Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
A For the 2014 calendar year, or tax year beginning 07-01-2014 , and ending 06-30-2015
BCheck if applicable:
CName of organization
Dayton Children's Hospital
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
One Childrens Plaza
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Dayton, OH454041815
D Employer identification number

31-0672132
E Telephone number

G Gross receipts $ 384,387,897
F Name and address of principal officer:
DEBORAH FELDMAN
ONE CHILDRENS PLAZA
DAYTON,OH454041815
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.childrensdayton.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1967
M State of legal domicile: OH
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: TO IMPROVE THE HEALTH STATUS OF ALL CHILDREN THROUGH SERVICE, EDUCATION, RESEARCH AND ADVOCACY.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 17
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 12
5 Total number of individuals employed in calendar year 2014 (Part V, line 2a) ...... 5 2,097
6 Total number of volunteers (estimate if necessary) ............. 6 896
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 53,944
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 52,944
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 13,842,373 27,104,214
9 Program service revenue (Part VIII, line 2g) ......... 222,448,755 234,171,510
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 16,779,095 21,194,516
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 3,476,755 2,404,437
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 256,546,978 284,874,677
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 286,187 226,113
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) 112,612,147 119,672,065
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,466,445    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 95,941,116 109,276,324
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 208,839,450 229,174,502
19 Revenue less expenses. Subtract line 18 from line 12....... 47,707,528 55,700,175
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 541,648,879 595,726,324
21 Total liabilities (Part X, line 26)............. 46,321,598 80,468,052
22 Net assets or fund balances. Subtract line 21 from line 20..... 495,327,281 515,258,272
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2014)
Form 990 (2014)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: TO IMPROVE THE HEALTH STATUS OF ALL CHILDREN THROUGH SERVICE, EDUCATION, RESEARCH AND ADVOCACY.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 213,313,008 including grants of $ 226,113 ) (Revenue $ 234,665,407 )
SEE SCHEDULE O.
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 expensesMediumBullet213,313,008
Form 990 (2014)
Form 990 (2014)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III
Click to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part VClick to see attachment......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If "Yes," complete Schedule D, Part VI.Click to see attachment
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII Click to see attachment.................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IVClick to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV... Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions) .... Click to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H.... Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see list of attachments
20b
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
Yes
 
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I.... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I................... Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................ Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV .......................... Click to see attachment
28a
Yes
 
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV
..................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..Click to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M............. Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2............. Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
89
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
1
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
2,097
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletBD
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If "Yes," did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?
.........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2014)
Form 990 (2014)
Page 6
Part VI
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
17
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
OH
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletCHRIS BERGMAN
ONE CHILDRENS PLAZA
DAYTON,OH454041815 (937) 641-5819
Form 990 (2014)
Form 990 (2014)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII ..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

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

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

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

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(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)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) EMILY CHAMBERS ENDED 1014........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(2) LESLIE BARNES CARSON........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(3) JEFFREY CHRISTIANMDENDED 1014........................................................................
TRUSTEE
40.0
.......................0.0
X           0 515,994 63,013
(4) GREGORY EBERHART MD........................................................................
TRUSTEE
1.0
.......................0.0
X           5,000 0 0
(5) ELIZABETH EY MD........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(6) SCOTT KELLY........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(7) THERESE MCNEA-WILEY........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(8) ARTHUR PICKOFF MD........................................................................
TRUSTEE
1.0
.......................0.0
X           116,225 0 0
(9) GREGORY SAMPLE........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(10) MICHAEL SHANE........................................................................
Vice Chair
1.0
.......................0.0
X   X       0 0 0
(11) BEVERLY SHILLITO........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(12) LAURENCE KLABEN........................................................................
Sec/Treas
1.0
.......................0.0
X   X       0 0 0
(13) COLLEEN RYAN ENDED 1014........................................................................
ASST. SECRETARY/TREASURER
1.0
.......................0.0
X   X       0 0 0
(14) VISHAL SOIN........................................................................
CHAIRMAN
1.0
.......................0.0
X   X       0 0 0
(15) DEBORAH FELDMAN........................................................................
PRESIDENT AND CEO
40.0
.......................1.0
X   X       681,099 0 151,939
(16) Linda Black-Kurek........................................................................
Trustee
1.0
.......................0.0
X           0 0 0
(17) James Whalen........................................................................
Trustee
1.0
.......................0.0
X           0 0 0
Form 990 (2014)
Form 990 (2014)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (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)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Adam Mezoff........................................................................
VP Medical Affairs CMO
40.0
.......................0.0
X   X       458,683 0 34,252
(19) MARK CHILSON BEG 1101........................................................................
TRUSTEE
1.0
.......................0.0
X           0 0 0
(20) THOMAS KRZMARZICK BEG 1101........................................................................
CHAIRMAN ELECT-PROF STAFF
1.0
.......................0.0
X           201,529 0 0
(21) DAVID T MILLER........................................................................
VP FINANCE AND CFO
40.0
.......................1.0
    X       392,160 0 173,718
(22) MATTHEW GRAYBILL........................................................................
VP AND CHIEF OPERATING OFFICER
40.0
.......................0.0
    X       327,774 0 100,660
(23) Lisa Coffey........................................................................
VP Corporate Support Services
40.0
.......................0.0
      X     212,827 0 50,014
(24) Renae Phillips........................................................................
VP Patient Care CNO
40.0
.......................0.0
      X     275,915 0 102,375
(25) BEN GOODSTEIN BEG 0114........................................................................
VP & CHIEF AMBULATORY OFFICER
40.0
.......................0.0
      X     193,862 0 38,412
(26) CINDY BURGER BEG 0114........................................................................
VP FOR PATIENT EXPERIENCE
40.0
.......................0.0
      X     184,869 0 43,678
(27) Gregory Ramey........................................................................
VP Outpatient Services
40.0
.......................0.0
        X   202,529 0 37,135
(28) Vicki Giambrone........................................................................
VP Maktng External Relations
40.0
.......................1.0
        X   275,581 0 31,149
(29) Maragret Hemmen........................................................................
CR Nurse Anesthetist
40.0
.......................0.0
        X   202,211 0 18,111
(30) Erika Green........................................................................
CR Nurse Anesthetist
40.0
.......................0.0
        X   179,686 0 16,937
(31) Elizabeth Fredette........................................................................
Director Info Services CIO
40.0
.......................0.0
        X   186,913 0 41,923
(32) DAVID KINSAUL........................................................................
FORMER PRESIDENT AND CEO
0.0
.......................0.0
          X 239,066 0 0
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 4,335,929 515,994 903,316
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet16
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
CHILDREN'S CARE GROUP,
1 CHILDRENS PLAZA
DAYTON,OH45404
PHYSICIAN SERVICES 12,781,593
WRIGHT STATE PHYSICIANS,
PO BOX 1144
DAYTON,OH45401
PHYSICIAN SERVICES 2,125,167
WRIGHT STATE UNIVERSITY,
PO BOX 927
DAYTON,OH45401
PHYSICIAN SERVICES 1,420,409
ORTHOPAEDIC CENTER FOR SPINAL PED,
1 CHILDRENS PLAZA
DAYTON,OH45404
PHYSICIAN SERVICES 573,006
MIDWEST LAUNDRY INC,
PO BOX 932696
CLEVELAND,OH44193
LAUNDRY SERVICE 465,397
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet5
Form 990 (2014)
Form 990 (2014)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a 28,369
b Membership dues....1b  
c Fundraising events....1c 534,105
d Related organizations...1d 5,395,092
e Government grants (contributions)1e 744,629
f All other contributions, gifts, grants, and
similar amounts not included above
1f
20,402,019
g Noncash contributions included in lines
1a-1f:$
128,502
h Total. Add lines 1a-1f.......MediumBullet 27,104,214
 Program Service RevenueAmt Business Code
2a PATIENT SERVICE REVENUE 624100 153,776,208 153,776,208    
b MEDICARE/MEDICAID 624100 80,996,628 80,996,628    
c SURGERY CENTER 621400 53,944   53,944  
d LOSS FOR JOINT VENTURE 624100 -655,270 -655,270    
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 234,171,510
 OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 4,908,874     4,908,874
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 289,313  
b Less: rental expenses 882,082  
c Rental income or (loss) -592,769 0
d Net rental income or (loss).......MediumBullet -592,769     -592,769
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 114,314,250 1,850
b Less: cost or other basis and sales expenses 97,997,947 32,511
c Gain or (loss) 16,316,303 -30,661
d Net gain or (loss)..........MediumBullet 16,285,642     16,940,912
8a Gross income from fundraising events (not including
$ 534,105
of contributions reported on line 1c). See Part IV, line 18 ..
a 493,464
b Less: direct expenses ...b 233,982
c Net income or (loss) from fundraising events..MediumBullet 259,482   259,482
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a 556,951
b Less: cost of goods sold ..b 366,698
c Net income or (loss) from sales of inventory..MediumBullet 190,253 190,253    
Miscellaneous Revenue Business Code
11a HITECH MEDICAL RECORDS 900099 292,507     292,507
b CAFETERIA/KIDS CARE 900099 1,266,480     1,266,480
c DAY CARE CENTER 812930 684,840     684,840
d All other revenue .... 303,644 303,644    
e Total. Add lines 11a–11d ...... MediumBullet 2,547,471
12 Total revenue. See Instructions......MediumBullet 284,874,677 234,611,463 53,944 23,760,326
Form 990 (2014)
Form 990 (2014)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 88,000 88,000
2 Grants and other assistance to domestic individuals. See Part IV, line 22 .... 138,113 138,113
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............ 0  
4 Benefits paid to or for members .... 0  
5 Compensation of current officers, directors, trustees, and key employees .... 3,482,183   3,482,183  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 239,066   239,066  
7 Other salaries and wages .... 89,667,483 85,097,185 3,808,884 761,414
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 6,933,671 6,581,206 293,744 58,721
9 Other employee benefits ....... 12,800,049 12,254,458 436,250 109,341
10 Payroll taxes ........... 6,549,613 6,216,670 277,474 55,469
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 405,390   405,390  
c Accounting ........... 252,780   252,780  
d Lobbying ........... 112,382 112,382    
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) .... 24,574,536 24,232,467 342,069  
12 Advertising and promotion .... 1,171,785 1,171,785    
13 Office expenses ....... 14,453,269 13,140,499 1,117,531 195,239
14 Information technology ...... 6,485,248 6,485,248    
15 Royalties .. 0      
16 Occupancy ........... 3,296,042 3,130,027 165,730 285
17 Travel ............ 794,053 564,218 182,705 47,130
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 199,193 199,193    
20 Interest ........... 747,653 747,653    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 15,185,596 14,706,738 441,594 37,264
23 Insurance .............. 1,453,696 1,453,696    
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 PURCHASED SERVICES 9,571,509 6,420,278 2,949,649 201,582
b STATE HOSPITAL ASSESSMENT 4,637,097 4,637,097    
c MISCELLANEOUS 23,185 23,185    
d MEDICAL SUPPLIES 25,912,910 25,912,910    
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 229,174,502 213,313,008 14,395,049 1,466,445
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2014)
Form 990 (2014)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 14,647 1 14,522
2 Savings and temporary cash investments ......... 69,523,361 2 74,834,812
3 Pledges and grants receivable, net ........... 862,058 3 8,071,553
4 Accounts receivable, net ............. 39,566,580 4 50,960,480
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
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
0 6 0
7 Notes and loans receivable, net ............. 14,794 7 0
8 Inventories for sale or use .............. 1,695,087 8 2,178,872
9 Prepaid expenses and deferred charges .......... 444,404 9 741,143
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 219,726,260
b Less: accumulated depreciation ..... 10b 95,482,599 104,080,751 10c 124,243,661
11 Investments—publicly traded securities .......... 264,538,849 11 251,484,299
12 Investments—other securities. See Part IV, line 11 ..... 47,882,926 12 73,688,396
13 Investments—program-related. See Part IV, line 11 ..... 3,238,611 13 2,621,333
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 9,786,811 15 6,887,253
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 541,648,879 16 595,726,324
Liabilities 17 Accounts payable and accrued expenses ......... 33,004,777 17 39,137,759
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 0 19 0
20 Tax-exempt bond liabilities ............. 0 20 27,907,804
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
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.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 13,316,821 25 13,422,489
26 Total liabilities. Add lines 17 through 25......... 46,321,598 26 80,468,052
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 493,785,276 27 505,388,759
28 Temporarily restricted net assets ........... 1,542,005 28 9,869,513
29 Permanently restricted net assets ........... 0 29 0
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 495,327,281 33 515,258,272
34 Total liabilities and net assets/fund balances ........ 541,648,879 34 595,726,324
Form 990 (2014)
Form 990 (2014)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
284,874,677
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
229,174,502
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
55,700,175
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
495,327,281
5
Net unrealized gains (losses) on investments ...............
5
-24,989,388
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-10,779,796
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
515,258,272
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII .............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? .................
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2014)
Form 990 (2014)
Page 13
Form 990, Special Condition Description:
Special Condition Description
Form 990 (2014)
Form 990 (2014)
Page 14
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
a
b
c
d
e
f
Enter the number of supported organizations .............................  
g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total    

