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) E CLAYTON GENGRAS III...................................................................... CHAIRMAN - DIRECTOR	1.0 ................. 0.0	X	X
(2) WILLIAM C POPIK MD...................................................................... VICE CHAIRMAN - DIRECTOR	1.0 ................. 0.0	X	X
(3) ROBERT J SHANFIELD...................................................................... SECRETARY - DIRECTOR	1.0 ................. 0.0	X	X
(4) GENO AURIEMMA...................................................................... DIRECTOR	1.0 ................. 0.0	X
(5) MARILYN A BACON MD...................................................................... DIRECTOR	1.0 ................. 0.0	X
(6) THOMAS O BARNES...................................................................... DIRECTOR	1.0 ................. 0.0	X
(7) CRAIG C BONANNI MD...................................................................... DIRECTOR - PRESIDENT MED STAFF	1.0 ................. 0.0	X
(8) JAMES W FANELLI CFP...................................................................... DIRECTOR	1.0 ................. 0.0	X
(9) GLEN R GREENBERG...................................................................... DIRECTOR	1.0 ................. 0.0	X
(10) SUSAN V HERBST PHD...................................................................... DIRECTOR	1.0 ................. 0.0	X
(11) JEFFREY S HOFFMAN...................................................................... DIRECTOR	1.0 ................. 0.0	X
(12) CATO LAURENCIN MD PHD...................................................................... DIRECTOR	1.0 ................. 0.0	X
(13) SOREN TORP LAURSEN...................................................................... DIRECTOR	1.0 ................. 0.0	X
(14) ROBERT S LE BLANC...................................................................... DIRECTOR	1.0 ................. 0.0	X
(15) EDWARD LEWIS...................................................................... DIRECTOR	1.0 ................. 0.0	X
(16) CHRISSY MONACO...................................................................... DIRECTOR	1.0 ................. 0.0	X
(17) KATHERINE O NIXON...................................................................... DIRECTOR	1.0 ................. 0.0	X

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(18) KOLAWOLE A OLOFINBOBA MD........................................................................ DIRECTOR	1.0 .......................0.0	X				0	0	0
(19) DAVID M ROTH ESQ........................................................................ DIRECTOR	1.0 .......................0.0	X				0	0	0
(20) ANNE P SARGENT........................................................................ DIRECTOR	1.0 .......................0.0	X				0	0	0
(21) JAMES E SHMERLING DHA FACHE........................................................................ DIRECTOR-PRES/CEO(EFF 11/1/15)	55.0 .......................0.0	X	X			176,960	0	2,934
(22) LESLIE SILVERMAN........................................................................ DIRECTOR	1.0 .......................0.0	X				0	0	0
(23) LAUREN K ZELIGSON........................................................................ DIRECTOR	1.0 .......................0.0	X				0	0	0
(24) SCOTT W FANNING........................................................................ DIRECTOR (TERMED 01/01/16)	1.0 .......................0.0	X				0	0	0
(25) MARTIN J GAVIN........................................................................ DIRECTOR-PRES/CEO (10/1-10/31)	55.0 .......................0.0	X	X			632,641	0	30,088
(26) JAMES A MANAFORT JR........................................................................ DIRECTOR (TERMED 07/01/16)	1.0 .......................0.0	X				0	0	0
(27) CHARLES W SHIVERY........................................................................ DIRECTOR (TERMED 12/31/15)	1.0 .......................0.0	X				0	0	0
(28) PATRICK J GARVEY CPA CHFP........................................................................ TREASURER - SVP/CFO	55.0 .......................0.0		X			344,255	0	44,346
(29) FERNANDO FERRER MD........................................................................ EVP,CLINICAL AFF(TERM 7/11/16)	55.0 .......................0.0		X			0	899,927	47,437
(30) CHRISTINE FINCK MD FACS........................................................................ EVP,SURG-IN-CHIEF(EFF 7/27/16)	55.0 .......................0.0		X			0	699,826	40,939
(31) PAUL H DWORKIN MD........................................................................ EVP, COMMUNITY CHILD HEALTH	55.0 .......................0.0		X			478,949	0	23,463
(32) JUAN SALAZAR MD MPH........................................................................ EVP, ACADEMIC AFFAIRS	55.0 .......................0.0		X			446,693	0	47,267
(33) ANN G TAYLOR JD........................................................................ EVP, CHIEF ADMIN. OFFICER	55.0 .......................0.0		X			391,090	0	36,332
(34) ANDREA L BENIN MD........................................................................ SVP, PATIENT SAFETY & QUALITY	55.0 .......................0.0		X			400,760	0	46,915
(35) KELLY STYLES MBA........................................................................ SVP, OPERATIONS & CIO	55.0 .......................0.0		X			374,129	0	19,960
(36) CHERYL HOEY RN BSN MBA........................................................................ SVP, CLINICAL SERVICES & CNO	55.0 .......................0.0		X			263,262	0	42,786
(37) LAWRENCE E MILAN MA........................................................................ SVP, HUMAN RESOURCES	55.0 .......................0.0		X			260,646	0	26,490
(38) THOMAS RICHARDSON........................................................................ VP, MKTG & COMM (TERM 4/22/16)	55.0 .......................0.0		X			192,878	0	40,493
(39) AUDREY WISE MBA........................................................................ VP,CHIEF MKTG OFF(EFF 9/26/16)	55.0 .......................0.0		X			0	0	0
(40) RICHELLE DEMAYO MD........................................................................ CHIEF MED INFORMATION OFFICER	55.0 .......................0.0		X			302,242	0	26,344
(41) TRISHA FARMER MSN RN........................................................................ CHIEF OF STAFF (EFF 4/24/16)	55.0 .......................0.0		X			139,098	0	37,324
(42) BOBBY M VARGAS........................................................................ General Counsel	55.0 .......................0.0		X			279,800	0	40,884
(43) JUNG PARK........................................................................ SR DIR, INFORMATION SERVICES	55.0 .......................0.0			X		190,790	0	12,246
(44) LINDA A GROOM........................................................................ CLINICAL NURSE IV	55.0 .......................0.0			X		184,085	0	14,033
(45) MARLENE E FERRIS........................................................................ SR DIR, ORGANIZATIONAL EFFECT.	55.0 .......................0.0			X		179,982	0	28,484
(46) ROBERT J FRALEIGH........................................................................ DIRECTOR CORP. COMMUNICATIONS	55.0 .......................0.0			X		178,150	0	7,977
(47) PHILIP B HOPKINS........................................................................ DIRECTOR TECHNICAL SERVICES	55.0 .......................0.0			X		176,097	0	12,694
(48) DEAN A RAPOZA........................................................................ FORMER OFFICER	55.0 .......................0.0				X	0	299,889	46,782

(A) Name and business address	(B) Description of services	(C) Compensation
UNIVERSITY OF CONNECTICUT HEALTH CE, 263 FARMINGTON AVENUE FARMINGTON,CT06032	MEDICAL	34,203,755
HARTFORD HOSPITAL, 80 SEYMOUR STREET PO BOX 5037 HARTFORD,CT061025037	MEDICAL	6,653,354
ARAMARK CORPORATION, PO BOX 651009 CHARLOTTE,NC282651009	CAFETERIA/DIETARY	2,820,060
AMN HEALTHCARE SERVICES INC, 12400 HIGH BLUFF DRIVE SAN DIEGO,CA92130	STAFFING	1,318,375
EPIC SYSTEMS CORPORATION, PO BOX 88314 MILWAUKEE,WI53288	IT	899,156
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 51

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

CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number

06-0646755

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

CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number

06-0646755

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 CONNECTICUT CHILDREN'S MEDICAL CENTER

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 CONNECTICUT CHILDREN'S MEDICAL CENTER		Employer identification number 06-0646755

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 CONNECTICUT CHILDREN'S MEDICAL CENTER			Employer identification number 06-0646755
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

CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number

06-0646755

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

Yes

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

Yes

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

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

Yes

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

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

Yes

64,135

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

Yes

255,610

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

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

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

319,745

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, PART II-B, LINES 1A, 1B, 1D, 1F & 1G	Connecticut Children's Medical Center advocates for child-friendly policies at the Connecticut General Assembly and the United States Congress. Advocacy can include messaging sent to legislators via email, letters and social media and sometimes the provision of opportunities for Medical Center employees, medical staff and supporters in the community to reach out to their Senators and Representatives by sharing action alerts through email. THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION, CONNECTICUT HOSPITAL ASSOCIATION AND NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS WHICH ALL ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS HAS BEEN ALLOCATED TOWARDS LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THIS ORGANIZATION. THIS ALLOCATION AMOUNTED TO $64,135 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2016. DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2016, THE ORGANIZATION PAID AN OUTSIDE INDEPENDENT CONSULTING FIRM $100,000 TO LOBBY ON BEHALF OF THE MEDICAL CENTER FOR LEGISLATION AFFECTING CHILDREN'S HEALTH AND OTHER HEALTHCARE LEGISLATIVE MATTERS. THE ORGANIZATION HAS ALLOCATED TOWARD LOBBYING ACTIVITIES A PERCENTAGE OF COMPENSATION PAID TO TWO CONNECTICUT CHILDREN'S MEDICAL CENTER EMPLOYEES TO REPRESENT TIME SPENT LOBBYING ON BEHALF OF THE ORGANIZATION. THIS ALLOCATION AMOUNTED TO $155,610 DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016. PLEASE NOTE THIS AMOUNT IS INCLUDED WITHIN CORE FORM, PART IX, LINES 5 AND 7 AS SALARIES EXPENSES. VOLUNTEER PARTICIPATION IN LOBBYING ACTIVITIES INCLUDING PHONE CALLS, EMAILS AND LETTERS TO LEGISLATORS AND FEDERAL AND STATE POLICY MAKERS REGARDING VARIOUS CHILD-RELATED ISSUES. THERE WAS NO MONEY INVOLVED IN THESE VOLUNTEER TRANSACTIONS.

Return Reference

Explanation

SCHEDULE C, PART II-B, LINES 1A, 1B, 1D, 1F & 1G

Connecticut Children's Medical Center advocates for child-friendly policies at the Connecticut General Assembly and the United States Congress. Advocacy can include messaging sent to legislators via email, letters and social media and sometimes the provision of opportunities for Medical Center employees, medical staff and supporters in the community to reach out to their Senators and Representatives by sharing action alerts through email. THE ORGANIZATION IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION, CONNECTICUT HOSPITAL ASSOCIATION AND NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS WHICH ALL ENGAGE IN LOBBYING EFFORTS ON BEHALF OF THEIR MEMBER HOSPITALS. A PORTION OF THE DUES PAID TO THESE ORGANIZATIONS HAS BEEN ALLOCATED TOWARDS LOBBYING ACTIVITIES PERFORMED ON BEHALF OF THIS ORGANIZATION. THIS ALLOCATION AMOUNTED TO $64,135 FOR THE FISCAL YEAR ENDED SEPTEMBER 30, 2016. DURING THE FISCAL YEAR ENDING SEPTEMBER 30, 2016, THE ORGANIZATION PAID AN OUTSIDE INDEPENDENT CONSULTING FIRM $100,000 TO LOBBY ON BEHALF OF THE MEDICAL CENTER FOR LEGISLATION AFFECTING CHILDREN'S HEALTH AND OTHER HEALTHCARE LEGISLATIVE MATTERS. THE ORGANIZATION HAS ALLOCATED TOWARD LOBBYING ACTIVITIES A PERCENTAGE OF COMPENSATION PAID TO TWO CONNECTICUT CHILDREN'S MEDICAL CENTER EMPLOYEES TO REPRESENT TIME SPENT LOBBYING ON BEHALF OF THE ORGANIZATION. THIS ALLOCATION AMOUNTED TO $155,610 DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016. PLEASE NOTE THIS AMOUNT IS INCLUDED WITHIN CORE FORM, PART IX, LINES 5 AND 7 AS SALARIES EXPENSES. VOLUNTEER PARTICIPATION IN LOBBYING ACTIVITIES INCLUDING PHONE CALLS, EMAILS AND LETTERS TO LEGISLATORS AND FEDERAL AND STATE POLICY MAKERS REGARDING VARIOUS CHILD-RELATED ISSUES. THERE WAS NO MONEY INVOLVED IN THESE VOLUNTEER TRANSACTIONS.

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

CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number

06-0646755

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 ....	22,267,000	21,942,979	19,645,169	18,169,769	17,602,539
b	Contributions ...	883,341	498,716	431,168	271,830	306,275
c	Net investment earnings, gains, and losses	263,705	1,211,645	2,467,087	1,670,841	632,722
d	Grants or scholarships ...	0	0	0	0	0
e	Other expenditures for facilities and programs ...	984,449	1,386,340	600,445	467,271	371,767
f	Administrative expenses ....	0	0	0	0	0
g	End of year balance ......	22,429,597	22,267,000	21,942,979	19,645,169	18,169,769

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

Board designated or quasi-endowment SchDMd Bullet

0 %

Permanent endowment SchDMd Bullet

83.460 %

Temporarily restricted endowment SchDMd Bullet

16.540 %

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 ...
b	Buildings	120,981,255	55,804,243	65,177,012
c	Leasehold improvements	24,392,343	9,736,403	14,655,940
d	Equipment ...	130,473,847	85,854,738	44,619,109
e	Other ...	2,206,605	79,533	2,127,072
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				126,579,133

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)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

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)501(C)(3) TAX-EXEMPT ORG.	108,498,436	F
(2)FUNDS HELD IN TRUST BY OTHERS	80,740,462	F
(3)RABBI TRUST	275,014	F
(4)SPECIALISTS, INC. INVESTMENT	200,000	F
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	189,713,912

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) INSURANCE RECEIVABLE				14,886,104
(2) BOND ISSUANCE COSTS				615,889
(3) OTHER RECEIVABLES				1,291,992
(4) OTHER ASSETS				10,597,305
(5) DUE FROM AFFILIATED ENTITIES				18,853
(6) GROUND LEASE				2,299,514
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				29,709,657

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
DUE TO THIRD PARTIES	12,076,475
DUE TO AFFILIATED ENTITIES	15,089,703
ACCRUED PENSION LIABILITY	24,478,050
OTHER LONG-TERM LIABILITIES	20,788,011
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	72,432,239
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

SCHEDULE D, PART V, QUESTION 4

THE ENDOWMENT FUNDS REPORTED IN SCHEDULE D, PART V, ARE HELD BY CONNECTICUT CHILDREN'S MEDICAL CENTER FOUNDATION, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION FOR THE BENEFIT OF CONNECTICUT CHILDREN'S MEDICAL CENTER. INCOME FROM ENDOWMENT FUNDS IS CONSIDERED TEMPORARILY RESTRICTED UNTIL IT MEETS THE ORIGINAL DONOR'S TIME OR PURPOSE RESTRICTION OF THE DONATION. THESE FUNDS ARE COMMINGLED WITH OTHER TEMPORARILY RESTRICTED CONTRIBUTIONS FOR THE SAME PURPOSES AND INVESTED UNTIL SUCH TIME THAT THE FUNDS ARE UTILIZED. CONNECTICUT CHILDREN'S MEDICAL CENTER'S SPENDING POLICY IS THAT ANY EXPENDITURE ASSOCIATED WITH THE ENDOWMENT IS APPROPRIATED BASED ON THE DONOR'S INTENTION. RESTRICTED FUNDS ARE USED TO SUPPORT AND FURTHER THE MISSION OF CONNECTICUT CHILDREN'S MEDICAL CENTER BY PROVIDING FUNDS IN SUPPORT OF OPERATIONS AND CAPITAL PURCHASES OF CONNECTICUT CHILDREN'S MEDICAL CENTER.

SCHEDULE D, PART X, QUESTION 2

AN INDEPENDENT FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF CONNECTICUT CHILDREN'S MEDICAL CENTER AND SUBSIDIARIES FOR THE FISCAL YEARS ENDED SEPTEMBER 30, 2016 AND SEPTEMBER 30, 2015; RESPECTIVELY. THE FOLLOWING FOOTNOTE IS INCLUDED IN THE ORGANIZATION'S AUDITED CONSOLIDATED FINANCIAL STATEMENTS THAT REPORTS THE ORGANIZATION'S LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): "THE MEDICAL CENTER ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN-NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD HAS BEEN MET. MANAGEMENT HAS DETERMINED THAT THERE WERE NO MATERIAL TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2016 AND 2015." IN ADDITION, THE ORGANIZATION IS AN AFFILIATE WITHIN CCMC CORPORATION AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE SYSTEM ISSUES AUDITED CONSOLIDATED FINANCIAL STATEMENTS WHICH INCLUDE ALL RELATED ENTITIES; INCLUDING THIS ORGANIZATION. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS ALSO CONTAIN CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. THE FOLLOWING FOOTNOTE IS INCLUDED IN THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS FOR THE FISCAL YEARS ENDED SEPTEMBER 30, 2016 AND SEPTEMBER 30, 2015 THAT REPORTS THE SYSTEMS LIABILITY FOR UNCERTAIN TAX POSITIONS UNDER FIN 48 (ASC 740): "THE CORPORATION ACCOUNTS FOR UNCERTAINTY IN INCOME TAXES USING A RECOGNITION THRESHOLD OF MORE-LIKELY-THAN NOT TO BE SUSTAINED UPON EXAMINATION BY THE APPROPRIATE TAXING AUTHORITY. MEASUREMENT OF THE TAX UNCERTAINTY OCCURS IF THE RECOGNITION THRESHOLD IS MET. MANAGEMENT HAS DETERMINED THAT THERE WERE NO MATERIAL TAX UNCERTAINTIES THAT MET THE RECOGNITION THRESHOLD IN 2016 AND 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
CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number

06-0646755

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		(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	Program Services	FINANCIAL VEHICLE	4,202,050
	Central America and the Caribbean	Program Services	FINANCIAL VEHICLE	880,000















3a	Sub-total .....			5,082,050
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)			5,082,050

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, PART I	THIS ORGANIZATION PAID CHS INSURANCE LIMITED, A FINANCIAL VEHICLE, MALPRACTICE PREMIUM PAYMENTS IN THE AMOUNT OF $4,202,050 DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016. ADDITIONALLY, THIS ORGANIZATION PAID CHS INSURANCE LIMITED MALPRACTICE PREMIUMS IN THE AMOUNT OF $2,048,444, ON BEHALF OF CONNECTICUT CHILDREN'S SPECIALTY GROUP, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. THIS AMOUNT IS REIMBURSED TO CONNECTICUT CHILDREN'S MEDICAL CENTER. IN ADDITION, CONNCECTICUT CHILDREN'S SPECIALTY GROUP, INC. REPORTS MALPRACTICE PREMIUM PAYMENTS IN THE AMOUNT OF $2,048,444 ON SCHEDULE F OF ITS FORM 990. DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016, CCMC CORPORATION, THE TAX-EXEMPT PARENT ORGANIZATION OF CONNECTICUT CHILDREN'S MEDICAL CENTER, CREATED NEW ENGLAND PEDIATRICS INDEMNITY, LTD. ("NEPI"), A FOREIGN WHOLLY OWNED CAPTIVE FINANCIAL VEHICLE. ON AUGUST 26, 2016, THE ORGANIZATION TRANSFERRED $880,000 TO NEPI, AS A CAPTIAL CONTRIBUTION, ON BEHALF OF CCMC CORPORATION FOR ITS INVESTMENT IN NEPI.

