE(S) THAT WAS WILLING TO PARTNER WITH CHILDREN'S HOSPITAL IN ENGAGING THE COMMUNITY IN NEW WAYS TO IMPROVE CHILD HEALTH OUTCOMES.THE INITIATIVE BEGAN WITH COMMUNITY CAFES, WHICH WERE LISTENING SESSIONS. AT THE COMMUNITY CAFES, RESIDENTS WERE ASKED OPEN-ENDED QUESTIONS AND ENGAGED IN TABLE CONVERSATIONS PROVIDING INPUT ON WHAT CONCERNS AND NEEDS EXIST WITHIN EACH OF THE THREE NEIGHBORHOODS. RESIDENTS IDENTIFIED THEMSELVES OR THEIR NEIGHBORS TO SERVE ON NEIGHBORHOOD ADVISORY COMMITTEES THAT THEY LEAD AND INVITE PARTNERS TO PARTICIPATE IN DISCUSSIONS AND ACTION AROUND PRIORITIES. RESIDENT FEEDBACK MADE CLEAR THAT PRIMARY CARE WAS NEEDED FOR BOTH CHILDREN AND THEIR CAREGIVERS IN THESE UNDERSERVED COMMUNITIES. THESE COMMUNITY CAFES PROVIDED CHILDREN'S HOSPITAL WITH A GOOD FOUNDATION TO INITIATE A MORE DETAILED LOOK AT THE HEALTH OF THE BROADER MILWAUKEE COMMUNITY.IN 2013, CHILDREN'S HOSPITAL AND FOUR OTHER HEALTH SYSTEMS IN MILWAUKEE (THE MILWAUKEE HEALTH CARE PARTNERSHIP) COMMISSIONED A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT IN COLLABORATION WITH THE MILWAUKEE HEALTH DEPARTMENT AND OTHER MUNICIPAL HEALTH DEPARTMENTS. THE ASSESSMENT CONSISTS OF THREE NARROWER REPORTS MEANT TO PROVIDE A HOLISTIC PICTURE OF HEALTH IN MILWAUKEE: - MILWAUKEE COUNTY COMMUNITY HEALTH SURVEY. THE PURPOSE OF THE MCCHS IS TO ASSESS THE HEALTH STATUS OF RESIDENTS. PRIMARY OBJECTIVES WERE TO (A) GATHER SPECIFIC DATA ON BEHAVIORAL AND LIFESTYLE HABITS OF THE ADULT POPULATION; (B) GATHER DATA ON THE PREVALENCE OF RISK FACTORS AND DISEASE CONDITIONS EXISTING WITHIN THE ADULT POPULATION; (C) COMPARE, WHERE APPROPRIATE, HEALTH DATA OF RESIDENTS TO PREVIOUS HEALTH STUDIES; AND (D) COMPARE, WHERE APPROPRIATE AND AVAILABLE, HEALTH DATA OF RESIDENTS TO STATE AND NATIONAL MEASUREMENTS. APPROXIMATELY 1,200 MILWAUKEE COUNTY RESIDENTS WERE SAMPLED USING RANDOM LANDLINE AND CELL PHONE-ONLY SAMPLES. COMBINED, POST-STRATIFICATION WAS CONDUCTED BY SEX AND AGE TO REFLECT THE 2010 CENSUS PROPORTION OF THESE CHARACTERISTICS IN THE AREA. - KEY INFORMANT REPORT. THE KEY INFORMANT REPORT IS A SUMMARY OF FINDINGS FROM POLICYMAKERS, HEALTH CARE PROVIDERS, LOCAL EXPERTS AND COMMUNITY MEMBERS CONDUCTED AS A PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT. THE SURVEY ASKED RESPONDENTS TO RANK UP TO FIVE PUBLIC HEALTH ISSUES, BASED ON THE FOCUS AREAS PRESENTED IN WISCONSIN'S STATE HEALTH PLAN. - SECONDARY DATA REPORT. THE SECONDARY DATA REPORT IS A SUPPLEMENT TO THE PRIMARY DATA COLLECTION CONDUCTED IN THE MILWAUKEE COUNTY COMMUNITY HEALTH SURVEY AND THE KEY INFORMANT REPORT. THE REPORT SUMMARIZES THE DISTRIBUTION OF HEALTH INDICATORS AMONG SOCIOECONOMIC GROUPS WITHIN THE CITY OF MILWAUKEE AND MILWAUKEE COUNTY. THE REPORT USES PUBLICLY AVAILABLE DATA SOURCES FROM LOCAL, STATE AND NATIONAL LEVELS. WHILE THESE REPORTS PROVIDE RICH DATA AND A HOLISTIC VIEW OF HEALTH IN MILWAUKEE, THE PRIMARY FOCUS WAS THE ADULT POPULATION. GIVEN THIS LIMITATION, THE FOLLOWING DATA SOURCES WERE USED TO SUPPLEMENT THE FINDINGS OF THE MILWAUKEE HEALTH CARE PARTNERSHIP'S COMMUNITY HEALTH NEEDS ASSESSMENT TO ENSURE CHILDREN'S HOSPITAL'S HIGHEST PRIORITY - CHILDREN - ARE WELL REPRESENTED: - KIDS COUNT! DATA. KIDS COUNT IS A NATIONAL AND STATE-BY-STATE EFFORT TO TRACK WELL-BEING INDICATORS FOR CHILDREN IN THE UNITED STATES. FUNDED BY THE ANNIE E. CASEY FOUNDATION, KIDS COUNT OFFERS HIGH-QUALITY DATA AND TRENDS ANALYSIS. - KAISER STATE HEALTH FACTS. KAISER STATE HEALTH FACTS, FUNDED BY THE HENRY J. KAISER FAMILY FOUNDATION, PROVIDES FREE DATA ON MORE THAN 800 HEALTH INDICATORS AT THE STATE, NATIONAL AND COUNTY LEVEL. DATA, COMPILED FROM A VARIETY OF PUBLIC, PRIVATE AND GOVERNMENT SOURCES, ALLOWS USERS TO MAP, RANK, TREND OR DOWNLOAD INFORMATION. - UNITED STATES CENSUS BUREAU. IN ADDITION TO CONDUCTING A CENSUS DECENNIALLY, THE U.S. CENSUS BUREAU COLLECTS AND DISSEMINATES DATA ACROSS A VARIETY OF TOPICS. SOURCES FOR THIS INFORMATION INCLUDE THE POPULATION AND HOUSING CENSUS, NATIONAL HEALTH INTERVIEW SURVEY, ECONOMIC CENSUS, THE AMERICAN COMMUNITY SURVEY, CURRENT POPULATION SURVEY AND OTHER RELATED SURVEYS. - OTHER PUBLIC AND GOVERNMENT SOURCES. ADDITIONAL PUBLIC AND GOVERNMENT DATA SOURCES INCLUDE THE CENTER FOR DISEASE CONTROL, WISCONSIN INSTITUTE ON POVERTY AND UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE. TOGETHER, THESE SOURCES PROVIDE BOTH EXPERT AND BROAD PUBLIC INPUT INTO THE HEALTH NEEDS OF THE COMMUNITY.
CHILDREN'S HOSPITAL OF WI-FOX VALLEY	PART V, SECTION B, LINE 3: THE REPORT FOR CHW FOX VALLEY USED DATA AND INFORMATION FROM THE FOX CITIES LIFE STUDY. CHILDREN'S HOSPITAL WORKED WITH UNITED WAY FOX CITIES, THE FOX CITIES CHAMBER OF COMMERCE, THE COMMUNITY FOUNDATION FOR THE FOX VALLEY REGION AND THE FOX CITIES OF WISCONSIN ECONOMIC DEVELOPMENT PARTNERSHIP IN SPONSORING THIS REPORT.CHILDREN'S HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS FOR THE FOX VALLEY COMMUNITY RELIED HEAVILY ON THE LEADING INDICATORS FOR EXCELLENCE STUDY, OR LIFE STUDY. THE LIFE STUDY IS A MULTIFACETED ASSESSMENT OF LIFE IN 10 KEY AREAS IN THE FOX CITIES. IT EXAMINES WHAT "EXCELLENCE" WOULD LOOK LIKE FOR THE FOX CITIES REGION AND IDENTIFIED OPPORTUNITIES FOR THE FOX CITIES IN THE FOLLOWING AREAS:- ARTS AND CULTURE - LEISURE- COMMUNITY - NATURAL ENVIRONMENT- HEALTH - SAFETY- HOME - SELF-SUFFICIENCY- LEARNING - WORKOF PARTICULAR USE WAS THE "HEALTHY LIFE" REPORT, A SECTION OF THE LIFE STUDY FOCUSED ON THE COMPONENTS OF A HEALTHY LIFESTYLE, INCLUDING INDICATORS RELATED TO ACCESS TO MEDICAL CARE, HEALTH STATUS, MENTAL HEALTH STATUS, PREVENTION EFFORTS, QUALITY OF MEDICAL CARE AND RISKY BEHAVIORS. PRIMARY DATA FOR THE REPORT WAS COLLECTED THROUGH A VARIETY OF METHODS. A COMMUNITY SURVEY WAS CONDUCTED OF RANDOMLY SAMPLED RESIDENTS OF THE FOX CITIES METRO AREA AND OF AREA LEADERS REPRESENTING GOVERNMENT, FAITH, BUSINESS, MEDIA, NONPROFITS AND FOUNDATIONS, HEALTH CARE, EDUCATION AND THE COMMUNITY AT LARGE. COMMUNITY FOCUS GROUPS WITH IMPORTANT SUBGROUPS OF THE COMMUNITY - OLDER ADULTS, YOUTH, WORKING PARENTS AND MEMBERS OF THE MULTICULTURAL COMMUNITY - WERE CONVENED TO GAUGE THEIR PERCEPTIONS OF QUALITY OF LIFE. EXPERT SECTOR PANELS WERE CONVENED AND ONE-ON-ONE INTERVIEWS WERE CONDUCTED WITH PROFESSIONALS WITHIN EACH OF THE 10 SECTIONS OF THE LIFE STUDY.IN ADDITION TO THE SURVEYS, FOCUS GROUPS AND INTERVIEWS, A NUMBER OF SECONDARY DATA SOURCES WERE USED TO COMPLETE THE PICTURE. THESE SOURCES INCLUDE:- UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE COUNTY HEALTH RANKINGS- WISCONSIN DEPARTMENT OF HEALTH SERVICES- BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM- YOUTH RISK BEHAVIOR SURVEY- WISCONSIN INTERACTIVE STATISTICS ON HEALTH- U.S. CENSUS BUREAU- ANNIE E. CASEY FOUNDATION "KIDS COUNT"- CHILDREN'S HOSPITAL OF WISCONSIN PROGRAM DATA
