TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) LESLIE BARNES CARSONEND1015...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(2) GREGORY EBERHART MD...................................................................... TRUSTEE	1.0 ................. 0.0	X		20,000	0
(3) ELIZABETH EY MD...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(4) SCOTT KELLY END 1015...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(5) THERESE MCNEA-WILEY...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(6) GREGORY SAMPLE...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(7) MICHAEL SHANE...................................................................... Vice Chair	1.0 ................. 0.0	X		630	0
(8) BEVERLY SHILLITO...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(9) LAURENCE KLABEN...................................................................... Sec/Treas	1.0 ................. 0.0	X		0	0
(10) VISHAL SOIN...................................................................... CHAIRMAN	1.0 ................. 0.0	X		1,063	0
(11) DEBORAH FELDMAN...................................................................... PRESIDENT AND CEO	40.0 ................. 0.0	X	X	658,256	417,090
(12) Linda Black-Kurek...................................................................... Trustee	1.0 ................. 0.0	X		0	0
(13) James Whalen...................................................................... Trustee	1.0 ................. 0.0	X		0	0
(14) Adam Mezoff...................................................................... VP Medical Affairs CMO	40.0 ................. 0.0	X		490,329	38,905
(15) MARK CHILSON...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(16) THOMAS KRZMARZICK...................................................................... TRUSTEE	1.0 ................. 0.0	X		0	0
(17) JOHN DUBY MD BEG 0115...................................................................... TRUSTEE	1.0 ................. 0.0	X		102,773	0

(A) Name and business address	(B) Description of services	(C) Compensation
CHILDREN'S CARE GROUP, 1 CHILDRENS PLAZA DAYTON,OH45404	PHYSICIAN SERVICES	18,610,775
WRIGHT STATE PHYSICIANS, PO BOX 1144 DAYTON,OH45401	PHYSICIAN SERVICES	2,212,006
WRIGHT STATE UNIVERSITY, PO BOX 927 DAYTON,OH45401	PHYSICIAN SERVICES	1,443,765
ORTHOPAEDIC CENTER FOR SPINAL PED, 1 CHILDRENS PLAZA DAYTON,OH45404	PHYSICIAN SERVICES	866,216
BRICKLER ECKLER, 100 SOUTH THIRD STREET COLUMBUS,OH43215	LEGAL SERVICE	589,562
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 16

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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

2015

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.)

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

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

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

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

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

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

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

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

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

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

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

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

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

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.

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

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

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.)..

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

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

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

Schedule A (Form 990 or 990-EZ) 2015

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

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.

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).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

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.

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.

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.

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.

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.

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).

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?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

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.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) 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.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

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

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

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

A family member of a person described in (a) above?

11b

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

Section B. Type I Supporting Organizations

Yes

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.

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.

Section C. Type II Supporting Organizations

Yes

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).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

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).

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.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

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.

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.

Parent of Supported Organizations. Answer (a) and (b) below.

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.

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.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

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

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) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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 2015 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-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

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) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2015

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

501(c)( ) (enter number) organization

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

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

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

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

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

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2

Name of organization Dayton Children's Hospital

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	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

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) (2015)

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No.from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

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

2015

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on 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.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures ...................................................................................................................... SchCMd Bullet

Volunteer hours .............................................................................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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-.
1
2
3
4
5
6

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

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2015

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ..............................................................................................................	Yes No

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) 2012	(b) 2013	(c) 2014	(d) 2015	(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) 2015

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Yes

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

64,681

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

12,681

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Yes

96,000

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

173,362

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

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."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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

Taxable amount of lobbying and political expenditures (see instructions) .........................................

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 1F: OHIO HOSPITAL ASSOCIATION $2,261 OHIO CHILDREN'S HOSPITAL ASSOCIATION $41,777 NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS $20,643 TOTAL: $64,681 LINE 1G: MANAGEMENT TIME $8,799 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 $3,882 TOTAL: $12,681 LINE 1H: CONSULTING EXPENSE $96,000 TOTAL LINE 1J: $173,362

Return Reference

Explanation

SCHEDULE C SUPPLEMENTAL INFORMATION

LINE 1F: OHIO HOSPITAL ASSOCIATION $2,261 OHIO CHILDREN'S HOSPITAL ASSOCIATION $41,777 NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS $20,643 TOTAL: $64,681 LINE 1G: MANAGEMENT TIME $8,799 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 $3,882 TOTAL: $12,681 LINE 1H: CONSULTING EXPENSE $96,000 TOTAL LINE 1J: $173,362

Schedule C (Form 990 or 990EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

2015

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" on 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 ....

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ...........

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ............................