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
CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number

06-0646755

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 GALA (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	776,507	776,507
2	Less: Contributions . . . .	512,562	512,562
3	Gross income (line 1 minus line 2) . . . . . .	263,945	263,945

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .	139,397	139,397
7	Food and beverages . . .	25,597	25,597
8	Entertainment . . . .	58,658	58,658
9	Other direct expenses . . .	40,293	40,293
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		263,945
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .

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 . . .	40,293	40,293

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

CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number

06-0646755

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 250 %

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 500 %

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

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) . . .	807,858		807,858	0.270 %
b	Medicaid (from Worksheet 3, column a) . . . . .	148,807,497	86,551,281	62,256,216	20.530 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	149,615,355	86,551,281	63,064,074	20.800 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	6,536,891	3,452,776	3,084,115	1.020 %
f	Health professions education (from Worksheet 5) . . .	13,346,560	1,263,069	12,083,491	3.980 %
g	Subsidized health services (from Worksheet 6) . . . .	1,548,253		1,548,253	0.510 %
h	Research (from Worksheet 7) .	9,024,425	3,141,545	5,882,880	1.940 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	63,320		63,320	0.020 %
j	Total. Other Benefits . .	30,519,449	7,857,390	22,662,059	7.470 %
k	Total. Add lines 7d and 7j .	180,134,804	94,408,671	85,726,133	28.270 %

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	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing	2,511,202	676,199	1,835,003	0.610 %
2	Economic development
3	Community support	3,546,935	1,399,810	2,147,125	0.710 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	252,052		252,052	0.080 %
7	Community health improvement advocacy	187,375	84,606	102,769	0.030 %
8	Workforce development
9	Other
10	Total	6,497,564	2,160,615	4,336,949	1.430 %

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

Yes

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

1,605,446

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

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

Section B. Medicare

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

103,224

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

379,097

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

-275,873

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?5 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)								Facility reporting group
1	CONNECTICUT CHILDREN'S MEDICAL CENTER 282 WASHINGTON STREET HARTFORD,CT06106 WWW.CONNECTICUTCHILDRENS.ORG 2-CH	X	X	X	X	X	X	1
2	CONNECTICUT CHILDREN'S MEDICAL CENTER 263 FARMINGTON AVENUE FARMINGTON,CT06030 WWW.CONNECTICUTCHILDRENS.ORG 2-CH	X	X	X	X	X		1
3	CONNECTICUT CHILDREN'S MEDICAL CENTER 80 SEYMOUR STREET HARTFORD,CT06102 WWW.CONNECTICUTCHILDRENS.ORG 2-CH	X	X	X	X	X		1
4	CONNECTICUT CHILDREN'S MEDICAL CENTER 56 FRANKLIN STREET WATERBURY,CT06706 WWW.CONNECTICUTCHILDRENS.ORG 2-CH	X	X	X	X			1
5	CONNECTICUT CHILDREN'S MEDICAL CENTER 505 FARMINGTON AVENUE FARMINGTON,CT06030 WWW.CONNECTICUTCHILDRENS.ORG 2-CH	X	X	X	X	X		1

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)

	CONNECTICUT CHILDREN'S MEDICAL CENTER
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 15

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

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): WWWW.CONNECTICUTCHILDRENS.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 16

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

Yes

If "Yes" (list url): WWW.CT.GOV

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)

	CONNECTICUT CHILDREN'S MEDICAL CENTER
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 250.% and FPG family income limit for eligibility for discounted care of 500.%

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):

WWWW.CONNECTICUTCHILDRENS.ORG

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

WWWW.CONNECTICUTCHILDRENS.ORG

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

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)

	CONNECTICUT CHILDREN'S MEDICAL CENTER
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
SCH H, PT V, SECT B, Q'S 2,3J,6A,13B,13H,15E,18D,19D,20E,21C,21D,22D,23&24	NOT APPLICABLE.
SCHEDULE H, PART V, SECTION B, QUESTION 5	While conducting its most recent Community Health Needs Assessment ("CHNA") for the fiscal year ended September 30, 2016, the organization took 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. The organization developed the CHNA with strong guidance from the Connecticut Childrens Office for Community Child Health ("the office"). Additionally, the organization partnered with various outside organizations as well as a variety of key community stakeholders. This collaboration allowed the organization to present community health needs across the age span and sectors of service and within the context of key community contributors to health. Primary Data Collection Efforts ------------------------------- As described in the organizations CHNA, in an effort to take into account input form persons who represent the broad interests of the community served, the organization used a variety of methods to compile data. These methods are outlined below: (1) Key Informant Interviews: In developing this Assessment, primary data collection efforts relied heavily on information obtained during interviews with key informants. Those interviews included city officials such as: - the director of the Hartford Department of Health and Human Services; - leaders of private foundations; - leaders of community-based nonprofit organizations; and - leaders of state agencies. In addition to Connecticut Children's, various other agencies participated in the key informant interviews. Those agencies include the following: - City of Hartford Department of Health and Human Services; - City of Hartford Fresh Food Initiative in Early Care and Education; - Comadrona; - Community Health Network of Connecticut; - Connecticut Dental Health Partnership; - Connecticut Department of Education; - Hartford Childhood Wellness Alliance; - Hartford Foundation for Public Giving; - Healthy Start; - Hispanic Health Council; - Maternal and Infant Outreach Program; - Minding the Baby Home Visiting Program; - Northeast Neighborhood Partnership; - Nurturing Families Network; - Successful Fatherhood Initiative; - United Way of Connecticut; AND - Village for Families and Children. Interviewees were asked a variety of questions that focused on identifying unmet needs within the community. (2) Hartford Blueprint for Womens and Childrens Health: The Hartford Blueprint for Womens and Childrens Health ("the Blueprint") provides a comprehensive look at the needs of the citys women and young children. The city of Hartford commissioned the Office to prepare the Blueprint as to articulate the need for building a comprehensive system in Hartford to ensure strong families and lifelong outcomes for children. The document provides a roadmap to address the needs identified for Hartfords women and children through system building and collective impact. Additional primary collection data efforts include the following with respect to the Blueprint: - The organization reviewed prior reports and surveys related to health, prenatal care, and early care and education; - Focus groups with early care and education providers, community leaders, and residents were conducted; - Various meetings with health and human services and early care and education steering committees and collaboratives took place; - Surveys from medical, behavioral health, and dental providers in Hartford were distributed; and - Leadership discussions with the Connecticut Childrens Office for Community Child Health office took place. (3) School Nurse Surveys: A survey of school nurses from across Connecticut was conducted in August 2014 and provided critical information about the needs of Hartfords older children. The survey, was conducted by the organization and listed a variety of public health concerns and asked respondents to rate them from zero, where the issue is perceived not to be a problem, to four, where the issue is perceived to be a major problem. The survey also asked respondents to provide ideas about how to improve the health of children in Connecticut. There were a total of 90 surveys collected from school nurses during a conference in August 2015. Arranged by county, there were 57 from Hartford County, eight from Tolland County, seven from New London County, six from Fairfield County, three from Litchfield County, and two each from New Haven, Windham, and Middlesex Counties. (4) SINA Neighborhood Economic Development Plan: Beyond health and child development, the CHNA also considers community needs as identified by the 2015 SINA Economic Development Plan. SINA, which is a partnership between Connecticut Childrens, Hartford Hospital, and Trinity College, conducted an analysis of neighborhood needs, opportunities and resources and compiled the results into the SINA Neighborhood Economic Development Study. The organization conducted interviews with senior managers of relevant departments within SINA member institutions. Additionally, focus groups with key community stakeholders were held. Secondary Data Collection Efforts --------------------------------- In addition to the primary data collections described above, the organization took into account various secondary data sources when developing its CHNA. These include, but are not limited to, the following: (1) Hartford Foundation for Public Giving Early Development Instrument ("EDI"): The EDI attempts to answer the question of what can be done to ensure children are ready for school. The organization analyzed the data to help identify community needs in this report. The EDI project was conducted at schools in Hartford and West Hartford as a population measure of how young children are developing in communities. It measures five areas of early childhood development: physical health and wellbeing; social competence; emotional maturity; language and cognitive development; and communications skills and general knowledge. The work was guided by the UCLA Center for Healthier Families, Children and Communities. The organization used the data to further gather information with respect to community needs related to early childhood care and education. (2) DataHaven Community Wellbeing Survey: The DataHaven Community Wellbeing Survey also provided key information for the CHNA. The non-profit group DataHaven, based in New Haven, Connecticut, is dedicated to improving the quality of life of residents by collecting, interpreting, and sharing public data to assist leaders with effective decision making. The organization has been in existence since 1992. The survey is its largest initiative and produces information on the quality of life, public health, economic development and civic vitality for more than 100 state and local government, health care, academic, and community partners across Connecticut. The organization analyzed data contained in the 2015 DataHaven Community Well-being Survey for Hartford, and used pertinent information to identify community needs. DataHaven contracted with the Siena College Research Institute to conduct a survey of 16,820 residents across the state of Connecticut, including 750 residents of the City of Hartford. Interviews were conducted in English and Spanish. To ensure that the statistics represented the true demographics of the state, the overall statewide sample was weighted by age, gender, reported race, and county. It was also weighted to match current patterns of telephone usage (landline only, cell phone only, or both). Local level samples, like those for Hartford, were weighed using the same parameters and applied at a local level (town instead of county). Surveys were conducted via landlines and cell phones. (3) United Way of Connecticuts 211 Program: The nonprofit United Way of Connecticut strives to meet the needs of state residents by providing them with information, education, and connections to services. It manages and operates the Child Development Infoline, which is accessible through 211, and serves as the statewide centralized telephone access point where care coordinators connect families in need with services that can help them. In the 2014-2015 fiscal year, Hartford residents called 211 a total of 54,695 times which resulted in 70,501 requests for services. The CHNA analyzed data provided by the United Way of Connecticuts 211 information and referral service, which shows the estimated number of calls for service coming in from Hartford during the 2015-2016 fiscal year. Data from the United Way of Central and Northeastern Connecticut, the region that includes Hartford, was also used. The organization used this data to gather additional information with respect to the community needs of the greater Hartford area.
SCHEDULE H, PART V, SECTION B, QUESTION 6B	Although the CHNA was conducted solely by Connecticut Childrens Medical Center, the following is stated within the CHNA "We believe that our approach to conducting this Assessment has allowed us to engage our community partners and have the greatest impact on our communitys health." The organization has many long standing and active partnerships with various government, social and civic organizations. Therefore, the CHNA is the result of a collaborative effort with various community partners who worked together to identify the unmet needs of community served.
SCHEDULE H, PART V, SECTION B, QUESTION 7D	THE ORGANIZATION'S CHNA was reviewed AND APPROVED by ITS Board of Directors. Once approved, the CHNA was posted on THE organization's website, noting that hardcopies were available on request. Hard copies were distributed to neighborhood leaders, community leaders around Hartford, city officials, Hartford's legislative representatives, business leaders in the community, and local funders.
SCHEDULE H, PART V, SECTION B, QUESTION 11	In CONDUCTING the CHNA, the Connecticut Childrens Office for Community Child Health ("the office") developed a robust strategy for addressing the identified needs to enhance health care for Hartfords women and children and to promote the optimal healthy development of the Citys youngest residents. Throughout the CHNA the organization identified the following unmet community health needs: 1) Developmental Surveillance and Screening ------------------------------------------- Identified Need: There is a need to bring to scale an existing assessment service, Mid-Level Developmental Assessment, and Help Me Grow opportunities for at-risk children who are not eligible for publicly funded intervention programs. Area of Focus: Many children with mild-to-moderate developmental or behavioral concerns are eluding early detection and are arriving at kindergarten without the developmental, socio-emotional, behavioral and/or cognitive skills to begin school. These children were often ineligible for early intervention or preschool special education services prior to school entry, as both of these services have strict eligibility requirements. 2) Cross-Sector Care Coordination --------------------------------- Identified Need: There is a need to bring existing care coordination programs to scale throughout the city and to expand the Hartford Care Coordination Collaborative ("HCCC") to include care coordination services from health, child care, home visiting and other child and family services. Area of Focus: Care coordination from a variety of service sectors is available to children and families in Hartford. There is also a program, the HCCC, which brings Hartford area care coordinators from a variety of child and family serving sectors together to increase the efficiency of services and decrease the duplication that can occur when families work with multiple care coordinators from different sectors. 3) Chronic Health Problems -------------------------- Identified Need: There is a need to bring existing programs that address asthma and lead concerns, such as Easy Breathing and the Connecticut Childrens Healthy Homes program, to scale throughout the city for maximum impact. Area of Focus: Chronic health conditions such as asthma and lead toxicity disproportionately impact urban children, especially those who live in poverty. 4) Childhood Obesity -------------------- Identified Need: There is a need to bring to scale existing nutrition and physical activity programs in preschools, childcare centers, and in the primary care setting. Area of Focus: Obesity disproportionately affects children of color and those in low-income families. More than one-third of Hartford preschoolers are overweight or obese, with rates far above the national average according to a University of Connecticut study. 5) Home Visiting Services Addressing Womens and Childrens Health ------------------------------------------------------------------ Identified Need: The challenge is to reduce waiting lists and bring this type of family support to scale for the entire population. Area of Focus: A variety of home visiting programs, such as the Maternal and Infant Outreach Program, exist for families in Hartford and have shown success in improving birth outcomes, ensuring that pregnant women enter prenatal care early, and addressing developmental and behavioral health needs of children. INITIAL GOALS ------------- IN ORDER TO FULFILL THE NEEDS OUTLINED ABOVE the organization ESTABLISHED initial goals. THESE GOALS include the following areas of focus to be overseen and implemented by the Office: 1) Engage key community stakeholders in setting implementation priorities: The organization felt that engagement of an array of stakeholders, including parents and providers from diverse sectors, is critical to the successful implementation of programs that address the needs identified in the CHNA. The Office aims to strengthen connections among key community stakeholders to facilitate collective impact by convening a Stakeholder Leadership Team. This work will include the prioritization of objectives and will set a timeline for their implementation. Community conversations will solicit input from parents and residents to ensure community buy-in. 2) Coordinate implementation of key recommendations and bring to scale evidence informed innovations: The Office has had remarkable success in diffusing innovation through the design, implementation, and dissemination of local and regional programs of statewide and national significance. THE HELP ME GROW ("HMG") PROGRAM, WHICH promotes the early detection of children at risk for developmental and behavioral problems and their connection to services, was piloted in Hartford before being scaled up across Connecticut. Now, more than 25 states are implementing the HMG model as part of the Offices HMG national affiliate network. Further, the Office has piloted and is disseminating two innovations, the Care Coordination Collaborative Model ("CCCM") and Mid-Level Developmental Assessment ("MLDA"). CCCM works to coordinate care coordinators from various child-serving sectors in the greater Hartford region. It was developed in response to the notion that a child may have multiple care coordinators from different agencies managing his or her care at the same time without integration across sectors. 3) Build the capacity of Hartford families and service providers across various settings to promote childrens optimal healthy development: A positive family foundation is the single most important influence on enhancing lifelong health and outcomes. The Center for the Study of Social Policys Protective Factors Framework identifies key influences that build family capacity to support optimal child development. Such factors include parental resilience, concrete support in times of need, social connections, parental knowledge of child development and parenting strategies, and childrens social and emotional competence. The Office has embraced the utility of the protective factors as a framework for strengthening families, as well as enhancing the capacity of child health, mental health, early care, and family support providers to contribute to childrens optimal healthy development. To ensure maximum contribution from Hartfords child health providers, the Office will support the expansion of its existing Educating Practices in the Community ("EPIC") program, which is operated in partnership with the Child Health and Development Institute of Connecticut. 4) Establishing a data-driven continuous quality improvement ("CQI") system for monitoring early childhood services and outcomes in Hartford: The Office will build upon its existing web-based data collection and reporting tools to design a robust data system for tracking project implementation and impact, to enable CQI and facilitate collective impact. The Office will do so by: - Utilizing CQI methodology and tools to engage providers and other stakeholders in the continuous monitoring of the quality of health services and encourage the testing of changes to improve service efficacy and outcomes. - Develop a comprehensive data system for tracking project implementation, CQI outcomes, and the achievement of project goals. In February of 2017, the organization created its Community Health Improvement Plan ("CHIP") which outlines how the organization will continue to work to address the need identified within its most recently conducted CHNA. The organizations CHIP states the following: "Our most recent CHNA utilized a number of components that included the input of many people working with the underserved, representing voices from both a local and state-wide level. Two major components were: the Hartford Blueprint for Women and Childrens Health ("the Blueprint") and Southside Institutions Neighborhood ALliances ("SINA") Economic Development Plan. It is from those sources that Connecticut Childrens will prioritize its initial actions for our CHIP." The Hartford Blueprint for Women and Childrens Health ------------------------------------------------------- the Blueprint recommended six steps be taken in order to build an effective healthcare system that benefits women and children of Hartford. They are: 1. Establish a public/private leadership team that includes the city, THE OFFICE, the Child Health and Development Institute of Connecticut, key stakeholders, and residents to guide and oversee Blueprint implementation; 2. Establish within the city a comprehensive women and childrens health system that ensures women of child-bearing age, children and families have timely access to a seamless and user-friendly range of services and support; 3. Develop and disseminate data on the health of women, the health and developmental status of children, and the status of programs and services to public officials, providers, community-based organizations, and residents to inform prioritization and decision making; 4. Engage all city p
SCHEDULE H, PART V, SECTION B, QUESTION 16I	THE BOTTOM OF ALL BILLING INVOICES INCLUDES A STANDARD NOTE INDICATING THE PATIENT FINANCIAL ASSISTANCE POLICY IS AVAILABLE ALONG WITH A PHONE NUMBER TO OBTAIN THE POLICY.