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 4: THE FOLLOWING INSTITUTIONS WERE INTEGRAL TO THE COMPLETION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT: AURORA HEALTH CARE, COLUMBIA ST. MARY'S HEALTH SYSTEM, FROEDTERT HEALTH, WHEATON FRANCISCAN HEALTHCARE AND PUBLIC HEALTH OFFICIALS IN THE CITY OF MILWAUKEE AND OTHER MILWAUKEE COUNTY MUNICIPALITIES
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 7: BECAUSE CHILDREN'S HOSPITAL IS A PEDIATRIC SPECIALTY HOSPITAL, OUR ATTENTION AND RESOURCES ARE FOCUSED ON AREAS IDENTIFIED IN THE MILWAUKEE HEALTH CARE PARTNERSHIP'S COMMUNITY HEALTH NEEDS ASSESSMENT WHERE WE CAN MAKE THE BIGGEST IMPACT ON THE HEALTH OF CHILDREN.THE FOLLOWING ISSUES WERE IDENTIFIED AS THE HIGHEST HEALTH NEEDS OF THE PEDIATRIC COMMUNITY AND THEREFORE, THE HIGHEST PRIORITIES FOR CHILDREN'S HOSPITAL OF MILWAUKEE:- ACCESS TO MENTAL, ORAL AND PRIMARY HEALTH CARE- OBESITY AND WEIGHT MANAGEMENT- INFANT MORTALITY- SEXUAL HEALTH- COMMUNITY AND HOME SAFETYTHE NEEDS IDENTIFIED BY THE CHNA WHICH MORE DIRECTLY IMPACT ADULT HEALTH AND THEREFORE WERE NOT ADDRESSED BY CHILDREN'S WERE BEHAVIORAL HEALTH, CHRONIC DISEASE, HEALTH ILLITERACY, AND DISPARATE IMPACT.
CHILDREN'S HOSPITAL OF WI-FOX VALLEY	PART V, SECTION B, LINE 7: BECAUSE CHILDREN'S HOSPITAL FOX VALLEY IS A PEDIATRIC SPECIALTY HOSPITAL, ITS ATTENTION AND RESOURCES ARE FOCUSED ON AREAS IDENTIFIED IN THE LIFE STUDY WHERE WE COULD MAKE THE BIGGEST IMPACT FOR THE HEALTH OF CHILDREN. THE FOLLOWING ISSUES WERE ESTABLISHED AS THE HIGHEST HEALTH PRIORITIES FOR CHILDREN'S HOSPITAL IN FOX VALLEY:- ACCESS TO MENTAL HEALTH CARE SERVICES- LIFESTYLE AND HEALTH- HEALTHY DEVELOPMENT OF ALL YOUTH- SUPPORT FOR CHILDRENTHE NEEDS THAT WERE NOT ADDRESSED BY CHILDREN'S BECAUSE THEY MORE DIRECTLY IMPACT ADULTS WERE AFFORDABLE HOUSING, CARE FOR ELDERLY AND PERSONS WITH A DISABILITY, FINANCIAL AND OTHER SUPPORT FOR QUALITY-OF-LIFE ACTIVITIES, INVESTMENT IN ENVIRONMENT, NEED FOR BETTER PAYING JOBS, PERSONAL SAFETY OF ADULTS, SELF-SUFFICIENCY CHALLENGES, AND SUPPORT FOR EDUCATION.
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 11: ALTHOUGH THE HOSPITAL'S FAP LIMITS ELIGIBILITY AT 350 PERCENT OF THE FPG, THE HOSPITAL MAY PROVIDE FINANCIAL ASSISTANCE FOR FAMILIES ABOVE 350 PERCENT OF THE FPG SINCE THE HOSPITAL MAKES ADDITIONAL CONSIDERATIONS FOR THE MEDICALLY INDIGENT.
CHILDREN'S HOSPITAL OF WI-FOX VALLEY	PART V, SECTION B, LINE 11: ALTHOUGH THE HOSPITAL'S FAP LIMITS ELIGIBILITY AT 350 PERCENT OF THE FPG, THE HOSPITAL MAY PROVIDE FINANCIAL ASSISTANCE FOR FAMILIES ABOVE 350 PERCENT OF THE FPG SINCE THE HOSPITAL MAKES ADDITIONAL CONSIDERATIONS FOR THE MEDICALLY INDIGENT.
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 14G: THE HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE CHILDREN'S FAP VIA ITS WEBSITE, BILLING INVOICES, AND AT VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES HAVE ACCESS TO THE FAP IN THE PATIENT HANDBOOK UPON ADMISSION. THE FULL WRITTEN POLICY IS AVAILABLE ON OUR WEBSITE AND UPON REQUEST. A PLAIN LANGUAGE SUMMARY IS INCLUDED IN BILLING INVOICES AND AVAILABLE IN WAITING AREAS.
CHILDREN'S HOSPITAL OF WI-FOX VALLEY	PART V, SECTION B, LINE 14G: THE HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE CHILDREN'S FAP VIA ITS WEBSITE, BILLING INVOICES, AND AT VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES HAVE ACCESS TO THE FAP IN THE PATIENT HANDBOOK UPON ADMISSION. THE FULL WRITTEN POLICY IS AVAILABLE ON OUR WEBSITE AND UPON REQUEST. A PLAIN LANGUAGE SUMMARY IS INCLUDED IN BILLING INVOICES AND AVAILABLE IN WAITING AREAS.
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 18E: THE HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE CHILDREN'S FAP VIA ITS WEBSITE, BILLING INVOICES, AND AT VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES HAVE ACCESS TO THE FAP IN THE PATIENT HANDBOOK UPON ADMISSION. PRIOR TO REFERRING AN ACCOUNT TO A COLLECTION AGENCY OR UNDERTAKING ANY EXTRAORDINARY COLLECTION ACTIONS, CHILDREN'S WILL MAKE EFFORTS TO COLLECT AMOUNTS DUE, INCLUDING REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER CHILDREN'S FAP. AT LEAST 3 BILLING STATEMENTS INCLUDING A PLAIN LANGUAGE SUMMARY OF THE FAP ARE SENT OVER A PERIOD OF 120 DAYS. THE HOSPITAL MAKES EXTENSIVE EFFORTS TO PROVIDE FACE-TO-FACE DIALOGUE, AS WELL AS COMMUNICATION VIA TELEPHONE, E-MAIL AND OTHER MEANS, AS NECESSARY TO ENSURE THAT FAMILIES ARE PROVIDED WITH SUFFICIENT INFORMATION REGARDING ALTERNATIVES FOR OBTAINING FREE OR DISCOUNTED CARE, AS WELL AS THE BILLING AND COLLECTION PROCESS GENERALLY. THE COMMUNICATION PROCESS IS SUPPORTED BY INTERPRETER SERVICES AS NEEDED.
CHILDREN'S HOSPITAL OF WI-FOX VALLEY	PART V, SECTION B, LINE 18E: THE HOSPITAL INFORMS THE PUBLIC OF THE AVAILABILITY OF THE CHILDREN'S FAP VIA ITS WEBSITE, BILLING INVOICES, AND AT VARIOUS LOCATIONS THROUGHOUT THE HOSPITAL'S FACILITIES. ADDITIONALLY, PATIENT FAMILIES HAVE ACCESS TO THE FAP IN THE PATIENT HANDBOOK UPON ADMISSION. PRIOR TO REFERRING AN ACCOUNT TO A COLLECTION AGENCY OR UNDERTAKING ANY EXTRAORDINARY COLLECTION ACTIONS, CHILDREN'S WILL MAKE EFFORTS TO COLLECT AMOUNTS DUE, INCLUDING REASONABLE EFFORTS TO DETERMINE WHETHER THE PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE UNDER CHILDREN'S FAP. AT LEAST 3 BILLING STATEMENTS INCLUDING A PLAIN LANGUAGE SUMMARY OF THE FAP ARE SENT OVER A PERIOD OF 120 DAYS. THE HOSPITAL MAKES EXTENSIVE EFFORTS TO PROVIDE FACE-TO-FACE DIALOGUE, AS WELL AS COMMUNICATION VIA TELEPHONE, E-MAIL AND OTHER MEANS, AS NECESSARY TO ENSURE THAT FAMILIES ARE PROVIDED WITH SUFFICIENT INFORMATION REGARDING ALTERNATIVES FOR OBTAINING FREE OR DISCOUNTED CARE, AS WELL AS THE BILLING AND COLLECTION PROCESS GENERALLY. THE COMMUNICATION PROCESS IS SUPPORTED BY INTERPRETER SERVICES AS NEEDED.
CHILDREN'S HOSPITAL OF WISCONSIN, INC.	PART V, SECTION B, LINE 20D: THE MAXIMUM AMOUNT THE HOSPITAL CHARGES PATIENTS IS DETERMINED BY APPLYING FINANCIAL ASSISTANCE DISCOUNTS TO CHILDREN'S GROSS CHARGES, BUT IN NO EVENT WILL THE AMOUNT BILLED TO A FAMILY QUALIFIED FOR FINANCIAL ASSISTANCE EXCEED THE AMOUNTS GENERALLY BILLED (AGB) BY CHILDREN'S TO INSURED PATIENTS. THE AGB IS CALCULATED ANNUALLY BASED ON THE LOOK-BACK METHOD AS PRESCRIBED UNDER THE IRS REGULATIONS AND IS BASED ON CHW'S OVERALL MEDICARE AND COMMERCIAL REIMBURSEMENT RATE.
CHILDREN'S HOSPITAL OF WI-FOX VALLEY	PART V, SECTION B, LINE 20D: THE MAXIMUM AMOUNT THE HOSPITAL CHARGES PATIENTS IS DETERMINED BY APPLYING FINANCIAL ASSISTANCE DISCOUNTS TO CHILDREN'S GROSS CHARGES, BUT IN NO EVENT WILL THE AMOUNT BILLED TO A FAMILY QUALIFIED FOR FINANCIAL ASSISTANCE EXCEED THE AMOUNTS GENERALLY BILLED (AGB) BY CHILDREN'S TO INSURED PATIENTS. THE AGB IS CALCULATED ANNUALLY BASED ON THE LOOK-BACK METHOD AS PRESCRIBED UNDER THE IRS REGULATIONS AND IS BASED ON CHW'S OVERALL MEDICARE AND COMMERCIAL REIMBURSEMENT RATE.