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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 VI.)..            
11 Total support Add lines 7 through 10.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
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) 2014
Schedule A (Form 990 or 990-EZ) 2014
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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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 VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 5
Part IV
Supporting Organizations (continued)

Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 6
Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1.   Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors (explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7   Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 7
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity
 
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions
 
9 Distributable amount for 2014 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions
(ii)
Underdistributions
Pre-2014
(iii)
Distributable
Amount for 2014
1 Distributable amount for 2014 from Section C, line
6
 
2 Underdistributions, if any, for years prior to 2014
(reasonable cause required--see instructions)
 
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2014 distributable amount  
i Carryover from 2009 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2014 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2014 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2014, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)
 
6 Remaining underdistributions for 2014. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)
 
7 Excess distributions carryover to 2015. Add lines
3j and 4c.
 
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......  
e From 2014.......  
Schedule A (Form 990 or 990-EZ) (2014)
Schedule A (Form 990 or 990-EZ) 2014
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Name of the organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 2
Name of organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
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


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 3
Name of organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 4
Name of organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Additional Data


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

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

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

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

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










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2014

Schedule C (Form 990 or 990-EZ) 2014
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in)
(a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e))
 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))
 
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2014


Schedule C (Form 990 or 990-EZ) 2014
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
Yes
 
500
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
64,950
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
23,021
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
Yes
 
40,908
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
129,379
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
No
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
SCHEDULE C SUPPLEMENTAL INFORMATION LINE 1D: MAILINGS $500 LINE 1F: OHIO HOSPITAL ASSOCIATION $2,121 OHIO CHILDREN'S HOSPITAL ASSOCIATION $42,047 NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS $20,782 TOTAL: $64,950 LINE 1G: MANAGEMENT TIME $16,997 DAYTON CHILDREN'S SPENDS TIME TRACKING SPECIFIC LEGISLATION THAT IS OF INTEREST TO PEDIATRIC HEALTH ISSUES. THEY PROVIDE SUGGESTIONS AND FEEDBACK TO LOCAL, STATE AND FEDERAL LEGISLATURES. THEIR MAIN FOCUS CONCERNS MEDICAID, CHILDREN'S SPECIFIC HEALTH ISSUES AND MEDICAL EDUCATION FUNDING. NACH 2014 FAMILY ADVOCACY DAYS $6,024 TOTAL: $23,021 LINE 1H: CONSULTING EXPENSE $40,908 TOTAL LINE 1J: $129,379
Schedule C (Form 990 or 990EZ) 2014

Additional Data


Software ID:  
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SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
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 value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
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.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenue included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
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) 2014

Schedule D (Form 990) 2014
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
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):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
b
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 .... 171,140,209 145,550,821 127,667,969 123,741,717 97,132,791
b Contributions ........ 3,053,446 7,058,671 7,549,823 7,937,991 7,689,808
c Net investment earnings, gains, and losses -1,935,200 23,383,702 14,908,772 434,441 22,325,672
d Grants or scholarships ..... 5,514,951 4,815,615 4,542,192 4,446,180 3,402,441
e Other expenditures for facilities
and programs ........
  37,370 33,551 0 4,113
f Administrative expenses ....   0 0 0 0
g End of year balance ...... 166,743,504 171,140,209 145,550,821 127,667,969 123,741,717
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
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 (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   4,995,723 4,995,723
b Buildings ................   51,343,355 24,421,091 26,922,264
c Leasehold improvements ............        
d Equipment ................   142,996,890 69,041,887 73,955,003
e Other .................   20,390,292 2,019,621 18,370,671
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 124,243,661
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 3
Part VII
Investments—Other 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    
(3)Other
(A) HIRTLE CALLAGHAN - OFFSHORE
52,445,623 F

(B) HIRTLE CALLAGHAN - COMMODITIES
17,568,287 F

(C) HIRTLE CALLAGHAN - REAL ESTATE
3,674,486 F






Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 73,688,396
Part VIII
Investments—Program 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.)Small Bullet  
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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
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 0
RESERVE FOR PROFESSIONAL LIA 5,403,783
EST REIMB/MEDICAID PROGRAM 411,716
DEFERRED COMPENSATION PAYABLE 1,644,624
SERP PENSION ACCRUAL 2,663,437
REINSURANCE 3,298,929




Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 13,422,489
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) 2014

Schedule D (Form 990) 2014
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 (losses) 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
SUPPLEMENTAL INFORMATION The endowments are held by Dayton Children's Hospital Foundation, a subsidiary of Dayton Children's Hospital. The funds are used exclusively to support Dayton Children's Hospital and its subsidiaries. The intended use of the funds is to support medical research, the child life program and the medical chairs of specific hospital departments.
Fin 48 (ABC) 740) FOOTNOTE ALL SUBSIDIARIES OF THE HOSPITAL EXCEPT CHILDREN'S CARE GROUP (CCG), CHILDREN'S ANESTHESIA GROUP (CAG), AND SELECTED JOINT VENTURE ENTITIES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE WHOLLY OWNED FOR-PROFIT SUBSIDIARIES CCG AND CAG HAD NO TAXABLE INCOME IN 2015 OR 2014. THE PROVISION FOR INCOME TAXES FOR THE JOINT VENTURE ENTITIES IS NOT SIGNIFICANT TO THE HOSPITAL. THE HOSPITAL COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE, AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2015 OR 2014.
Schedule D (Form 990) 2014

Additional Data


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Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990.Right pointing arrow large image Information about Schedule F (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
Part I
General Information on Activities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria
used to award the grants or assistance? ...........................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region
(f) Total expenditures
for and investments
in region
Central America and the Caribbean 1 2 Investments   106,311,583
Central America and the Caribbean 1 2 Program Services Captive Insurance 1,737,147
           
           
           
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 2 4 108,048,730
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 2 4 108,048,730
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2014
Schedule F (Form 990) 2014
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)
(a)(c) Region (b)(d) Purpose of
grant
(e) Amount of
cash grant
(f) Manner of
cash
disbursement
(g) Amount
of non-cash
assistance
(h) Description
of non-cash
assistance
(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2 Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ....MediumBullet
 
3
Enter total number of other organizations or entities .......................MediumBullet
 
Schedule F (Form 990) 2014
Schedule F (Form 990) 2014Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant
(e) Manner of cash
disbursement
(f) Amount of
non-cash
assistance
(g) Description
of non-cash
assistance
(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2014
Schedule F (Form 990) 2014
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes,"the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926)......................................
2 Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; do not file with Form 990)............................
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621)...............................................
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships. (see Instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713; do not file with Form 990).....................................
Schedule F (Form 990) 2014
Schedule F (Form 990) 2014
Page 5
Part V
Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
ReturnReference Explanation
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule F (Form 990) 2014
Additional Data


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SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ.
right arrowInformation about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Form 990-EZ
filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser)
(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity
(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i)
(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2014
Schedule G (Form 990 or 990-EZ) 2014
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

DINNER DANCE
(event type)
(b) Event #2

GOLF OUTING
(event type)
(c) Other events

3
(total number)
(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 595,996 188,976 242,597 1,027,569
2 Less: Contributions . . 366,970 127,115 40,020 534,105
3 Gross income (line 1
minus line 2) . . .
229,026 61,861 202,577 493,464
VerticalDirectExpenses 4 Cash prizes . . .        
5 Noncash prizes . .     931 931
6 Rent/facility costs . . 6,488 22,875 13,250 42,613
7 Food and beverages . 44,382 18,667 40,203 103,252
8 Entertainment . . . 1,500 300 1,340 3,140
9 Other direct expenses . 31,910 15,789 36,347 84,046
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 233,982
11 Net income summary. Subtract line 10 from line 3, column (d)........... right arrow 259,482
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo
(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
%
%
%
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Subtract line 7 from line 1, column (d) ......... right arrow  
9
Enter the state(s) in which the organization conducts gaming activities:
a
Is the organization licensed to conduct gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2014
Schedule G (Form 990 or 990-EZ) 2014
Page 3
11
Does the organization conduct gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activities conducted in:
a
The organization's facility ......................
13a
%
b
An outside facility ........................
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $  
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information (see instructions).
Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2014
Additional Data


Software ID:  
Software Version:  
SCHEDULE H (Form 990)
Department of the TreasuryInternal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

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

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) ..
    1,093,428   1,093,428 0.470 %
b Medicaid (from Worksheet 3,
column a) ....
    115,065,439 86,426,496 28,638,943 12.430 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) .
           
d Total Financial Assistance
and Means-Tested
Government Programs .
    116,158,867 86,426,496 29,732,371 12.900 %
Other Benefits
    767,592   767,592 0.330 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) ..
    3,928,575 1,347,124 2,581,451 1.120 %
g Subsidized health services
(from Worksheet 6) ..
    12,822,293 5,206,620 7,615,673 3.310 %
h Research (from Worksheet 7)            
i Cash and in-kind
contributions for community
benefit (from Worksheet 8)
    167,435   167,435 0.070 %
j Total. Other Benefits ..     17,685,895 6,553,744 11,132,151 4.830 %
k Total. Add lines 7d and 7j .     133,844,762 92,980,240 40,864,522 17.730 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing     339,797   339,797 0.150 %
2 Economic development     18,107   18,107 0.010 %
3 Community support     33,772   33,772 0.010 %
4 Environmental improvements     1,748   1,748  
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy     5,132   5,132  
8 Workforce development     38,703   38,703 0.020 %
9 Other            
10 Total     437,259   437,259 0.190 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
4,293,220
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
767,251
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
202,327
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
202,327
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
 
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 DAYTON CHILDREN'S HOSPITAL
ONE CHILDRENS PLAZA
DAYTON,OH454041815
www.childrensdayton.org
X X X X     X      
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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)
DAYTON CHILDREN'S HOSPITAL
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):
1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?....................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C.......... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12.................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................ 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public? .............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............
8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website? ........ 10 Yes  
a If "Yes" (list url): WWW.CHILDRENSDAYTON.ORG
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

DAYTON CHILDREN'S HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
Financial Assistance Policy (FAP)
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?....... 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