Yes No

Part II

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

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

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

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d

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

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

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

Yes No

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

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

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

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

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

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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

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

Cat. No. 52283D

Schedule D (Form 990) 2015

Page 2

Part III

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

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

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

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

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

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

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

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

Part V

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

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	166,743,504	171,140,209	145,550,821	127,667,969	123,741,717
b	Contributions ...	9,088,944	3,053,446	7,058,671	7,549,823	7,937,991
c	Net investment earnings, gains, and losses	-3,600,121	-1,935,200	23,383,702	14,908,772	434,441
d	Grants or scholarships ...	6,073,989	5,514,951	4,815,615	4,542,192	4,446,180
e	Other expenditures for facilities and programs ...	20,000		37,370	33,551	0
f	Administrative expenses ....			0	0	0
g	End of year balance ......	166,138,338	166,743,504	171,140,209	145,550,821	127,667,969

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

Board designated or quasi-endowment SchDMd Bullet

100.000 %

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

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

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

Yes

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

3a(i)

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

3a(ii)

Yes

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

Yes

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

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on 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 ...	5,710,037		5,710,037
b	Buildings	50,881,723	24,763,130	26,118,593
c	Leasehold improvements
d	Equipment ...	147,249,692	68,057,283	79,192,409
e	Other ...	84,097,122	2,147,172	81,949,950
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				192,970,989

Schedule D (Form 990) 2015

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' on 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	56,035,991	F
(B) HIRTLE CALLAGHAN - COMMODITIES	15,986,198	F
(C) HIRTLE CALLAGHAN - REAL ESTATE	4,365,754	F
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	76,387,943

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

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

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
RESERVE FOR PROFESSIONAL LIA	5,839,625
EST REIMB/MEDICAID PROGRAM	367,988
DEFERRED COMPENSATION PAYABLE	1,651,162
SERP PENSION ACCRUAL	3,131,179
REINSURANCE	2,523,370
PENSION LIABILITY	18,074,158
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	31,587,482
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) 2015

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on 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' on 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 2016 OR 2015. 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, 2016 OR 2015.

Schedule D (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

See separate instructions. Right pointing arrow large image

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

OMB No. 1545-0047

2015

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.

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

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

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		107,977,703
	Central America and the Caribbean	1	2	Program Services	self insurance	1,837,896















3a	Sub-total .....	2	4			109,815,599
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)	2	4			109,815,599

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2015

Schedule F (Form 990) 2015

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 .......
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2015

Schedule F (Form 990) 2015Page 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) 2015

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2015

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) 2015

Additional Data

Software ID:
Software Version:

- TIN:

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" on 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 arrow

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

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

OMB No. 1545-0047

2015

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" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

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?

YesNo

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)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

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 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2015

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on 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 GOLF OUTING (event type)	(b) Event #2 SFOT (event type)	(c) Other events 2 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	177,507	122,711	93,048	393,266
2	Less: Contributions . . . .	138,100	40,780		178,880
3	Gross income (line 1 minus line 2) . . . . . .	39,407	81,931	93,048	214,386

4	Cash prizes . . . . .
5	Noncash prizes . . . .			612	612
6	Rent/facility costs . . . .	28,504	6,000	7,250	41,754
7	Food and beverages . . .	16,832	22,575	16,646	56,053
8	Entertainment . . . .	300		550	850
9	Other direct expenses . . .	8,397	14,291	2,804	25,492
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				124,761
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				89,625

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .	8,397	14,291	2,804	25,492

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2015

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

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

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

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

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

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 complete this part to provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on 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

2015

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

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

Yes

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

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

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

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

If the organization used factors other than FPG in determining eligibility, describe in Part VI the 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.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

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

Yes

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

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

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

Yes

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

Yes

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

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	817,352		817,352	0.340 %
b	Medicaid (from Worksheet 3, column a) . . . . .	123,249,429	97,443,272	25,806,158	10.590 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	124,066,781	97,443,272	26,623,510	10.930 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	447,816		447,816	0.180 %
f	Health professions education (from Worksheet 5) . . .	4,134,508	1,531,551	2,602,957	1.070 %
g	Subsidized health services (from Worksheet 6) . . . .	18,044,195	6,758,039	11,286,156	4.630 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	214,618		214,618	0.090 %
j	Total. Other Benefits . .	22,841,137	8,289,590	14,551,547	5.970 %
k	Total. Add lines 7d and 7j .	146,907,918	105,732,862	41,175,057	16.900 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	805,446	805,446	0.330 %
2	Economic development	97,948	97,948	0.040 %
3	Community support	10,801	10,801	0.010 %
4	Environmental improvements
5	Leadership development and training for community members	9,838	9,838	0.010 %
6	Coalition building	5,200	5,200	0.010 %
7	Community health improvement advocacy	8,560	8,560	0.010 %
8	Workforce development	10,219	10,219	0.010 %
9	Other
10	Total	948,012	948,012	0.420 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

3,865,282

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. ......