Schedule H (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990
lBullet

Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization
CHILDREN'S HOSPITAL OF WISCONSIN INC

Employer identification number
39-0812532

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) BROWN COUNTY ORAL HLTH PARTNERSHIP 331 N BROADWAY GREEN BAY,WI54303	20-8969896	501(C)(3)	43,047	DENTAL SEALANT
(2) CESA #11 225 OSTERMANN DR TURTLE LAKE,WI54889	39-1483818		32,000	DENTAL SEALANT
(3) CHIPPEWA VALLEY TECHNICAL COLLEGE 620 W CLAIREMONT AVE EAU CLAIRE,WI54701	39-1096972	CHIPPEWA COUNTY	9,453	DENTAL SEALANT
(4) CITY OF WATERTOWN 106 JONES ST WATERTOWN,WI53094	39-6005640	GOVERNMENT	13,973	DENTAL SEALANT
(5) CLARK COUNTY HEALTH DEPT 517 COURT STREET NEILSVILLE,WI54456	39-6005679	CLARK COUNTY	5,305	DENTAL SEALANT
(6) COLUMBIA COUNTY PO BOX 132 PORTAGE,WI53901	39-6005681	COLUMBIA COUNTY	18,000	DENTAL SEALANT
(7) COLUMBIA ST MARY'S FOUNDATION 2320 N LAKE DRIVE MILWAUKEE,WI53211	39-1494981	501(C)(3)	25,000	DENTAL SEALANT
(8) CITY OF WEST ALLIS 7525 W GREENFIELD AVENUE WEST ALLIS,WI53211	39-6005651	CITY OF WEST ALLIS	5,000	CDC ADDRESSING ASTHMA FROM A PUBLIC HEALTH PERSPECTIVE
(9) FOND DU LAC COUNTY ASTHMA COALITION 160 S MACY ST FOND DU LAC,WI54935	39-6005696	FOND DU LAC COUNTY	5,000	CDC ADDRESSING ASTHMA FROM A PUBLIC HEALTH PERSPECTIVE
(10) HOLT DENTAL N30 W22383 GREEN RD WAUKESHA,WI53186	39-1939853		5,000	DENTAL SEALANT
(11) IN HEALTH COMMUNITY WELLNESS FREE CLINIC 109 E BLUFF ST BOSCOBEL,WI53805	33-1170597	501(C)(3)	7,088	DENTAL SEALANT
(12) JUNEAU COUNTY 220 E STATE ST MAUSTON,WI53948	39-6005706	JUNEAU COUNTY	8,965	DENTAL SEALANT
(13) JUST KIDS DENTAL INC PO BOX 146 TWO HARBORS,MN55616	27-2311353	501(C)(3)	5,723	DENTAL SEALANT
(14) KENOSHA COMMUNITY HEALTH CENTER 625 57TH STE 700 KENOSHA,WI55616	39-1789874	KENOSHA COUNTY	7,192	DENTAL SEALANT
(15) MARATHON COUNTY ASTHMA COALITION 1000 LAKE VIEW DRIVE ROOM 100 WAUSAU,WI54403	39-6005716	MARATHON COUNTY	5,000	CDC ADDRESSING ASTHMA FROM A PUBLIC HEALTH PERSPECTIVE
(16) MARQUETTE UNIVERSITY PO BOX 1881 MILWAUKEE,WI53201	39-0806251	501(C)(3)	95,042	DENTAL SEALANT
(17) MEDICAL COLLEGE OF WISCONSIN 1155 N MAYFAIR RD MILWAUKEE,WI53226	39-0806261	501(C)(3)	14,799	COOPERATIVE AGREEMENTS TO SUPPORT STATE-BASED SAFE MOTHERHOOD AND INFANT HEALTH INITIATIVE PROGRAMS
(18) PORTAGE COUNTY HEALTH AND HUMAN SERVICES 817 WHITING AVENUE STEVENS POINT,WI54481	39-6005731	PORTAGE COUNTY	18,557	DENTAL SEALANT
(19) PREFERRED DENTISTRY ASSOCIATION OF WISCONSIN LLC 1029 HOWARD ST EVANSTON,IL60202	27-2634563		50,000	DENTAL SEALANT
(20) PRICE COUNTY HEALTH DEPARTMENT 104 S EYDER AVENUE PHILLIPS,WI54555	39-6005733	PRICE COUNTY	14,926	DENTAL SEALANT
(21) PROFESSIONAL DENTAL HYGIENE EXPRESS 5388 STATE HWY 64 BLOOMER,WI54724	27-4969600		25,000	DENTAL SEALANT
(22) SAUK COUNTY 505 BROADWAY BARABOO,WI53913	39-6005740	SAUK COUNTY	23,270	DENTAL SEALANT
(23) SEALS ON WHEELS 1710 GOLDEN OAK LN MADISON,WI53711	38-8086637		12,846	DENTAL SEALANT
(24) SHEBOYGAN COUNTY 1011 N 8TH ST SHEBOYGAN,WI53081	39-6005744	SHEBOYGAN COUNTY	7,649	DENTAL SEALANT
(25) TREMPELEAU COUNTY 36245 MAIN STREET WHITEHALL,WI54773	39-6005747	TREMPELEAU COUNTY	7,100	DENTAL SEALANT
(26) VILAS COUNTY PUBLIC HEALTH 330 COURT STREET EAGLE RIVER,WI54521	39-6005751	VILAS COUNTY	27,369	DENTAL SEALANT
(27) WALWORTH COUNTY HEALTH DEPARTMENT W4051 COUNTY ROAD NN ELKHORN,WI53121	39-6005752	WALWORTH COUNTY	58,349	DENTAL SEALANT
(28) WAUPACA COUNTY 811 HARDING ST WAUPACA,WI54981	39-6005758	WAUPACA COUNTY	18,070	DENTAL SEALANT
(29) WAUSHARA COUNTY PO BOX 837 WAUTOMA,WI54982	39-6005759	WAUSHARA COUNTY	12,604	DENTAL SEALANT
(30) WOOD COUNTY 400 MARKET STREET WISCONSIN RAPIDS,WI54494	39-6005763	WOOD COUNTY	24,903	DENTAL SEALANT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

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

Cat. No. 50055P

Schedule I (Form 990) 2013

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.