DAYTON CHILDREN'S HOSPITAL
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other 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?......... 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?................ 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ................................ 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
PART V - 1J THE DAYTON CHILDREN'S COMMUNITY HEALTH NEEDS ASSESMENT ALSO INCLUDED A PARENT PERCEPTION SURVEY TO BETTER UNDERSTAND TOP PEDIATRIC HEALTH AND SAFETY NEEDS AND HOW PARENTS VIEW THOSE NEEDS IN ORDER TO FORM OUR IMPLEMENTATION STRATEGIES. SIX HUNDRED AND FORTY-TWO PARENTS OF CHILDREN LIVING IN THE DAYTON CHILDREN'S HOSPITAL GENERAL SERVICE AREA WERE SURVEYED EITHER ONLINE OR VIA TELEPHONE INTERVIEW BETWEEN JANUARY 27 AND FEBRUARY 25,2014. FOCUS GROUPS WERE CONDUCTED WITH PARENTS TO DIG DEEPER INTO SOME OF THE CHALLENGES AND BARRIERS ASSOCIATED WITH THEIR TOP HEALTH AND SAFETY CONCERNS.
PART V - 5 & 6B IN ADDITION TO THE SECONDARY DATA SCAN, PARENT PERCEPTION SURVEY AND PARENT FOCUS GROUPS USED TO IDENTIFY HEALTH ISSUES AND PRIORITIES AS PART OF OUR COMMUNITY HEALTH NEEDS ASSESSMENT, DAYTON CHILDREN'S HOSPITAL CONDUCTED IN-DEPTH INTERVIEWS WITH A REPRESENTATIVE GROUP OF PRACTICING PHYSICIANS WITHIN THE GREATER DAYTON COMMUNITY. PHYSICIANS SERVING A VARIETY OF DEMOGRAPHICS AND COUNTIES WITHIN THE REGION WERE REPRESENTED INCLUDING PUBLIC HEALTH CLINICS. THESE SURVEYS WERE USED TO IDENTIFY AND PRIORITIZE KEY PEDIATRIC HEALTH ISSUES, UNDERSTAND HOW CONSUMERS RECEIVE CARE FOR THESE ISSUES TODAY AND DETERMINE HOW HEALTH PROFESSIONALS BELIEVE DAYTON CHILDREN'S HOSPITAL CAN RESPOND TO PEDIATRIC HEALTH PRIORITIES. DAYTON CHILDREN'S ALSO ASSEMBLED A MULTIDISCIPLINARY TEAM TO HELP PRIORITIZE OUR FINDINGS. THIS TEAM INCLUDED THE FOLLOWING: COMMUNITY HEALTH NEEDS ASSESSMENT TEAM: BELINDA HUFFMAN, RCP, BS, CPFT, PULMONARY HEALTH AND HEALTH COORDINATOR DAVID MIRKIN, MD, MEDICAL DIRECTOR LABORATORY/PATHOLOGY JACK PASCOE, MD, PROFESSOR WRIGHT STATE UNIVERSITY PEDIATRICS DEPARTMENT LISA SCHWING, RN, TRAUMA PROGRAM MANAGER RACHEL RIDDIFORD, MS, RD, LD, ORGANIZATIONAL NUTRITION AND HEALTHY WAY OFFICER SARA PATON, EPIDEMIOLOGIST, PUBLIC HEALTH DAYTON & MONTGOMERY COUNTY SHERYL WYNN, GREEN COUNTY COMBINED HEALTH DISTRICT ADDITIONAL SUBJECT MATTER EXPERTS CONSULTED ANN MARIE SCHMERSAL, MS, RN, CPNP-AC, NURSE PRACTITIONER, GENERAL PEDIATRICS ELAINE MARKLAND, BSN, RN, CPEN, EMERGENCY DEPARTMENT GREG RAMEY, PhD, EXECUTIVE DIRECTOR, CENTER FOR PEDIATRIC MENTAL HEALTH RESOURCES JIM EBERT, MD, MPH, PEDIATRIC LIPID CLINIC PHYSICIAN
PART V - 7D DAYTON CHILDREN'S ASSESSMENT AND IMPLEMENTATION PLAN WAS SHARED WITH THE PUBLIC AT A MEDIA CONFERENCE ON JUNE 20, 2014, TO DISSEMINATE THE INFORMATION. IN ADDITION, WE CREATED A SUMMARY REPORT AND OUTLINED THE NEXT STEPS FOR EACH OF THE KEY ISSUES WHICH WAS DISSEMINATED TO LEGISLATORS. WE ALSO WRITE A BLOG ARTICLE (FOR THE DAYTON CHILDREN'S BLOG) ABOUT THE HEALTH ASSESSMENT FINDINGS AND CONTINUE TO REFERENCE THE HEALTH ASSESSMENT VIA THAT ONLINE TOOL. WE ALSO CREATED AN INFOGRAPHIC IDENTIFYING OUR KEY PRIORITIES WHICH IS A VISUAL REPRESENTATION AS WE CONTINUE TO SHARE OUR FINDINGS. FINALLY, OUR HEALTH ASSESSMENT WAS PUBLISHED ON OUR HOSPITAL WEBSITE AND IS AVAILABLE UPON REQUEST FOR ANY INTERESTED PARTY AT WWW.CHILDRENSDAYTON.ORG.
PART V - 11 THE CHNA TEAM, WITH THE HELP OF ADDITIONAL SUBJECT MATTER EXPERTS AND PROJECT OWNERS, CREATED AN IMPLEMENTATION PLAN FOR EACH OF THE TOP THREE PRIORITY AREAS. EACH IMPLEMENTATION PLAN OUTLINES GOALS AND STRATEGIES FOR THE NEXT THREE YEARS. ADDITIONAL NEEDS, ALTHOUGH IDENTIFIED, WILL NOT BE THE TOP PRIORITIES GIVEN THE RESOURCES WE HAVE AVAILABLE. THE IMPLEMENTATION PLAN INCLUDES THE FOLLOWING STRATEGIES: 1. DAYTON CHILDREN'S WILL FOCUS ON DECREASING PEDIATRIC OBESITY BY WORKING WITH LOCAL PEDIATRICIANS AND HEALTH CARE PROVIDERS TO MAKE SURE THEY HAVE APPROPRIATE RESOURCES AVAILABLE TO HELP CHILDREN AND THEIR FAMILIES CHOOSE HEALTHIER LIFESTYLES. 2. DAYTON CHILDREN'S WILL CREATE A CENTER FOR PEDIATRIC MENTAL HEALTH TO INCREASE ACCESS AND COORDINATE RESOURCES FOR PEDIATRIC MENTAL HEALTH IN THE HOSPITAL'S PRIMARY SERVICE AREA. 3. DAYTON CHILDREN'S WILL INVEST IN EDUCATION FOR PARENTS ABOUT SAFE SLEEP PRACTICES FOR THEIR INFANTS. OUR ASSESSMENT AND IMPLEMENTATION PLAN WAS SHARED WITH THE PUBLIC AT A MEDIA CONFERENCE ON JUNE 20, 2014, TO DISSEMINATE THE INFORMATION. IN ADDITION, WE CREATED A SUMMARY REPORT AND OUTLINED THE NEXT STEPS FOR EACH OF THE KEY ISSUES. FINALLY, OUR HEALTH ASSESSMENT WAS PUBLISHED ON OUR HOSPITAL WEBSITE AND IS AVAILABLE UPON REQUEST FOR ANY INTERESTED PARTY.
PART V, LINE 22D ALL PATIENTS ARE CHARGED THE SAME FOR SERVICES RECEIVED. HOWEVER, CHARGES BILLED TO ALL FAP ELIGIBLE PATIENTS ARE DISCOUNTED BASED ON THE HOSPITAL'S SLIDING FEE SCALE FOR DISCOUNTED CARE. THIS IS BASED ON CURRENT FEDERAL POVERTY LEVELS.
PART V DAYTON CHILDREN'S HAS 9 HEALTH CARE FACILITIES OTHER THAN THOSE REQUIRED TO BE LICENSED, REGISTERED OR SIMILARLY RECOGNIZED AS A HEALTH CARE FACILITY UNDER STATE LAW. WE HAVE 5 TESTING CENTERS, 4 OFFSITE CLINICS, AND 1 URGENT CARE CENTER (50% OWNED).
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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?9
Name and address Type of Facility (describe)
1 WARREN COUNTY SPECIALTY CARE CENTER
100 CAMPUS LOOP ROAD SUITE A
FRANKLIN,OH45005
OUTPATIENT CARE CENTER AND OUTPATIENT DIAGNOSTIC CENTER
2 SPRINGBORO URGENT CARE & OP CARE CENTER
3333 WEST TECH ROAD
MIAMISBURG,OH45342
URGENT CARE CENTER AND OUTPATIENT DIAGNOSTIC CENTER
3 DAYTON ORTHOPAEDICS - SOUTH
2350 MIAMI VALLEY DRIVE
DAYTON,OH45459
OUTPATIENT CARE CENTER
4 VANDALIA OUTPATIENT TESTING CENTER
810 FALLS CREEK DRIVE SUITE A
VANDALIA,OH45377
OUTPATIENT DIAGNOSTIC CENTER
5 BEAVERCREEK OUTPATIENT TESTING CENTER
3224 DAYTON-XENIA ROAD
BEAVERCREEK,OH45431
OUTPATIENT DIAGNOSTIC CENTER
6 SUGARCREEK OUTPATIENT TESTING CENTER
6116 WILMINGTON PIKE
CENTERVILLE,OH45459
OUTPATIENT DIAGNOSTIC CENTER
7 KETTERING OUTPATIENT TESTING CENTER
4475 FAR HILLS AVENUE
KETTERING,OH45429
OUTPATIENT DIAGNOSTIC CENTER
8 SPRINGFIELD SPECIALTY CARE CENTER
30 W MCCREIGHT AVENUE
SPRINGFIELD,OH45504
OUTPATIENT CARE CENTER
9 DAYTON ORTHOPAEDICS - TROY
31 STANFIELD ROAD
TROY,OH45473
OUTPATIENT CARE CENTER
10
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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
Schedule H Part VI DAYTON CHILDREN'S INCLUDED $12,822,293 OF PHYSICIAN CLINIC COSTS IN THE SUBSIDIZED HEALTH SERVICES CATEGORY. PART I. LINE 7 THE FOLLOWING COSTING METHODOLOGIES WERE USED IN PREPARATION OF SCHEDULE H PART I, LINE 7: -CHARITY CARE AT COST WAS CALCULATED USING THE COST TO CHARGE RATIO. -UNREIMBURSED MEDICAID WAS CALCULATED USING THE COST TO CHARGE RATIO. -COMMUNITY HEALTH IMPROVEMENT SERVICES WERE VALUED AT THE ACTUAL CASH COSTS, INCLUDING DIRECTLY ASSIGNABLE PAYROLL COSTS, RELATED TO THESE ACTIVITIES. NO OVERHEAD ALLOCATION WAS CHARGED TO ANY AMOUNT INCLUDED IN THIS COMPUTATION. -HEALTH PROFESSIONS EDUCATION COSTS WERE DETERMINED USING THE FACILITY'S MEDICARE COST REPORTED, SUPPLEMENTED BY THE ACTUAL CASH COSTS, INCLUDING DIRECTLY ASSIGNABLE PAYROLL COSTS, RELATED TO THESE ACTIVITIES. -SUBSIDIZED HEALTH SERVICES COSTS WERE DETERMINED USING THE FACILITY'S INTERNAL COST ACCOUNTING SYSTEM. THE COST OF THESE SERVICES INCLUDES DIRECT COSTS ATTRIBUTABLE TO HEALTH SERVICES OPERATIONS, TOGETHER WITH AN ALLOCATION OF FACILITY DIRECT AND INDIRECT OVERHEAD USING A COST FINDING METHODOLOGY PATTERNED AFTER THE MEDICARE COST REPORT. -CASH AND IN KIND CONTRIBUTIONS WERE VALUED AT THE ACTUAL CASH COSTS, INCLUDING DIRECTLY ASSIGNABLE PAYROLL COSTS, RELATED TO THESE ACTIVITIES. NO OVERHEAD ALLOCATION WAS CHARGED TO ANY AMOUNT INCLUDED IN THIS COMPUTATION. PART III, LINE 4: THE COSTING METHODOLOGY USED IN PREPARATION OF BAD DEBT ATTRIBUTABLE TO PATIENT ACCOUNTS IS THE COST TO CHARGE RATIO, RATIO OF PATIENT COST-TO-CHARGE. THE DAYTON CHILDREN'S AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE DISCUSSING BAD DEBT EXPENSE. A PROVISION FOR BAD DEBT EXPENSE IS SHOWN ON THE PROFIT AND LOSS STATEMENT. THE CALCULATION OF BAD DEBT EXPENSE IS IN CONFORMITY WITH ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES REQUIRING MANAGEMENT TO MAKE ESTIMATES AND ASSUMPTIONS BASED ON HISTORICAL DATA THAT AFFECT THE REPORTED AMOUNTS OF REVENUE AND EXPENSES DURING THE REPORTED PERIOD. LIKEWISE, AN ALLOWANCE FOR BAD DEBT IS SHOWN ON THE BALANCE SHEET UNDER THE SAME PRINCIPLE AFFECTING THE REPORTED AMOUNTS OF ASSETS AND LIABILITIES DURING THE REPORTED PERIOD. PART III, LINE 8: THE COSTS REPORTED FOR SERVICES PROVIDED TO MEDICARE PATIENTS COME FROM SCHEDULE E OF THE FACILITY'S COST REPORT AS FILED. SINCE DAYTON CHILDREN'S IS REIMBURSED FOR MEDICARE SERVICES UNDER A TEFRA METHODOLOGY, THERE IS NORMALLY NO SHORTFALL, AS ALLOWED COSTS AND PAYMENTS DUE ARE EQUAL. PART III, LINE 9B: THE HOSPITAL'S POLICIES ON BILLING AND COLLECTIONS ARE POSTED ON OUR WEBSITE UNDER THE "FINANCIAL MATTERS" TAB. IT IS THE HOSPITAL'S POLICY TO PUBLICIZE THE AVAILABILITY OF FREE CARE, GOVERNMENT AND OTHER FINANCIAL ASSISTANCE PROGRAMS UP FRONT BEFORE SERVICES ARE PROVIDED THROUGH MEANS SUCH AS ONSITE FINANCIAL COUNSELORS AND BROCHURES PROVIDED IN THE REGISTRATION AREAS. EACH OF THESE AVENUES OF COMMUNICATION INCLUDES DETAILED INSTRUCTIONS ON HOW PATIENTS AND FAMILIES MAY APPLY FOR ASSISTANCE. THE HOSPITAL'S POLICIES ON BILLING AND COLLECTIONS SPECIFY WHEN COLLECTION ACTION MAY BE TAKEN AND MAKES IT CLEAR THAT THESE MEASURES WILL ONLY OCCUR AFTER DAYTON CHILDREN'S HAS MADE REASONABLE EFFORTS TO CONTACT A FAMILY ABOUT ITS BILL AND THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAMS. THESE PRACTICES APPLY TO ALL PATIENTS IN GENERAL, NOT ONLY PATIENTS WHO MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE. IN ADDITION, PATIENTS ARE INFORMED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAMS THROUGH SIGNS DISPLAYED IN REGISTRATION AREAS AND THROUGH MESSAGES APPEARING ON BILLING STATEMENTS MAILED BY THE HOSPITAL. FINALLY, THE HOSPITAL EMPLOYS ON-SITE FINANCIAL COUNSELORS WHO CONTACT PATIENTS WITHOUT COVERAGE IN ORDER TO DISCUSS THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS VIA PHONE OR THROUGH FACE-TO-FACE INTERVIEWS. THESE FINANCIAL COUNSELORS WILL ASSIST FAMILIES IN APPLYING FOR FINANCIAL ASSISTANCE PROGRAMS IF DESIRED.