474,322

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

Section B. Medicare

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

233,345

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

233,345

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

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

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

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

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

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

Schedule H (Form 990) 2015

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)
1	DAYTON CHILDREN'S HOSPITAL ONE CHILDRENS PLAZA DAYTON,OH454041815 www.childrensdayton.org	X	X	X	X	X

Schedule H (Form 990) 2015

Page 4

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):

Yes

Community Health Needs Assessment

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

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

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

Yes

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

A definition of the community served by the hospital facility

Demographics of the community

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

How data was obtained

The significant health needs of the community

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

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

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

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

Other (describe in Section C)

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

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

Yes

6 a

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

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

Yes

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

Yes

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

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

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

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

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): WWW.CHILDRENSDAYTON.ORG

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

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

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	DAYTON CHILDREN'S HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 100% and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

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):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

WWW.CHILDRENSDAYTON.ORG

The FAP application form was widely available on a website (list url):

WWW.CHILDRENSDAYTON.ORG

A plain language summary of the FAP was widely available on a website (list url):
WWW.CHILDRENSDAYTON.ORG

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	DAYTON CHILDREN'S HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

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

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

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

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

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

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

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

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

Other (describe in Section C)

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

If "Yes," explain in Section C.

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

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

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 10 HEALTH CARE FACILITIES OTHER THAN THOSE REQUIRED TO BE LICENSED, REGISTERED OR SIMILARLY RECOGNIZED AS A HEALTH CARE FACILITY UNDER STATE LAW. WE HAVE 6 TESTING CENTERS, 4 OFFSITE CLINICS, AND 1 URGENT CARE CENTER (50% OWNED).

Schedule H (Form 990) 2015

Page 8

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?10
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	HUBER HEIGHTS OUTPATIENT TESTING CENTER 8501 OLD TROY PIKE HUBER HEIGHTS,OH45424	OUTPATIENT DIAGNOSTIC CENTER