Return Reference

Explanation

PART I, LINE 2:

MONITORING PROCEDURES - THE ORGANIZATION RECEIVES GRANT FUNDING FROM VARIOUS STATE AND FEDERAL AGENCIES. SOME OF THE GRANT AWARDS ARE SUB-AWARDED TO OTHER AGENCIES BASED ON THE REQUIREMENTS OF THE INDIVIDUAL GRANT AGREEMENTS. IN ORDER TO MONITOR THE USE OF THE FUNDS, THE ORGANIZATION ENTERS INTO SIGNED AGREEMENTS WITH THE SUB-GRANTEE AGENCIES TO OUTLINE THE TERMS OF THE ARRANGEMENTS INCLUDING THE PROPER USE OF FUNDS. THESE AGREEMENTS REQUIRE AGENCIES TO PROVIDE CERTIFICATIONS OF EXPENSES SUBMITTED FOR REIMBURSEMENT ALONG WITH DESCRIPTIONS OF THE ACTUAL EXPENSES INCURRED COMPARED TO THE BUDGETED AWARD TOTAL. EACH AWARD IS MONITORED BY A DESIGNATED EMPLOYEE OF THE ORGANIZATION WHO VERIFIES THAT ALL SERVICES ARE PROVIDED ACCORDING TO THE CONTRACT, APPROVES PAYMENTS TO THE AGENCY, AND ENSURES THAT THE AWARD OBJECTIVES ARE MET. IN SOME CASES, THE ORGANIZATION REQUIRES THE AGENCY TO SUBMIT A COPY OF ITS ANNUAL OMB 133 AUDIT ALONG WITH ANY RELEVANT AUDIT FINDINGS. ADDITIONALLY, CHW AWARDS GRANTS TO ITS TAX-EXEMPT AFFILIATES. GRANTS ARE AWARDED BASED ON THE STRATEGIC INITIATIVES OF THE HEALTH SYSTEM, THE NEEDS OF THE AFFILIATES, AND ANY PURPOSE RESTRICTIONS SET BY THE DONORS. THE NEEDS OF THE AFFILIATES ARE EVALUATED IN THE ANNUAL BUDGET PROCESS. FINAL BUDGETS REQUIRE APPROVAL FROM MANAGEMENT, THE ENTITY'S BOARD OF DIRECTORS AND THE CHHS BOARD OF DIRECTORS AND SENIOR MANAGEMENT. IN ADDITION, THE OPERATIONS OF ALL AFFILIATES ARE SUBJECT TO SYSTEM CONTROLS, POLICIES AND PROCEDURES, AND ARE REFLECTED IN THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF CHHS AND ITS AFFILIATES.

Schedule I (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

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, line 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL OF WISCONSIN INC

Employer identification number

39-0812532

Part I

Questions Regarding Compensation

Yes

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.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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 of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used 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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

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:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

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:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

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 ............

Yes

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 .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

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

Cat. No. 50053T

Schedule J (Form 990) 2013

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 (E) amounts for that individual.

(A) Name and Title		(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
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable 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
(1)MARGARET TROYDIRECTOR/CHHS PRESIDENT	(i) (ii)	0 766,613	0 410,197	0 54,969	0 270,958	0 47,196	0 1,549,933	0 0
(2)ELIZABETH BEDWELLVP RESEARCH ADMINISTRATION	(i) (ii)	0 167,941	0 22,825	0 530	0 7,790	0 18,632	0 217,718	0 0
(3)CINTHIA S CHRISTENSENPRESIDENT & COO	(i) (ii)	418,624 0	169,200 0	67,149 0	66,840 0	42,129 0	763,942 0	0 0
(4)WELDON GAGETREASURER / CFO	(i) (ii)	0 377,897	0 132,129	0 540	0 47,434	0 22,544	0 580,544	0 0
(5)MICHAEL GUTZEIT MDVP, CHW / CHIEF MEDICAL OFFICER	(i) (ii)	328,328 0	108,725 0	21,741 0	57,371 0	32,715 0	548,880 0	0 0
(6)BARBARA JOERSVICE PRESIDENT, CHW	(i) (ii)	158,884 0	71,638 0	17,825 0	0 0	14,573 0	262,920 0	0 0
(7)JULIET KERSTENVICE PRESIDENT, CHW	(i) (ii)	219,633 0	69,932 0	8,387 0	18,950 0	22,847 0	339,749 0	7,671 0
(8)NANCY KOROMVP, CHW / CHIEF NURSING OFFICER	(i) (ii)	292,693 0	92,915 0	2,282 0	51,378 0	30,526 0	469,794 0	0 0
(9)MARGARET NEIMERVP CHW	(i) (ii)	146,015 46,040	83,829 0	30,397 3,447	48,727 0	20,732 4,349	329,700 53,836	0 0
(10)SHEILA REYNOLDSSECRETARY	(i) (ii)	0 270,873	0 92,602	0 19,616	0 48,727	0 33,438	0 465,256	0 0
(11)MARK SHIPVP REVENUE CYCLE	(i) (ii)	0 248,850	0 71,920	0 425	0 0	0 20,839	0 342,034	0 0
(12)DONNA JAMIESONEXECUTIVE DIR, PATIENT CARE	(i) (ii)	178,976 0	0 0	894 0	14,953 0	29,548 0	224,371 0	0 0
(13)TOM LAUSTENDIRECTOR, PHARMACY SVS	(i) (ii)	165,903 0	0 0	2,329 0	13,740 0	24,513 0	206,485 0	0 0
(14)ERIN YALEDIR, DIAG IMAGING & EMERGENCY	(i) (ii)	166,510 0	0 0	8,867 0	11,109 0	23,298 0	209,784 0	0 0
(15)SUZAN BUCHAKLIANDIR, SURGICAL SERVICES	(i) (ii)	161,911 0	0 0	25,038 0	7,142 0	21,214 0	215,305 0	0 0
(16)LORI BARBEAU DDSMEDICAL DIRECTOR DENTAL PROGRAM	(i) (ii)	250,601 0	0 0	1,242 0	21,500 0	23,941 0	297,284 0	0 0
(17)ANDREW SCHMITT MDHOSPITALIST	(i) (ii)	234,387 0	0 0	16,869 0	7,650 0	24,781 0	283,687 0	0 0
(18)MARYLYN RANTA MDDIR, CHW PHYSICIAN AFFAIRS	(i) (ii)	231,389 0	0 0	18,193 0	21,500 0	29,149 0	300,231 0	0 0
(19)SHANE FISHER DDSPEDIATRIC DENTIST	(i) (ii)	209,975 0	0 0	29,537 0	12,817 0	11,582 0	263,911 0	0 0
(20)A CHARLES POST DDSPROGRAM ADMIN DENTAL RESIDENCY	(i) (ii)	201,070 0	0 0	16,399 0	19,184 0	8,548 0	245,201 0	0 0
(21)MARC CADIEUXFORMER INTERIM TREASURER	(i) (ii)	0 198,631	0 0	0 430	0 14,272	0 6,725	0 220,058	0 0