Schedule H Part VI #2: Needs Assessment: Describe how the organization assesses the health care needs of the communities it serves. Improving the health status of children is a key component of the Dayton Children's Hospital mission. To help develop meaningful and impactful community engagement and child health programs, Dayton Children's evaluates the status of our region's pediatric health every three years through a Community Health Needs Assessment (CHNA). Dayton Children's CHNA includes feedback from the groups convened by the hospital including community members, experts in public health and clinical practitioners and includes data regarding the health needs of vulnerable pediatric populations, those with chronic illnesses, as well as health disparities among minorities, low income and medically-underserved populations. The first assessment was conducted in 2002 then in 2005, 2008, and 2011. Our fifth and most current assessment was completed in June 2014. Funded by the Dayton Children's Foundation Board, guided by the Dayton Children's Board of Trustees Advocacy Committee and adopted by the Dayton Children's Board of Trustees, the needs assessment uncovers the highest priority child health and safety issues. As the leaders in child health, Dayton Children's provides the assessment report to provide community health advocates insights into the health and well-being of our region's children and to provide a path to work together to develop or refine programs to improve the health status of all children through community benefit investments. Dayton Children's approached our needs assessment through a four-part data collection process: 1. Secondary Data Scan: In partnership with the Greater Dayton Area Hospital Association and the Center for Urban and Public Affairs at Wright State University, a report was compiled to paint a detailed picture of the Dayton Children's Hospital primary service area. Aggregate hospital ICD9 emergency room and hospital inpatient discharge diagnoses data were obtained from the Ohio Hospital Association via the Greater Dayton Area Hospital Association. Cancer data and vital statistics were obtained from the Ohio Department of Health. 2. Parent Perception Survey: Dayton Children's used an independent research firm to conduct a parent perception survey to better understand top pediatric health and safety needs. Six hundred and forty-two parents of children living in the Dayton Children's Hospital general service area were surveyed either online or via telephone interview between January 27 and February 25, 2014. 3. Physician Conversations: An in-depth interview was done with a representative group of practicing physicians within the Greater Dayton community. Physicians serving a variety of demographics and counties within the region were represented including public health clinics. These surveys were used to identify and prioritize key pediatric health issues, understand how consumers receive care for these issues today and determine how health professionals believe Dayton Children's Hospital can respond to pediatric health priorities. 4. Parent Focus Groups: Focus groups were conducted with parents to dig deeper into some of the challenges and barriers associated with their top health and safety concerns. To choose priorities for action, the Dayton Children's CHNA multidisciplinary team reviewed the data from all four segments and then rated the needs against criteria including prevalence, seriousness (hospitalization and/or death), impact on other health issues, urgency, prevention, economics/feasibility, acceptability and resources. This multidisciplinary team included staff from Dayton Children's along with representatives from local health departments. While children are generally healthy, the study pointed to key areas where our community can work to improve the health of children in our community. 1. Childhood obesity remains at the forefront of child health issues. In the 2014 parent survey, 41 percent of children were identified as overweight or obese. The majority of parents of overweight and obese children do not perceive their children as having any weight problem. Ten percent of parents of obese children believe that their child is underweight and only 5 percent of those parents correctly identify their child as being "very overweight." 2. Mental disorders are the most common inpatient discharge diagnosis for youth ages 5-14. Fifteen percent of parents named chronic and congenital conditions that concern them. Of those 15 percent, 25 percent chose developmental or learning disabilities as a top concern and 24 percent chose autism as a top chronic or congenital concern. There is an inadequate number of resources for the number of pediatric patients needing mental health support. 3. The regional infant mortality rate was substantially lower than Ohio's rate over most of the study period then climbed up to the Ohio's rate in more recent years. Sleep-related deaths are a large contributor to infant mortality. According to the Ohio Child Fatality Review, 2007-2011, 41 percent of infant deaths from 1 month to 1 year are sleep related. In that same report, the 819 infant sleep-related deaths accounted for 15 percent of the 5,418 total reviews for infant deaths from 2007 to 2011, more than any single cause of death except prematurity. In Montgomery County alone, 16.7 percent of the infant deaths in 2012 were sleep-related incidents. Future investments are outlined in an implementation strategy adopted by the Dayton Children's Board of Trustees, per IRS requirements. The implementation plan includes the following strategies: 1. Dayton Children's will focus on decreasing pediatric obesity by working with local pediatricians and health care providers to make sure they have appropriate resources available to help children and their families choose healthier lifestyles. 2. Dayton Children's will create a Center for Pediatric Mental Health to increase access and coordinate resources for pediatric mental health in the hospital's primary service area. 3. Dayton Children's will invest in education for parents about safe sleep practices for their infants. Our assessment and implementation plan was shared with the public at a media conference on June 20, 2014, to disseminate the information. In addition, we created a summary report and outlined the next steps for each of the key issues. Finally, our health assessment was published on our hospital website and is available upon request for any interested party.
Schedule H Part VI #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. THE HOSPITAL'S POLICIES ON BILLING AND COLLECTIONS ARE POSTED ON OUR WEBSITE UNDER THE "FINANCIAL MATTERS" TAB. IT IS THE HOSPITAL'S POLICY TO PUBLICIZE THE AVAILABILITY OF FREE CARE, GOVERNMENT, AND OTHER FINANCIAL ASSISTANCE PROGRAMS BEFORE SERVICES ARE PROVIDED THROUGH MEANS SUCH AS ONSITE FINANCIAL COUNSELORS AND BROCHURES PROVIDED IN THE REGISTRATION AREAS. EACH OF THESE AVENUES OF COMMUNICATION INCLUDES DETAILED INSTRUCTIONS ON HOW PATIENTS AND FAMILIES MAY APPLY FOR ASSISTANCE. THE HOSPITAL'S POLICIES ON BILLING AND COLLECTIONS SPECIFY WHEN COLLECTION ACTION MAY BE TAKEN AND MAKES IT CLEAR THAT THESE MEASURES WILL ONLY OCCUR AFTER DAYTON CHILDREN'S HAS MADE REASONABLE EFFORTS TO CONTACT A FAMILY ABOUT ITS BILL AND THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAMS. THESE PRACTICES APPLY TO ALL PATIENTS IN GENERAL, NOT ONLY PATIENTS WHO MIGHT BE ELIGIBLE FOR FINANCIAL ASSISTANCE. IN ADDITION, PATIENTS ARE INFORMED OF THE AVAILABILITY OF FINANCIAL ASSISTANCE PROGRAMS THROUGH SIGNS DISPLAYED IN REGISTRATION AREAS AND THROUGH MESSAGES APPEARING ON BILLING STATEMENTS MAILED BY THE HOSPITAL. FINALLY, THE HOSPITAL EMPLOYS ON-SITE FINANCIAL COUNSELORS WHO CONTACT PATIENTS WITHOUT COVERAGE IN ORDER TO DISCUSS THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE PROGRAMS VIA PHONE OR THROUGH FACE-TO-FACE INTERVIEWS. THESE FINANCIAL COUNSELORS WILL ASSIST FAMILIES IN APPLYING FOR FINANCIAL ASSISTANCE.
Schedule H Part VI #4: Community information: Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves. Dayton Children's Hospital is located in Old North Dayton, northeast of downtown Dayton and the urban core, in Montgomery County in southwestern Ohio. The hospital's roots can be traced back to 1919, when philanthropist and activist Anna Barney Gorman planned a North Dayton community center to offer health services, education and recreation. The Barney Community Center later developed into the Barney Convalescent Hospital, which cared for polio victims. In 1967 a full-service children's hospital, The Barney Children's Medical Center, opened. The name was changed in 1970 to The Children's Medical Center of Dayton. In spring 2013, the hospital changed its name once again to Dayton Children's Hospital. Dayton Children's now serves 20 Ohio counties, including the primary (Montgomery, Greene, Clark and Miami Counties), the northern (Allen, Auglaize and Shelby counties), and the southern (parts of Butler and Warren counties) service areas and our secondary service area including Preble, Darke, Mercer, Van Wert, Clinton, Madison, Hancock, Hardin, Logan, Fayette, Champaign and Wayne County, Indiana. Our service area spans 9,000 square miles with a 2.1 million pediatric population that includes poor urban and rural areas. We are the only pediatric health care provider and the largest provider of medical care to low-income children in the region. Currently, we serve a disproportionate share of children from low-income families. Currently over 50 percent of the patients at Dayton Children's are covered by Medicaid. In addition, Dayton Children's serves as the pediatric resource for military families stationed at nearby Wright-Patterson Air Force Base. Dayton Children's has always believed that infants, children and teens need to be cared for by pediatric specialists. With improved access to pediatric specialty services, we were able to provide expert care to over 300,000 children in our 20-county region. Our outpatient and alternative services including pediatric laboratory and imaging, complement our inpatient services. Many programs have received certifications and accreditations from organizations setting the standards of quality care; our scores from the Joint Commission on Accreditation of Healthcare Organizations are consistently among the highest in the nation. In Fall 2013, Dayton Children's Hospital received Magnet designation, meaning the hospital is recognized nationally as the gold standard in patient care and the professional practice of nursing by the American Nurses Credentialing Center (ANCC).