Schedule H (Form 990) 2015

Page 9

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 $18,044,195 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. Our most current assessment was completed in June 2014. The next assessment will be completed in June 2017. 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 conducts the assessment to provide community health advocates insights into the health and well-being of our region's children. The assessment offers 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. Data is available to public health and other child-serving entities to assis in their individual needs assessment as well. We continuously work to align our implementation strategies with other local and state health departments and other health entities to ensure the greatest impact on health issues.
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, with 75 percent of our patients coming from our Montgomery, Greene, Clark, Miami and Northern Warren Counties. 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 nearly 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: Community Building Activities: Describe how the organization's community-building activities, as reported in Part II, promote the health of the communities the organization serves. As the only children's hospital in the region, we take our pediatric expertise into the community to solve probems and create a healthy community for our children. Our community relationships demonstrate our commitment to Dayton and the surrounding community - a community we have called home for nearly 5o years. Dayton Children's is committed to working with our many valued partners to help ensure Dayton remains a great city for children to live, learn, grow and play. Schedule H Part VI #6: 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 to better identify and address obesity. 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 FY2015-2016, an average of 15 providers & office staff attended in-office CEUs and an average of 11 providers per month received additional nutritional guidance. The dietetic liaison program also piloted tele-heath of patient/family classes, improved centralized scheduling option, transitioning to centralized classes and expanding to accept referrals from all pediatric primary care providers. The program continues to provide a menu of continuing education sessions to provider office personnel on topics that address childhood overweight and obesity. 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 9,321 kids and parents were reached through outreach events and 6,956,685 people were reached through focusing on obesity prevention. WITHIN THE HOSPITAL, DAYTON CHILDREN'S continues to provide healthy lifestyle and individualized growth information to each admitted patient. Additionally, the Children's Health Clinic continues to emphasize early identification and prevention/treatment in their patient care and through mentoring the care provided by the medical residents. A medical resident quality improvement project identified the need to further residents' preparation to address childhood overweight and obesity. Together, with information gathered during a collaborative symposium (with Wright State University and local pediatricians), hospital leadership is formulating a plan on current successes and opportunitties in addressing this public health and medical issue. Finally, Dayton Children's piloted and now implemented a collaborative healthy lifestyle program with community partners (The Ohio State Extension Service, Children's Hunger Alliance, the Salvation Army Kroc Center, Kiser Elementary, and neighborhood leaders) with measured outcomes for children and parents. The hospital initiated ongoing collaborative discussions with Greater Old North Dayton leaders, businesses, public services, and community activists on how to support each other's promotion of healthy lifestyles. 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 2015-2016, DAYTON CHILDREN'S SAW 2,495 patient visits, an increase from 1,953 the previous year. The hospital hired a Psychiatry Nurse Practitioner that will further expand access and is actively recruiting for additional specialists to meet the demand. 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 continues to MEET throughout the past year, addressing a number of significant community pediatric health issues. 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 WAITing TIME FOR NEW EVALUATIONS HAS DECREASED FROM OVER 200 DAYS TO LESS THAN 30 DAYS. We will achieve our 10 day access within time for new evaluations decreasing from 101 days in FY 2015 to 6 days last fiscal year. Key members of our team make regular visits to pediatric prectices to educate them on the availability of our services. In FY 2015-2016, members of our team did 75 presentations/interviews on topics related to pediatric mental health. 3: INFANT MORTALITY/SAFE SLEEP PRACTICES 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 25 community events in FY 2015-2016. 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 TH
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 for Child Health and Wellness engages with a broad and diverse set of stackholders to influence and positively impact children's overall health in a measurable way in support of Dayton Children's mission. The Center is responsible for focusing the hospital's community engagement to have a true impact on children's health. This work is accomplished through resource connection and community collaboration and is based in data and research of the community's greatest pediatric health needs. The center aims to address the "upstream" social determinants of health most greatly affecting children in our region. Using the data and information obtained from our Community Health Needs Assessment, the Center plays a variety of roles to impact children's health in our community depending on the health issue, our expertise and partnership opportunities. Here are the various roles played by the Center: - Awareness builder: to enable understanding of the state of health of our region's children and what's required to improve their overall health. - Connector: to provide links between families or professionals and resources to help children reach their optimal ealth. - Educator: to identify and provide instruction about best practices and emerging trends influencing pediatric health and safety. - Advocate: to influence public opinion and policy furthering systems level change impacting pediatric health and safety. -Engaged participant: to leverage and support community health initiatives that address health disparities and improving population health. - Backbone: to produce a collective impact on significant health issues affecting the children of our region through the identification and stewardship of resources and increasing support for community health. Two key initiatives planned during FY 2015-2016 included the Dayton Asthma Aliiance and the Family Resource Connection. Dayton Asthma Alliance The Dayton Asthma Alliance aims to positively impact the health and wellness of children with asthmas in the Dayton area, focusing on the most at risk populations. Using the Collective Impact framework, the Alliance engages local partner organizations to collaboratively implement a variety of strategic actions to improve outcomes for children with asthma. The Centers for Disease Control and Prevention (CDC) reports that asthma is the most common chronic condition affecting children younger than age 18 and that the number of persons with asthma increased 2.9% each year from 2001 to 2010. Children with asthma are often limited in their ability to live to their fullest potential, have increased absences from school, are more likely to be hospitalized or even die. Economically, CDC has also estimated that asthma costs the United States $56 billion each year. Historically, Ohio's asthma prevalence has exceeded national rates and recent data suggests that Dayton-area figures are even higher. In 2008 the Ohio Family Survey also reported disparties regarding asthma prevalence, significantly impacted by personal income and race. Additionally, during the FY 2014-2015, Dayton Children's Hospital admitted nearly 900 patients for asthma and provided emergency department services to over 14,000 children with asthma. To have the greatest impact and ensure all children with asthma have the opportunity of optimal health outcomes, the Alliance identified three strategic focus areas for their work 1) Ensure asthma-friendly environments; 2) Enhance access to high quality healthcare and supportive social services through clinical-community linkages; and 3) Educate and equip children, families and the community for asthma wellness. To support work in these areas, Dayton Children's serves as the backbone organization convening the group of committed stakeholders and supporting the Alliance with staff and resources. The Alliance is governed by entities with a common purpose to improve health outcomes for children with asthma in the Dayton region. The Alliance consults with additional organizations to gather data and research, ascertain best practices, and to identify community resources to suppor children with asthma and to inform the strategic focus areas. Ultimately, the Alliance aims to reduce hospital admission rates and emergency department visits triggered by uncontrolled asthma as reported by the Ohio Hospital Association and Dayton Children's. The Alliance also aims to reduce school abscences related to asthma. To meet these goals the Alliance is implementing multiple projects focusing on improved education of children and families around triggers and management, enhanced education of school personnel around asthma triggers and management, greater communit resources provided to children and families to help manage asthma, improving primary health care of children and decreased environmental triggers. This work could not be done without alignment with a variety of community stakeholders. In addition to staff and personnel from Dayton Children's Center for Child Health and Wellness and Dayton Children's Pulmonary Clinic, partners in the Dayton Asthma Alliance include community primary care physicians, community allergists, Caresource, Community Health Centers of Greater Dayton, Dayton Public Schools, Greater Dayton Premier Management, Legal Aid of Western Ohio (Medical-Legal Partnership), Public Health-Dayton & Montgomery County, Think TV, Wright State University Center for Healthy Communities and School of Nursing. Additional partners and collaborators are continually invited to join the Alliance as the needs or interest arise. During FY 2015-2016, the Dayton Asthma Alliance focused energy around a pilot program with Dayton Public Schools. In this pilot program, children with asthma received the American Lung Association's Open Airways training in-school.Those children and their caregivers were then invited to come to a clinical education session at the school where they received education from the Dayton Children's asthma educator. Finally, the families were offered home visits by a community health worker, obtained through a MEDTAPP grant and Wright State University Center for Healthy Communities. The home visitor assessed homes and identified opportunities for remediation and assisted families with their social needs. This Program will be expanded to all 17 Dayton Public Schools in FY 2016-2017. Family Resource Connection The second significant initiative of the Center for Child Health and Wellness is the Family Resource Connection. In FY 2015-2016, Center staff worked alongside Health leads to plan and pilot pieces of this innovative program. When patients and their families seek medical care, they often are additionally facing critical challenges in their lives - they may have little food, they may not have a job or they struggle to keep up with bills for utilities. Unfortunately, these challenges often affect their health. The Family Resource Connection uses a patient's visit to the doctor as an opportunity to address the non-medical issues that have an impact on health. This program screens patient families for social needs and then identified families are referred to an Advocate working in the Dayton Children's Hospital Family Resource Connection for resource connection and follow-up. The Family Resource Connection is modeled after the well-known and respected Health Leads program. Health Leads (healthleadsusa.org) is a national movement that envisions a healthcare system that addresses all patients' basic resource needs as a standard part of quality care. Health Leads' mission is to catalyze this healthcare system by connecting patients with the basic resources they need to be healthy, and in doing so, build leaders with the conviction and ability to champion quality care for all patients. Health Leads has over 19 years experience building social needs programs in hospital and clinic settings. In FY 2015-2016, Dayton Children's laid the groundwork for this program by attending education and consultation sessions with Health Leads, building a staffing plan, researching community resources, testing and piloting the screening instrument within the Children's Health Clinic, hiring and training a program coordinator. 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