Schedule J (Form 990) 2013

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 3	CHW AND CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS"), THE CORPORATE MEMBER OF CHW, SHARE A BOARD OF DIRECTORS WHICH INCLUDES AN INDEPENDENT COMPENSATION COMMITTEE. THIS COMMITTEE IS RESPONSIBLE FOR ESTABLISHING THE COMPENSATION OF CHW'S PRESIDENT, AND USED THE METHODS LISTED AND CHECKED IN SCHEDULE J LINE 3.
PART I, LINE 4B	IN 2013, THERE WAS A CHHS FLEXIBLE BENEFIT PLAN IN PLACE WHICH WAS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (457(F) PLAN). THE CORPORATION CONTRIBUTES 10% OF EACH PARTICIPATING EXECUTIVE'S SALARY. THE AMOUNTS OF EMPLOYER CONTRIBUTIONS TO THIS PLAN FOR PARTICIPATING EXECUTIVES IN 2013 WERE AS FOLLOWS: M. TROY, $55,802; C. CHRISTENSEN, $45,340; W. GAGE, $38,684; M. GUTZEIT, M.D., $35,871; N. KOROM, $29,878; AND S. REYNOLDS, $29,777. AFTER A VESTING PERIOD, PARTICIPANTS MAY ELECT TO WITHDRAW AMOUNTS PREVIOUSLY CONTRIBUTED AND REPORTED. AMOUNTS WITHDRAWN BY PARTICIPANTS IN 2013 WERE: J. KERSTEN, $7,671. CHHS HAS REPORTED ADDITIONAL AMOUNTS SET ASIDE FOR A NONQUALIFIED RETIREMENT PLAN ON BEHALF OF ITS PRESIDENT AND CEO. THE AMOUNT SET ASIDE IN 2013 WAS $201,306.
PART I, LINE 7	CERTAIN EXECUTIVES PARTICIPATE IN AN ANNUAL BONUS PLAN THAT PROVIDES COMPENSATION BASED ON ACHIEVING SPECIFIC PRE-DEFINED GOALS. BONUS CRITERIA ARE COMPRISED OF BOTH SYSTEM LEVEL AND EXECUTIVE SPECIFIC COMPONENTS. SUCH CRITERIA PERTAIN TO MATTERS WITHIN THE EXECUTIVE'S AREA OF RESPONSIBILITY, AS WELL AS ACHIEVEMENT OF OVERALL STRATEGIC OBJECTIVES OF THE ORGANIZATION AND ITS AFFILIATES IN ALIGNMENT WITH SYSTEM-WIDE BALANCED MEASURES.
FORM 990, PART VII, COLUMN E & SCHEDULE J, PART II:	SALARIES PAID BY RELATED ORGANIZATIONS: MARGARET TROY, PRESIDENT & CEO OF CHHS, ELIZABETH BEDWELL, VP RESEARCH ADMINISTRATION, WELDON GAGE, TREASURER OF CHW AND TREASURER & CFO OF CHHS, MARGARET NIEMER, VP CHW, SHEILA REYNOLDS, SECRETARY OF CHW AND CORPORATE VICE PRESIDENT & GENERAL COUNSEL OF CHHS, AND MARK SHIP, VP REVENUE CYCLE, AND MARC CADIEUX, FORMER INTERIM TREASURER OF CHW AND FORMER INTERIM TREASURER & CFO OF CHHS - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SERVICES PROVIDED (40 HOURS PER WEEK) TO CHHS AND ITS AFFILIATES. THESE AMOUNTS WERE PAID BY CHHS. SERVICES BY MS. TROY AS A MEMBER OF THE BOARD OF DIRECTORS OF CHW WERE PROVIDED ON A PART-TIME VOLUNTARY BASIS.

Schedule J (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

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.
SchKMediumBullet

Information about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization
CHILDREN'S HOSPITAL OF WISCONSIN INC

Employer identification number
39-0812532

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
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	WI HEALTH & EDUCATIONAL FACILITIES AUTHORITY	39-1337855	97710BCS9	07-29-2008	152,300,000	SEE PART VI		X		X		X
B	WI HEALTH & EDUCATIONAL FACILITIES AUTHORITY	39-1337855	97710BCC4	06-25-2008	100,771,610	SEE PART VI		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	152,300,953		113,903,904
4 Gross proceeds in reserve funds . . . . . . . . . . . .
5 Capitalized interest from proceeds . . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . . .	149,225,000		100,000,000
7 Issuance costs from proceeds . . . . . . . . . . . .	1,000,301		771,611
8 Credit enhancement from proceeds . . . . . . . . . . .
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .	2,075,652		13,132,293
11 Other spent proceeds . . . . . . . . . . . . . .
12 Other unspent proceeds . . . . . . . . . . . . . .
13 Year of substantial completion . . . . . . . . . . . .	2009		2009
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .	X		X
15 Were the bonds issued as part of an advance refunding issue? . . . . .		X		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	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
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .	X			X

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

Cat. No. 50193E

Schedule K (Form 990) 2013

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
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
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		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?
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 . .	0.200 %
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 . . . . . . .	0 %
6 Total of lines 4 and 5 . . . . . . . . . . . . .	0.200 %
7 Does the bond issue meet the private security or payment test? . . . . .	X		X
8a Has there been a sale or disposition of any of the bond financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .
9 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

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T? . . . . .		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .		X		X
b Exception to rebate? . . . . . . . .	X		X
c No rebate due? . . . . . . . .		X		X
If you checked "No rebate due" in line 2c, provide in Part VI the date the rebate computation was performed
3 Is the bond issue a variable rate issue? . . . .		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider . . . . . . . . .
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was the hedge terminated? . . . . . .

Schedule K (Form 990) 2013

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X
b Name of provider . . . . . . . . .
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .	X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
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?	X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference

Explanation

SCHEDULE K SUPPLENTAL INFORMATION

CONSIDER THE FOLLOWING FOR PART VI: SCHEDULE K, PART I, LINE A, COLUMN (F): THE SERIES 2008B BONDS WERE ISSUED TO REFUND SEVERAL SERIES OF PRIOR BONDS, INCLUDING: (1) THE ISSUER'S SERIES 2007-3 BONDS (CHILDREN'S HOSPITAL OF WISCONSIN), WHICH WERE ISSUED ON NOVEMBER 20, 2007 TO REFUND A PORTION OF THE ISSUER'S SERIES 1998 BONDS (CHILDREN'S HOSPITAL OF WISCONSIN), WHICH WERE ISSUED ON JUNE 2, 1998. (2) THE ISSUER'S SERIES 2004B BONDS (CHILDREN'S HOSPITAL OF WISCONSIN), WHICH WERE ISSUED ON MAY 6, 2004 TO CONSTRUCT AND EQUIP CERTAIN HEALTH CARE FACILITIES (INCLUDING A MEDICAL OFFICE BUILDING/CHILDREN'S CORPORATE CENTER, PARKING STRUCTURE, TUNNEL, UTILITIES AND A NEW PATIENT TOWER) AND TO PAY COSTS OF ISSUANCE. THE SERIES 2008 BONDS ALSO FUNDED CONSTRUCTION, RENOVATION AND EQUIPPING OF CERTAIN HEALTH CARE FACILITIES (A NEW PATIENT TOWER) AND TO PAY COSTS OF ISSUANCE. SCHEDULE K, PART I, LINE B, COLUMN (F): THE SERIES 2008A BONDS WERE ISSUED TO REFUND THE ISSUER'S SERIES 2007-1 AND SERIES 2007-2 BONDS (CHILDREN'S HOSPITAL OF WISCONSIN), WHICH WERE ISSUED ON NOVEMBER 20, 2007 FOR THE CONSTRUCTION, RENOVATION AND EQUIPPING OF CERTAIN HEALTH CARE FACILITIES (A NEW PATIENT TOWER) AND TO PAY COSTS OF ISSUANCE. SCHEDULE K, PART II, LINE 3, COLUMN (A): THE TOTAL PROCEEDS OF THE ISSUE EXCEED THE ISSUE PRICE DUE TO INVESTMENT PROCEEDS OF $953. SCHEDULE K, PART II, LINE 3, COLUMN (B): THE TOTAL PROCEEDS OF THE ISSUE EXCEED THE ISSUE PRICE DUE TO INVESTMENT PROCEEDS OF $48,153 AND TRANSFERRED PROCEEDS FROM THE SERIES 2007-1 AND SERIES 2007-2 BONDS OF $13,084,140. SCHEDULE K, PART III, COLUMN B, LINE 3A: THE ORGANIZATION HAS DETERMINED BASED ON A LEGAL REVIEW THAT A MANAGEMENT CONTRACT WITH RESPECT TO THE PROPERTY FINANCED BY THE BOND ISSUE LISTED IN COLUMN B DOES NOT RESULT IN PRIVATE BUSINESS USE.

PART IV, LINE 7

THE ORGANIZATION MONITORS THE PRIVATE USE OF ITS BOND-FINANCED ASSETS AND ROUTINELY TAKES STEPS TO LIMIT PRIVATE USE. THE ORGANIZATION DOES NOT SEPARATELY TRACK PRIVATE PAYMENTS AND PRIVATE SECURITIES, RATHER IT ASSUMES SUCH TESTS WILL BE MET AND MANAGES COMPLIANCE THROUGH THIS PRIVATE USE MONITORING. BASED SOLEY ON THIS ASSUMPTION, THE ORGANIZATION HAS RESPONDED YES TO THIS QUESTION.