Schedule H Part VI #5: PROMOTION OF COMMUNITY HEALTH. PROVIDE ANY OTHER INFORMATION IMPORTANT TO DESCRIBING HOW THE ORGANIZATION'S HOSPITALS FACILITIES OR OTHER HEALTH CARE FACILITIES FURTHER ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY. THROUGH A VARIETY OF COMMUNITY-BUILDING ACTIVITIES, DAYTON CHILDREN'S STAFF AND SENIOR LEADERSHIP ARE WORKING BEYOND THE WALLS OF OUR HOSPITAL TO CREATE A HEALTHY COMMUNITY FOR ALL CHILDREN AND FAMILIES IN OUR REGION. AS THE ONLY CHILDREN'S HOSPITAL IN THE REGION, WE TAKE OUR PEDIATRIC EXPERTISE INTO THE COMMUNITY TO SOLVE PROBLEMS AND CREATE A HEALTHY COMMUNITY FOR OUR CHILDREN. OUR COMMUNITY RELATIONSHIPS DEMONSTRATE OUR COMMITMENT TO DAYTON AND SURROUNDING COMMUNITY - A COMMUNITY WE HAVE CALLED HOME FOR NEARLY 50 YEARS. DAYTON CHILDREN'S IS COMMITTED TO WORKING WITH OUR MANY VALUED PARTNERS TO HELP ENSURE DAYTON REMAINS A GREAT CITY TO LIVE, WORK AND PLAY. TIED DIRECTLY TO THE COMMUNITY NEEDS IDENTIFIED THROUGH OUR ASSESSMENT, DAYTON CHILDREN'S PARTICIPATES IN A VARIETY OF COMMUNITY BUILDING AND COMMUNITY OUTREACH INITIATIVES TO ADDRESS THE LEADING HEALTH ISSUES AFFECTING CHILDREN IN OUR COMMUNITY. KEY INITIATIVES IN 2014-2015 COMMUNITY HEALTH NEEDS ASSESSMENT IMPLEMENTATION PLAN PRIORITY 1: NUTRITION EDUCATION/CHILDHOOD OBESITY IN THE 2014 PARENT SURVEY, 41 PERCENT OF CHILDREN WERE IDENTIFIED AS OVERWEIGHT OR OBESE. THE MAJORITY OF PARENTS OF OVERWEIGHT AND OBESE CHILDREN DO NOT PERCEIVE THEIR CHILDREN AS HAVING ANY WEIGHT PROBLEM. TEN PERCENT OF PARENTS OF OBESE CHILDREN BELIEVE THAT THEIR CHILD IS UNDERWEIGHT AND ONLY 5 PERCENT OF THOSE PARENTS CORRECTLY IDENTIFY THEIR CHILD AS BEING "VERY OVERWEIGHT." NEARLY ALL PHYSICIANS BELIEVE OBESITY IS A SIGNIFICANT MEDICAL ISSUE WITHIN DAYTON, AND PARTICULARLY WITHIN THE UNDERSERVED/MEDICAID POPULATION. IMPLEMENTATION PLAN UPDATE: DAYTON CHILDREN'S IS FOCUSING ON DECREASING THE LOCAL PEDIATRIC OBESITY RATE BY WORKING WITH LOCAL PEDIATRICIANS AND HEALTH CARE PROVIDERS OVER THE NEXT THREE YEARS. DAYTON CHILDREN'S CREATED A DIETETIC LIAISON PROGRAM PLACING DIETICIANS IN COMMUNITY PHYSICIAN PRACTICES AND OFFERING EDUCATION TO BOTH FAMILIES AND PRACTITIONERS TO ADDRESS CHILDHOOD OBESITY AND NUTRITION. IN FY2015, THIS PROGRAM GAVE EDUCATION TO ROUGHLY 40 PROVIDERS AND OFFICE STAFF PERSONNEL PER MONTH. IN ADDITION, 20 INDIVIDUALS (PARENTS AND CHILDREN) HAVE RECEIVED EDUCATION EACH MONTH. TO COMPLEMENT THE ONE ON ONE EDUCATION AROUND OBESITY OFFERED TO PARENTS AND PROVIDERS, DAYTON CHILDREN'S KOHL'S A MINUTE FOR KIDS CAMPAIGN, OFFERED IN PARTNERSHIP WITH KOHL'S DEPARTMENT STORES, REACHED 9,106,000 PEOPLE THOUGH PAID MEDIA ADVERTISING AND 20,000 THROUGH OUTREACH EVENTS- BOTH FOCUSING ON THE IMPORTANCE OF TALKING WITH A PHYSICIAN ABOUT WEIGHT CONCERNS. WITHIN THE HOSPITAL, DAYTON CHILDREN'S PROVIDES INFORMATION TO PARENTS REGARDING THEIR CHILD'S BMI IN BOTH THE INPATIENT AND OUTPATIENT SETTINGS TO BEGIN A CONVERSATION ABOUT HEALTHY GROWTH. PRIORITY 2: MENTAL HEALTH MENTAL DISORDERS ARE THE MOST COMMON INPATIENT DISCHARGE DIAGNOSIS FOR YOUTH AGES 5 TO 14. FIFTEEN PERCENT OF PARENTS NAMED CHRONIC AND CONGENITAL CONDITIONS THAT CONCERN THEM. OF THOSE FIFTEEN PERCENT, 25 PERCENT CHOSE DEVELOPMENTAL OR LEARNING DISABILITIES AS A TOP CONCERN AND 24 PERCENT CHOSE AUTISM AS A TOP CHRONIC OR CONGENITAL CONCERN. ALSO CITED WAS AN INADEQUATE NUMBER OF RESOURCES FOR THE NUMBER OF PEDIATRIC PATIENTS NEEDING MENTAL HEALTH SUPPORT. IMPLEMENTATION PLAN UPDATE: ON JANUARY 1, 2014, DAYTON CHILDREN'S OPENED THE CENTER FOR PEDIATRIC MENTAL HEALTH RESOURCES, INCREASING ACCESS TO THESE VITAL SERVICES. IN ORDER TO PROVIDE THESE SERVICES, DAYTON CHILDREN'S PARTNERED WITH ADAMHS BOARD OF MONTGOMERY COUNTY, MONTGOMERY COUNTY DEVELOPMENTAL DISABILITIES SERVICES AND THE PSYCHIATRY DIVISION OF WRIGHT STATE UNIVERSITY BOONSHOFT SCHOOL OF MEDICINE. IN FY 2015, DAYTON CHILDREN'S SAW APPROXIMATELY 2,000 PSYCHIATRY VISITS AND OFFERED PEDIATRIC PSYCHIATRY SERVICES NOT PREVIOUSLY AVAILABLE IN OUR REGION. THE CENTER FOR PEDIATRIC MENTAL HEALTH RESOURCES ALSO FINALIZED, APPROVED AND FUNDED A THREE-YEAR STRATEGIC PLAN TO IMPROVE MENTAL HEALTH RESOURCES IN OUR COMMUNITY. AS PART OF THE PLAN, THE CENTER ESTABLISHED A REGIONAL PEDIATRIC MENTAL HEALTH ADVISORY ALLIANCE TO IMPROVE COLLABORATION AMONG CARE PROVIDERS TO REDUCE GAPS IN SERVICE. THE ALLIANCE CURRENTLY CONSISTS OF 21 COMMUNITY AGENCIES AND MEETS SIX TIMES PER YEAR. IN APRIL 2015, DAYTON CHILDREN'S OPENED AN AUTISM DIAGNOSTIC AND RESOURCE CENTER. THIS CENTER PROVIDES SCREENING TESTS FOR CHILDREN YOUNGER THAN 5 YEARS TO DETERMINE WHETHER BEHAVIORS ARE CONSISTENT WITH AUTISM OR ANOTHER DEVELOPMENTAL OR LEARNING DISORDER. THE WAIT TIME FOR NEW EVALUATIONS HAS DECREASED FROM OVER 200 DAYS TO LESS THAN 5 DAYS. THE INCREASED FOCUS ON MENTAL HEALTH HAS ALLOWED DAYTON CHILDREN'S TO IMPLEMENT SEVERAL SIGNIFICANT IMPROVEMENTS TO ADDRESS AN INCREASING NUMBER OF CHILDREN (APPROXIMATELY 600) COMING TO OUR EMERGENCY DEPARTMENT FOR MENTAL HEALTH EVALUATIONS. WE HAVE REVISED INTERNAL PROCESSES TO PROVIDE FOR GREATER SUPERVISION AND SAFETY FOR THESE CHILDREN, AS WELL AS DEVELOPED RELATIONSHIPS WITH PEDIATRIC PSYCHIATRIC INPATIENT UNITS TO EXPEDITE THE TRANSFER OF THESE PATIENTS. DAYTON CHILDREN'S ALSO SUCCESSFULLY RECRUITED A PEDIATRIC NEUROPSYCHOLOGIST, WHO WILL DEVELOP A PROGRAM TO EVALUATE CHILDREN NEEDING THESE SPECIALIZED ASSESSMENTS. AND THE HOSPITAL CONTINUES TO ENGAGE PEDIATRIC PRACTICES TO EDUCATE THEM ON THE AVAILABILITY OF OUR SERVICES. CENTER STAFF HAS ALSO MADE OVER 30 PRESENTATIONS TO VARIOUS COMMUNITY GROUPS THIS PAST YEAR. PRIORITY 3: INFANT MORTALITY/SAFE SLEEP PRACTICES THE REGIONAL INFANT MORTALITY RATE WAS SUBSTANTIALLY LOWER THAN THE STATE'S RATE OVER MOST OF THE STUDY PERIOD THEN CLIMBED UP TO THE STATE RATE IN MORE RECENT YEARS. SLEEP-RELATED DEATHS ARE A LARGE CONTRIBUTOR TO INFANT MORTALITY. ACCORDING TO THE OHIO CHILD FATALITY REVIEW, 2007-2011, 41 PERCENT OF INFANT DEATHS FROM 1 MONTH TO 1 YEAR ARE SLEEP RELATED. IN THAT SAME REPORT, THE 819 INFANT SLEEP-RELATED DEATHS ACCOUNTED FOR 15 PERCENT OF THE 5,418 TOTAL REVIEWS FOR INFANT DEATHS FROM 2007 TO 2011, MORE THAN ANY SINGLE CAUSE OF DEATH EXCEPT PREMATURITY. IN MONTGOMERY COUNTY ALONE, 16.67 PERCENT OF THE INFANT DEATHS IN 2012 WERE SLEEP-RELATED INCIDENTS. IMPLEMENTATION STRATEGY: DAYTON CHILDREN'S IS INVESTED IN EDUCATION FOR PARENTS ABOUT SAFE SLEEP PRACTICES FOR THE INFANTS THEY TREAT. DAYTON CHILDREN'S CONTINUES TO EDUCATE FAMILIES WITH CHILDREN YOUNGER THAN 12 MONTHS OLD BY MODELING SAFE SLEEP PRACTICES AND BY HAVING ONE-ON-ONE CONVERSATIONS ON SAFE SLEEP TO SCREEN FOR BABIES WHO MAY NOT BE SLEEPING IN A SAFE ENVIRONMENT. DAYTON CHILDREN'S ALSO SHARES SAFE SLEEP MESSAGES IN THE COMMUNITY AND ATTENDED MORE THAN 35 COMMUNITY EVENTS REACHING OVER 4,000 COMMUNITY MEMBERS WITH MESSAGING. DAYTON CHILDREN'S ALSO PARTICIPATES ON A VARIETY OF COALITIONS AND COMMUNITY GROUPS TO ADDRESS INFANT MORTALITY IN OUR COMMUNITY INCLUDING THE OHIO INJURY PREVENTION PARTNERSHIP, OHIO COLLABORATIVE TO PREVENT INFANT MORTALITY, MONTGOMERY COUNTY INFANT MORTALITY COALITION AND THE OHIO AAP. DAYTON CHILDREN'S IS ALSO A DESIGNATED CRIBS FOR KIDS SITE. THROUGH THIS PROGRAM, PARENTS/CAREGIVERS NEEDING A SAFE PLACE FOR THEIR BABY TO SLEEP ATTEND A ONE HOUR SAFE-SLEEP CLASS GIVEN BY TRAINED STAFF. AT THE END OF THE CLASS, PARENTS/CAREGIVERS ARE PROVIDED WITH A GRACO PACK 'N PLAY PORTABLE CRIB. WE ALSO OFFER A COMPLETE 'SAFE SLEEP SURVIVAL KIT: WHICH CONTAINS A HALO SLEEP SACK (WEARABLE BLANKET), A PACK N PLAY CRIB SHEET, AND A PACIFIER APPROVED BY THE AMERICAN ACADEMY OF PEDIATRICS. IN FY 2015, DAYTON CHILDREN'S DISTRIBUTED OVER 485 PACK N PLAYS THROUGH THIS PROGRAM. THIS YEAR, DAYTON CHILDREN'S ALSO RECEIVED A GRANT FROM THE OHIO INJURY PREVENTION PARTNERSHIP/OHIO DEPARTMENT OF HEALTH TO TRAIN HOME VISITORS EMPLOYED BY WIC AND HELP ME GROW, AS WELL AS EDUCATORS WHO TRAIN DAY CARE CENTER PROGRAM STAFF, ON THE SAFE SLEEP ENVIRONMENT. DURING THIS FISCAL YEAR FUNDING WAS SECURED AND INITIAL TRAININGS WERE HELD. DURING THIS FISCAL YEAR WE ALSO REALIGNED OUR INTERNAL INFANT MORTALITY AWARENESS AND PREVENTION COMMITTEE AREAS OF FOCUS WITH THE OHIO DEPARTMENT OF HEALTH OHIO INFANT MORTALITY REDUCTION WORK PLAN TO ENSURE OUR STRATEGIES ALIGNED WITH THE WORK BEING DONE AT THE STATE LEVEL. WHILE THERE IS A LOT OF WORK TO DO AROUND INFANT MORTALITY WITHIN OUR REGION AND ACROSS THE STATE OF OHIO, MONTGOMERY COUNTY SAW A DROP IN OUR INFANT MORTALITY RATE IN 2014 TO 6.1 COMPARED TO OUR 10-YEAR AVERAGE OF 7.7 DEATHS PER 1,000 (ODH IN THE 2014 OHIO INFANT MORTALITY DATA: GENERAL FINDINGS).
Schedule H Part VI ADDITIONAL INITIATIVES CENTER FOR CHILD HEALTH AND WELLNESS DAYTON CHILDREN'S MISSION IS TO IMPROVE THE HEALTH AND WELLBEING OF ALL CHILDREN, NOT JUST THOSE WHO COME TO THE ORGANIZATION FOR CARE. AS A RESULT, THE BOARD OF TRUSTEES APPROVED THE FORMATION OF THE CENTER FOR CHILD HEALTH AND WELLNESS IN FEBRUARY 2015 TO BETTER ADDRESS THE ISSUES IDENTIFIED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT. THE CENTER ADDS MORE CAPACITY TO ADDRESS CHILD HEALTH AND SAFETY CONCERNS BEYOND THE WALLS OF THE HOSPITAL AND TO HELP PRIORITIZE THE HEALTH AND SAFETY NEEDS IN OUR COMMUNITY ENSURING ALL CHILDREN IN OUR REGION THRIVE. THE CENTER OPERATES IN FOUR AREAS OF CHILD HEALTH: EDUCATION AND OUTREACH, POLICY AND RESEARCH. BY COORDINATING INTERNAL, REGIONAL, STATE AND NATIONAL ORGANIZATIONS AND RESOURCES, THE CENTER AND ITS PARTNERS ARE ABLE TO PROVIDE SPECIFIC PROGRAMS DESIGNED TO PREVENT ILLNESS, INJURY AND OTHER HARM, AS WELL AS IMPROVE THE HEALTH OF CHILDREN. THE CENTER FOCUSES ON CROSS-SECTOR COLLABORATION TO ADDRESS THE SOCIAL DETERMINANTS OF HEALTH AND HEALTH DISPARITY THAT LEAD TO ALIGNED PROGRAMS THAT WILL ALLOW US TO MAKE OUR REGION ONE OF THE HEALTHIEST PLACES TO GROW UP. THE CENTER WILL LEAD THE COMMUNITY HEALTH ASSESSMENT RESEARCH, PLANNING AND PRIORITY AREA PROGRAM IMPLEMENTATION, OUTREACH AND EDUCATION PROGRAMMING, AND CHILD HEALTH POLICY INITIATIVES TO MOVE CHILDREN'S HEALTH AND SAFETY ISSUES FORWARD. THROUGH THE CENTER FOR CHILD HEALTH AND WELL NESS, THE HOSPITAL WILL WORK WITH ORGANIZATIONS FOCUSED ON CHILD HEALTH AND SAFETY ISSUES TO ESTABLISH A COMMUNITYWIDE CHILD HEALTH AND WELLNESS PUBLIC POLICY AGENDA. THE INITIAL FOCUS ON THE CENTER FOR CHILD HEALTH AND WELL NESS WILL BE TO ADDRESS TWO ADDITIONAL NEEDS IDENTIFIED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT, PEDIATRIC ASTHMA AND THE NEED FOR GREATER CONNECTIONS TO RESOURCES FOR PATIENT FAMILIES. INJURY PREVENTION UNINTENTIONAL INJURY IS A LEADING CAUSE OF DEATH AND DISABILITY FOR CHILDREN ACROSS THE COUNTRY AND THE STATISTICS ARE VERY SIMILAR FOR OUR SERVICE AREAS AS WELL AS IDENTIFIED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT. DAYTON CHILDREN'S CONTINUES OUR WORK TO PREVENT CHILDHOOD INJURIES. WE WORK WITH PARTNERS SUCH AS SAFE COMMUNITIES, OHIO INJURY PREVENTION PARTNERSHIP, OHIO OCCUPANT PROTECTION REGIONAL COORDINATOR PROGRAM AND THE MONTGOMERY COUNTY CHILD FATALITY REVIEW BOARD TO ADDRESS SOME OF THE KEY UNINTENTIONAL INJURIES TO CHILDREN IN OUR COMMUNITY, SUCH AS MOTOR VEHICLE ACCIDENTS, PEDESTRIAN ACCIDENTS AND UNSAFE SLEEP PRACTICES. WE ARE THE LEAD AGENCY OF SAFE KIDS GREATER DAYTON, WHICH