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

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

Complete if the organization answered "Yes," on 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

2015

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

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

Yes No

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

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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) RONALD MCDONALD HOUSE 555 VALLEY ST DAYTON,OH45404	31-0964793	501(C)(3)	12,500	CORPORATE DONATION
(2) CULTURE WORKS 110 N MAIN STREET SUITE 165 DAYTON,OH45402	23-7412338	501(C)(3)	6,500	PROGRAM DONATION
(3) THE LEUKEMIA & LYMPHOMA SOCIETY 1311 MAMARONECK AVE WHITE PLAINS,NY106055221	13-5644916	501(C)(3)	8,500	CORPORATE SPONSORSHIP
(4) UNITED WAY OF GREATER DAYTON 184 SALEM AVENUE FOUNDATION BUILDING 375 DAYTON,OH45406	31-0536658	501(C)(3)	22,500	CORPORATE PLEDGE
(5) GOODWILL EASTER SEALS 1511 KUNTZ ROAD DAYTON,OH45404	37-0537112	501(C)(3)	10,000	CORPORATE DONATION
(6) DAYTON SOCIETY OF NATURAL HISTORY 2600 DEWEESE PARKWAY DAYTON,OH45414	31-0585917	501(C)(3)	7,500	CORPORATE DONATION
(7) GALA OF HOPE FOUNDATION 3500 PENTAGON BOULEVARD SUITE 500 DAYTON,OH45431	46-4277044	501(C)(3)	50,000	CORPORATE SPONSOR
(8) DAYTON METRO LIBRARY 215 EAST THIRD STREET DAYTON,OH45402	31-6000100		6,666	CORPORATE SPONSORSHIP

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 2015

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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	251	63,264
(2) MEALS/FOOD	762	25,324
(3) TRANSPORTATION	1048	30,657
(4) RENT/UTILITIES	48	15,560
(5) SPECIAL EQUIPMENT	18	9,706
(6) OTHER	14	6,224
(6)
(7)

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) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on 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

2015

Open to Public Inspection

Name of the organization

Dayton Children's Hospital

Employer identification number

31-0672132

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

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

Travel for companions Payments for business use of personal residence

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

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

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Yes

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? ..

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

During the year, did any person listed on Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

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

Yes

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

Yes

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

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

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

Any related organization?

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization?

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

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

For persons listed on 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 ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

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

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

Cat. No. 50053T

Schedule J (Form 990) 2015

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 on 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 on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1DEBORAH FELDMANPRESIDENT AND CEO	(i) (ii)	606,582 ------------- 0	0 ------------- 0	51,674 ------------- 0	416,560 ------------- 0	530 ------------- 0	1,075,346 ------------- 0	0 ------------- 0
2DAVID T MILLER END 1215VP FINANCE AND CFO	(i) (ii)	340,746 ------------- 0	0 ------------- 0	62,622 ------------- 0	73,696 ------------- 0	22,360 ------------- 0	499,424 ------------- 0	0 ------------- 0
3MATTHEW GRAYBILLVP AND CHIEF OPERATING OFFICER	(i) (ii)	302,616 ------------- 0	0 ------------- 0	30,081 ------------- 0	213,395 ------------- 0	27,126 ------------- 0	573,218 ------------- 0	0 ------------- 0
4Adam MezoffVP Medical Affairs CMO	(i) (ii)	465,714 ------------- 0	0 ------------- 0	24,615 ------------- 0	15,900 ------------- 0	23,005 ------------- 0	529,234 ------------- 0	0 ------------- 0
5Renae PhillipsVP Patient Care CNO	(i) (ii)	90,278 ------------- 0	0 ------------- 0	639,771 ------------- 0	9,517 ------------- 0	23,185 ------------- 0	762,751 ------------- 0	415,041 ------------- 0
6Gregory RameyEXEC DIRECTOR PED MENTAL HEALT	(i) (ii)	181,296 ------------- 0	15,946 ------------- 0	36,133 ------------- 0	8,347 ------------- 0	26,749 ------------- 0	268,471 ------------- 0	0 ------------- 0
7Vicki GiambroneVP Maktng External Relations	(i) (ii)	106,057 ------------- 0	0 ------------- 0	593,051 ------------- 0	5,769 ------------- 0	0 ------------- 0	704,877 ------------- 0	593,051 ------------- 0
8Lisa CoffeyVP Physician Services	(i) (ii)	194,200 ------------- 0	0 ------------- 0	22,066 ------------- 0	27,610 ------------- 0	30,361 ------------- 0	274,237 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2015