Schedule K (Form 990) 2013

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.
MediumBullet

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

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL OF WISCONSIN INC

Employer identification number

39-0812532

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e)Original principal amount	(f)Balance due	(g) In default?		(h) Approved by board or committee?		(i)Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ...... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2013

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) JOHNSON CONTROLS INC	DIRECTOR (CD MYERS)	808,250	MR. MYERS IS VICE PRESIDENT AND PRESIDENT, BUILDING EFFICIENCY AT JOHNSON CONTROLS, INC. THE ORGANIZATION PAID $808,250 TO JOHNSON CONTROLS, INC. IN MAINTENANCE FEES FOR HEATING, VENTILATION, AND AIR CONDITIONING INSTALLATION AND REPAIR.		No
(2) BAIRD ADVISORS	DIRECTOR (T BOLGER)	287,362	MR. BOLGER, WHO IS ON THE ORGANIZATION'S BOARD OF DIRECTORS, HAS A FAMILY RELATIONSHIP WITH MARY ELLEN STANEK, THE MANAGING DIRECTOR AND CHIEF INVESTMENT OFFICER FOR BAIRD ADVISORS. THE ORGANIZATION PAID BAIRD ADVISORS $287,362 FOR INVESTMENT SERVICES.		No
(3) WE ENERGIES	DIRECTOR (C CULVER)	6,088,406	MR. CULVER IS ON THE BOARD OF DIRECTORS AT WE ENERGIES. THE ORGANIZATION PAID WE ENERGIES $6,088,406 FOR UTILITIES.		No
(4) WE ENERGIES	DIRECTOR (T BOLGER)	6,088,406	MR. BOLGER, WHO IS ON THE ORGANIZATIONS BOARD OF DIRECTORS, HAS A FAMILY RELATIONSHIP WITH MARY ELLEN STARIEK, WHO IS ON THE BOARD OF DIRECTORS AT WE ENERGIES. THE ORGANIZATION PAID WE ENERGIES $6,088,406 FOR UTILITIES.		No
(5) POBLOCKI SIGN COMPANY	DIRECTOR (D DRURY)	122,437	MR. DRURY IS THE CHIEF EXECUTIVE OFFICER AT POBLOCKI SIGN COMPANY. THE ORGANIZATION PAID $122,437 TO POBLOCKI SIGN COMPANY FOR SIGNAGE.		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

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.
MediumBullet

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

OMB No. 1545-0047

2013

Open to Public
Inspection

Name of the organization

CHILDREN'S HOSPITAL OF WISCONSIN INC

Employer identification number

39-0812532

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	BUSINESS RELATIONSHIPS EXIST BETWEEN THE FOLLOWING BOARD MEMBERS: ORR AND PEPKE, DRURY AND SCHLIFSKE, DRURY AND SOMMERHAUSER, DRURY AND BRENNER, DRURY AND SULLIVAN, BRENNER AND SULLIVAN, ROTHMAN AND ABRAHAM, SCHLIFSKE AND SOMMERHAUSER, SCHLIFSKE AND MANSELL, MANSELL AND SOMMERHAUSER, ABRAHAM AND QUADRACCI, WITT AND SOMMERHAUSER, KERSCHNER AND BRENNER, KERSCHNER AND CULVER, KERSCHNER AND MELLOWES, KERSCHNER AND SULLIVAN, BOLGER AND SULLIVAN, CULVER AND GORELICK, BRENNER AND GORELICK, KERSCHNER AND GORELICK, MELLOWES AND GORELICK, WILLIAMS AND TROY, WITT AND ABRAHAM, AND SULLIVAN AND GORELICK.
FORM 990, PART VI, SECTION A, LINE 6	THE ORGANIZATION HAS A SOLE CORPORATE MEMBER WHICH IS CHHS.
FORM 990, PART VI, SECTION A, LINE 7A	CHHS, THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, ELECTS THE ORGANIZATION'S GOVERNING BODY.
FORM 990, PART VI, SECTION A, LINE 7B	THE SOLE CORPORATE MEMBER, CHHS, HAS CERTAIN RESERVE POWERS OVER THE CORPORATION, INCLUDING AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS; APPROVAL OF MERGER, CONSOLIDATION OR THE CREATION OF ANY SUBSIDIARIES BY THE CORPORATION; APPROVAL OF THE ANNUAL BUDGET AND ANY DEBT; AND SELECTION OF THE PRESIDENT.
FORM 990, PART VI, SECTION B, LINE 11	THE FORM 990 WAS REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE CHHS/CHW BOARD OF DIRECTORS, AND PRIOR TO FILING, A COPY WAS PROVIDED TO ALL DIRECTORS OF CHW.
FORM 990, PART VI, SECTION B, LINE 12C	ANNUALLY, ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUESTED TO SUBMIT A CONFLICT OF INTEREST DISCLOSURE TO THE CORPORATE VICE PRESIDENT AND GENERAL COUNSEL OF CHHS. A LIST OF POTENTIAL CONFLICTS IS PREPARED AND IS AVAILABLE AT EACH BOARD AND COMMITTEE MEETING. THE COMPLIANCE DEPARTMENT MONITORS AND PERIODICALLY REVIEWS TRANSACTIONS BETWEEN THE ORGANIZATION AND BOARD MEMBERS OR ENTITIES WITH WHICH THEY ARE AFFILIATED.
FORM 990, PART VI, SECTION B, LINE 15	THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT, TREASURER, SECRETARY, CHHS PRESIDENT, VP CHIEF MEDICAL OFFICER, AND VP CHIEF NURSING OFFICER WAS REVIEWED AND APPROVED BY THE INDEPENDENT COMPENSATION COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS. WITH THE ASSISTANCE OF AN INDEPENDENT COMPENSATION CONSULTANT AND INFORMATION FROM A VARIETY OF EXTERNAL SOURCES (AS INDICATED ON SCHEDULE J), THE COMMITTEE CONFIRMED THAT TOTAL COMPENSATION AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES WAS SET BY SUPERVISORY EXECUTIVES IN CONSULTATION WITH CHHS HUMAN RESOURCES LEADERS. THE PROCESS INCLUDED REVIEW BY INDEPENDENT PERSONS WHO, USING A VARIETY OF EXTERNAL SOURCES (AS INDICATED ON SCHEDULE J), CONFIRMED THAT TOTAL COMPENSATION AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. THE PROCESS AND DATA RELIED ON WERE THOROUGHLY AND TIMELY DOCUMENTED.
FORM 990, PART VI, SECTION C, LINE 19	THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION OF CHHS ARE AVAILABLE TO THE PUBLIC UPON REQUEST THROUGH THE CHHS MARKETING AND COMMUNICATION DEPARTMENT.
FORM 990, PART IX, LINE 11G	MEDICAL COLLEGE OF WISCONSIN FEES: PROGRAM SERVICE EXPENSES 23,781,894. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,781,894. RESIDENT STIPENDS AND BENEFITS: PROGRAM SERVICE EXPENSES 10,406,644. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,406,644. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 27,956,177. MANAGEMENT AND GENERAL EXPENSES 5,033,760. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,989,937.
FORM 990, PART XI, LINE 9:	CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENTS 17,957,119. INCREASE IN BENEF. INTEREST IN NET ASSETS OF CHILDREN'S HOSPITAL FOUNDATION 45,568,744. PENSION-RELATED CHANGES OTHER THAN NET PERIODIC PENSION COST 61,773,996.
FORM 990, SCHEDULE R, PART V, LINE 1E:	PURSUANT TO AN AMENDED AND RESTATED MASTER TRUST INDENTURE DATED MAY 1, 2004, CHILDREN'S HOSPITAL OF WISCONSIN, INC. AND CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION, INC. ARE MEMBERS OF AN OBLIGATED GROUP WHICH JOINTLY AND SEVERALLY GUARANTEE CERTAIN DEBT ISSUED BY A MEMBER OF THE OBLIGATED GROUP THROUGH THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY. PAYMENT OF SCHEDULED PRINCIPAL AND INTEREST IS SECURED BY A PLEDGE OF THE HOSPITAL'S AND FOUNDATION'S GROSS UNRESTRICTED RECEIPTS.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2013