IS OUR REGION'S LEADER IN CHILDHOOD INJURY PREVENTION PROGRAMMING. THE SAFE KIDS GREATER DAYTON COALITION ADDRESSES KEY PEDIATRIC SAFETY ISSUES WITH COMMUNITY PROGRAMMING INCLUDING CHILD PASSENGER SAFETY, PEDESTRIAN SAFETY, HOME/FIRE SAFETY, MEDICATION POISONING PREVENTION AND BICYCLE HELMET EDUCATION. DAYTON CHILDREN'S ALSO WORKS WITH SPORTS TEAMS AND COACHES TO PREVENT SPORTS INJURIES AND CONCUSSIONS. THE DAVINCI PROJECT THE DAVINCI PROJECT IS A COMPREHENSIVE STRATEGY FOR NEIGHBORHOOD REVITALIZATION SUPPORTED IN THE OLD NORTH DAYTON AND MCCOOK FIELD NEIGHBORHOODS AND THE BUSINESS COMMUNITY AROUND IT- INCLUDING DAYTON CHILDREN'S. DAYTON CHILDREN'S LEADS THIS EFFORT AND IS JOINED BY PARTNERS INCLUDING THE CITY OF DAYTON, GREATER OLD NORTH DAYTON BUSINESS ASSOCIATION, THE SALVATION ARMY KROC CENTER, THE UNIVERSITY OF DAYTON FITZ CENTER OF LEADERSHIP IN COMMUNITY, ST. MARY'S COMMUNITY DEVELOPMENT CORP. AND CITY WIDE DEVELOPMENT. THE DAVINCI PROJECT IS WORKING ON EFFORTS TO DEMOLISH NUISANCE BUILDINGS, REALIGN STREETS, BUILD A CHILDREN'S GARDEN, REVITALIZE BUS STOPS, IMPROVE WAYFINDING AND BEAUTIFY THE NEIGHBORHOOD SO IT CONTINUES TO BE ATTRACTIVE TO FAMILIES AND BUSINESSES. THIS PROJECT IS IMPORTANT TO DAYTON CHILDREN'S, NOT ONLY BECAUSE WE WANT TO BE AN ACTIVE PARTICIPANT IN OUR COMMUNITY, WE WANT PATIENTS, STAFF, VOLUNTEERS AND VISITORS TO FEEL WELCOME WHEN THEY ENTER THE OLD NORTH DAYTON- A NEIGHBORHOOD THAT WE ARE PROUD TO CALL HOME. THIS PAST FISCAL YEAR, THE DAVINCI PROJECT LED SOME SIGNIFICANT CHANGES. IN DECEMBER 2014, FIVE COMMERCIAL BUILDINGS, MANY IN SEVERE DISREPAIR, WERE DEMOLISHED TO ALLOW FOR A FUTURE ROAD THAT WILL BE CONSTRUCTED IN 2020. IN THEIR PLACE, SIZABLE NEW GREEN SPACE HAS BEEN REALIZED. IN MID-MAY 2015, CREWS LAID GRASS SEED, INSTALLED TREES AND BUSHES, AND MADE MULTIPLE OTHER LANDSCAPE ENHANCEMENTS CREATING A BEAUTIFUL GREEN GATEWAY INTO THE OLD NORTH DAYTON NEIGHBORHOOD AND DAYTON CHILDREN'S HOSPITAL CAMPUS. IN SPRING 2015, A NEW BUS STOP WAS INSTALLED IN FRONT OF DAYTON CHILDREN'S. THIS BUS STOP HAS A MUCH SAFER DESIGN FOR PATIENT FAMILIES AND NEIGHBORHOOD MEMBERS. ADDITIONAL COMMUNITY SUPPORT BEYOND PARTICIPATION IN ORGANIZATIONS THAT DIRECTLY IMPACT CHILDREN AND CHILDREN'S HEALTH, DAYTON CHILDREN'S STAFF AND LEADERSHIP SERVE ON VARIOUS COALITIONS TO IMPROVE THE ECONOMIC AND SOCIAL HEALTH OF OUR COMMUNITY INCLUDING THE ST. VINCENT DE PAUL, RONALD MCDONALD HOUSE BOARD OF TRUSTEES, THE FAMILY AND CHILDREN FIRST COUNCIL AND THE NATIONAL CONFERENCE FOR COMMUNITY AND JUSTICE. THROUGH THESE ACTIVITIES, DAYTON CHILDREN'S STRIVES TO CREATE A COMMUNITY THAT IS A PLACE WHERE ALL CHILDREN AND FAMILIES GROW AND THRIVE. PROVIDE ANY OTHER INFORMATION IMPORTANT TO DESCRIBING HOW THE ORGANIZATION'S HOSPITALS 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.). DAYTON CHILDREN'S IS AN INDISPENSABLE RESOURCE TO OUR COMMUNITY BECAUSE WE: - SERVE AS THE COMMUNITY'S SAFETY NET HOSPITAL BY CARING FOR ALL CHILDREN REGARDLESS OF THEIR ABILITY TO PAY, WHILE PROVIDING AND SUBSIDIZING HOSPITAL AND COMMUNITY-BASED SERVICES THAT ARE EITHER LIMITED OR UNAVAILABLE ELSEWHERE IN OUR COMMUNITY. - SERVE AS A VOICE FOR CHILDREN THROUGH PUBLIC POLICY ADVOCACY TO CHANGE LAWS, POLICIES OR SYSTEMS LEADING TO THE IMPROVEMENT OF HEALTH AND SAFETY FOR CHILDREN AND FAMILIES. - JOIN WITH COMMUNITY PARTNERS AND LEND SUPPORT THROUGHOUT OUR REGION TO IMPROVE THE LIVES OF CHILDREN AND THEIR FAMILIES. - TRAIN FUTURE DOCTORS AND HEALTH CARE PROVIDERS TO BECOME THE NEXT GENERATION OF HIGH QUALITY, PROFESSIONAL PEDIATRIC EXPERTS, OFTEN AT A FINANCIAL LOSS TO THE HOSPITAL. AT DAYTON CHILDREN'S, WE ARE COMMITTED TO LIVING OUR MISSION TO IMPROVE THE HEALTH STATUS OF ALL CHILDREN. OUR COMMUNITY BENEFIT ACTIVITIES DEMONSTRATE THIS COMMITMENT TO OUR COMMUNITY'S CHILDREN. AS A NOT-FOR-PROFIT HOSPITAL, WE RECOGNIZE THAT WE MUST ALWAYS DO WHAT IS IN THE BEST INTEREST OF THE PATIENTS AND THE COMMUNITY-THAT OUR MISSION TRUMPS PROFIT. AT DAYTON FHILDR1N'S, WE SERVE A DISPROPORTIONATE SHARE OF CHILDREN FROM LOW-INCOME FAMILIES. IN FACT, OVER 56 PERCENT OF THE PATIENTS AT DAYTON CHILDREN'S ARE COVERED BY MEDICAID. DAYTON CHILDREN'S IS A LEADER IN IMPROVING ACCESS TO HEALTH INSURANCE FOR CHILDREN AND FAMILIES THROUGH ITS ADVOCACY EFFORTS. WE HAVE WORKED TO EXPAND CHILDREN'S COVERAGE STATEWIDE AND NATIONALLY. THE HOSPITAL HAS PROVIDED CRITICAL RESOURCES AND SUPPORT TO EFFORTS TO ENSURE THAT THESE GAINS ARE TRANSLATED INTO ACTUAL COVERAGE BY ENROLLING UNINSURED CHILDREN ON-SITE. DAYTON CHILDREN'S HEALTH CLINIC IS A PRIMARY CARE PROVIDER FOR MANY OF THE REGION'S INFANTS, CHILDREN AND TEENS. NOT ONLY IS CHILDREN'S HEALTH CLINIC A "SAFETY NET" FOR MANY FAMILIES WITH MORE THAN 10,000 VISITS EACH YEAR, IT IS ALSO A RICH TRAINING SETTING FOR FUTURE PEDIATRICIANS. AS A TEACHING HOSPITAL, DAYTON CHILDREN'S IS DEDICATED TO TRAINING THE NEXT GENERATION OF PEDIATRICIANS AND PEDIATRIC SPECIALISTS. EACH YEAR, DAYTON CHILDREN'S HOSTS 49 MEDICAL RESIDENTS FROM THE WRIGHT STATE UNIVERSITY BOONSHOFT SCHOOL OF MEDICINE. IN ADDITION, DAYTON CHILDREN'S HOUSES THIS COUNTRY'S ONLY CIVILIAN/MILITARY INTEGRATED PEDIATRIC RESIDENCY PROGRAM WITH WRIGHT-PATTERSON AIR FORCE BASE. PHYSICIANS TRAINED AT DAYTON CHILDREN'S ARE CARING FOR CHILDREN IN OUR REGION AND THROUGHOUT THE WORLD. TRAINING RESIDENT PHYSICIANS INVOLVES SIGNIFICANT COSTS FAR BEYOND THOSE USUALLY ASSOCIATED WITH PATIENT CARE. HOWEVER, WE RECOGNIZE TRAINING THE NEXT GENERATION OF PEDIATRIC PROVIDERS IS ESSENTIAL TO THE OVERALL HEALTH OF OUR COMMUNITY.
schedule H Part VI AT DAYTON CHILDREN'S, 100 PERCENT OF OUR ACTIVE STAFF PHYSICIANS ARE BOARD CERTIFIED OR BOARD ELIGIBLE IN AT LEAST ONE KEY PEDIATRIC SPECIALTY AREA. THESE PEDIATRIC SPECIALISTS ARE THE CORE OF OUR CENTERS OF EXCELLENCE AVAILABLE RIGHT HERE IN DAYTON: -THERE ARE 10 PEDIATRIC CANCER CARE PROGRAMS IN THE NATION ACCREDITED BY THE AMERICAN COLLEGE OF SURGEONS COMMISSION ON CANCER AND HOUSED IN FREESTANDING CHILDREN'S HOSPITAL. DAYTON CHILDREN'S COMPREHENSIVE CARE CENTER OF CANCER AND BLOOD DISORDERS IS ONE OF THEM. THIS MEANS WE SHARE THE LATEST PROTOCOLS, RESEARCH AND CLINICAL TRIALS SO A CHILD WITH CANCER IN DAYTON GETS THE SAME CARE AS THEY WOULD AT ANY OTHER TOP CENTER IN THE COUNTRY. IN JULY 2013, DAYTON CHILDREN'S HOSPITAL WAS AWARDED A THREE-YEAR NATIONAL RE-ACCREDITATION WITH COMMENDATION TO THE CANCER PROGRAM BY THE COMMISSION ON CANCER OF THE AMERICAN COLLEGE OF SURGEONS. -OUR DESIGNATED LEVEL III REGIONAL NICU PROVIDES A STATE-OF-THE-ART, DEVELOPMENTALLY-CENTERED UNIT THAT OFFERS A FULL RANGE OF NEWBORN CARE INCLUDING EMERGENCY AND CONTINUING CRITICAL CARE FOR PREMATURE AND CRITICALLY-ILL NEWBORNS. -DAYTON CHILDREN'S HOUSES THE REGIONAL CENTERS FOR CYSTIC FIBROSIS, HEMOPHILIA AND SICKLE CELL. -THE SOIN PEDIATRIC TRAUMA AND EMERGENCY CENTER IS THE REGION'S ONLY VERIFIED (LEVEL II) PEDIATRIC TRAUMA CENTER. -DAYTON CHILDREN'S PERFORMS THE MAJORITY OF SPINAL SURGERIES IN OUR REGION. WE DO EVERYTHING WE CAN TO CREATE A HIGH-QUALITY, SAFE ENVIRONMENT FOR OUR YOUNG PATIENTS. IN ADDITION TO PROVIDING CHILD LIFE SPECIALISTS, TRAINED IN DISTRACTION TECHNIQUES, WE "KID-SIZE" OUR CARE. OUR MEDICAL IMAGING DEPARTMENT HAS STATE-OF-THE-ART EQUIPMENT DESIGNED TO PERFORM DIAGNOSTIC EXAMINATIONS WITH A MINIMUM OF RADIATION EXPOSURE TO PATIENTS, REDUCING LONG-TERM EFFECTS LATER IN LIFE. CHILDREN COME TO OUR TRAUMA CENTER TO RECEIVE TREATMENT FOR COMMON EMERGENCIES - BREATHING DIFFICULTIES AND ASTHMA, SEIZURES AND DEHYDRATION - AS WELL AS TRAUMA CONDITIONS RESULTING FROM MOTOR VEHICLE CRASHES, BURNS, NEAR DROWNINGS, PLAYGROUND- AND SPORTS-RELATED ACCIDENTS, FRACTURES AND CHILD ABUSE. THESE CHILDREN NEED CARE FROM STAFF TRAINED TO USE CHILD-SIZED MEDICAL EQUIPMENT, PEDIATRIC PROTOCOLS THAT LIMIT RADIATION EXPOSURE AND WEIGHT-BASED MEDICATION DOSAGES. EMERGENCY ROOMS AT ADULT HOSPITALS ARE NOT WELL EQUIPPED OR STAFFED TO CARE FOR SERIOUSLY ILL CHILDREN. THESE FACILITIES MAY PROVIDE INITIAL, STABILIZING TREATMENT, BUT OFTEN THE NEXT STEP IS CONTACTING DAYTON CHILDREN'S TO PROVIDE A HIGHER LEVEL OF CARE. OUR EMERGENCY AND TRAUMA SERVICES CAN MAKE THE DIFFERENCE BETWEEN LIFE AND DEATH SINCE STUDIES SHOW CHILDREN HAVE A HIGHER SURVIVAL RATE AT PEDIATRIC TRAUMA CENTERS THAN AT ADULT TRAUMA CENTERS. WHILE HOSPITAL-WIDE, OVER 50 PERCENT OF PATIENTS ARE ON MEDICAID, MORE THAN 65 PERCENT OF OUR EMERGENCY AND TRAUMA PATIENTS RELY ON MEDICAID, WHICH IS REIMBURSED AT ROUGHLY 70 PERCENT THE COST OF CARE. AN ADDITIONAL FOUR PERCENT OF EMERGENCY PATIENTS HAVE NO INSURANCE AT ALL. NEVERTHELESS, DAYTON CHILDREN'S IS COMMITTED TO TREATING ALL CHILDREN AND SUBSIDIZES THE CARE OF UNINSURED OR UNDERINSURED CHILDREN. THAT'S WHY WE ARE KNOWN THROUGHOUT THE REGION AS A SAFETY NET FOR CHILDREN FROM LOW-INCOME AND UNEMPLOYED FAMILIES. TO PROVIDE THE BEST CARE FOR CHILDREN, DAYTON CHILDREN'S OFFERS MANY CLINICAL PROGRAMS DESPITE FINANCIAL LOSS BECAUSE THEY MEET AN IDENTIFIED COMMUNITY HEALTH NEED. THESE SPECIALTY PROGRAMS INCLUDE PEDIATRIC PULMONARY, ENDOCRINOLOGY, HEMATOLOGY/ONCOLOGY, GASTROENTEROLOGY, PSYCHIATRY, NEPHROLOGY, UROLOGY, SURGERY, CHILD ABUSE, NEUROLOGY, DEVELOPMENTAL PEDIATRICS, CARDIOLOGY, PLASTICS SURGERY, SPORTS MEDICINE, OUR SPECIALTY CLINICS AND GENERAL PEDIATRICS. DAYTON CHILDREN'S JOINS WITH OTHER CHILDREN'S HOSPITALS ACROSS THE COUNTRY TO ADDRESS ISSUES UNIQUE TO THE POPULATION WE SERVE. WE WORK WITH THE CHILDREN'S HOSPITAL ASSOCIATION, THE OHIO CHILDREN'S HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION TO ENSURE CHILDREN HAVE A VOICE IN POLICY MATTERS. IN THE HEALTH CARE REFORM CONVERSATION WE MAKE SURE CHILDREN'S ISSUES, SUCH AS ACCESS TO APPROPRIATE CARE, ARE NOT FORGOTTEN. DAYTON CHILDREN'S FURTHER SUPPORTS COMMUNITY EFFORTS TO IMPROVE THE HEALTH AND SAFETY OF CHILDREN THROUGHOUT THE REGION THROUGH DONATIONS AND SPONSORSHIPS MADE TO PROGRAMS THAT SUPPORT, HELP AND IMPROVE THE HEALTH STATUS OF CHILDREN AND IMPROVE THE QUALITY OF LIFE FOR CHILDREN AND THEIR FAMILIES. DAYTON CHILDREN'S HAS ASSISTED MANY ORGANIZATIONS INCLUDING: A SPECIAL WISH, AMERICAN HEART ASSOCIATION, AMERICAN RED CROSS, CLOTHES THAT WORK, CRAYONS TO CLASSROOMS, CYSTIC FIBROSIS FOUNDATION, EPILEPSY FOUNDATION OF WESTERN OHIO, JUVENILE DIABETES RESEARCH FOUNDATION, MARCH OF DIMES, RONALD MCDONALD HOUSE CHARITIES, ST. VINCENT DE PAUL AND UNITED REHABILITATION SERVICES. IN ADDITION, WE HAVE SUPPORTED MANY COMMUNITY YOUTH SPORTS TEAMS. AT DAYTON CHILDREN'S, WE BELIEVE THAT ALL CHILDREN IN OUR REGION DESERVE A GREAT CHILDREN'S HOSPITAL CLOSE TO HOME. WE ARE DEDICATED TO ADDRESSING THE HEALTH AND WELLNESS NEEDS OF CHILDREN BOTH THROUGH CLINICAL PRACTICE AS WELL AS OUR COMMUNITY BENEFIT ACTIVITIES. STATE FILING OF COMMUNITY BENEFIT REPORT OH
Schedule H (Form 990) 2014
Additional Data