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?6
Name and address		Type of Facility (describe)
1	CONNECTICUT CHILDREN'S MEDICAL CENTER 100 RETREAT AVENUE 4TH FLOOR HARTFORD,CT06106	SPEECH THERAPY
2	CONNECTICUT CHILDREN'S MEDICAL CENTER 11 SOUTH ROAD FARMINGTON,CT06032	SPEECH THERAPY, AUDIOLOGY
3	CONNECTICUT CHILDREN'S MEDICAL CENTER 399 FARMINGTON AVENUE 3RD FLOOR FARMINGTON,CT06032	OCCUPATIONAL & PHYSICAL THERAPY
4	CONNECTICUT CHILDREN'S MEDICAL CENTER 399 FARMINGTON AVENUE 3RD FLOOR FARMINGTON,CT06032	MOTION ANALYSIS
5	CONNECTICUT CHILDREN'S MEDICAL CENTER 320 WESTERN BOULEVARD GALSTONBURY,CT06033	OCCUPATIONAL, PHYSICAL & SPEECH THERAPY, AUDIOLOGY
6	CONNECTICUT CHILDREN'S MEDICAL CENTER 111 FOUNDERS PLAZA EAST HARTFORD,CT06108	CLINICAL NUTRITION
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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 I; LINE 3C	Not applicable.
SCHEDULE H, PART I; LINE 6A	The organization prepared a 2015 2016 community benefit report which reports the results of its efforts to service the community and have a measurable impact on children and families across the State of Connecticut and beyond. The organizations community benefit report is made widely available on the following website: https://www.connecticutchildrens.org/wp-Content/uploads/2016/09/CommunityB enefitReport_2015-2016.pdf
SCHEDULE H, PART I; LINE 7	Lines 7a and 7b were determined using a ratio of cost to charges. Lines 7e through 7i were all reported at true cost, not using a cost to charge ratio.
SCHEDULE H, PART I; QUESTION 7G	The subsidized health service reported on line 7g are for shared psychiatric services with the institute of living.
SCHEDULE H, PART II	Connecticut Children's Medical Center's ("Connecticut Children's") core mission is to improve the physical and emotional health of children across the state of Connecticut. The organization recognizes that children do not live in isolation, and that they are a part of families and communities. In order to fulfill its mission, the organization provides leadership and participates in community based programs that help build healthier communities. As one of its five key organizational strategies, the organization has created the Connecticut Childrens Office of Community Child Health ("the Office"). The Office serves as its coordinating entity for our community-oriented programs. In 2016, there were fifteen community programs that were overseen by the Office: - Help Me Grow National Center; -Easy Breathing; -Care Coordination Collaborative Model ("CCCM"); -Mid-Level Developmental Assessment ("MLDA"); -Connecticut Childrens Center for Care Coordination; -Connecticut Childrens Healthy Homes Program; -Advancing Kids Innovation Program ("AKIP"); -Childrens Center on Family Violence; -Hartford Youth HIV Identification and Linkage Consortium ("HYHIL"); -Co-Management; -Connecticut Childrens Injury Prevention Center; -Educating Practices in the Community ("EPIC"); -Person-Centered Medical Home ("PCMH"); -Practice Quality Improvement ("PQI"); and -Resident Education in Advocacy and Community Health ("REACH"). All fifteen programs have elements of community building in their purpose. Some involve working with local communities, some with state-wide communities and some working with communities on a national level. The Office has helped these existing programs progress and evolve, while also acting an as incubator for new, innovative community-oriented programs. The goal of the office is to maximize the organizations impact in the community. Additional community building activities include Connecticut Children's work with a neighborhood partnership called Southside Institutions Neighborhood Alliance and the United Way of Central and Northeastern Connecticut. Southside Institutions Neighborhood Alliance ("SINA") is a partnership between Connecticut Children's, Hartford Hospital and Trinity College. We are all located in one of Hartford's poorest neighborhoods. Each institution pays dues that act as the foundation for SINA's annual operating budget. Three employees of Connecticut Children's are on SINA's board of directors, and in 2016, employees participated in committees and activities that promoted education, improved housing, and public safety in the surrounding neighborhoods. Connecticut Childrens supported education through SINA through the sponsorship of the Sanchez School science fair. The goal was to support the school in their encouragement of promoting students interest in the sciences. Along with a financial sponsorship, employees acted as judges for the event and served as volunteers to help with the event coordination. SINA has also set up two scholarship programs. In 2016, three graduates from the local high school received scholarships for their community service contributions. All three will be attending 4-year college programs. The scholarship is renewable for each of the four years, and has allowed students awarded scholarships from the previous years to continue with their education. In total, twelve scholarships were given out for the year. Four adults from the neighborhood who attend Capital Community College received a "SINA Student Support Scholarships" to support their efforts in getting into a career in either healthcare or education. SINA's housing program has focused on taking blighted buildings, razing them, and then building new single and two-family homes. SINA has been able to bring together federal, state, and city financial support to construct 65 homes during the past 10 years, having recently sold 5 completed homes to first-time home buyers. The organization estimates that the 65 new homes have put more than $250,000 onto the yearly tax roll for the city. SINA continues to own rental properties that were obtained some years ago to address the need of inadequate quality low-cost housing for the neighborhood, and through SINA, dialogue continues with the community on strategies to balance housing efforts to meet the greatest community need. In 2016, SINA received a $2.5 million dollar grant from the State of Connecticut to continue the housing work, targeting a neighborhood that has many blighted properties. These properties have some historical significance, but the building rehabilitation is beyond what the city and or individuals can afford. Public safety is promoted in a number of ways. SINA staff and staff from Connecticut Children's participate in one of Hartford's Neighborhood Revitalization Zone ("NRZ") meetings. The organization participates on the NRZ's public safety committee supporting block watch programs and organizing a Neighborhood Safety Team. SINA organizes regular meetings with the Hartford police department and the campus safety managers of the three institutions to discuss collaborative efforts for patrolling the neighborhood. The organizations collaboration with the United Way includes a yearly employee campaign in which employee committees are established to raise money that is invested in the community. Aside from the campaign activities, Connecticut Children's employees participated in the United Way's community investment process, helping to evaluate community programs receiving United Way funds. Employees volunteered time to be readers in local schools and one member of Connecticut Children's also represents the organization on the Operations Committee of the United Way.
SCHEDULE H, PART III, SECTION A; QUESTIONS 2, 3 & 4	Bad debt is based upon historical collection percentage analysis of accounts written off. Bad debt expense was calculated using the providers' bad debt expense from financial statement, net of accounts written off at charges. Connecticut children's medical center ("Connecticut Children's") and its subsidiaries prepare and issue audited consolidated financial statements. Connecticut Children's allowance for doubtful accounts (bad debt expense) methodology and charity care policies are consistently applied across all hospital facilities. The attached text was obtained from the footnotes to the audited financial statements of Connecticut Children's And Subsidiaries: Patient accounts receivable --------------------------- Patient accounts receivable and revenues are recorded when patient services are performed. Amounts received from certain payors are different from established billing rates of the medical center, and the difference is accounted for as allowances. The medical center records its provision for bad debts based upon a review of all of its outstanding receivables. Write-offs of receivable balances are related to its population of underinsured patients. An underinsured patient is one who has commercial insurance which leaves a significant portion of the medical center's reimbursement to be paid by the patient, either through large deductibles or co-pay requirements. Self-pay patients are rare in the pediatric environment, as Medicaid is readily available to children. Self-pay net revenue approximated $4,500,000 and $3,600,000 for the years ended September 30, 2016 and 2015, respectively. Charity care ------------ The medical center accepts all patients regardless of their ability to pay. A patient is classified as a charity patient by reference to the established policies of the medical center. Essentially, those policies define charity services as those services for which no payment is anticipated. In assessing a patient's inability to pay, the medical center utilizes the generally recognized poverty income levels for the state of Connecticut, but also includes certain cases where incurred charges are significant when compared to incomes. The costs of charity care incurred were $1,107,000 and $929,000 for the years ended September 30, 2016 and 2015, respectively. The costs of charity care are derived from both estimated and actual data. The estimated cost of charity care includes the direct and indirect cost of providing such services and is estimated utilizing the medical center's ratio of cost to gross charges, which is then multiplied by the gross uncompensated charges associated with providing care to charity patients.
SCHEDULE H, PART III, SECTION B; QUESTION 8	Medicare costs were derived from the 2015 Medicare cost report. The organization feels that Medicare underpayments (shortfall) and bad debt are community benefit and associated costs are includable on the form 990, schedule h, part i. As outlined more fully below the organization believes that these services and related costs promote the health of the community as a whole and are rendered in conjunction with the organization's charitable tax-exempt purposes and mission in providing medically necessary healthcare services to all individual's in a non-discriminatory manner without regard to race, color, creed, sex, national origin or ability to pay and consistent with the community benefit standard promulgated by the irs. The community benefit standard is the current standard for a hospital for recognition as a tax-exempt and charitable organization under internal revenue code ("irc") 501(c)(3). The organization is recognized as a tax-exempt entity and charitable organization under 501(c)(3) of the irc. Although there is no definition in the tax code for the term "charitable" a regulation promulgated by the department of the treasury provides some guidance and states that "[t]he term charitable is used in 501(c)(3) in its generally accepted legal sense,provides examples of charitable purposes, including the relief of the poor or unprivileged; the promotion of social welfare; and the advancement of education, religion, and science. Note it does not explicitly address the activities of hospitals. In the absence of explicit statutory or regulatory requirements applying the term "charitable" to hospitals, it has been left to the irs to determine the criteria hospitals must meet to qualify as irc 501(c)(3) charitable organizations. The original standard was known as the charity care standard. This standard was replaced by the irs with the community benefit standard which is the current standard. Charity care standard In 1956, the irs issued revenue ruling 56-185, which addressed the requirements hospitals needed to meet in order to qualify for irc 501(c)(3) status. One of these requirements is known as the "charity care standard." under the standard, a hospital had to provide, to the extent of its financial ability, free or reduced-cost care to patients unable to pay for it. A hospital that expected full payment did not, according to the ruling, provide charity care based on the fact that some patients ultimately failed to pay. The ruling emphasized that a low level of charity care did not necessarily mean that a hospital had failed to meet the requirement since that level could reflect its financial ability to provide such care. The ruling also noted that publicly supported community hospitals would normally qualify as charitable organizations because they serve the entire community, and a low level of charity care would not affect a hospital's exempt status if it was due to the surrounding community's lack of charitable demands. Community benefit standard In 1969, the irs issued revenue ruling 69-545, which "remove[d]" from revenue ruling 56-185 "the requirements relating to caring for patients without charge or at rates below cost." under the standard developed in revenue ruling 69-545, which is known as the "community benefit standard," hospitals are judged on whether they promote the health of a broad class of individuals in the community. The ruling involved a hospital that only admitted individuals who could pay for the services (by themselves, private insurance, or public programs such as Medicare), but operated a full-time emergency room that was open to everyone. The irs ruled that the hospital qualified as a charitable organization because it promoted the health of people in its community. The irs reasoned that because the promotion of health was a charitable purpose according to the general law of charity, it fell within the "generally accepted legal sense" of the term "charitable," as required by treas. Reg. 1.501(c)(3)-1(d)(2). The irs ruling stated that the promotion of health, like the relief of poverty and the advancement of education and religion, is one of the purposes in the general law of charity that is deemed beneficial to the community as a whole even though the class of beneficiaries eligible to receive a direct benefit from its activities does not include all members of the community, such as indigent members of the community, provided that the class is not so small that its relief is not of benefit to the community. The irs concluded that the hospital was "promoting the health of a class of persons that is broad enough to benefit the community" because its emergency room was open to all and it provided care to everyone who could pay, whether directly or through third-party reimbursement. Other characteristics of the hospital that the irs highlighted included the following: its surplus funds were used to improve patient care, expand hospital facilities, and advance medical training, education, and research; it was controlled by a board of trustees that consisted of independent civic leaders; and hospital medical staff privileges were available to all qualified physicians. Medicare underpayments and bad debt are community benefit and associated costs should be includable on the form 990, schedule h, part i. The American Hospital Association ("AHA") feels that Medicare underpayments (shortfall) and bad debt are community benefit and thus includable on the form 990, schedule h, part i. This organization agrees with the aha position. As outlined in the aha letter to the irs dated august 21, 2007 with respect to the first published draft of the new form 990 and schedule h, the aha felt that the irs should incorporate the full value of the community benefit that hospitals provide by counting Medicare underpayments (shortfall) as quantifiable community benefit for the following reasons: - providing care for the elderly and serving Medicare patients is an essential part of the community benefit standard. - Medicare, like Medicaid, does not pay the full cost of care. Recently, Medicare reimburses hospitals only 92 cents for every dollar they spend to take care of Medicare patients. The Medicare payment advisory commission ("MEDPAC") in its march 2007 report to congress cautioned that underpayment will get even worse, with margins reaching a 10-year low at negative 5.4 percent. - Many Medicare beneficiaries, like their Medicaid counterparts, are poor. More than 46 percent of Medicare spending is for beneficiaries whose income is below 200 percent of the federal poverty level. Many of those Medicare beneficiaries are also eligible for Medicaid -- so called eligibles." There is every compelling public policy reason to treat Medicare and Medicaid underpayments similarly for purposes of a hospital's community benefit and include these costs on form 990, schedule h, part i. Medicare underpayment must be shouldered by the hospital in order to continue treating the community's elderly and poor. These underpayments represent a real cost of serving the community and should count as a quantifiable community benefit. Both the aha and this organization also feel that patient bad debt is a community benefit and thus includable on the form 990, schedule h, part i. Like Medicare underpayment (shortfalls), there also are compelling reasons that patient bad debt should be counted as quantifiable community benefit as follows: - a significant majority of bad debt is attributable to low-income patients, who, for many reasons, decline to complete the forms required to establish eligibility for hospitals' charity care or financial assistance programs. A 2006 congressional budget office ("CBO") report, nonprofit hospitals and the provision of community benefits, cited two studies indicating that "the great majority of bad debt was attributable to patients with incomes below 200% of the federal poverty line." - the report also noted that a substantial portion of bad debt is pending charity care. Unlike bad debt in other industries, hospital bad debt is complicated by the fact that hospitals follow their mission to the community and treat every patient that comes through their emergency department, regardless of ability to pay. Patients who have outstanding bills are not turned away, unlike other industries. Bad debt is further complicated by the auditing industry's standards on reporting charity care. Many patients cannot or do not provide the necessary, extensive documentation required to be deemed charity care by auditors. As a result, roughly 40% of bad debt is pending charity care. - The CBO concluded that its findings "support the validity of the use of uncompensated care [bad debt and charity care] as a measure of community benefits" assuming the findings are generalizable nationwide; the experience of hospitals around the nation reinforces that they are generalizable. As outlined by the aha, despite the hospitals' best effor
SCHEDULE H, PART III, SECTION B; QUESTION 9B	Connecticut Children's Medical Center ("Connecticut Children's") has a billing and collection policy. The purpose of this policy is to ensure that the organizations billing, credit and collection practices comply with all Federal and State laws, regulations guidelines and policies. Connecticut Children's is committed to providing the available healthcare, along with convenient billing services, payment options and financial assistance. Connecticut Children's will make every effort to communicate the patient financial assistance, billing, credit and collection processes to the patient and/or their family. Patients and their families are responsible to provide timely and accurate information such as, but not limited to, demographic, insurance, and income to Connecticut Children's to facilitate the patient financial assistance, billing, credit and collection processes. It is the responsibility of the patients and their families to know, understand, and comply with their insurance coverage, coinsurance, copays, deductibles, and benefit/coverage limitations. We ask our patients families to remember that an insurance policy is a contract between them and the insurance company, and that they have the final responsibility for payment of their hospital bill. Connecticut Children's provides patient financial services to help families navigate the process of billing and medical insurance. In addition, customer service representatives are available to provide copies of itemized patient bills, explain particular bills, set up payment arrangements or review what costs insurance has paid and what payments are due. As a courtesy to its patients, Connecticut Children's submits bills to their insurance companies and makes every effort to advance their claim. However, it may become necessary for a policy holder to contact their insurance provider or supply additional information required for claims processing purposes or to expedite payment. The organization requests bills be paid in full within thirty (30) days. The guarantor is responsible to obtain the necessary funds from any source, such as obtaining a loan through their bank and/or credit union. If the guarantor is unable to pay by obtaining a loan or use of a credit card, payment arrangements may be made with Counselors. Monthly payments are required. Requests for establishing payment plans that extend past the above recommended terms greater than 12 months must be reviewed and approved by management. In addition, any requests for establishing payment plans that extend past a 60 month term must be reviewed and approved by Management. Connecticut Children's will only refer those accounts to Collection agencies when it has been determined that the Patient/guarantor has the means to pay the balance and has chosen not to apply for patient financial assistance.
SCHEDULE H, PART VI; QUESTION 2	In September of 2016, Connecticut Children's released its Community Health Needs Assessment ("CHNA") with the full support of the organizations Board of Directors. The assessment had components that focused on its neighborhood, Hartford, and the Greater Hartford area. Those components included the blueprint for Women and Childrens Health in Hartford. There were numerous partners, contributors and local voices that spelled out specific recommendations to make improvements in Hartfords young children achieving their optimal healthy development. Additional components for the CHNA included SINAs Economic Development Plan for our neighborhood (addressing a number of social determinants of health), a survey Administered to school nurses from around the state, and information from Data Havens s Statewide Well-Being survey. In addition to the internal revenue code 501(r) community health needs assessment information outlined in form 990, schedule h, part v, section b, Connecticut Children's also conducted the following activities with respect to its CHNA: The organization continuously gathers information that informs its work in promoting childrens optimal healthy development in communities around the state. Some of those vehicles include: - Sitting on the city's public health advisory committee; - collecting information about health trends from our clinics and emergency department; - researching local and national health related issues; - participating on neighborhood, local, statewide and national committees, coalitions, networks and boards of directors using those opportunities to guide our decision making; and - responding to grant opportunities which require us to assess specific needs as they relate to a specific grant. The Connecticut state hospital association has developed a network of community benefit reporters who share their community health needs assessments and also a Community Health Network. The organizations participation allows them to see what the association has identified as needs in pediatrics at its local levels. The organization views the process for assessing the healthcare needs of the community as a rolling, evolving process. The CHNA may represent a snapshot in time, but the community is not stagnant. While "health" within community residents may get better or worse, there are many contributing factors that are beyond the control of health providers. It is imperative that as a provider, the organization is aware of any opportunity that might inform how they practice, partner, and contribute toward a healthier environment. While the formal CHNA did provide an opportunity to learn from many individuals and organizations in the city, the city and state that are facing budget challenges that affect non-profit organizations, program partners, and government entities that support the efforts to create and sustain a thriving environment for children and families. The narrative within Schedule H, Part V, Section B makes reference to a number of information sources that informs the organizations work. At various times they may happen upon a new source of information, identify assets in the community, or develop new relationships with potential collaborators. In the event that the organization identifies a need and opportunity to address it quickly, which may be outside of our formal CHNA and community health improvement plan (chip), they are obliged to act.
SCHEDULE H, PART VI; QUESTION 3	In addition to being posted on the organization's website and available within the facility upon request, information addressing the patient financial assistance policy and the credits and collections policy are also posted (in English and Spanish) in general public areas in an effort to notify patients and their guarantors of the availability of hospital-based assistance and other programs of public assistance. If the hospital determines that a patient or guarantor is potentially eligible for Medicaid or other government program, it will encourage the patient or guarantor to apply for such program and the financial counselors will assist patient guarantors in applying for Medicaid, hospital-based assistance, or other assistance and payment plan programs when appropriate. Connecticut children's medical center offers hospital-based assistance for medically necessary inpatient and outpatient services for those patients unable to pay who can demonstrate financial need according to Connecticut Children's Medical Center's patient financial assistance eligibility determination methodology. It is available as a last resort after all other third party resources have been exhausted. Once approved, the duration for eligibility for financial assistance is six months.
SCHEDULE H, PART VI; QUESTION 4	Connecticut Children's Medical Center is located in Hartford Connecticut. We serve children and families from the entire state, though the heaviest concentration of those served come from the Hartford/Greater Hartford area. Connecticut ranks as one of the wealthier states in the U.S. based on per capita income. While Hartford has a rich history, it is now consistently ranked among the poorest cities of its size in the country, with one recent study placing it at seventh poorest. Some statistics that describe our community served include: - The U.S. Census lists CT's population at 3.5 million people. 70% of the residents are white, 15% are Hispanic of Latino, and 11% are black or African American. According to numerous sources, Connecticut ranks anywhere from #1 - #3 of the richest states in per capita income. - Hartfords population is close to 125,000. 43% of the residents are Hispanic or Latino, 38% are black or African American, and 15% are identified as white. An estimated 38% of the city's residents live in poverty, compared to 10.7% of the state's overall population. An estimated 44% of Hartford families with children below age 18 live in poverty. More than 50,000 residents (42%) participate in the Supplemental Nutrition Assistance Program. An estimated 77% of Hartford students were eligible for free or reduced price school meals during the year. More than 52% of the 70,501 requests from Hartford residents to the United Way's information and referral service, 2-1-1, were for assistance for basic needs such as housing, food and utilities (information from the Blueprint on Women and Children's Health). - According to SINA's Neighborhood Economic Development study, the neighborhoods around Connecticut Children's Medical Center consist of more than 60% Latino residents and more than 20% other minorities, mainly African American. Almost 60% of the households have annual incomes of less than $25,000, and about 25% have annual incomes of less than $10,000. Fewer than 20% have incomes greater than $50,000. These figures are all lower than the city average. Additionally, more than 50% of the households receive cash assistance and/or food stamps, figures that are higher than the city average. About 40% of the adults age 25 and older do not have a high school diploma or equivalent. Less than 20% have earned an Associate's Degree or higher. It is safe to say that Connecticut had great economic disparity among its residents.
SCHEDULE H, PART VI; QUESTION 5	Connecticut Children's Medical Center has a vision to make Connecticuts children the healthiest in the nation. While the organization provides leading medical care, treatment, and follow-up support within its facilities, some of their best work is promoting children's health happens within Connecticuts communities. Connecticut Childrens Office for Community Child Health ("the Office") is dedicated to developing and supporting community-based programs that promote children's optimal healthy development. The Office has enabled the organization to place community focused programs under one umbrella. This has provided the opportunity to more efficiently use resources, develop new partnerships, and promote community health, keeping focused on its mission to make Connecticut's children the healthiest in the country. The Office promotes community health on a local, statewide, and national level, with much of the messaging focused on the importance of having a system that supports the healthy development of all children. Health providers are key resources as community providers, but without other partnerships on the local, state, and federal levels, maximizing the promotion of children's health in all of our communities will not be achieved. Programs under the Office, notably Easy Breathing, EPIC, Practice Quality Improvement, and Co-Management, work with other providers across the state to help identify better approaches to managing children's health issues as a means of promoting better health and working toward better health outcomes. Additionally, the organization provides weekly Grand Rounds, inviting participation from community providers. Subject matter for Grand Rounds includes innovative approaches to better health in the community. The organization has a Referring Provider Board of pediatricians that represents different geographic communities around the state. Their input is solicited as to best promote children's health throughout the state. Some of its programs have health promotion as a component. The Injury Prevention Center promotes community health with all of its prevention activities; car seat clinics, new teen driver activities, programs on pedestrian safety, toy safety and smoke detector use. Intentional and unintentional injuries that result in children and youth ending up in emergency rooms are studied to see if there might be opportunities to advocate, educate, and collaborate with community partners to prevent injuries. Healthy Homes promotes community health in the areas of lead paint hazards, mold and other asthma triggers, and home safety issues, working with individual homeowners, individuals being trained as housing inspectors, and municipal workers. HYHIL focuses on building a collaborative that promotes safe sexual behaviors among adolescents and young adults. REACH provides pediatric residents the opportunity to learn about the community and the many ways they can broaden their impact on the lives of young people. The Government Relations Department is a vehicle whereby children's community health information can be brought before elected officials. An example of this is when the organization began to study accident rates of new teen drivers. The sharing of those studies with legislative leaders and community partners was the start of what later became legislation that added some restrictions to new young drivers. In continuing to study accident reports, a decline in accident rates over the past two years is apparent. The Marketing and Communications Department produces numerous publications throughout the year. While many of the works are intended to market our services, many also contain messaging about community health.
SCHEDULE H, PART VI; QUESTION 6	Outlined below is a summary of the entities which comprise CCMC Corporation and subsidiaries: Not for-profit entities: CCMC Corporation ---------------- CCMC Corporation is the tax-exempt parent of an integrated healthcare delivery system which consists of a group of affiliated healthcare organizations. CCMC Corporation is an organization recognized by the internal revenue service as tax-exempt pursuant to internal revenue code 501(c)(3) and as a non-private foundation pursuant to internal revenue code 509(a)(3). As the parent organization, CCMC Corporation strives to continually develop and operate a healthcare system which provides substantial community benefit through the provision of a comprehensive spectrum of healthcare services to the children of Connecticut and surrounding communities. CCMC corporation ensures that its system provides medically necessary healthcare services to all children regardless of race, color, creed, sex, national origin or ability to pay. No children are denied necessary medical care, treatment or services. CCMC Corporation is the sole member of Connecticut children's medical center operates consistently with the following criteria outlined in irs revenue ruling 69-545: 1. It provides medically necessary healthcare services to all children regardless of ability to pay, including charity care, self-pay, Medicare and Medicaid patients; 2. It operates an active emergency department for all children; which is open 24 hours a day, 7 days a week, 365 days per year; 3. It maintains an open medical staff, with privileges available to all qualified physicians; 4. Control of the hospital rests with its board of directors and the board of directors of CCMC Corporation. Both boards are comprised of a majority of independent civic leaders and other prominent members of the community; and 5. Surplus funds are used to improve the quality of patient care, expand and renovate facilities and advance medical care; programs and activities. Connecticut Children's Medical Center Foundation, Inc. ------------------------------------------------------ Connecticut Children's Medical Center Foundation, Inc. Is an organization recognized by the internal revenue service as tax-exempt pursuant to internal revenue code 501(c)(3) and as a non-private foundation pursuant to internal revenue code 509(a)(1). The organization supports Connecticut children's medical center; a related internal revenue code section 501(c)(3) tax-exempt organization, and its affiliates in providing medically necessary healthcare services to the community in a non-discriminatory manner regardless of race, color, creed, sex, national origin or ability to pay. CCMC Affiliates, Inc. --------------------- CCMC Affiliates, Inc. is an organization recognized by the internal revenue service as tax-exempt pursuant to internal revenue code 501(c)(3) and as a non-private foundation pursuant to internal revenue code 509(a)(2). The organization provides specialized education and child development programs to children of Connecticut and the surrounding areas. Connecticut Children's Specialty Group, Inc. -------------------------------------------- Connecticut Children's Specialty Group, Inc. Is an organization recognized by the internal revenue service as tax-exempt pursuant to internal revenue code 501(c)(3) and as a non-private foundation pursuant to internal revenue code 509(a)(2). The organization provides medically necessary healthcare services to all children regardless of race, color, creed, sex, national origin or ability to pay. Children's Fund of Connecticut, Inc. ------------------------------------ Children's Fund Of Connecticut, Inc. is an organization recognized by the internal revenue service as tax-exempt pursuant to internal revenue code 501(c)(3) and as a non-private foundation pursuant to internal revenue code 509(a)(3). The organization supports Connecticut Children's Medical Center; a related internal revenue code section 501(c)(3) tax-exempt organization, and its affiliates in providing medically necessary healthcare services to all children regardless of race, color, creed, sex, national origin or ability to pay. Children's Health and Development Institute, Inc. ------------------------------------------------- Children's Health And Development Institute, Inc. is an organization recognized by the internal revenue service as tax-exempt pursuant to internal revenue code 501(c)(3) and as a non-private foundation pursuant to internal revenue code 509(a)(1). The organization provides medically necessary healthcare services to all individuals regardless of race, color, creed, sex, national origin or ability to pay. Capital Area Health Consortium, Inc. ------------------------------------ Capital Area Health Consortium, Inc. is an organization recognized by the internal revenue service as tax-exempt pursuant to internal revenue code 501(c)(3) and as a non-private foundation pursuant to internal revenue code 509(a)(3). The organization supports Connecticut Children's Medical Center; a related internal revenue code section 501(c)(3) tax-exempt organization, and its affiliates in providing medically necessary healthcare services to all children regardless of race, color, creed, sex, national origin or ability to pay. For-profit entities: CCMC Ventures, Inc. ------------------- A for-profit entity, whose sole shareholder is CCMC Corporation. The organization is located in Hartford, Connecticut. This entity is currently inactive. New England Pediatrics Indemnity, Ltd. -------------------------------------- A for-profit entity, whose sole shareholder is CCMC Corporation. The organization is a Medical Malpractice Insurance foreign captive organization located in Bermuda.
SCHEDULE H, PART VI; QUESTION 7	The state of Connecticut has an Office of the Healthcare Advocate. They survey each hospitals schedule H of the 990 filing to ensure that community benefits have been reported in lieu of separate reports from hospitals.