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.
MediumBullet

Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2013

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL OF WISCONSIN INC

Employer identification number

39-0812532

Part I

Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE,WI53201 39-1500074	OPERATIONAL SUPPORT SERVICES	WI	501(C)(3)	LINE 3	N/A		No
(2) CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE,WI53201 39-1500075	FUND DEVELOPMENT	WI	501(C)(3)	LINE 7	CHILDREN'S HOSPITAL & HEALTH SYSTEM INC	Yes
(3) CHILDREN'S MEDICAL GROUP INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE,WI53201 39-1789197	PEDIATRIC PHYSICIAN SERVICES	WI	501(C)(3)	LINE 3	CHILDREN'S HOSPITAL & HEALTH SYSTEM INC	Yes
(4) CHILDREN'S PHYSICIAN GROUP PC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE,WI53201 36-4303682	PEDIATRIC PHYSICIAN SERVICES	IL	501(C)(3)	LINE 9	CHILDREN'S HOSPITAL & HEALTH SYSTEM INC	Yes
(5) CHILDREN'S SERVICE SOCIETY OF WISCONSIN 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE,WI53201 39-0806380	CHILD WELFARE SERVICES	WI	501(C)(3)	LINE 7	CHILDREN'S HOSPITAL & HEALTH SYSTEM INC	Yes
(6) CHILDREN'S COMMUNITY HEALTH PLAN INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE,WI53201 27-1494977	WISCONSIN MEDICAID HMO	WI	501(C)(3)	LINE 9	CHILDREN'S HOSPITAL & HEALTH SYSTEM INC	Yes
(7) MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS INC 8701 WATERTOWN PLANK ROAD MILWAUKEE,WI53226 39-1341366	GRADUATE MEDICAL EDUCATION SUPPORT	WI	501(C)(3)	LINE 11 TYPE 1	N/A		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2013

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) VIRTUAL PICU SYSTEMS LLC 401 WYTHE STREET SUITE 101 ALEXANDRIA,VA22314 20-1414664	QUALITY/OUTCOMES ANALYSIS	DE	CHILDREN'S HOSPITAL & HEALTH SYSTEM INC	RELATED				No			No

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	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) MED-HEALTH FINANCIAL SERVICES INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE,WI53201 39-1547907	COLLECTION SERVICES	WI	CHILDREN'S HOSPITAL & HEALTH SYSTEM INC	C			Yes

Schedule R (Form 990) 2013

Page 3

Part V

Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

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 or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

Yes

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CHILDREN'S MEDICAL GROUP INC - RENT (LINE 1A (IV) ABOVE)	A	365,178	CASH PAID/RECEIVED
(2) CHILDREN'S SERVICE SOCIETY OF WISCONSIN - RENT (LINE 1A (IV) ABOVE)	A	1,956	CASH PAID/RECEIVED
(3) CHILDREN'S PHYSICIAN GROUP PC	B	6,800,961	CASH PAID/RECEIVED
(4) CHILDREN'S MEDICAL GROUP INC	B	375,000	CASH PAID/RECEIVED
(5) CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION INC	C	3,504,237	CASH PAID/RECEIVED
(6) CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION INC	E	253,655,712	NET BOOK VALUE
(7) CHILDREN'S COMMUNITY HEALTH PLAN INC - PATIENT REIMBURSEMENT	L	19,413,572	CASH PAID/RECEIVED
(8) CHILDREN'S SERVICE SOCIETY OF WISCONSIN	M	50,186	CASH PAID/RECEIVED
(9) CHILDREN'S MEDICAL GROUP INC	Q	153,291	CASH PAID/RECEIVED
(10) CHILDREN'S COMMUNITY HEALTH PLAN INC - WI MEDICAID PASS THROUGH PAYMENTS	S	13,269,137	CASH PAID/RECEIVED

Schedule R (Form 990) 2013

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V?UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2013

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R (see instructions).

Return Reference

Explanation

SCHEDULE R, PART V, LINE 1E

PURSUANT TO AN AMENDED AND RESTATED MASTER TRUST INDENTURE DATED MAY 1, 2004, CHILDREN'S HOSPITAL OF WISCONSIN, INC. AND CHILDREN'S HOSPITAL OF WISCONSIN FOUNDATION, INC. ARE MEMBERS OF AN OBLIGATED GROUP WHICH JOINTLY AND SEVERALLY GUARANTEE CERTAIN DEBT ISSUED BY A MEMBER OF THE OBLIGATED GROUP THROUGH THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY. PAYMENT OF SCHEDULED PRINCIPAL AND INTEREST IS SECURED BY A PLEDGE OF THE HOSPITAL'S AND FOUNDATION'S GROSS UNRESTRICTED RECEIPTS.

Schedule R (Form 990) 2013

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: PEDIATRIC HEALTH CARE SERVICES
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	23
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	13
5	Total number of individuals employed in calendar year 2013 (Part V, line 2a) ......	5	3,634
6	Total number of volunteers (estimate if necessary) .............	6	336
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	119,234
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	-183,581

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	15,053,773	14,968,706
9	Program service revenue (Part VIII, line 2g) .........	533,784,943	567,199,047
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	8,239,508	11,454,416
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	9,031,363	9,243,421
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	566,109,587	602,865,590
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	12,557,033	16,816,637
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)	213,111,810	209,671,517
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	309,688,106	325,559,912
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	535,356,949	552,048,066
19	Revenue less expenses. Subtract line 18 from line 12.......	30,752,638	50,817,524
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,270,795,904	1,338,956,397
21	Total liabilities (Part X, line 26).............	456,687,546	363,798,431
22	Net assets or fund balances. Subtract line 21 from line 20.....	814,108,358	975,157,966