Software ID:  
Software Version:  
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
2014
Open to Public
Inspection
Name of the organization
Dayton Children's Hospital
 
Employer identification number
31-0672132
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
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 Domestic Organizations and Domestic Governments. 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 section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) DAYTON DEVELOPMENT COALITION

 
 
31-1423890 501(C)(6) 10,000       CORPORATE SPONSOR
(2) RONALD MCDONALD HOUSE

 
 
31-0964793 501(C)(3) 12,500       CORPORATE DONATION
(3) CULTURE WORKS
110 N MAIN STREET
SUITE 165
DAYTON,OH45402
23-7412338 501(C)(3) 6,500       CORPORATE PLEDGE
(4) THE LEUKEMIA & LYMPHOMA SOCIETY
1311 MAMARONECK AVE
WHITE PLAINS,NY106055221
13-5644916 501(C)(3) 7,500       MAN & WOMAN OF THE YEAR
(5) UNITED WAY OF GREATER DAYTON
184 SALEM AVENUE
FOUNDATION BUILDING 375
DAYTON,OH45406
31-0536658 501(C)(3) 24,000       CORPORATE PLEDGE
(6) GOODWILL EASTER SEALS
1511 KUNTZ ROAD
DAYTON,OH45404
37-0537112 501(C)(3) 10,000       INJURY PREVENTION
(7) DAYTON SOCIETY OF NATURAL HISTORY
2600 DEWEESE PARKWAY
DAYTON,OH45414
31-0585917 501(C)(3) 7,500       HEALTH AND FITNESS
(8) GALA OF HOPE FOUNDATION
3500 PENTAGON BOULEVARD
SUITE 500
DAYTON,OH45431
46-4277044 501(C)(3) 10,000       CORPORATE SPONSOR








2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
7
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2014

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. 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
(1) PHARMACY 295 39,583      
(2) MEALS/FOOD 1069 32,308      
(3) TRANSPORTATION 1236 30,792      
(4) RENT/UTILITIES 49 24,055      
(5) SPECIAL EQUIPMENT 26 7,200      
(6) OTHER 7 4,175      


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
SUPPLEMENTAL INFORMATION SCHEDULE 1, PART 1, LINE 2 THE FINANCE COMMITTEE AND COMMUNITY RELATIONS MANAGER APPROVE ALL GRANTS AND CHARITABLE DONATIONS.
Schedule I (Form 990) 2014


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
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.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
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 in column(B) reported as deferred in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1JEFFREY CHRISTIANMDENDED 101TRUSTEE (i)
(ii)
0
...............................
489,382
0
...............................
0
0
...............................
26,612
0
...............................
36,271
0
...............................
26,742
0
...............................
579,007
0
...............................
0
2DAVID KINSAULFORMER PRESIDENT AND CEO (i)
(ii)
0
...............................
0
0
...............................
0
239,066
...............................
0
0
...............................
0
0
...............................
0
239,066
...............................
0
239,066
...............................
0
3DEBORAH FELDMANPRESIDENT AND CEO (i)
(ii)
486,703
...............................
0
168,000
...............................
0
26,396
...............................
0
151,939
...............................
0
0
...............................
0
833,038
...............................
0
0
...............................
0
4DAVID T MILLERVP FINANCE AND CFO (i)
(ii)
272,746
...............................
0
60,170
...............................
0
59,244
...............................
0
152,307
...............................
0
21,411
...............................
0
565,878
...............................
0
0
...............................
0
5MATTHEW GRAYBILLVP AND CHIEF OPERATING OFFICER (i)
(ii)
236,318
...............................
0
66,306
...............................
0
25,150
...............................
0
73,775
...............................
0
26,885
...............................
0
428,434
...............................
0
0
...............................
0
6Adam MezoffVP Medical Affairs CMO (i)
(ii)
352,473
...............................
0
70,210
...............................
0
36,000
...............................
0
15,600
...............................
0
18,652
...............................
0
492,935
...............................
0
0
...............................
0
7Lisa CoffeyVP Corporate Support Services (i)
(ii)
161,122
...............................
0
34,109
...............................
0
17,596
...............................
0
25,296
...............................
0
24,718
...............................
0
262,841
...............................
0
0
...............................
0
8Renae PhillipsVP Patient Care CNO (i)
(ii)
208,595
...............................
0
41,991
...............................
0
25,329
...............................
0
81,659
...............................
0
20,716
...............................
0
378,290
...............................
0
0
...............................
0
9Gregory RameyVP Outpatient Services (i)
(ii)
169,470
...............................
0
0
...............................
0
33,059
...............................
0
13,759
...............................
0
23,376
...............................
0
239,664
...............................
0
0
...............................
0
10Vicki GiambroneVP Maktng External Relations (i)
(ii)
184,975
...............................
0
42,587
...............................
0
48,019
...............................
0
20,465
...............................
0
10,684
...............................
0
306,730
...............................
0
0
...............................
0
11Maragret HemmenCR Nurse Anesthetist (i)
(ii)
189,836
...............................
0
0
...............................
0
12,375
...............................
0
17,984
...............................
0
127
...............................
0
220,322
...............................
0
0
...............................
0
12Erika GreenCR Nurse Anesthetist (i)
(ii)
161,858
...............................
0
0
...............................
0
17,828
...............................
0
10,800
...............................
0
6,137
...............................
0
196,623
...............................
0
0
...............................
0
13Elizabeth FredetteDirector Info Services CIO (i)
(ii)
158,548
...............................
0
10,288
...............................
0
18,077
...............................
0
16,610
...............................
0
25,313
...............................
0
228,836
...............................
0
0
...............................
0
14THOMAS KRZMARZICK BEG 1101CHAIRMAN ELECT-PROF STAFF (i)
(ii)
201,529
...............................
0
0
...............................
0
0
...............................
0
0
...............................
0
0
...............................
0
201,529
...............................
0
0
...............................
0
15BEN GOODSTEIN BEG 0114VP & CHIEF AMBULATORY OFFICER (i)
(ii)
156,712
...............................
0
24,502
...............................
0
12,648
...............................
0
8,236
...............................
0
30,176
...............................
0
232,274
...............................
0
0
...............................
0
16CINDY BURGER BEG 0114VP FOR PATIENT EXPERIENCE (i)
(ii)
155,858
...............................
0
11,753
...............................
0
17,258
...............................
0
16,740
...............................
0
26,938
...............................
0
228,547
...............................
0
0
...............................
0
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
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
SUPPLEMENTAL INFORMATION SCHEDULE J, PART I, LINE 4B PARTICIPANTS IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND THE INCREASE IN ACTUARIAL VALUE: DEBORAH FELDMAN - 136,339 ADAM MEZOFF - 0 DAVID T. MILLER - 141,910 GREGORY RAMEY - 5,833 VICKI GIAMBRONE - 13,052 MATTHEW GRAYBILL - 63,449 RENAE PHILLIPS - 72,446 LISA COFFEY - 17,961 CINDY BURGER - 9,561 BEN GOODSTEIN - 0
Schedule J (Form 990) 2014