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
CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number
06-0646755

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) URBAN LEAGUE OF GREATER HARTFORD INC
140 WOODLAND STREET
HARTFORD,CT06105

06-6066491

501(C)(3)

10,000

PROGRAM SUPPORT

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)
(2)
(3)
(4)
(5)
(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
SCHEDULE I, PART I, QUESTION 2	GRANTS ARE MONITORED BY THE ORGANIZATION'S FINANCE PERSONNEL THROUGH THE UTILIZATION OF COST CENTERS AND OTHER INFORMATION; INCLUDING WRITTEN DOCUMENTATION AND RECEIPTS.

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

CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number

06-0646755

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 .........

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

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

During the year, did any person listed 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? ................

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

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

Yes

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)
1JAMES E SHMERLING DHA FACHEDIRECTOR-PRES/CEO(EFF 11/1/15)	(i) (ii)	93,936 ------------- 0	82,713 ------------- 0	311 ------------- 0	0 ------------- 0	2,934 ------------- 0	179,894 ------------- 0	0 ------------- 0
2MARTIN J GAVINDIRECTOR-PRES/CEO (10/1-10/31)	(i) (ii)	277,975 ------------- 0	314,625 ------------- 0	40,041 ------------- 0	26,500 ------------- 0	3,588 ------------- 0	662,729 ------------- 0	0 ------------- 0
3PATRICK J GARVEY CPA CHFPTREASURER - SVP/CFO	(i) (ii)	209,158 ------------- 0	116,250 ------------- 0	18,847 ------------- 0	14,575 ------------- 0	29,771 ------------- 0	388,601 ------------- 0	0 ------------- 0
4FERNANDO FERRER MDEVP,CLINICAL AFF(TERM 7/11/16)	(i) (ii)	0 ------------- 772,428	0 ------------- 95,628	0 ------------- 31,871	0 ------------- 17,225	0 ------------- 30,212	0 ------------- 947,364	0 ------------- 0
5CHRISTINE FINCK MD FACSEVP,SURG-IN-CHIEF(EFF 7/27/16)	(i) (ii)	0 ------------- 652,725	0 ------------- 13,287	0 ------------- 33,814	0 ------------- 15,900	0 ------------- 25,039	0 ------------- 740,765	0 ------------- 0
6PAUL H DWORKIN MDEVP, COMMUNITY CHILD HEALTH	(i) (ii)	299,223 ------------- 0	153,728 ------------- 0	25,998 ------------- 0	19,875 ------------- 0	3,588 ------------- 0	502,412 ------------- 0	0 ------------- 0
7JUAN SALAZAR MD MPHEVP, ACADEMIC AFFAIRS	(i) (ii)	273,195 ------------- 0	149,500 ------------- 0	23,998 ------------- 0	18,550 ------------- 0	28,717 ------------- 0	493,960 ------------- 0	0 ------------- 0
8ANN G TAYLOR JDEVP, CHIEF ADMIN. OFFICER	(i) (ii)	230,554 ------------- 0	131,125 ------------- 0	29,411 ------------- 0	18,550 ------------- 0	17,782 ------------- 0	427,422 ------------- 0	0 ------------- 0
9ANDREA L BENIN MDSVP, PATIENT SAFETY & QUALITY	(i) (ii)	247,745 ------------- 0	143,375 ------------- 0	9,640 ------------- 0	15,900 ------------- 0	31,015 ------------- 0	447,675 ------------- 0	0 ------------- 0
10KELLY STYLES MBASVP, OPERATIONS & CIO	(i) (ii)	186,520 ------------- 0	166,500 ------------- 0	21,109 ------------- 0	17,225 ------------- 0	2,735 ------------- 0	394,089 ------------- 0	0 ------------- 0
11CHERYL HOEY RN BSN MBASVP, CLINICAL SERVICES & CNO	(i) (ii)	168,439 ------------- 0	92,600 ------------- 0	2,223 ------------- 0	17,225 ------------- 0	25,561 ------------- 0	306,048 ------------- 0	0 ------------- 0
12LAWRENCE E MILAN MASVP, HUMAN RESOURCES	(i) (ii)	165,364 ------------- 0	89,375 ------------- 0	5,907 ------------- 0	16,414 ------------- 0	10,076 ------------- 0	287,136 ------------- 0	0 ------------- 0
13THOMAS RICHARDSONVP, MKTG & COMM (TERM 4/22/16)	(i) (ii)	132,870 ------------- 0	57,400 ------------- 0	2,608 ------------- 0	12,956 ------------- 0	27,537 ------------- 0	233,371 ------------- 0	0 ------------- 0
14RICHELLE DEMAYO MDCHIEF MED INFORMATION OFFICER	(i) (ii)	212,570 ------------- 0	88,566 ------------- 0	1,106 ------------- 0	15,900 ------------- 0	10,444 ------------- 0	328,586 ------------- 0	0 ------------- 0
15TRISHA FARMER MSN RNCHIEF OF STAFF (EFF 4/24/16)	(i) (ii)	106,837 ------------- 0	31,645 ------------- 0	616 ------------- 0	11,038 ------------- 0	26,286 ------------- 0	176,422 ------------- 0	0 ------------- 0
16BOBBY M VARGASGeneral Counsel	(i) (ii)	217,151 ------------- 0	62,065 ------------- 0	584 ------------- 0	14,575 ------------- 0	26,309 ------------- 0	320,684 ------------- 0	0 ------------- 0
17JUNG PARKSR DIR, INFORMATION SERVICES	(i) (ii)	151,254 ------------- 0	39,156 ------------- 0	380 ------------- 0	10,472 ------------- 0	1,774 ------------- 0	203,036 ------------- 0	0 ------------- 0
18LINDA A GROOMCLINICAL NURSE IV	(i) (ii)	175,922 ------------- 0	500 ------------- 0	7,663 ------------- 0	11,979 ------------- 0	2,054 ------------- 0	198,118 ------------- 0	0 ------------- 0
19MARLENE E FERRISSR DIR, ORGANIZATIONAL EFFECT.	(i) (ii)	143,094 ------------- 0	34,698 ------------- 0	2,190 ------------- 0	11,674 ------------- 0	16,810 ------------- 0	208,466 ------------- 0	0 ------------- 0
20ROBERT J FRALEIGHDIRECTOR CORP. COMMUNICATIONS	(i) (ii)	155,099 ------------- 0	22,303 ------------- 0	748 ------------- 0	4,446 ------------- 0	3,531 ------------- 0	186,127 ------------- 0	0 ------------- 0
21PHILIP B HOPKINSDIRECTOR TECHNICAL SERVICES	(i) (ii)	151,598 ------------- 0	23,712 ------------- 0	787 ------------- 0	10,549 ------------- 0	2,145 ------------- 0	188,791 ------------- 0	0 ------------- 0
22DEAN A RAPOZAFORMER OFFICER	(i) (ii)	0 ------------- 271,904	0 ------------- 25,400	0 ------------- 2,585	0 ------------- 18,550	0 ------------- 28,232	0 ------------- 346,671	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
CORE FORM, PART VII AND SCHEDULE J	IN ACCORDANCE WITH INTERNAL REVENUE SERVICE FORM 990 RULES, REGULATIONS AND INSTRUCTIONS, THE COMPENSATION REPORTED IN CORE FORM, PART VII AND SCHEDULE J, PART II OF THIS FORM 990 IS DERIVED FROM 2015 FORMS W-2.
SCHEDULE J, PART I; QUESTION 3	EACH YEAR, TOWERS WATSON CONDUCTS A MARKET ANALYSIS OF CONNECTICUT CHILDREN'S MEDICAL CENTER'S ("Connecticut Children's") PRESIDENT/CHIEF EXECUTIVE OFFICER, OFFICERS AND OTHER KEY EMPLOYEES. TO AUGMENT THEIR PROPRIETARY AND OTHER DATA TO WHICH THEY HAVE ACCESS, Connecticut Children's PROVIDES THE DATA RESULTS FROM SALARY SURVEYS IN WHICH Connecticut Children's PARTICIPATES. THE ANALYSIS AND PRESENTATION OF THE DATA IS PRESENTED BY THE TOWERS WATSON REPRESENTATIVE TO THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND THE MEMBERS OF THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. ANNUALLY THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND THE BOARD OF DIRECTORS THEN REVIEW AND DISCUSS SALARY RECOMMENDATIONS FOR THE OFFICERS AND OTHER KEY EMPLOYEES AND SIGN OFF ON THE FINAL RECOMMENDATIONS. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS MEETS INDEPENDENTLY WITH THE PRESIDENT/CHIEF EXECUTIVE OFFICER TO DISCUSS HIS INDIVIDUAL PERFORMANCE. FOLLOWING THE PERFORMANCE EVALUATION, A SALARY RECOMMENDATION IS MADE AND COMMUNICATED TO THE SENIOR VICE PRESIDENT OF HUMAN RESOURCES TO AUTHORIZE PROCESSING.
SCHEDULE J, PART I; QUESTION 7 AND CORE FORM, PART VII	CERTAIN INDIVIDUALS INCLUDED IN SCHEDULE J, PART II RECEIVED A BONUS DURING CALENDAR YEAR 2015 WHICH AMOUNTS WERE INCLUDED IN COLUMN B(II) HEREIN AND IN EACH INDIVIDUAL'S 2015 FORM W-2, BOX 5, AS TAXABLE MEDICARE WAGES. PLEASE REFER TO THIS SECTION OF THE FORM 990, SCHEDULE J FOR THIS INFORMATION BY PERSON BY AMOUNT.