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 4A KAREN BRAUN - 77,686 RENAE PHILLIPS - 217,935 SCHEDULE J, PART I, LINE 4B PARTICIPANTS IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND THE INCREASE IN ACTUARIAL VALUE: DEBORAH FELDMAN - 401,660 ADAM MEZOFF - 0 DAVID T. MILLER - 63,166 GREGORY RAMEY - 0 VICKI GIAMBRONE - 5,366 MATTHEW GRAYBILL - 202,795 RENAE PHILLIPS - 5,287 RECEIVED PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: RENEA PHILLIPS - 415,041 VICKI GIAMBRONE - 417,846

Schedule J (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2015

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
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	COUNTY OF MONTGOMERY	31-6000172	000000000	11-20-2015	12,675,000	HOSPITAL RENOVATION		X		X		X
B	COUNTY OF MONTGOMERY	31-6000172	000000000	08-19-2014	117,055,000	HOSPITAL RENOVATION		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	0		0
2 Amount of bonds legally defeased ..............	0		0
3 Total proceeds of issue ..................	12,675,000		117,055,000
4 Gross proceeds in reserve funds .............	0		0
5 Capitalized interest from proceeds .............	0		0
6 Proceeds in refunding escrows ...............	0		0
7 Issuance costs from proceeds ...............	40,000		400,070
8 Credit enhancement from proceeds .............	0		0
9 Working capital expenditures from proceeds .............	0		0
10 Capital expenditures from proceeds .............	0		0
11 Other spent proceeds .............	0		65,758,000
12 Other unspent proceeds .............	12,635,000		50,896,930
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		X
15 Were the bonds issued as part of an advance refunding issue? .....		X		X
16 Has the final allocation of proceeds been made? ..........		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2015

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		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 .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............		X		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		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		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X
b Exception to rebate? ........		X		X
c No rebate due? .........		X		X
If "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		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider ..........	0		0
c Term of hedge .........
d Was the hedge superintegrated? ......		X		X
e Was the hedge terminated? ........		X		X

Schedule K (Form 990) 2015

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........	0		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		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X		X

Part VI

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

Return Reference	Explanation

Schedule K (Form 990) 2015

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2015

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

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

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

Part II

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

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










Total ............... $

Part III

Grants or Assistance 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) 2015

Page 2

Part IV

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

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) ELIZABETH EY	TRUSTEE	173,982	MEDICAL SERVICES		No
(2) JULIE CHRISTIAN	SPOUSE OF FORMER TRUSTEE	21,646	EMPLOYMENT		No

Part V

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

Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete 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 image

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

OMB No. 1545-0047

2015

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	8	1,357,760	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 ( )
26 Other ( )
27 Other ( )
28 Other ( )

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

Yes

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

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

Yes

If "Yes," describe in Part II.

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) (2015)

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) (2015)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 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

2015

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, 2016, the hospital's mix of patients was 57.5% Medicaid, 36.7% Commercial, 3.9% Other Government Programs and 1.9% 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, 2016 are as follows: # of beds: 155, Inpatient days: 29,540, Admissions: 7,221 Average length of stay: 4.09 days. Average daily census: 81, Occupancy rate: 52.3%, Surgeries performed: 11,437, X-Ray studies: 50,837, Lab Test: 506,619, Respiratory therapy procedures: 88,009, Pharmacy doses dispensed: 3,542,530, cardiology procedures: 18,040, Neurology procedures: 3,464, Urgent care visits: 16,022, Emergency department visits: 78,578, Outpatient clinics: 103,294. 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 05/15/17. 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 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 -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. -John Duby, MD is employed by Wright State University. Dayton Children's Hospital contracts with Wright State University for Dr. Duby to provide services at Dayton Children's Hospital as the chairman of the department of pediatrics. -Thomas Krzmarzick, MD is employed by Children's Emergency Services. Dayton Children's Hospital Contracts with Children's Emergency Services for Dr. Krzmarzick to provide services at Dayton Children's Emergency Department.
Form 990, Part XI	Transfer to Dayton Children's Hospital Foundation (9,563,757) Restricted net assets used for purchase of pp&e 5,603,325 Temporarily restricted net assets (7,689,717) Change in pension benefit obligation and plan assets (17,810,907) TOTAL ADJUSTMENT (29,461,056)
FORM 990 PART IX LINE 11G	DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:26986799
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED SERVICES TOTAL FEES:11284324
FORM 990 PART IX LINE 11G	DESCRIPTION:JOINT VENTURE - MVH TOTAL FEES:445758
FORM 990 PART IX LINE 11G	DESCRIPTION:JOINT VENTURE - PREMIER TOTAL FEES:1080