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 404,297,234 including grants of $ 16,816,637 ) (Revenue $ 566,579,003 )
	INPATIENT SERVICES:CHILDREN'S HOSPITAL OF WISCONSIN, INC. ("CHW" OR "THE HOSPITAL") OPERATES A 296-BED HOSPITAL AT ITS MILWAUKEE CAMPUS, WHICH INCLUDES AN EMERGENCY ROOM OPEN ON A 24/7 BASIS. IT IS A FREESTANDING WISCONSIN HOSPITAL DEDICATED SOLELY TO THE CARE AND TREATMENT OF CHILDREN AND IS ONE OF THE LEADING CENTERS FOR PEDIATRIC HEALTH CARE IN THE U.S. THE HOSPITAL SERVES CHILDREN WITH ALL TYPES OF ILLNESSES, INJURIES, BIRTH DEFECTS AND OTHER DISORDERS. THE HOSPITAL PROVIDES ACUTE LEVEL SERVICES, AS WELL AS EMERGENCY AND SPECIALTY CARE, TO CHILDREN FROM WISCONSIN, THE UPPER PENINSULA OF MICHIGAN, NORTHERN ILLINOIS AND BEYOND. IN 2013, 23,945 CHILDREN WERE ADMITTED TO THE MILWAUKEE HOSPITAL, WHICH INCLUDES A NEONATAL INTENSIVE CARE UNIT (NICU), PEDIATRIC INTENSIVE CARE UNITS (PICU), A CANCER AND BLOOD DISORDERS CENTER, MEDICAL/SURGICAL UNITS AND A DAY SURGERY SHORT STAY UNIT. THE HOSPITAL ALSO OPERATES A SEPARATELY-LICENSED 42-BED PEDIATRIC HOSPITAL, WHICH INCLUDES A NICU AND A PEDIATRIC MEDICAL/SURGICAL UNIT, LOCATED AT THEDA CLARK MEDICAL CENTER IN NEENAH, WIS., THROUGH WHICH IT PROVIDES PEDIATRIC EXPERTISE TO THE GREATER FOX VALLEY AND GREEN BAY AREAS. IN 2013, 1,731 CHILDREN WERE ADMITTED TO THE FOX VALLEY CAMPUS.OUTPATIENT AND AMBULATORY SERVICES:THE HOSPITAL PROVIDES A FULL ARRAY OF OUTPATIENT AMBULATORY, DIAGNOSTIC, TREATMENT AND SURGICAL SERVICES. PROVIDERS AT MORE THAN 70 SUBSPECIALTY CLINICS DIAGNOSE AND TREAT A WIDE VARIETY OF PEDIATRIC DISORDERS. THE HOSPITAL IS A CERTIFIED LEVEL 1 PEDIATRIC TRAUMA CENTER, AND HANDLED 61,863 VISITS TO THE EMERGENCY DEPARTMENT IN 2013. OUTPATIENT SERVICES ARE OFFERED AT ACCESSIBLE LOCATIONS THROUGHOUT SOUTHEASTERN WISCONSIN AND NORTHERN ILLINOIS, AND IN THE FOX VALLEY AND GREEN BAY MARKETS. THE HOSPITAL'S NATIONALLY KNOWN AND RECOGNIZED SPECIALTY PROGRAMS INCLUDE THOSE FOR TREATING CHILDREN WITH AIRWAY, DIGESTIVE AND VOICE CONDITIONS; BURNS; CANCER AND BLOOD DISORDERS; CONGENITAL AND ACQUIRED HEART DEFECTS AND DISEASES; CRANIOFACIAL DISORDERS; DERMATOLOGY, BIRTHMARKS AND VASCULAR ANOMALIES; DIABETES; GASTROINTESTINAL PROBLEMS; GENETIC DISORDERS; HIV; NEUROLOGICAL DISORDERS; ORTHOPEDIC CONDITIONS (INCLUDING SPINE, SPORTS MEDICINE, CONCUSSION); IMMUNODEFICIENCIES AND IMMUNE DYSREGULATION SYNDROMES; PSYCHIATRY; SLEEP DISORDERS; SOLID ORGAN TRANSPLANTATION; SPEECH AND HEARING DISORDERS; AND SPASTICITY AND OTHER TONE AND MOBILITY CONDITIONS. THE HOSPITAL PROVIDES PRIMARY CARE, DENTAL CARE AND CHILD PROTECTIVE SERVICES TO UNDERSERVED CHILDREN AT CLINICS IN CENTRAL CITY MILWAUKEE NEIGHBORHOODS. THE HOSPITAL ALSO OFFERS CASE MANAGEMENT SERVICES AND A FULL RANGE OF MEDICAL, PSYCHOLOGICAL, NURSING AND SOCIAL SERVICES FOR CHILDREN WITH DEVELOPMENTAL, BEHAVIORAL AND LEARNING PROBLEMS. IN 2013, THERE WERE A TOTAL OF 286,836 OUTPATIENT VISITS.RESEARCH, EDUCATION AND COMMUNITY OUTREACH:THE HOSPITAL IS INVOLVED IN EXTENSIVE RESEARCH, EDUCATION AND COMMUNITY OUTREACH PROGRAMS.RESEARCH: THE HOSPITAL AND ITS CHILDREN'S RESEARCH INSTITUTE PARTICIPATE IN AN ARRAY OF RESEARCH INITIATIVES SEEKING TO IMPROVE THE DIAGNOSIS AND TREATMENT OF CONGENITAL AND ACQUIRED PEDIATRIC HEALTH CONDITIONS. THESE RESEARCH INITIATIVES INCLUDE BEHAVIORAL HEALTH, EPILEPSY AND OTHER NEUROLOGICAL CONDITIONS; ORGAN TRANSPLANTATION; BIRTH DEFECTS AND FETAL ANOMALIES; IMMUNOLOGICAL CONDITIONS, BLOOD DISORDERS AND VARIOUS CHILDHOOD CANCERS; AND ENVIRONMENTAL HEALTH CONDITIONS. ADDITIONAL RESEARCH IS CONDUCTED IN COLLABORATION WITH ACADEMIC INVESTIGATORS AT THE MEDICAL COLLEGE OF WISCONSIN, MARQUETTE UNIVERSITY, UNIVERSITY OF WISCONSIN-MADISON AND OTHER INSTITUTIONS. NURSING RESEARCH INCLUDES STUDIES REGARDING PAIN MANAGEMENT, QUALITY OF LIFE, COPING SKILLS, FAMILY READINESS AND SEDATION PROTOCOLS.EDUCATION: THE HOSPITAL IS A MAJOR TEACHING AFFILIATE OF THE MEDICAL COLLEGE OF WISCONSIN, WITH THIRD- AND FOURTH-YEAR MEDICAL STUDENTS ROTATING THROUGH THE HOSPITAL FOR REQUIRED AND ELECTIVE ROTATIONS. THE HOSPITAL ALSO MAINTAINS A THREE-YEAR PEDIATRIC RESIDENCY PROGRAM, A TWO-YEAR DENTAL TRAINING PROGRAM AND ACADEMIC FELLOWSHIP PROGRAMS IN AN ARRAY OF SPECIALTIES. THE HOSPITAL HAS RELATIONSHIPS WITH MORE THAN TWO DOZEN UNIVERSITIES FOR THE CLINICAL EDUCATION OF PEDIATRIC NURSES AND OTHER HEALTH CARE PROFESSIONAL STUDENTS, AS WELL AS HEALTH CARE ADMINISTRATION AND VARIOUS OTHER DISCIPLINES. THE HOSPITAL'S PEDIATRIC SPECIALISTS ALSO PROVIDE EDUCATION AND TRAINING TO HEALTH CARE PROFESSIONALS AT COMMUNITY HOSPITALS, PRIMARY CARE CLINICS AND SCHOOLS THROUGHOUT WISCONSIN IN CONNECTION WITH THE IDENTIFICATION, DIAGNOSIS AND TREATMENT OF PEDIATRIC HEALTH AND WELFARE CONDITIONS. COMMUNITY OUTREACH: THE HOSPITAL OFFERS A WIDE VARIETY OF COMMUNITY EDUCATION, OUTREACH AND CHILD HEALTH ADVOCACY PROGRAMS. THROUGH COMMUNITY EDUCATION PROGRAMS ON TOPICS SUCH AS CHILD HEALTH, INJURY PREVENTION, PARENTING, MANAGEMENT OF CHRONIC DISEASES, AND PREVENTIVE HEALTH, THE HOSPITAL REACHES THOUSANDS OF FAMILIES. ALONG WITH THE MEDICAL COLLEGE, THE HOSPITAL SPONSORS THE CENTER FOR THE ADVANCEMENT OF UNDERSERVED CHILDREN, WHICH SEEKS TO IMPROVE THE HEALTH AND WELL-BEING OF CHILDREN IN THE STATE OF WISCONSIN. THE HOSPITAL PARTICIPATES IN AND STAFFS THE CHILDREN'S HEALTH ALLIANCE OF WISCONSIN, THROUGH WHICH PROVIDERS AROUND THE STATE WORK COLLABORATIVELY TO RAISE AWARENESS OF CHILDREN'S HEALTH ISSUES, INCREASE ACCESS TO PEDIATRIC CARE, AND PROMOTE BEST PRACTICES. OTHER COMMUNITY OUTREACH AND ADVOCACY INITIATIVES INCLUDE, FOR EXAMPLE, CAR SEAT CLINICS, THE DANIEL M. SOREF FAMILY RESOURCE CENTER AND PROJECT ADAM (EDUCATION AND PREVENTION INITIATIVES IN THE AREA OF PEDIATRIC SUDDEN CARDIAC DEATH).

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 expenses404,297,234

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	4,324,872	2,886,475	1,304,095

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		3,504,237
e	Government grants (contributions)1e		10,640,786

f	All other contributions, gifts, grants, and similar amounts not included above1f		823,683

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			14,968,706
			Business Code
2a	NET PATIENT SVC REV		621990	559,643,221	559,643,221
b	RENTAL INCOME		531120	5,658,183	1,114,559		4,543,624
c	OUTSIDE SALARY SUPPORT		541900	1,897,643	1,897,643
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			567,199,047
3	Investment income (including dividends, interest, and other similar amounts).......			10,171,671			10,171,671
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	87,845,175	2,168,403
b	Less: cost or other basis and sales expenses	88,195,637	535,196
c	Gain or (loss)	-350,462	1,633,207
d	Net gain or (loss)..........			1,282,745			1,282,745
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..
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...
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..
Miscellaneous Revenue			Business Code
11a	CAFETERIA		722210	2,394,215			2,394,215
b	PHARMACY SALES TO EMPLOYEES		446110	1,892,710			1,892,710
c	REBATES AND DISCOUNTS		900099	1,144,078	1,144,078
d	All other revenue ....			3,812,418	2,972,787	119,234	720,397
e	Total. Add lines 11a–11d ......			9,243,421
12	Total revenue. See Instructions......			602,865,590	566,772,288	119,234	21,005,362


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			20,934,534	1	73,284,774
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ...........			1,890,349	3	1,519,728
4	Accounts receivable, net .............			78,401,999	4	79,560,551
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
				10,000	5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............			511,460	7	613,001
8	Inventories for sale or use ..............			4,089,825	8	4,627,972
9	Prepaid expenses and deferred charges ..........			5,162,899	9	5,096,354
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	713,455,935
b	Less: accumulated depreciation .....	10b	290,099,745	444,556,620	10c	423,356,190
11	Investments—publicly traded securities ..........			298,749,648	11	271,668,117
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			416,488,570	15	479,229,710
16	Total assets. Add lines 1 through 15 (must equal line 34)......			1,270,795,904	16	1,338,956,397
17	Accounts payable and accrued expenses .........			73,260,669	17	66,523,306
18	Grants payable .................				18
19	Deferred revenue ................			1,157,530	19	1,308,172
20	Tax-exempt bond liabilities .............			269,599,134	20	266,060,711
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..				23
24	Unsecured notes and loans payable to unrelated third parties ....				24
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....................			112,670,213	25	29,906,242
26	Total liabilities. Add lines 17 through 25.........			456,687,546	26	363,798,431
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			649,591,292	27	779,256,568
28	Temporarily restricted net assets ...........			36,839,166	28	51,344,554
29	Permanently restricted net assets ...........			127,677,900	29	144,556,844
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........			814,108,358	33	975,157,966
34	Total liabilities and net assets/fund balances ........			1,270,795,904	34	1,338,956,397