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
CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number
06-0646755

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	CT HEALTH & EDUCATIONAL FACILITIES AUTHORITY	06-0806186		06-30-2011	41,580,000	REFI SER B&C BOND/LEASE FINANCINGS		X		X		X
B	CT HEALTH & EDUCATIONAL FACILITIES AUTHORITY	06-0806186		10-12-2007	8,500,000	LEASE FINANCE VARIOUS EQUIPMENT	X			X		X
C	CT HEALTH & EDUCATIONAL FACILITIES AUTHORITY	06-0806186		09-28-2012	8,800,000	ELECTRONIC MEDICAL RECORDS		X		X		X
D	CT HEALTH & EDUCATIONAL FACILITIES AUTHORITY	06-0806186		10-18-2011	11,200,000	ELECTRONIC MEDICAL RECORDS		X		X		X
	CT HEALTH & EDUCATIONAL FACILITIES AUTHORITY	06-0806186		04-04-2013	13,500,000	CONSTRUCT & EQUIP ASC		X		X		X
	CT HEALTH & EDUCATIONAL FACILITIES AUTHORITY	06-0806186		09-11-2014	3,250,865	FINANCING OF CAPITAL MEDICAL EQUIP		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	6,310,375		0		4,837,977		7,630,431
2 Amount of bonds legally defeased ..............	0		8,500,000		0		0
3 Total proceeds of issue ..................	41,580,000		8,500,000		8,800,000		11,200,000
4 Gross proceeds in reserve funds .............	0		0		0		0
5 Capitalized interest from proceeds .............	0		0		0		0
6 Proceeds in refunding escrows ...............	10,255,050		0		0		0
7 Issuance costs from proceeds ...............	733,635		34,581		31,338		56,108
8 Credit enhancement from proceeds .............	0		0		0		0
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	0		8,645,419		8,768,662		11,143,892
11 Other spent proceeds .............	30,591,315		0		0		0
12 Other unspent proceeds .............	0		0		0		0
13 Year of substantial completion .............	2011		2010		2015		2014
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X			X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....	X			X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part III

Private Business Use

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

For 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		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	X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.540 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............	1.540 %
7 Does the bond issue meet the private security or payment test? ...	X		X		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		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		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		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		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......
b Exception to rebate? ........	X		X		X		X
c No rebate due? .........
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		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X			X		X		X
b Name of provider ..........	BANK OF AMERICA		0		0		0
c Term of hedge .........	2080 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		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		X		X
b Name of provider ..........	0		0		0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		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		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 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
CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number
06-0646755

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	CT HEALTH & EDUCATIONAL FACILITIES AUTHORITY	06-0806186		06-30-2011	41,580,000	REFI SER B&C BOND/LEASE FINANCINGS		X		X		X
B	CT HEALTH & EDUCATIONAL FACILITIES AUTHORITY	06-0806186		10-12-2007	8,500,000	LEASE FINANCE VARIOUS EQUIPMENT	X			X		X
C	CT HEALTH & EDUCATIONAL FACILITIES AUTHORITY	06-0806186		09-28-2012	8,800,000	ELECTRONIC MEDICAL RECORDS		X		X		X
D	CT HEALTH & EDUCATIONAL FACILITIES AUTHORITY	06-0806186		10-18-2011	11,200,000	ELECTRONIC MEDICAL RECORDS		X		X		X
	CT HEALTH & EDUCATIONAL FACILITIES AUTHORITY	06-0806186		04-04-2013	13,500,000	CONSTRUCT & EQUIP ASC		X		X		X
	CT HEALTH & EDUCATIONAL FACILITIES AUTHORITY	06-0806186		09-11-2014	3,250,865	FINANCING OF CAPITAL MEDICAL EQUIP		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	6,310,375		0		4,837,977		7,630,431
2 Amount of bonds legally defeased ..............	0		8,500,000		0		0
3 Total proceeds of issue ..................	41,580,000		8,500,000		8,800,000		11,200,000
4 Gross proceeds in reserve funds .............	0		0		0		0
5 Capitalized interest from proceeds .............	0		0		0		0
6 Proceeds in refunding escrows ...............	10,255,050		0		0		0
7 Issuance costs from proceeds ...............	733,635		34,581		31,338		56,108
8 Credit enhancement from proceeds .............	0		0		0		0
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	0		8,645,419		8,768,662		11,143,892
11 Other spent proceeds .............	30,591,315		0		0		0
12 Other unspent proceeds .............	0		0		0		0
13 Year of substantial completion .............	2011		2010		2015		2014
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X			X		X		X
15 Were the bonds issued as part of an advance refunding issue? .....	X			X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part III

Private Business Use

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

For 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		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	X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	1.540 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............	1.540 %
7 Does the bond issue meet the private security or payment test? ...	X		X		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		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		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		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		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......
b Exception to rebate? ........	X		X		X		X
c No rebate due? .........
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		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X			X		X		X
b Name of provider ..........	BANK OF AMERICA		0		0		0
c Term of hedge .........	2080 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		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		X		X
b Name of provider ..........	0		0		0		0
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		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		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

CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number

06-0646755

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) EVERSOURCE	DIRECTOR (10/1-12/31)	943,797	UTILITIES		No
(2) EPIC SYSTEMS CORPORATION	SUBSTANTIAL CONTRIBUTOR	899,156	INFORMATION TECHNOLOGY		No
(3) INTEGRATED ANESTHESIA ASSOCIATES	SUBSTANTIAL CONTRIBUTOR	176,766	MEDICAL SERVICES		No

Part V

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

Return Reference

Explanation

SCHEDULE L, PART IV

CHARLES W. SHIVERY WAS A DIRECTOR OF THIS ORGANIZATION THROUGH DECEMBER 31, 2015. MR. SHIVERY HAS AN OWNERSHIP INTEREST IN EVERSOURCE, A DIVISION OF CONNECTICUT LIGHT AND POWER COMPANY. THIS ORGANIZATION UTILIZED THE SERVICES OF EVERSOURCE DURING ITS FISCAL YEAR ENDED SEPTEMBER 30, 2016. TOTAL FEES PAID TO EVERSOURCE DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016 AMOUNTED TO $943,797. SERVICES WERE RENDERED AT FAIR MARKET VALUE RATES PURSUANT TO ARMS-LENGTH NEGOTIATIONS. PLEASE NOTE THAT EVERSOURCE IS THE SOLE PROVIDER OF POWER IN THE AREA SURROUNDING THE MEDICAL CENTER. EPIC SYSTEMS CORPORATION WAS A SUBSTANTIAL CONTRIBUTOR TO THE ORGANIZATION DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016. CONNECTICUT CHILDREN'S MEDICAL CENTER UTILIZED THE SERVICES OF EPIC SYSTEMS CORPORATION. TOTAL FEES PAID TO EPIC SYSTEMS CORPORATION DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016 AMOUNTED TO $899,156. SERVICES WERE RENDERED AT FAIR MARKET VALUE RATES PURSUANT TO ARMS-LENGTH NEGOTIATIONS. INTEGRATED ANESTHESIA ASSOCIATES, LLC, WAS A SUBSTANTIAL CONTRIBUTOR TO THE ORGANIZATION DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016. CONNECTICUT CHILDREN'S MEDICAL CENTER UTILIZED THE SERVICES OF INTEGRATED ANESTHESIA ASSOCIATES, LLC. TOTAL FEES PAID TO INTEGRATED ANESTHESIA ASSOCIATES, LLC, DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016 AMOUNTED TO $176,766. SERVICES WERE RENDERED AT FAIR MARKET VALUE RATES PURSUANT TO ARMS-LENGTH NEGOTIATIONS.

Schedule L (Form 990 or 990-EZ) 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