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2015

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)CHILDREN'S 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) 2015

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	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets		Yes	No
(1) CHILDREN'S CARE GROUP ONE CHILDRENS PLAZA DAYTON,OH45404 31-1411364	SPEC PHYS GRO	OH	DCH	C-CORP	20,337,707	12,238,545	100.000 %	Yes
(2) CHILDREN'S ANESTHESIA GROUP ONE CHILDRENS PLAZA DAYTON,OH45404 26-0887231	ANESTHESIA SV	OH	DCH	C-CORP	8,090,887	2,016,259	100.000 %	Yes
(3) PEDIATRIC ASSURANCE COMPANY LTD BUTTERFIELD BANK BLDG 6TH FLOOR HAMILTON,BERMUDAHM12 BD 98-0478183	SELF-INSURANC	BD	DCH	N/A	1,399,925	47,952,720	100.000 %	Yes
(4) DAYTON CHILDREN'S ORTHOPAEDIC ONE CHILDRENS PLAZA DAYTON,OH45404 45-3934418	ORTHO SERVICE	OH	DCH	C-CORP	6,267,713	656,010	100.000 %	Yes

Schedule R (Form 990) 2015

Page 3

Part V

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

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

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

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

Yes

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

Yes

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

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

Yes

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

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

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

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

Yes

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

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

Yes

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

Yes

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

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	9,563,757	FMV
(2) DAYTON CHILDREN'S HOSPITAL FOUNDATION	C	8,173,164	CASH
(3) DAYTON ORTHOPAEDICS	J	143,579	CASH
(4) CHILDREN'S HOME CARE OF DAYTON	M	369,312	CASH
(5) DAYTON CHILDREN'S HOSPITAL FOUNDATION	L	75,080	FMV
(6) CHILDREN'S CARE GROUP	M	17,701,220	CASH
(7) CHILDREN'S ANESTHESIA GROUP	M	8,090,887	CASH
(8) CHILDREN'S CARE GROUP	O	211,803	FMV
(9) CHILDREN'S ANESTHESIA GROUP	O	1,372,086	FMV
(10) CHILDREN'S HOME CARE OF DAYTON	Q	7,283,929	CASH
(11) CHILDREN'S CARE GROUP	Q	2,000,306	CASH
(12) DAYTON ORTHOPAEDICS	Q	710,000	CASH
(13) CHILDREN'S ANESTHESIA GROUP	R	985,000	FMV
(14) CHILDREN'S HOME CARE OF DAYTON	R	109,000	FMV
(15) DAYTON ORTHOPAEDICS	R	747,180	FMV
(16) DAYTON CHILDREN'S HOSPITAL FOUNDATION	E	65,757,804	FMV
(17) DAYTON ORTHOPAEDICS	K	109,428	FMV

Schedule R (Form 990) 2015

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2015

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) 2015

Additional Data

Software ID:
Software Version:

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
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	16
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	2,225
6	Total number of volunteers (estimate if necessary) .............	6	993
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	55,759
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	54,759

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	27,104,214	25,788,633
9	Program service revenue (Part VIII, line 2g) .........	234,171,510	255,318,286
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	21,194,516	16,699,522
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	2,404,437	2,241,227
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	284,874,677	300,047,668
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	226,113	274,901
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)	119,672,065	126,544,320
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 1,780,101
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	109,276,324	115,525,589
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	229,174,502	242,344,810
19	Revenue less expenses. Subtract line 18 from line 12.......	55,700,175	57,702,858
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	595,726,324	668,978,426
21	Total liabilities (Part X, line 26).............	80,468,052	145,564,664
22	Net assets or fund balances. Subtract line 21 from line 20.....	515,258,272	523,413,762

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 224,741,171 including grants of $ 274,901 ) (Revenue $ 255,759,033 )
	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 expenses224,741,171

(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
(A) Name and Title
(18) TIMOTHY PEPPER BEG 1115........................................................................ TRUSTEE	1.0 .......................0.0	X			0	0	0
(19) ARTHUR PICKOFF END 1015........................................................................ TRUSTEE	1.0 .......................0.0	X			0	0	0
(20) DAVID T MILLER END 1215........................................................................ VP FINANCE AND CFO	40.0 .......................0.0		X		403,368	0	96,056
(21) CHRIS BERGMAN BEG 0116........................................................................ VP FINANCE & CFO	40.0 .......................0.0		X		0	0	0
(22) MATTHEW GRAYBILL........................................................................ VP AND CHIEF OPERATING OFFICER	40.0 .......................0.0			X	332,697	0	240,521
(23) Renae Phillips........................................................................ VP Patient Care CNO	40.0 .......................0.0			X	730,049	0	32,702
(24) Gregory Ramey........................................................................ EXEC DIRECTOR PED MENTAL HEALT	40.0 .......................0.0			X	233,375	0	35,096
(25) Vicki Giambrone........................................................................ VP Maktng External Relations	40.0 .......................0.0			X	699,108	0	5,769
(26) Lisa Coffey........................................................................ VP Physician Services	40.0 .......................0.0			X	216,266	0	57,971