Additional Data


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

SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
Dayton Children's Hospital
 
Employer identification number
31-0672132
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer
(i) Pool
financing
Yes No Yes No Yes No
A COUNTY OF MONTGOMERY
 
31-6000172   08-19-2014 117,055,000 HOSPITAL RENOVATION   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . . 0      
2 Amount of bonds legally defeased . . . . . . . . . . . 0      
3 Total proceeds of issue . . . . . . . . . . . . . . 117,055,000      
4 Gross proceeds in reserve funds . . . . . . . . . . . . 0      
5 Capitalized interest from proceeds . . . . . . . . . . . 0      
6 Proceeds in refunding escrows . . . . . . . . . . . . 0      
7 Issuance costs from proceeds . . . . . . . . . . . . 400,070      
8 Credit enhancement from proceeds . . . . . . . . . . . 0      
9 Working capital expenditures from proceeds . . . . . . . . . 0      
10 Capital expenditures from proceeds . . . . . . . . . . . 0      
11 Other spent proceeds . . . . . . . . . . . . . . 0      
12 Other unspent proceeds . . . . . . . . . . . . . . 0      
13 Year of substantial completion . . . . . . . . . . . . 2017
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . . .   X            
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . X              
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
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            
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?                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .   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 . . SchKMediumBullet 0 %      
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0 %      
6 Total of lines 4 and 5 . . . . . . . . . . . . . 0 %      
7 Does the bond issue meet the private security or payment test? . . . . .   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            
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. 0 %      
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .   X            
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            
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .   X            
c No rebate due? . . . . . . . .   X            
If "Yes" to line 2c, provide in Part VI the date the rebate
computation was performed . . . . . .
3 Is the bond issue a variable rate issue? . . . . X              
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . . 0
 
 
 
 
 
 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . .   X            
e Was the hedge terminated? . . . . . .   X            
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
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            
b Name of provider . . . . . . . . . 0
 
 
 
 
 
 
 
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            
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   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            
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
Schedule K (Form 990) 2014

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





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

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-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?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefiting 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) 2014
Schedule L (Form 990 or 990-EZ) 2014
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) DAYTON PEDIATRIC IMAGING TRUSTEE 158,492 MEDICAL SERVICES   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
PART IV LINE 1 ELIZABETH EY, MD IS EMPLOYED BY DAYTON PEDIATRIC IMAGING. DAYTON CHILDREN'S HOSPITAL CONTRACTS WITH DAYTON PEDIATRIC IMAGING FOR DR. EY TO PROVIDE SERVICES AT DAYTON CHILDREN'S HOSPITAL AS THE MEDICAL DIRECTOR OF RADIOLOGY. DR. EY IS ALSO PAID TO BE CHAIRPERSON OF DAYTON CHILDREN'S MEDICAL STAFF.
Schedule L (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)


Department of the Treasury
Internal Revenue Service
Noncash Contributions
Right pointing arrow large imageComplete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.

Right pointing arrow large imageInformation about Schedule M (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
Part I
Types of Property
(a)
Check if applicable
(b)
Number of contributions or items contributed
(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g
(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods .......
     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded . X 4 128,502 SELLING PRICE
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests ....
       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures .....
       
14 Qualified conservation
contribution—Other ...
       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( )
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement
...
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that
it must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ..........................
32a
Yes
 
b
If "Yes," describe in Part II.
33
If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2014)
Schedule M (Form 990) (2014)
Page 2
Part II
Supplemental Information. Provide the information required by Part I, lines 30b,
32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Return Reference Explanation
SUPPLEMENTAL INFORMATION ALL STOCK DONATIONS ARE TRANSFERRED TO EITHER MORGAN STANLEY/SMITH BARNEY OR Dayton CHILDREN'S Hospital KEY BANK TRUST ACCOUNT TO SELL STOCK. MORGAN STANLEY/SMITH BARNEY SENDS CHECK FOR CASH RECEIVED TO CHILDREN'S. KEY BANK DIRECTLY DEPOSITS PROCEEDS INTO CHILDREN'S CHECKING ACCOUNT.
Schedule M (Form 990) (2014)
Additional Data


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

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
Return Reference Explanation
SUPPLEMENTAL INFORMATION FORM 990, PART III, LINE 4A Dayton Children's Hospital is a pediatric hospital located in downtown Dayton, Ohio. The hospital and its staff are committed to serving as an advocate for the children and their families in the Miami Valley through a variety of different programs. It offers inpatient, outpatient and ancillary services to the children in the surrounding 20 counties. Services are provided to patients without regard to their ability to pay. For the fiscal year ending June 30, 2015, the hospital's mix of patients was 55.9% Medicaid, 38.5% Commercial, 3.6% Other Government Programs and 2.1% Self Pay. The hospital provides a Level III neonatal nursery for premature newborns as well as critical care and general pediatric inpatient beds. A 24 hour emergency department is available to all children in the area. Some of the specialties offered at the hospital are neurosurgery, hematology/oncology, pulmonary, gastroenterology, neurology, urology, developmental disorders, psychology, psychiatry, endocrinology, genetics, cardiology, orthopaedics and general surgery. Without Dayton Children's Hospital, many children in the area would have to travel a good distance to receive these services. The hospital also offers a Pediatric Residency Program that trains new pediatricians who will care for the next generation of children. Dayton Children's also sponsors many community events where children's health and safety are promoted. Some statistics for the fiscal year ending June 30, 2015 are as follows: # of beds: 155, Inpatient days: 28,517, Admissions: 6,321 Average length of stay: 4.52 days. Average daily census: 78, Occupancy rate: 50.3%, Surgeries performed: 11,121, X-Ray studies: 50,490, Lab Test: 500,408, Respiratory therapy procedures: 92,934, Pharmacy doses dispensed: 2,813,167, cardiology procedures: 21,568, Neurology procedures: 3,523, Urgent care visits: 14,576, Emergency department visits: 79,330, Outpatient clinics: 76,128. Form 990, Part VI, Line 11B The CFO reviews key disclosures with appropriate committees of the Board of Trustees. Then prior to filing, the Form 990 is electronically loaded to a secure website for the entire Board of Trustees to review. An email is sent to all members notifying them that the form is available for their review and that it will be filed on or before 05/15/16. Form 990, Part VI, line 12C - Monitoring Conflict of Interest At the beginning of each meeting, the chairman of the Board asks each member to identify and disclose any potential conflicts of interest based on the agenda or any changes in their business practice that might be relevant. If there are any conflicts, the member(s) recuse themselves and do not participate in the discussion and do not vote on the item. This then is noted in the minutes of that meeting. Board members annually agree to abide by written conflict of interest and confidentiality policies. Board members also work to represent and balance the interests of Dayton Children's Hospital's many constituents. The board annually evaluates its own performance.
Form 990, Part VI, lines 15a & 15b Compensation for the hospital's Chief Executive Officer (CEO) is set by an Executive Compensation Committee (the Committee) made up of three independent trustees who are also officers of the Board. This Committee also approves compensation levels, incentive plan payouts and executive benefits for each executive employed by the hospital. The Committee operates under a formal charter and keeps contemporaneous minutes of its proceedings. The Committee uses a total compensation philosophy to guide all decisions related to executive compensation at Dayton Children's Hospital (DCH), and as such determines and approves all aspects of the CEO's total compensation package, including benefits and expense allowances. These are detailed in a written employment agreement for the CEO. The Committee uses an outside consultant to conduct periodic reviews of the executive compensation levels of the organization versus those of similarly sized and situated organizations using published surveys. These survey results are used by the Committee in setting executive levels and the CEO's compensation in particular. The Committee follows a formal calendar of meetings and the chairman of the Committee reports to the Board of Trustees at least annually on the Committee's activities and on details of the CEO's compensation and benefits package. The Committee also reviews and approves disclosures related to executive compensation made as part of IRS Form 990. Form 990, Part VI, Line 19 Availability of Financial statements, conflict of interest, organizing documents Dayton Children's Hospital's conflict of interest policy is made available on our website. The financial statements and the organizing documents are made available as required by the extent of the law. Form 990, Part VII -Jeffrey Christian, MD works 40 hours per week for the subsidiary, Children's Care Group. -Elizabeth EY, MD is employed by Dayton Pediatric imaging. Dayton Children's Hospital contracts with Dayton Pediatric imaging for Dr. EY to provide services at Dayton Children's Hospital as the Medical Director of Radiology. Dr. Ey is also paid to be chairperson of our medical staff. -Arthur Pickoff, MD is employed by Wright State University. Dayton Children's Hospital contracts with Wright State University for Dr. Pickoff to provide services at Dayton Children's Hospital as the chairman of the department of pediatrics.
Form 990, Part XI Transfer to Dayton Children's Hospital Foundation (3,334,932) Restricted net assets used for purchase of pp&e 2,989,906 Temporarily restricted net assets (5,288,785) Change in pension benefit obligation and plan assets (5,145,985) TOTAL ADJUSTMENT (10,779,796)
FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:22863524
FORM 990 PART IX LINE 11G DESCRIPTION:JOINT VENTURE - PREMIER TOTAL FEES:29743
FORM 990 PART IX LINE 11G DESCRIPTION:JOINT VENTURE - MVH TOTAL FEES:1681269
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet
Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
Dayton Children's Hospital
 
Employer identification number

31-0672132
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?
Yes No
(1) CHILDREN'S HOME CARE OF DAYTON
ONE CHILDRENS PLAZA

DAYTON,OH45404
31-1356037
HOME CARE OH 501(C)(3) 9 DCH
 
Yes
 
(2) DAYTON CHILDREN'S HOSPITAL FOUNDATION
ONE CHILDRENS PLAZA

DAYTON,OH45404
31-1045247
SUPPORT OH 501(C)(3) 11a DCH
 
Yes
 










For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



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

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




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



(k)
Percentage
ownership


Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) CHILDREN'S CARE GROUP

ONE CHILDRENS PLAZA
DAYTON,OH45404
31-1411364
SPEC PHYS GRO OH DCH
 
C-CORP 18,221,410 11,621,431 100.000 % Yes  
(2) CHILDREN'S ANESTHESIA GROUP

ONE CHILDRENS PLAZA
DAYTON,OH45404
26-0887231
ANESTHESIA SV OH DCH
 
C-CORP 6,311,672 2,095,665 100.000 % Yes  
(3) PEDIATRIC ASSURANCE COMPANY LTD

BUTTERFIELD BANK BLDG 6TH FLOOR
HAMILTON,BERMUDAHM12
BD
98-0478183
SELF-INSURANC BD DCH
 
N/A 1,240,493 49,661,483 100.000 % Yes  
(4) DAYTON CHILDREN'S ORTHOPAEDIC

ONE CHILDRENS PLAZA
DAYTON,OH45404
45-3934418
ORTHO SERVICE OH DCH
 
C-CORP 6,636,074 275,357 100.000 % Yes  






Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
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
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) DAYTON CHILDREN'S HOSPITAL FOUNDATION

B 3,334,932 FMV
(2) DAYTON CHILDREN'S HOSPITAL FOUNDATION

C 7,411,822 CASH
(3) DAYTON ORTHOPAEDICS

J 143,579 CASH
(4) CHILDREN'S HOME CARE OF DAYTON

M 440,131 CASH
(5) DAYTON CHILDREN'S HOSPITAL FOUNDATION

L 77,425 FMV
(6) CHILDREN'S CARE GROUP

M 14,952,871 CASH
(7) CHILDREN'S ANESTHESIA GROUP

M 6,311,672 CASH
(8) CHILDREN'S CARE GROUP

O 181,800 FMV
(9) CHILDREN'S ANESTHESIA GROUP

O 971,464 FMV
(10) CHILDREN'S HOME CARE OF DAYTON

Q 10,720,503 CASH
(11) CHILDREN'S CARE GROUP

Q 1,965,000 CASH
(12) DAYTON ORTHOPAEDICS

Q 810,000 CASH
(13) CHILDREN'S ANESTHESIA GROUP

R 656,000 FMV
(14) CHILDREN'S HOME CARE OF DAYTON

R 161,677 FMV
(15) DAYTON ORTHOPAEDICS

R 498,161 FMV
(16) DAYTON CHILDREN'S HOSPITAL FOUNDATION

E 27,907,804 FMV
(17) DAYTON ORTHOPAEDICS

K 109,428 FMV
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2014
Additional Data


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