CONNECTICUT CHILDREN'S MEDICAL CENTER

Employer identification number

06-0646755

Return Reference	Explanation
CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	BACKGROUND ========== CONNECTICUT CHILDREN'S MEDICAL CENTER ("CONNECTICUT CHILDREN'S") IS RECOGNIZED BY THE INTERNAL REVENUE SERVICE ("IRS") AS AN INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. PURSUANT TO ITS CHARITABLE PURPOSES CONNECTICUT CHILDREN'S PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL CHILDREN IN A NON-DISCRIMINATORY MANNER REGARDLESS OF RACE, COLOR, CREED, SEX, NATIONAL ORIGIN OR ABILITY TO PAY. MOREOVER, CONNECTICUT CHILDREN'S OPERATES CONSISTENTLY WITH THE FOLLOWING CRITERIA OUTLINED IN IRS REVENUE RULING 69-545: 1. CONNECTICUT CHILDREN'S PROVIDES MEDICALLY NECESSARY HEALTHCARE SERVICES TO ALL CHILDREN REGARDLESS OF ABILITY TO PAY, INCLUDING CHARITY CARE, SELF-PAY, MEDICARE AND MEDICAID PATIENTS; 2. CONNECTICUT CHILDREN'S OPERATES AN ACTIVE EMERGENCY ROOM FOR ALL CHILDREN WHICH IS OPEN 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS PER YEAR; 3. CONNECTICUT CHILDREN'S MAINTAINS AN OPEN MEDICAL STAFF, WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS; 4. CONTROL OF CONNECTICUT CHILDREN'S RESTS WITH ITS BOARD OF DIRECTORS. ITS BOARD IS COMPRISED OF INDEPENDENT CIVIC LEADERS AND OTHER PROMINENT MEMBERS OF THE COMMUNITY; AND 5. SURPLUS FUNDS ARE USED TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND RENOVATE FACILITIES AND ADVANCE MEDICAL CARE, PROGRAMS AND ACTIVITIES. THE OPERATIONS OF CONNECTICUT CHILDREN'S, AS SHOWN THROUGH THE FACTORS OUTLINED ABOVE AND OTHER INFORMATION CONTAINED HEREIN, CLEARLY DEMONSTRATE THE HOSPITAL PROVIDES SUBSTANTIAL COMMUNITY BENEFIT AND THAT THE USE AND CONTROL OF CONNECTICUT CHILDREN'S IS FOR THE BENEFIT OF THE PUBLIC, AND THAT NO PART OF THE INCOME OR NET EARNINGS OF THE ORGANIZATION INURES TO THE BENEFIT OF ANY PRIVATE INDIVIDUAL, NOR IS ANY PRIVATE INTEREST BEING SERVED OTHER THAN INCIDENTALLY. HISTORY ======= CONNECTICUT CHILDREN'S IS A NATIONALLY RECOGNIZED NOT-FOR-PROFIT WITH A MEDICAL STAFF OF MORE THAN 1,000 PHYSICIANS WHO PROVIDE COMPREHENSIVE, WORLD-CLASS HEALTHCARE IN MORE THAN 30 PEDIATRIC SPECIALTIES AND SUBSPECIALTIES. CONNECTICUT CHILDRENS IS THE PRIMARY PEDIATRIC TEACHING HOSPITAL FOR THE UCONN SCHOOL OF MEDICINE, HAS A TEACHING PARTNERSHIP WITH THE FRANK H. NETTER, M.D. SCHOOL OF MEDICINE AT QUINNIPIAC UNIVERSITY AND IS A RESEARCH PARTNER OF THE JACKSON LABORATORY. THE HISTORY OF CONNECTICUT CHILDREN'S SPANS MORE THAN 100 YEARS. FOUNDED AS A 10-BED HOSPITAL FOR CHILDREN WHO SUFFERED THEN INCURABLE CONDITIONS SUCH AS CEREBRAL PALSY, SPINA BIFIDA AND POLIO, CONNECTICUT CHILDREN'S IS NOW ONE OF ONLY TWO FREESTANDING CHILDREN'S HOSPITALS IN NEW ENGLAND AND IS THE ONLY FREESTANDING CHILDREN'S HOSPITAL IN CONNECTICUT. CONNECTICUT CHILDREN'S PROVIDES AN ARRAY OF PEDIATRIC SERVICES IN LOCATIONS ACROSS CONNECTICUT AND IN MASSACHUSETTS, INCLUDING AT HOSPITALS IN HARTFORD AND WATERBURY, NEONATAL INTENSIVE CARE UNITS IN HARTFORD AND FARMINGTON, AN AMBULATORY SURGERY CENTER IN FARMINGTON PRIMARY CARE CENTERS AND EAST HARTFORD AND WEST HARTFORD, FIVE SPECIALTY CARE CENTERS, AND 11 OTHER LOCATIONS. ITS LEVEL 1 PEDIATRIC TRAUMA CENTER IS THE BUSIEST BETWEEN BOSTON AND NEW YORK. MISSION ======= CONNECTICUT CHILDREN'S IS DEDICATED TO IMPROVING THE PHYSICAL AND EMOTIONAL HEALTH OF CHILDREN THROUGH FAMILY-CENTERED CARE, RESEARCH, EDUCATION AND ADVOCACY. CONNECTICUT CHILDREN'S EMBRACES DISCOVERY, TEAMWORK, INTEGRITY AND EXCELLENCE IN ALL THAT IT DOES. PROGRAMS OF EXCELLENCE ====================== CONNECTICUT CHILDREN'S OFFERS THE HIGHEST LEVEL OF CARE TO CHILDREN AND OUR PHYSICIANS AND PROGRAMS ARE CONSISTENTLY HONORED FOR THEIR EXCELLENCE. RECENT AWARDS INCLUDE THE 2017 WOMENS CHOICE AWARD FOR BEST CHILDRENS HOSPITALS AND THE 2016 PRESS GANEY SUCCESS STORY AWARD. IN ADDITION, THERE ARE SEVERAL PROGRAMS OF EXCELLENCE AT THE MEDICAL CENTER THAT HAVE TIME AND AGAIN EARNED NATIONAL AND INTERNATIONAL HONORS AND ACCOLADES INCLUDING, BUT NOT LIMITED TO: - DIABETES & ENDOCRINOLOGY; - GASTROENTEROLOGY; - NEONATOLOGY; - ORTHOPAEDICS; - RECONSTRUCTIVE AND SOLID TUMOR SURGERY; - SURGERY; AND - UROLOGY. EACH OF OUR PROGRAMS OF EXCELLENCE OFFERS SUPERIOR PEDIATRIC CLINICAL CARE AND HAS DEMONSTRATED THE ABILITY TO: 1) EXPAND ACCESS TO SERVICES TO MEET THE GROWING NEEDS OF CHILDREN AND FAMILIES; 2) INTEGRATE VARIOUS DISCIPLINES OF CLINICAL PRACTICE TO PROVIDE EXPANDED ADVANCED CARE; 3) DEVELOP OPPORTUNITIES TO EXPAND BASIC AND CLINICAL RESEARCH; AND 4) CREATE OPPORTUNITIES TO BE AN INNOVATIVE LEADER IN EDUCATION AND TRAINING. OUTCOMES -------- NOTHING MATTERS MORE THAN THE OUTCOME. CONNECTICUT CHILDREN'S KEEPS KIDS HEALTHY, PROTECTS THEM FROM SURGICAL COMPLICATIONS AND IMPROVES THE QUALITY OF LIFE OF THOSE WITH CHRONIC CONDITIONS. PROCESS OF CARE --------------- SEVERAL ELEMENTS ARE CONSIDERED, INCLUDING HOSPITAL COMPLIANCE WITH BEST PRACTICES AND A COMMITMENT TO INFECTION CONTROL. RESEARCH ======== CONNECTICUT CHILDREN'S IS COMMITTED TO MAKING CHILDREN AND FAMILIES HEALTHIER. OUR TALENTED MEDICAL PROFESSIONALS ARE AT THE FOREFRONT OF RESEARCH AND CLINICAL TRIALS. SUCH SCIENTIFIC INQUIRIES CHANGE THE FUTURE OF CHILDREN'S HEALTHCARE. FROM FUNDAMENTAL MOLECULAR SCIENCE THAT HELPS US UNDERSTAND DISEASES AT THE MOST BASIC LEVEL, TO MOTION STUDIES DESIGNED TO DISCOVER NEW WAYS FOR YOUNG ATHLETES TO AVOID INJURIES AND CLINICAL TRIALS THAT ESTABLISH THE MOST EFFECTIVE AND EFFICIENT PROTOCOLS FOR TREATING CHILDREN, CONNECTICUT CHILDREN'S IS A RESEARCH LEADER. FOR EXAMPLE, CONNECTICUT CHILDREN'S DIVISION OF HEMATOLOGY & ONCOLOGY IS ENGAGED IN CONDUCTING MORE THAN 100 ACTIVE CLINICAL TRIALS AND RESEARCH STUDIES THROUGH THE CHILDREN'S ONCOLOGY GROUP, THE NEUROBLASTOMA AND MEDULLOBLASTOMA TREATMENT RESEARCH CONSORTIUM, THE PEDIATRIC CANCER FOUNDATION'S SUNSHINE PROJECT, THE SUNCOAST COMMUNITY CLINICAL ONCOLOGY PROGRAM AND PHARMACEUTIC COMPANY SPONSORS. THIS NUMBER OF OPEN PROTOCOLS DISTINGUISHES CONNECTICUT CHILDREN'S HEMATOLOGY & ONCOLOGY DIVISION AMONG THE TOP 20 PERCENT AMONG ITS PEERS. ADDITIONALLY, THE DIVISION IS IN THE TOP THIRD PERCENTILE FOR TOTAL PEDIATRIC CANCER PATIENTS ENROLLED IN TRIALS. THIS IS ESPECIALLY IMPRESSIVE GIVEN THAT CONNECTICUT CHILDREN'S IS CONSIDERED ONE OF THE SMALLER FREE-STANDING CHILDREN'S HOSPITALS IN THE COUNTRY. AWARDS AND RECOGNITION ====================== CONNECTICUT CHILDRENS HAS RECENTLY RECEIVED THE FOLLOWING AWARDS: - 2017 WOMENS CHOICE AWARD FOR BEST CHILDRENS HOSPITALS; - 2016 CHILDKIND HOSPITAL DESIGNATION; - 2016 PRESS GANEY SUCCESS STORY AWARD; - 2016 HARTFORD BUSINESS JOURNAL HEALTHCARE HERO (CHRISTINE FINCK, M.D.); - 2016 HARTFORD BUSINESS JOURNAL BEST IN BUSINESS, ONCOLOGY (CENTER FOR CANCER AND BLOOD DISORDERS); - 2016 TOP MASTERS IN HEALTHCARE ADMINISTRATION; - 2016 GET WITH THE GUIDELINES - RESUSCITATION SILVER AWARD; AND - 2015 TOP WORKPLACE IN CONNECTICUT, RANKED 10TH IN LARGE ORGANIZATION CATEGORY. OFFICE OF COMMUNITY CHILD HEALTH ("OCCH") ========================================= CONNECTICUT CHILDRENS OFFICE FOR COMMUNITY CHILD HEALTH ELEVATES THE EFFECTIVENESS AND STATUS OF THE MEDICAL CENTER AS A CRITICAL COMMUNITY RESOURCE BY DEVELOPING, PROMOTING, SUPPORTING, EVALUATING AND DISSEMINATING INNOVATIVE, EFFECTIVE COMMUNITY-ORIENTED PROGRAMS AND SERVICES TO ADDRESS CHILDRENS CRITICAL HEALTH NEEDS.
CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	WHAT WE DO ---------- OCCH ADDRESSES CRITICAL CONTEMPORARY ISSUES IN CHILDRENS LIVES THAT HAVE THE POTENTIAL TO ADVERSELY AFFECT THEIR HEALTH AND DEVELOPMENT. THE OFFICE NOT ONLY SERVES AS A CRITICAL COMMUNITY RESOURCE, BUT ALSO CULTIVATES INNOVATIVE AND COST-EFFECTIVE SOLUTIONS TO ADDRESS EXISTING GAPS IN OUR HEALTH CARE AND CHILD SERVICE SYSTEMS. THROUGH THE OFFICE, CONNECTICUT CHILDRENS MEDICAL CENTER ENSURES THAT FAMILIES HAVE ACCESS TO A COMPREHENSIVE SYSTEM OF COMMUNITY PROGRAMS AND SERVICES THAT SUPPORTS THEM IN PROMOTING THEIR CHILDRENS OPTIMAL HEALTHY DEVELOPMENT. OUR MODEL --------- THE OFFICE OVERSEES A VARIETY OF COMMUNITY-ORIENTED PROGRAMS THAT ADDRESS A WIDE RANGE OF FACTORS THAT INFLUENCE CHILDRENS HEALTHY DEVELOPMENT. THOSE PROGRAMS, AND THEIR COMMUNITY-BASED PARTNERS, NOT ONLY FOCUS ON THE TRADITIONAL AREAS OF CHILD HEALTH SERVICES, FAMILY SUPPORT, AND EARLY CARE AND EDUCATION, BUT ALSO TOUCH OTHER SECTORS INCLUDING FOOD AND NUTRITION, HOUSING, ECONOMIC DEVELOPMENT, CHILD WELFARE, AND TRANSPORTATION. THE OFFICE TAKES A THREE-PRONGED APPROACH TO PROMOTING CHILDRENS OPTIMAL HEALTHY DEVELOPMENT: 1. STRENGTHENING EXISTING COMMUNITY-ORIENTED PROGRAMS; 2. FACILITATING SYNERGIES AMONG THOSE PROGRAMS; AND 3. SERVING AS AN INNOVATION INCUBATOR FOR PROMISING APPROACHES THAT IMPROVE SHORT AND LONG-TERM HEALTH OUTCOMES FOR CHILDREN. THE OFFICE SERVES AS A NEW MODEL FOR OTHER CHILDRENS HOSPITALS TO FOLLOW IN TERMS OF DEMONSTRATING THEIR COMMUNITY BENEFIT TO MAINTAIN TAX EXEMPT STATUS. IN THE PAST, HOSPITALS HAVE TRADITIONALLY RELIED ON DOCUMENTING THE DISCOUNTED AND UNREIMBURSED CARE THAT THEY PROVIDE TO PATIENTS. NOW, UNDER THE AFFORDABLE CARE ACT, THERE HAS BEEN A SHARP REDUCTION IN THE NUMBER OF AMERICANS WHO ARE UNINSURED AND, THEREFORE, A REDUCTION IN THE NEED FOR DISCOUNTED OR UNREIMBURSED CARE. BECAUSE OF THAT, HOSPITALS ARE BEING ENCOURAGED TO FIND NEW WAYS TO DEMONSTRATE THE BENEFIT THEY OFFER TO THEIR COMMUNITIES. THE OFFICES MODEL OFFERS A STRATEGIC APPROACH THAT SHOWS HOW ITS PROGRAMS ARE LINKED TO CRITICAL COMMUNITY NEEDS AND HOW THEY ARE ADDRESSING THOSE NEEDS. ALSO, THE OFFICES FOCUS ON PREVENTIVE AND COST-EFFECTIVE MODELS OF CARE FOR CHILDREN IS TIMELY GIVEN THE SHIFT IN HEALTHCARE TOWARDS ACCOUNTABLE CARE THAT EMPHASIZES VALUE IN TERMS OF KEEPING POPULATIONS HEALTHY. THE OFFICE TAKES AN ACTIVE LEADERSHIP ROLE IN INFORMING POPULATION HEALTH EFFORTS AT THE LOCAL, STATE AND NATIONAL LEVELS. OUR IMPACT, AT A GLANCE ----------------------- THE OCCH HAS ESTABLISHED ITSELF AS A CRITICAL RESOURCE IN THE LOCAL COMMUNITY AND ACROSS THE NATION AND IS: - LEADING EFFORTS TO DEVELOP A BLUEPRINT FOR WOMEN'S AND CHILDREN'S HEALTH FOR THE CITY OF HARTFORD; - PARTNERING WITH THE CONNECTICUT OFFICE FOR EARLY CHILDHOOD TO LEAD THE DEVELOPMENT OF A COMPREHENSIVE, STATEWIDE EARLY CHILDHOOD SYSTEM; AND - ENGAGED IN ONGOING DIALOGUE ON KEY PUBLIC POLICY CONCEPTS NECESSARY FOR SYSTEM-BUILDING WITH A WIDE ARRAY OF FEDERAL AGENCIES, INCLUDING THE MATERNAL AND CHILD HEALTH BUREAU, THE ADMINISTRATION FOR CHILDREN AND FAMILIES AND THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION. OCCH PROGRAMS ------------- CONNECTICUT CHILDREN'S OCCH OPERATES A TOTAL OF 15 PROGRAMS: INNOVATION: - THE HELP ME GROW NATIONAL CENTER; - CONNECTICUT CHILDRENS ADVANCING KIDS INNOVATION PROGRAM; - EASY BREATHING; - MID-LEVEL DEVELOPMENTAL ASSESSMENT; AND - CARE COORDINATION COLLABORATIVE MODEL. DIRECT SERVICES: - CONNECTICUT CHILDRENS CENTER FOR CARE COORDINATION; - CONNECTICUT CHILDRENS HEALTHY HOMES PROGRAM; - HARTFORD YOUTH HIV IDENTIFICATION AND LINKAGE CONSORTIUM; AND - PERSON-CENTERED MEDICAL HOME. EDUCATION AND RESEARCH: - INJURY PREVENTION CENTER; - CO-MANAGEMENT; - CHILDRENS CENTER ON FAMILY VIOLENCE; - EDUCATING PRACTICES IN THE COMMUNITY; - PRACTICE QUALITY IMPROVEMENT PROGRAM; AND - RESIDENT EDUCATION IN ADVOCACY AND COMMUNITY HEALTH.
CORE FORM, PART III; STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	DESCRIPTIONS OF THE ABOVE PROGRAMS ARE LISTED BELOW: INNOVATION: - THE HELP ME GROW NATIONAL CENTER, INNOVATED IN HARTFORD AND BASED AT CONNECTICUT CHILDRENS MEDICAL CENTER, SERVES AS A NATIONAL RESOURCE FOR SUPPORTING THE REPLICATION OF HELP ME GROW SYSTEMS THROUGHOUT THE COUNTRY. TESTED AS A PILOT PROJECT IN HARTFORD IN 1997, THE PROGRAM EXPANDED STATEWIDE IN 2002 AND IS ALSO BEING REPLICATED AROUND THE COUNTRY. HELP ME GROW LINKS CHILDREN WHO ARE AT RISK FOR DEVELOPMENTAL OR BEHAVIORAL PROBLEMS TO HELPFUL COMMUNITY-BASED PROGRAMS AND SERVICES. - CONNECTICUT CHILDRENS ADVANCING KIDS INNOVATION PROGRAM CONNECTICUT CHILDRENS ADVANCING KIDS INNOVATION PROGRAM ("AKIP") OFFERS INDIVIDUALS AND ORGANIZATIONS AN EXCITING OPPORTUNITY TO GET CRUCIAL GUIDANCE, ACCESS TO KEY STAKEHOLDERS, AND TECHNICAL ASSISTANCE NEEDED TO MAKE INNOVATIONS PROMOTING THE OPTIMAL HEALTHY DEVELOPMENT OF CHILDREN SUCCESSFUL ON A LOCAL, STATEWIDE, AND EVEN NATIONAL LEVEL. AKIP, WHICH IS PART OF CONNECTICUT CHILDRENS OFFICE FOR COMMUNITY CHILD HEALTH (THE OFFICE), SEEKS TO ESTABLISH A PIPELINE OF INNOVATIONS THAT FOCUS ON THE HEALTH OF CHILDREN, STRENGTHEN FAMILIES, AND SHOW HIGH POTENTIAL FOR BEING BOTH SUSTAINABLE AND REPLICABLE. AKIP SEEKS TO ENGAGE A BROAD RANGE OF POTENTIAL COMMUNITY HEALTH INNOVATORS ADDRESSING CRITICAL COMMUNITY HEALTH NEEDS, INCLUDING INDIVIDUAL ENTREPRENEURS, BUSINESSES, COMMUNITY-BASED ORGANIZATIONS; RESEARCHERS; BEHAVIORAL HEALTH PROVIDERS, OTHER HEALTHCARE PROVIDERS, HEALTHCARE PAYERS AND OTHERS COMMITTED TO IMPROVING CHILDRENS HEALTHY DEVELOPMENT. THE PROGRAM PLANS TO SUPPORT INNOVATIONS AS THEY MOVE TOWARDS MORE EVIDENCE-INFORMED, HIGHER IMPACT SOLUTIONS DESIGNED TO CLOSE EXISTING GAPS IN PROGRAMS AND SERVICES CURRENTLY OFFERED TO CHILDREN ACROSS A VARIETY OF SECTORS. - EASY BREATHING IS A COMMUNITY-BASED ASTHMA MANAGEMENT PROGRAM INNOVATED AT CONNECTICUT CHILDRENS AND HOUSED IN OUR ASTHMA CENTER. IT ENSURES CHILDREN, FAMILIES AND PHYSICIANS WORK TOGETHER TO MANAGE ASTHMA SYMPTOMS USING NATIONAL ASTHMA GUIDELINES. THE PROGRAM IS AVAILABLE TO CHILDREN ACROSS CONNECTICUT AND IS ALSO BEING REPLICATED IN OTHER STATES. - THE MID-LEVEL DEVELOPMENTAL ASSESSMENT INNOVATION PROVIDES A NEW MODEL FOR ASSESSING CHILDREN WITH MILD OR MODERATE DEVELOPMENTAL DELAYS TO DETERMINE WHICH SERVICES WOULD BE MOST BENEFICIAL TO THEM. CHILDREN WITH MILD TO MODERATE DELAYS, OR THOSE WHO ARE AT RISK FOR DELAYS, ARE TYPICALLY INELIGIBLE FOR PUBLICLY FUNDED PROGRAMS SUCH AS EARLY INTERVENTION OR PRESCHOOL SPECIAL EDUCATION PROGRAMS. THIS ASSESSMENT CAN EFFICIENTLY DETERMINE THEIR NEEDS AND ENSURE THEIR CONNECTION TO COMMUNITY-BASED PROGRAMS THROUGH THE HELP ME GROW SYSTEM IN CONNECTICUT. MID-LEVEL DEVELOPMENTAL ASSESSMENT HAS EXPANDED STATEWIDE AND IS CURRENTLY BEING REPLICATED IN OTHER STATES. - THE CARE COORDINATION COLLABORATIVE MODEL IS THE SIGNATURE INNOVATION OF CONNECTICUT CHILDRENS CETNER FOR CARE COORDINATION. THE MODEL IMPROVES COLLABORATION AMONG CARE COORDINATORS FROM DIVERSE SECTORS INCLUDING CHILD HEALTH, EARLY CARE AND EDUCATION, AND FAMILY SUPPORT. IT ALSO PROVIDES CHILDREN AND FAMILIES WITH LINKS TO EFFECTIVE SERVICES. IT WORKS BY BRINGING TOGETHER CARE COORDINATORS FROM SEVERAL CHILD-SERVING SECTORS FOR PERIODIC MEETINGS TO LEARN ABOUT AVAILABLE SERVICES AND HOW TO HELP FAMILIES ACCESS THEM, TO REVIEW CHALLENGING CASES AND DEVELOP SOLUTIONS FOR FAMILIES, AND TO ADVOCATE FOR POLICY LEVEL SOLUTIONS TO HELP FAMILIES ADDRESS CHALLENGES THEY FACE CONNECTING TO SERVICES. INITIALLY LAUNCHED IN THE GREATER HARTFORD AREA, THE PROGRAM HAS EXPANDED ACROSS THE STATE OF CONNECTICUT AND INTO ADDITIONAL STATES. DIRECT SERVICES: - THE CONNECTICUT CHILDRENS CENTER FOR CARE COORDINATION (THE CENTER) EMPOWERS FAMILIES OF ALL CHILDREN, INCLUDING THOSE WITH SPECIAL NEEDS, BY HELPING THEM ADVOCATE FOR ACCESS TO APPROPRIATE MEDICAL, BEHAVIORAL, EDUCATIONAL, LEGAL, AND SOCIAL SERVICES. THE CENTER ALSO PROVIDES TRAINING AND TECHNICAL SUPPORT FOR COMMUNITY-BASED PRIMARY CARE PROVIDERS, SUPPORTING THEM TO BECOME MEDICAL HOMES FOR THE CHILDREN THEY SERVE. - THE CONNECTICUT CHILDRENS HEALTHY HOMES PROGRAM IMPROVES THE LIVES OF CHILDREN BY MAKING THEIR HOMES HEALTHIER, SAFER AND MORE ENERGY EFFICIENT. THE PROGRAM PROVIDES QUALIFIED HOMEOWNERS AND TENANTS WITH INSPECTIONS AND PLANS FOR THE REMOVAL OF LEAD, ASTHMA TRIGGERS, AND SAFETY HAZARDS. IT ALSO PROVIDES FINANCIAL ASSISTANCE FOR REMEDIATION, RELOCATION ASSISTANCE DURING CONSTRUCTION, REFERRALS TO LOW-COST OR NO-COST WEATHERIZATION PROGRAMS TO INCREASE ENERGY EFFICIENCY, AND EDUCATION PERTAINING TO HEALTHY AND SAFE HOMES. - THE HARTFORD YOUTH HIV IDENTIFICATION AND LINKAGE CONSORTIUM WORKS TO PREVENT THE SPREAD OF HIV AND OTHER SEXUALLY TRANSMITTED DISEASES AMONG YOUTH. THE PROGRAM PROVIDES INTERACTIVE PREVENTION EDUCATION, COMMUNITY ENGAGEMENT AND OUTREACH, AND YOUTH FRIENDLY HIV/STD SCREENINGS. THE CONSORTIUM ALSO LINKS YOUTH TO MEDICAL CARE SERVICES, EMPLOYMENT SERVICES AND OTHER COMMUNITY RESOURCES. - THE CONNECTICUT CHILDREN'S PRIMARY CARE CENTER RECENTLY RECEIVED DESIGNATION AS A PERSON CENTERED MEDICAL HOME. IN ACHIEVING THAT RECOGNITION, THE CENTER MET RIGOROUS STANDARDS SET BY THE NATIONAL COMMITTEE FOR QUALITY ASSURANCE AND WAS RECOGNIZED FOR COORDINATING PATIENT CARE, MAINTAINING A HIGH LEVEL OF QUALITY IN SERVICE DELIVERY, AND ENSURING THAT PATIENTS AND FAMILIES REMAIN AT THE CENTER OF ALL CARE. SEVERAL PROGRAMS OVERSEEN BY THE OFFICE FOR COMMUNITY CHILD HEALTH SUPPORT THE PRIMARY CARE CENTER IN ITS MEDICAL HOME STATUS. EDUCATION AND