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,887,914	0	924,110

1a	Federated campaigns..		1a	32,136
b	Membership dues..		1b
c	Fundraising events..		1c	178,880
d	Related organizations		1d	5,960,440
e	Government grants (contributions)		1e	967,886

f	All other contributions, gifts, grants, and similar amounts not included above		1f	18,649,291

g	Noncash contributions included in lines 1a-1f:$ 1,357,760
h Total.Add lines 1a-1f.......		25,788,633

			Business Code
2a	PATIENT SERVICE REVENUE	624100	157,496,979	157,496,979
b	MEDICARE/MEDICAID	624100	97,765,548	97,765,548
c	SURGERY CENTER	621400	55,759		55,759
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			255,318,286

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			4,625,990			4,625,990
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		309,980
b	Less: rental expenses		850,756
c	Rental income or (loss)	0	-540,776
d	Net rental income or (loss)......			-540,776			-540,776
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	10,245	38,244,808
b	Less: cost or other basis and sales expenses	54,372	26,127,149
c	Gain or (loss)	-44,127	12,117,659
d	Net gain or (loss).....			12,073,532			12,073,532
8a	Gross income from fundraising events (not including $ 178,880of contributions reported on line 1c). See Part IV, line 18 ....
	a		214,386
b	Less: direct expenses ...b		124,761
c	Net income or (loss) from fundraising events..			89,625			89,625
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..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		584,293
b	Less: cost of goods sold ..b		381,017
c	Net income or (loss) from sales of inventory..			203,276	203,276
Business Code			Miscellaneous Revenue
11a	HITECH MEDICAL RECORDS		900099	306,384			306,384
b	CAFETERIA/KIDS CARE		900099	1,251,708			1,251,708
c	DAY CARE CENTER		812930	693,539			693,539
d	All other revenue ....			237,471	237,471
e	Total. Add lines 11a–11d ......			2,489,102
12	Total revenue. See Instructions......			300,047,668	255,703,274	55,759	18,500,002

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	124,166	124,166
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	150,735	150,735
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	2,062,407		2,062,407
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	21,646	21,646
7	Other salaries and wages	100,429,723	94,011,811	5,498,459	919,453
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,026,633	5,737,263	233,271	56,099
9	Other employee benefits .......	10,826,193	10,442,852	281,232	102,109
10	Payroll taxes ...........	7,177,718	6,833,079	277,826	66,813
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	575,027		575,027
c	Accounting ...........	260,364		260,364
d	Lobbying ...........	164,562	164,562
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)	38,717,961	34,100,691	4,306,120	311,150
12	Advertising and promotion ....	1,207,652	1,207,652
13	Office expenses .......	15,240,742	13,796,190	1,215,238	229,314
14	Information technology ......	7,167,114	7,167,114
15	Royalties ..	0
16	Occupancy ...........	3,623,327	3,420,871	202,045	411
17	Travel ............	968,674	717,071	192,396	59,207
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	75,642	75,642
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	16,078,213	15,323,515	719,153	35,545
23	Insurance ...	945,361	945,361
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	STATE HOSPITAL ASSESSMENT	4,795,182	4,795,182
b	MISCELLANEOUS	24,644	24,644
c	MEDICAL SUPPLIES	25,681,124	25,681,124
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	242,344,810	224,741,171	15,823,538	1,780,101
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			14,522	1	15,047
2	Savings and temporary cash investments .........			74,834,812	2	43,401,742
3	Pledges and grants receivable, net ......			8,071,553	3	12,686,320
4	Accounts receivable, net .............			50,960,480	4	55,637,213
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 ....			0	7	0
8	Inventories for sale or use ........			2,178,872	8	2,755,392
9	Prepaid expenses and deferred charges ......			741,143	9	614,926
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	287,938,574
b	Less: accumulated depreciation	10b	94,967,585	124,243,661	10c	192,970,989
11	Investments—publicly traded securities .			251,484,299	11	276,629,671
12	Investments—other securities. See Part IV, line 11 .....			73,688,396	12	76,387,943
13	Investments—program-related. See Part IV, line 11 ..			2,621,333	13	3,691,172
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			6,887,253	15	4,188,011
16	Total assets. Add lines 1 through 15 (must equal line 34)...			595,726,324	16	668,978,426

17	Accounts payable and accrued expenses .....	39,137,759	17	48,219,378
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	27,907,804	20	65,757,804
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	13,422,489	25	31,587,482
26	Total liabilities. Add lines 17 through 25..	80,468,052	26	145,564,664

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	505,388,759	27	508,210,423
28	Temporarily restricted net assets ...........	9,869,513	28	15,203,339
29	Permanently restricted net assets	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	515,258,272	33	523,413,762
34	Total liabilities and net assets/fund balances ........	595,726,324	34	668,978,426

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). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately 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). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
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). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
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) .	Yes	No
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). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
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 separately file Form 5713, International Boycott Report (see Instructions for Form 5713).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No