RESEARCH: - THE INJURY PREVENTION CENTER ENGAGES IN RESEARCH, COMMUNITY OUTREACH, EDUCATION, TRAINING, AND PUBLIC POLICY WORK TO REDUCE PREVENTABLE INJURIES AND VIOLENCE TO CHILDREN. ITS THREE PRIMARY FOCUS AREAS ARE TEEN DRIVING SAFETY, TEEN SUICIDE PREVENTION AND DOMESTIC VIOLENCE PREVENTION. ITS COMMUNITY PROGRAMS, INCLUDING SAFE KIDS CONNECTICUT AND THE INJURY FREE COALITION FOR KIDS OF HARTFORD, ADDRESS A WIDE RANGE OF CHILD SAFETY CONCERNS RANGING FROM CHILD PASSENGER SAFETY TO POISONING PREVENTION AND OTHER HOME SAFETY ISSUES. - CO-MANAGEMENT EMPOWERS PRIMARY CARE PROVIDERS TO IMPROVE THE BREADTH AND QUALITY OF CARE THEY PROVIDE TO CHILDREN. PRIMARY CARE PROVIDERS PARTNER WITH SUBSPECIALISTS TO DESIGN PROTOCOLS FOR THE CARE OF CERTAIN HIGH PREVALENCE CONDITIONS THAT ARE TYPICALLY REFERRED TO SUBSPECIALISTS. BY DOING SO, THIS CARE MODEL ALLOWS CHILDREN TO RECEIVE SOME SUBSPECIALTY CARE WITHIN THEIR MEDICAL HOME AND ENSURES THAT THEY RECEIVE TIMELY ACCESS TO SUBSPECIALTY CARE WHEN NEEDED. THE MODEL FREES UP SUBSPECIALTY APPOINTMENTS FOR CHILDREN WHOSE CONDITIONS CANNOT BE MANAGED IN THE PRIMARY CARE SETTING. - THE CHILDRENS CENTER ON FAMLIY VIOLENCE AIMS TO INCREASE UNDERSTANDING ABOUT THE IMPACT FAMILY VIOLENCE HAS ON CHILDREN AND TO INCREASE SUPPORT SERVICES FOR AFFECTED CHILDREN. THE CENTER IS A PARTNERSHIP BETWEEN THE CONNECTICUT CHILDRENS SUSPECTED CHILD ABUSE AND NEGLECT PROGRAM, THE CONNECTICUT CHILDRENS INJURY PREVENTION CENTER, AND THE CONNECTICUT COALITION AGAINST DOMESTIC VIOLENCE. THE CENTERS GOALS INCLUDE IMPROVING SERVICE SYSTEMS FOR AFFECTED FAMILIES, WHICH CURRENTLY OFTEN DO NOT UTILIZE BEST PRACTICES, AND ENHANCING RESEARCH EFFORTS FOR CHILD-FOCUSED INTERVENTIONS, WHERE THE EVIDENCE BASE IS CURRENTLY INADEQUATE. THE CENTER ALSO PLANS TO ESTABLISH A STATEWIDE FAMILY VIOLENCE INFORMATION SYSTEM TO GATHER DATA, IDENTIFY TRENDS, AND TRACK PROGRESS OVER TIME. - THE EDUCATING PRACTICES IN THE COMMUNITY PROGRAM IS A SIGNATURE INNOVATION OF THE CHILD HEALTH AND DEVELOPMENT INSTITUTE OF CONNECTICUT AND IS SUPPORTED BY THE CONNECTICUT CHILDRENS OFFICE FOR COMMUNITY CHILD HEALTH. ITS DESIGNED TO BRING THE NEWEST DEVELOPMENTS IN PEDIATRIC PRIMARY CARE TO CONNECTICUTS CHILD HEALTH PROVIDERS THROUGH THE PROCESS OF ACADEMIC DETAILING AND WORKS TO ADVANCE SUSTAINABLE IMPROVEMENTS IN PRIMARY AND PREVENTIVE HEALTH AND MENTAL HEALTH CARE PRACTICES FOR ALL CONNECTICUT CHILDREN. - THE PRACTICE QUALITY IMPROVEMENT PROGRAM HELPS PRIMARY CARE PHYSICIANS USE A DATA-DRIVEN, QUALITY IMPROVEMENT APPROACH TO ENHANCE THE SERVICES THEY PROVIDE TO CHILDREN. PROGRAM ACTIVITIES HELP PRACTICES IMPROVE THEIR SURVEILLANCE AND SCREENING FOR DEVELOPMENTAL RISKS, IMPROVE THEIR IDENTIFICATION OF BEHAVIORAL CONCERNS, AND CONNECT CHILDREN AND FAMILIES TO HELPFUL SERVICES. - THE RESIDENT EDUCATION IN ADVOCACY AND COMMUNITY HEALTH PROGRAM HELPS TO FOSTER THE GROWTH OF FUTURE GENERATIONS OF PEDIATRICIANS WHO ARE COMMUNITY CHILD HEALTH ADVOCATES. THE PROGRAM NURTURES PEDIATRIC RESIDENTS TO BECOME FUTURE LEADERS BY PROVIDING THEM WITH UNIQUE OPPORTUNITIES TO DEVELOP KNOWLEDGE AND SKILLS IN THE AREAS OF ADVOCACY, COMMUNITY HEALTH AND PUBLIC POLICY. DURING THEIR TIME IN THE PROGRAM, PEDIATRIC RESIDENTS WORK CLOSELY WITH EXPERTS IN THE FIELDS OF POPULATION HEALTH, COMMUNITY RESEARCH, POLICY REFORM, AND SOCIAL INNOVATION ALL WITH THE GOAL OF PROMOTING CHILDRENS HEALTHY DEVELOPMENT.
CORE FORM, PART VI, SECTION A, QUESTION 2	WILLIAM C. POPIK, M.D. & DAVID M. ROTH, ESQ. - BUSINESS RELATIONSHIP.
CORE FORM, PART VI, SECTION A; QUESTIONS 6 & 7	CCMC CORPORATION IS THE SOLE MEMBER OF THIS ORGANIZATION. CCMC CORPORATION HAS THE RIGHT TO ELECT THE MEMBERS OF THIS ORGANIZATION'S BOARD OF DIRECTORS AND HAS CERTAIN RESERVED POWERS AS DEFINED IN THIS ORGANIZATION'S BYLAWS.
CORE FORM, PART VI, SECTION B; QUESTION 11B	THE ORGANIZATION IS AN AFFILIATE WITHIN CCMC CORPORATION AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE ORGANIZATION'S FEDERAL FORM 990 WAS PROVIDED TO EACH VOTING MEMBER OF ITS GOVERNING BODY (ITS BOARD OF DIRECTORS) PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE ("IRS"). THE ORGANIZATION'S FINANCE AND AUDIT COMMITTEE ASSUMES THE RESPONSIBILITY TO OVERSEE AND COORDINATE THE FEDERAL FORM 990 PREPARATION, REVIEW AND FILING PROCESS. AS PART OF THE ORGANIZATION'S FEDERAL FORM 990 TAX RETURN PREPARATION PROCESS THE ORGANIZATION HIRED A PROFESSIONAL CPA FIRM WITH EXPERIENCE AND EXPERTISE IN BOTH HEALTHCARE AND NOT-FOR-PROFIT TAX RETURN PREPARATION TO PREPARE THE FEDERAL FORM 990. THE CPA FIRM'S TAX PROFESSIONALS WORKED CLOSELY WITH THE SYSTEM'S FINANCE PERSONNEL INCLUDING THE SENIOR VICE PRESIDENT/CHIEF FINANCIAL OFFICER, CORPORATE CONTROLLER, ACCOUNTING MANAGER AND VARIOUS OTHER INDIVIDUALS ("INTERNAL WORKING GROUP") TO OBTAIN THE INFORMATION NEEDED IN ORDER TO PREPARE A COMPLETE AND ACCURATE TAX RETURN. THE CPA FIRM PREPARED A DRAFT FEDERAL FORM 990 AND FURNISHED IT TO THE SYSTEM'S INTERNAL WORKING GROUP FOR REVIEW. THE SYSTEM'S INTERNAL WORKING GROUP REVIEWED THE DRAFT FEDERAL FORM 990 AND DISCUSSED QUESTIONS AND COMMENTS WITH THE CPA FIRM. REVISIONS WERE MADE TO THE DRAFT FEDERAL FORM 990 WHERE NECESSARY AND A FINAL DRAFT WAS FURNISHED BY THE CPA FIRM TO THE SYSTEM'S INTERNAL WORKING GROUP FOR FINAL REVIEW AND APPROVAL. THE FORM 990 WAS THEN PROVIDED AND PRESENTED TO THE ORGANIZATION'S FINANCE AND AUDIT COMMITTEE AND SUBSEQUENTLY TO EACH VOTING MEMBER OF ITS GOVERNING BODY PRIOR TO FILING WITH THE IRS.
CORE FORM, PART VI, SECTION B; QUESTION 12	THE ORGANIZATION IS AN AFFILIATE WITHIN CCMC CORPORATION AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE ORGANIZATION AND SYSTEM REGULARLY MONITOR AND ENFORCE COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. ANNUALLY ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS AND SENIOR MANAGEMENT PERSONNEL ARE REQUIRED TO REVIEW THE EXISTING CONFLICT OF INTEREST POLICY AND COMPLETE A QUESTIONNAIRE. THE ORGANIZATION'S CORPORATE COMPLIANCE/CONFLICT OF INTEREST COMMITTEE ("COMMITTEE") HAS OVERSIGHT OVER THE MANAGEMENT OF IDENTIFIED OR REPORTED CASES OF CONFLICTS OF INTEREST. The Committee is also responsible for developing, approving, and implementing, as appropriate, policies and education relating to various types of conflicts of interest. THE COMMITTEE HAS DELEGATED THE DAY TO DAY INVESTIGATION OF DISCLOSURES TO THE SYSTEM'S GENERAL COUNSEL AND DIRECTOR OF COMPLIANCE. COMPLETED QUESTIONNAIRES ARE RETURNED TO THE SYSTEM'S GENERAL COUNSEL, WHO PERFORMS AN INITIAL SCREENING OF THE CONFLICT OF INTEREST DISCLOSURES. IF POTENTIAL CONFLICTS OF INTERESTS ARE REPORTED, GENERAL COUNSEL COMPLETES FURTHER INVESTIGATION AND RECOMMENDS A MANAGEMENT PLAN OR OTHER CORRECTIVE ACTIONS TO THE COMMITTEE.
CORE FORM, PART VI, SECTION B; QUESTION 15	THE ORGANIZATION IS AN AFFILIATE WITHIN CCMC CORPORATION AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM. THE ORGANIZATION'S BOARD OF DIRECTORS HAS AN EXECUTIVE COMPENSATION COMMITTEE ("COMMITTEE"). THE COMMITTEE HAS ADOPTED A WRITTEN EXECUTIVE COMPENSATION PHILOSOPHY WHICH IT FOLLOWS WHEN IT REVIEWS AND APPROVES OF THE COMPENSATION AND BENEFITS OF Connecticut Children's SENIOR MANAGEMENT, INCLUDING, but not limited to, THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND Senior VICE PRESIDENT/CHIEF FINANCIAL OFFICER. THE COMMITTEE REVIEWS THE "TOTAL COMPENSATION" OF THESE INDIVIDUALS WHICH IS INTENDED TO INCLUDE BOTH CURRENT AND DEFERRED COMPENSATION AND ALL EMPLOYEE BENEFITS, BOTH QUALIFIED AND NON-QUALIFIED. THE COMMITTEE'S REVIEW IS DONE ON AT LEAST AN ANNUAL BASIS AND ENSURES THAT THE "TOTAL COMPENSATION" OF SENIOR MANAGEMENT OF THE ORGANIZATION IS REASONABLE. THE ACTIONS TAKEN BY THE COMMITTEE ENABLE THE ORGANIZATION TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE SECTION 4958 WITH RESPECT TO THE TOTAL COMPENSATION OF CERTAIN MEMBERS OF THE SENIOR MANAGEMENT TEAM, INCLUDING, but not limited to, THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND Senior VICE PRESIDENT/CHIEF FINANCIAL OFFICER. THE THREE FACTORS WHICH MUST BE SATISFIED IN ORDER TO RECEIVE THE REBUTTABLE PRESUMPTION OF REASONABLENESS ARE THE FOLLOWING: 1. THE COMPENSATION ARRANGEMENT IS APPROVED IN ADVANCE BY AN "AUTHORIZED BODY" OF THE APPLICABLE TAX-EXEMPT ORGANIZATION WHICH IS COMPOSED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A "CONFLICT OF INTEREST" WITH RESPECT TO THE COMPENSATION ARRANGEMENT; 2. THE AUTHORIZED BODY OBTAINED AND RELIED UPON "APPROPRIATE DATA AS TO COMPARABILITY" PRIOR TO MAKING ITS DETERMINATION; AND 3. THE AUTHORIZED BODY "ADEQUATELY DOCUMENTED THE BASIS FOR ITS DETERMINATION" CONCURRENTLY WITH MAKING THAT DETERMINATION. THE COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES EACH OF WHO ARE INDEPENDENT AND ARE FREE FROM ANY CONFLICTS OF INTEREST. THE COMMITTEE RELIED UPON APPROPRIATE COMPARABLE DATA; SPECIFICALLY THE COMMITTEE OBTAINED A WRITTEN COMPENSATION STUDY FROM AN INDEPENDENT FIRM WHICH SPECIALIZES IN THE REVIEWING OF HOSPITAL AND HEALTHCARE SYSTEM EXECUTIVE COMPENSATION AND BENEFITS THROUGHOUT THE UNITED STATES. THIS STUDY USED COMPARABLE GEOGRAPHIC AND DEMOGRAPHIC MARKET DATA INCLUDING BUT NOT LIMITED TO SIMILAR SIZED HOSPITALS, # OF LICENSED BEDS AND NET PATIENT SERVICE REVENUE, INCLUDING COMPLEXITY OF SERVICES. THE COMMITTEE ADEQUATELY DOCUMENTED ITS BASIS FOR ITS DETERMINATION THROUGH THE TIMELY PREPARATION OF WRITTEN MINUTES OF THE COMPENSATION COMMITTEE MEETINGS DURING WHICH THE EXECUTIVE COMPENSATION AND BENEFITS WAS REVIEWED AND SUBSEQUENTLY APPROVED. THE ACTIONS OUTLINED ABOVE WITH RESPECT TO THE COMMITTEE AND THE ESTABLISHMENT OF THE REBUTTABLE PRESUMPTION OF REASONABLENESS ONLY APPLIES TO CERTAIN SENIOR MANAGEMENT PERSONNEL, INCLUDING, BUT NOT LIMITED TO THE PRESIDENT/CHIEF EXECUTIVE OFFICER AND Senior VICE PRESIDENT/CHIEF FINANCIAL OFFICER. THE COMPENSATION AND BENEFITS OF CERTAIN OTHER INDIVIDUALS CONTAINED IN THIS FORM 990 ARE REVIEWED ANNUALLY BY THE PRESIDENT/CHIEF EXECUTIVE OFFICER WITH ASSISTANCE FROM THE ORGANIZATION'S Senior vice president OF HUMAN RESOURCES AND THE HUMAN RESOURCES DEPARTMENT, IN CONJUNCTION WITH THE INDIVIDUAL'S JOB PERFORMANCE DURING THE YEAR AND IS BASED UPON OTHER OBJECTIVE FACTORS DESIGNED TO ENSURE THAT REASONABLE AND FAIR MARKET VALUE COMPENSATION IS PAID BY THE ORGANIZATION. OTHER OBJECTIVE FACTORS INCLUDE MARKET SURVEY DATA FOR COMPARABLE POSITIONS, INDIVIDUAL GOALS AND OBJECTIVES, PERSONNEL REVIEWS, EVALUATIONS, SELF-EVALUATIONS AND PERFORMANCE FEEDBACK MEETINGS. PLEASE ALSO REFER TO OUR RESPONSE INCLUDED IN SCHEDULE J, PART III, QUESTION 3 FOR FURTHER INFORMATION ON HOW CONNECTICUT CHILDREN'S MEDICAL CENTER SATISFIES THE CRITERIA TO SATISFY THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR PURPOSES OF INTERNAL REVENUE CODE SECTION 4958 WITH RESPECT TO EXECUTIVE COMPENSATION REVIEW AND APPROVAL.
CORE FORM, PART VI, SECTION C; QUESTION 19	THE ORGANIZATION'S GOVERNING POLICIES AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.CONNECTICUTCHILDRENS.ORG, OR BY REQUEST. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
CORE FORM, PART VII AND SCHEDULE J	CORE FORM, PART VII AND SCHEDULE J REFLECT CERTAIN BOARD MEMBERS AND OFFICERS RECEIVING COMPENSATION AND BENEFITS FROM THIS ORGANIZATION OR A RELATED ORGANIZATION. PLEASE NOTE THIS REMUNERATION WAS FOR SERVICES RENDERED AS FULL-TIME EMPLOYEES OF THIS ORGANIZATION OR THE RELATED ORGANIZATION; NOT FOR SERVICES RENDERED AS A VOTING MEMBER OR OFFICER OF THE ORGANIZATION'S BOARD OF DIRECTORS.
CORE FORM, PART VII AND SCHEDULE J	PLEASE NOTE THAT AUDREY WISE, MBA, BECAME THE VICE PRESIDENT AND CHIEF MARKETING OFFICER EFFECTIVE SEPTEMBER 26, 2016. IN ACCORDANCE WITH INTERNAL REVENUE SERVICE FORM 990 RULES, REGULATIONS AND INSTRUCTIONS, THE COMPENSATION REPORTED IN CORE FORM, PART VII AND SCHEDULE J, PART II OF THIS FORM 990 IS DERIVED FROM 2015 FORMS W-2. ACCORDINGLY, THIS INDIVIDUAL HAS NO COMPENSATION REPORTED ON THE CURRENT YEAR FEDERAL FORM 990. ADDITIONALLY, CHRISTINE FINCK, M.D., FACS, AND TRISHA FARMER, MSN, RN, THE EXECUTIVE VICE PRESIDENT, SURGEON IN CHIEF AND CHIEF OF STAFF; RESPECTIVELY, BECAME OFFICERS OF THE ORGANIZATION DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016. HOWEVER, THESE INDIVIDUALS WERE PREVIOUSLY EMPLOYED WITHIN THE ORGANIZATION IN A NON-OFFICER CAPACITY. THE COMPENSATION BEING REPORTED ON THIS FORM 990 REFLECTS THEIR COMPENSATION FROM THEIR PREVIOUS ROLES.
CORE FORM, PART VII AND SCHEDULE J	DEAN A. RAPOZA, FORMER OFFICER OF THIS ORGANIZATION, IS STILL EMPLOYED WITHIN THE SYSTEM AS THE PRESIDENT OF CONNECTICUT CHILDREN'S SPECIALTY GROUP.
CORE FORM, PART VII, SECTION A, COLUMN B	THE ORGANIZATION IS AN AFFILIATE WITHIN CCMC CORPORATION AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). CERTAIN BOARD OF DIRECTOR MEMBERS AND OFFICERS LISTED ON CORE FORM, PART VII AND SCHEDULE J OF THIS FORM 990 MAY HOLD SIMILAR POSITIONS WITH BOTH THIS ORGANIZATION AND OTHER AFFILIATES WITHIN THE SYSTEM. THE HOURS SHOWN ON THIS FORM 990, FOR BOARD MEMBERS WHO RECEIVE NO COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, REPRESENT THE ESTIMATED HOURS DEVOTED PER WEEK FOR THIS ORGANIZATION. TO THE EXTENT THESE INDIVIDUALS SERVE AS A MEMBER OF THE BOARD OF DIRECTORS OF OTHER RELATED ORGANIZATIONS WITHIN THE SYSTEM, THEIR RESPECTIVE HOURS ARE APPROXIMATELY THE SAME AS REFLECTED ON CORM FORM, PART VII OF THIS FORM 990. THE HOURS REFLECTED ON CORE FORM, PART VII OF THIS FORM 990, FOR BOARD MEMBERS WHO RECEIVE COMPENSATION FOR SERVICES RENDERED IN A NON-BOARD CAPACITY, PAID OFFICERS, REFLECT TOTAL HOURS WORKED PER WEEK ON BEHALF OF THE SYSTEM; NOT SOLELY THIS ORGANIZATION.
CORE FORM, PART XI; QUESTION 9	OTHER CHANGES IN NET ASSETS OR FUND BALANCES INCLUDE: - CHANGE IN FAIR MARKET VALUE OF SWAP AGREEMENTS - $825,126; - CHANGE IN EQUITY INTEREST IN THE NET ASSETS OF CONNECTICUT CHILDREN'S MEDICAL CENTER FOUNDATION; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION - $6,917,740; - TRANSFER TO CONNECTICUT CHILDREN'S SPECIALTY GROUP, INC.; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION - ($20,061,044); - TRANSFER TO NEW ENGLAND PEDIATRICS INDEMNITY, LTD.; A RELATED ORGANIZATION - ($880,000); - CHANGE IN FUNDED STATUS OF PENSION AND POST-RETIREMENT PLANS - ($4,937,060); - TEMPORARILY RESTRICTED CHANGE IN EQUITY INTEREST IN THE NET ASSETS OF CONNECTICUT CHILDREN'S MEDICAL CENTER FOUNDATION; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION - $317,579; - PERMANENTLY RESTRICTED CHANGE IN FUNDS HELD IN TRUST BY OTHERS - $5,455,109; AND - PERMANENTLY RESTRICTED CHANGE IN EQUITY INTEREST IN THE NET ASSETS OF CONNECTICUT CHILDREN'S MEDICAL CENTER FOUNDATION; A RELATED INTERNAL REVENUE CODE SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION - $883,341.
CORE FORM, PART XII; QUESTION 2	THE ORGANIZATION IS AN AFFILIATE WITHIN CCMC CORPORATION AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). AN INDEPENDENT CPA FIRM AUDITED THE CONSOLIDATED FINANCIAL STATEMENTS OF CONNECTICUT CHILDREN'S MEDICAL CENTER AND SUBSIDIARIES, FOR THE FISCAL YEARS ENDED SEPTEMBER 30, 2016 AND SEPTEMBER 30, 2015; RESPECTIVELY. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAIN CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. THE INDEPENDENT CPA FIRM ISSUED AN UNQUALIFIED OPINION WITH RESPECT TO THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. IN ADDITION, CCMC CORPORATION AND SUBSIDIARIES ALSO RECEIVED AUDITED CONSOLIDATED FINANCIAL STATEMENTS FOR THE FISCAL YEARS ENDED SEPTEMBER 30, 2016 AND SEPTEMBER 30, 2015; RESPECTIVELY. THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS CONTAIN CONSOLIDATING SCHEDULES ON AN ENTITY BY ENTITY BASIS. THE INDEPENDENT CPA FIRM ISSUED AN UNQUALIFIED OPINION WITH RESPECT TO THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS. THE ORGANIZATION'S FINANCE AND AUDIT COMMITTEE ASSUMES RESPONSIBILITY FOR THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT AUDITOR.
CORE FORM, PART XII; QUESTION 3	THE ORGANIZATION IS AN AFFILIATE WITHIN CCMC CORPORATION AND SUBSIDIARIES; A TAX-EXEMPT INTEGRATED HEALTHCARE DELIVERY SYSTEM ("SYSTEM"). THE SYSTEM ENGAGED AN INDEPENDENT ACCOUNTING FIRM TO PREPARE AND ISSUE A CONSOLIDATED AUDIT UNDER THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133. THIS ORGANIZATION WAS INCLUDED IN THE CONSOLIDATED AUDIT.
FORM 990 PART IX LINE 11G	DESCRIPTION:PURCHASED SERVICES TOTAL FEES:22815576
FORM 990 PART IX LINE 11G	DESCRIPTION:CONTRACTED SERVICES TOTAL FEES:15899562
FORM 990 PART IX LINE 11G	DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:12588471
FORM 990 PART IX LINE 11G	DESCRIPTION:CONSULTING FEES TOTAL FEES:4441163
FORM 990 PART IX LINE 11G	DESCRIPTION:COLLECTION FEES TOTAL FEES:353371
FORM 990 PART IX LINE 11G	DESCRIPTION:AGENCY FEES TOTAL FEES:418683
FORM 990 PART IX LINE 11G	DESCRIPTION:ACTUARIAL FEES TOTAL FEES:100420
FORM 990 PART IX LINE 11G	DESCRIPTION:ADMINISTRATIVE FEES TOTAL FEES:57158
FORM 990 PART IX LINE 11G	DESCRIPTION:OTHER FEES TOTAL FEES:392235

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

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1	Briefly describe the organization’s mission or most significant activities: CONNECTICUT CHILDREN'S MEDICAL CENTER IS DEDICATED TO IMPROVING THE PHYSICAL AND EMOTIONAL HEALTH OF CHILDREN THROUGH FAMILY-CENTERED CARE, RESEARCH, EDUCATION AND ADVOCACY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	23
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	22
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	2,120
6	Total number of volunteers (estimate if necessary) .............	6	362
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	22,898,068	20,434,065
9	Program service revenue (Part VIII, line 2g) .........	294,961,171	307,571,046
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,174,785	93,295
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,251,414	1,299,205
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	320,285,438	329,397,611
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	16,890
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)	144,710,363	149,766,958
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 2,710,661
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	143,339,977	153,479,146
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	288,050,340	303,262,994
19	Revenue less expenses. Subtract line 18 from line 12.......	32,235,098	26,134,617
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	380,119,520	385,271,416
21	Total liabilities (Part X, line 26).............	181,869,675	172,366,163
22	Net assets or fund balances. Subtract line 21 from line 20.....	198,249,845	212,905,253

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	Signature of officer	Date

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4a	(Code: ) (Expenses $ 226,130,286 including grants of $ 16,890 ) (Revenue $ 307,571,046 )
	ACUTE CARE CHILDREN'S HOSPITAL: EXPENSES INCURRED TO PROVIDE ACUTE CARE INPATIENT AND OUTPATIENT SERVICES TO CHILDREN FROM CONNECTICUT AND THE SURROUNDING AREA. IN FISCAL YEAR 2016 THERE WERE 6,331 ADMISSIONS AND 76,678 OUTPATIENT VISITS. PLEASE REFER TO SCHEDULE O FOR THE ORGANIZATION'S COMMUNITY BENEFIT STATEMENT.

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 expenses226,130,286

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	5,592,507	1,899,642	676,218

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	512,562
d	Related organizations		1d	7,661,054
e	Government grants (contributions)		1e	8,361,536

f	All other contributions, gifts, grants, and similar amounts not included above		1f	3,898,913

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		20,434,065

			Business Code
2a	NET PATIENT SERVICE REVENUE	541900	305,164,135	305,164,135
b	OTHER HEALTHCARE RELATED REVENUE	541900	2,406,911	2,406,911
c
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			307,571,046

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			93,295			93,295
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		219,502
b	Less: rental expenses		147,202
c	Rental income or (loss)	0	72,300
d	Net rental income or (loss)......			72,300			72,300
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss).....			0
8a	Gross income from fundraising events (not including $ 512,562of contributions reported on line 1c). See Part IV, line 18 ....
	a		263,945
b	Less: direct expenses ...b		263,945
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		5,720
b	Less: direct expenses ...b		1,947
c	Net income or (loss) from gaming activities..			3,773			3,773
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	FOOD SERVICES		453000	1,147,153			1,147,153
b	CONSULTING		541900	75,979			75,979
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			1,223,132
12	Total revenue. See Instructions......			329,397,611	307,571,046		1,392,500

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	16,890	16,890
2	Grants and other assistance to individuals in the United States. See Part IV, line 22	0
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	6,948,254		6,948,254
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	117,842,702	92,609,873	23,265,133	1,967,696
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	7,023,505	5,519,611	1,386,618	117,276
9	Other employee benefits .......	8,643,899	6,954,710	1,541,421	147,768
10	Payroll taxes ...........	9,308,598	7,259,468	1,894,887	154,243
11	Fees for services (non-employees):
a	Management ......	319,541	273,286	46,255
b	Legal .........	387,446	438	387,008
c	Accounting ...........	242,311		242,311
d	Lobbying ...........	164,135	164,135
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	929,220		929,220
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	57,066,639	50,141,863	6,893,744	31,032
12	Advertising and promotion ....	1,271,598		1,271,598
13	Office expenses .......	5,685,095	3,818,103	1,846,777	20,215
14	Information technology ......	5,785,256	591,343	5,193,913
15	Royalties ..	0
16	Occupancy ...........	12,895,778	8,110,098	4,746,131	39,549
17	Travel ............	381,046	236,679	140,573	3,794
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	874,193	660,454	193,008	20,731
20	Interest ...........	1,137,843	722,752	405,106	9,985
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	19,046,493	12,098,248	6,781,109	167,136
23	Insurance ...	2,894,693	2,630,225	264,468
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES	30,598,321	30,558,700	39,164	457
b	SPECIALITY GROUP SUPPORT	8,796,478		8,796,478
c	REPAIRS & MAINTENANCE	2,944,998	2,416,578	528,420
d	DUES, LICENSES & SUBSCRIPT.	1,366,675	662,958	680,451	23,266
e	All other expenses	691,387	683,874		7,513
25	Total functional expenses. Add lines 1 through 24e	303,262,994	226,130,286	74,422,047	2,710,661
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 ........			8,339,532	1	4,161,628
2	Savings and temporary cash investments .........			0	2	0
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			31,383,650	4	32,051,457
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 ........			1,443,429	8	2,407,715
9	Prepaid expenses and deferred charges ......			761,737	9	647,914
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	278,054,050
b	Less: accumulated depreciation	10b	151,474,917	130,307,644	10c	126,579,133
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			0	12	0
13	Investments—program-related. See Part IV, line 11 ..			176,116,474	13	189,713,912
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			31,767,054	15	29,709,657
16	Total assets. Add lines 1 through 15 (must equal line 34)...			380,119,520	16	385,271,416

17	Accounts payable and accrued expenses .....	49,959,877	17	47,706,884
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	59,216,334	20	52,065,004
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 ..	51,544	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	196,004	24	162,036
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	72,445,916	25	72,432,239
26	Total liabilities. Add lines 17 through 25..	181,869,675	26	172,366,163

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	75,698,045	27	86,365,161
28	Temporarily restricted net assets ...........	29,429,877	28	27,079,719
29	Permanently restricted net assets	93,121,923	29	99,460,373
	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 ...........	198,249,845	33	212,905,253
34	Total liabilities and net assets/fund balances ........	380,119,520	34	385,271,416

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

(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)CCMC CORPORATION 282 WASHINGTON STREET HARTFORD,CT06106 22-2619876	HLTHCARE SVCS	CT	501(C)(3)	509(A)(3)	NA		No
(2)CONNECTICUT CHILDREN'S MEDICAL CTR FDN 282 WASHINGTON STREET HARTFORD,CT06106 22-2619869	FUNDRAISING	CT	501(C)(3)	509(A)(1)	CCMC CORP		No
(3)CCMC AFFILIATES INC 282 WASHINGTON STREET HARTFORD,CT06106 22-2619870	HLTHCARE SVCS	CT	501(C)(3)	509(A)(2)	CCMC CORP		No
(4)CONNECTICUT CHILDREN'S SPECIALTY GROUP 282 WASHINGTON STREET HARTFORD,CT06106 06-1446900	HLTHCARE SVCS	CT	501(C)(3)	509(A)(2)	CT CHILDRENS	Yes
(5)CHILDREN'S FUND OF CONNECTICUT INC 270 FARMINGTON AVENUE FARMINGTON,CT06032 06-1364513	HLTHCARE SVCS	CT	501(C)(3)	509(A)(3)	CT CHILDRENS	Yes
(6)CHILDREN'S HEALTH & DEVEL INSTITUTE INC 270 FARMINGTON AVENUE FARMINGTON,CT06032 06-1504725	HLTHCARE SVCS	CT	501(C)(3)	509(A)(1)	CFCT		No
(7)CAPITAL AREA HEALTH CONSORTIUM INC 270 FARMINGTON AVENUE FARMINGTON,CT06032 51-0173264	SUPPORT SVCS	CT	501(C)(3)	509(A)(3)	CT CHILDRENS	Yes

(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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CONNECTICUT CHILDREN'S SPECIALTY GROUP	O	21,254,033	COST
(2) CONNECTICUT CHILDREN'S SPECIALTY GROUP	P	28,889,986	COST
(3) CONNECTICUT CHILDREN'S SPECIALTY GROUP	Q	26,343,942	COST
(4) CONNECTICUT CHILDREN'S SPECIALTY GROUP	R	21,402,101	COST
(5) CCMC CORPORATION	O	84,993	COST
(6) CCMC CORPORATION	R	7,870,348	COST
(7) CCMC CORPORATION	S	9,212,678	COST

(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