TY 2021 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/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) GRACE WAKULCHIK...................................................................... BOD/OFFICER - PRESIDENT & CEO	46.00 ................. 4.00	X	X			1,439,903	277,587
(2) JOHN CROW MD...................................................................... ASST. CHIEF MEDICAL OFFICER	48.00 ................. 2.00				X	1,095,934	29,334
(3) ABDELAZIZ SALEH MD...................................................................... PERINATOLOGIST	50.00 ................. 1.00				X	1,067,170	45,704
(4) TSULEE CHEN MD...................................................................... DIRECTOR OF PEDIATRIC NEUROSURGERY	49.00 ................. 1.00				X	1,046,233	26,899
(5) MARK WULKAN MD...................................................................... DEPARTMENT CHAIR - SURGERY	50.00 ................. 0.00				X	1,038,618	31,432
(6) JODI REGAN MD...................................................................... PERINATOLOGIST	50.00 ................. 0.00				X	1,033,972	27,048
(7) SHAWN LYDEN...................................................................... CHIEF STRATEGY OFFICER	47.00 ................. 3.00			X		849,992	134,164
(8) ROBERT MCGREGOR MD...................................................................... CHIEF MEDICAL OFFICER	49.00 ................. 1.00	X				744,105	120,456
(9) MICHAEL BIGHAM MD...................................................................... CHIEF QUALITY OFFICER	49.00 ................. 1.00			X		729,742	116,752
(10) SPENCER KOWAL...................................................................... CFO/TREASURER - PART YEAR	46.00 ................. 4.00		X			810,763	28,224
(11) LISA AURILIO...................................................................... CHIEF OPERATING OFFICER	37.00 ................. 13.00			X		733,114	98,925
(12) RHONDA LARIMORE...................................................................... CHIEF OF HUMAN RESOURCES	50.00 ................. 0.00			X		628,041	98,171
(13) HARUN RASHID...................................................................... CHIEF INFORMATION OFFICER	50.00 ................. 0.00			X		528,015	112,814
(14) ANTHEA DANIELS...................................................................... CHIEF LEGAL OFFICER/ ASST. SECRETARY	46.00 ................. 4.00			X		543,823	89,034
(15) CRAIG MCGHEE...................................................................... CHIEF NON HOSP SRVCS OFFICER	49.00 ................. 1.00			X		522,578	81,050
(16) CHRISTINE YOUNG...................................................................... CHIEF NURSING OFFICER	49.00 ................. 1.00			X		453,730	95,105
(17) MICHAEL FORBES MD...................................................................... INTERIM CHAIR DEPT. OF PEDS	50.00 ................. 0.00	X				494,946	30,831

(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/1099-NEC)
(18) ALICIA LAMANCUSA........................................................................ INTERIM CHIEF FINANCIAL OFFICER	43.00 .......................7.00	X	X		427,371	15,935
(19) SHEFALI MAHESH MD........................................................................ DIRECTOR - DEPARTMENT CHAIR - NEPHROLOGY AND DIALY	47.00 .......................3.00	X			363,722	31,762
(20) CHRISTOPHER GESSNER........................................................................ PRESIDENT - CEO	45.00 .......................5.00	X	X		207,270	48,032
(21) WILLIAM CONSIDINE........................................................................ FORMER CEO EMERITUS	48.00 .......................2.00			X	269,595	877
(22) JOHN ORR........................................................................ CHAIRMAN	20.00 .......................1.00	X	X		0	0
(23) SUZANNE LOCKE........................................................................ SECRETARY	14.00 .......................0.00	X	X		0	0
(24) VIRGINIA ADDICOTT........................................................................ DIRECTOR	5.00 .......................0.00	X			0	0
(25) ROBERT BERK........................................................................ DIRECTOR/ CHAIR AUDIT COMMITTEE	8.00 .......................2.00	X			0	0
(26) TIMOTHY BURKE........................................................................ DIRECTOR/ VICE CHAIR FINANCE COMMITTEE	2.00 .......................0.00	X			0	0
(27) PAUL CATANIA........................................................................ DIRECTOR	4.00 .......................0.00	X			0	0
(28) PATRICK COVEY........................................................................ DIRECTOR	2.00 .......................0.00	X			0	0
(29) VIRGINIA DROSOS........................................................................ DIRECTOR	1.00 .......................0.00	X			0	0
(30) PAUL DUTTON........................................................................ DIRECTOR	3.00 .......................2.00	X			0	0
(31) JOANNE FELDEN........................................................................ DIRECTOR	14.00 .......................0.00	X			0	0
(32) TAMMY GERSMAN........................................................................ DIRECTOR	14.00 .......................0.00	X			0	0
(33) WILLIAM HOPKINS........................................................................ DIRECTOR	9.00 .......................0.00	X			0	0
(34) MONTRELLA JACKSON........................................................................ DIRECTOR	1.00 .......................0.00	X			0	0
(35) WILLIAM KELLEHER........................................................................ DIRECTOR	5.00 .......................0.00	X			0	0
(36) KARA LEWIS........................................................................ DIRECTOR	5.00 .......................0.00	X			0	0
(37) MICHELLE LUECKE........................................................................ DIRECTOR	2.00 .......................0.00	X			0	0
(38) JOHN MAYER........................................................................ DIRECTOR	1.00 .......................0.00	X			0	0
(39) GREG MCDERMOTT........................................................................ DIRECTOR - PART YEAR	6.00 .......................1.00	X			0	0
(40) RICHARD ROGERS........................................................................ DIRECTOR	4.00 .......................0.00	X			0	0
(41) PEG STALTER........................................................................ DIRECTOR	17.00 .......................1.00	X			0	0
(42) GLEN STEPHENS........................................................................ DIRECTOR	3.00 .......................0.00	X			0	0
(43) SHELLEY TAYLOR........................................................................ DIRECTOR	1.00 .......................0.00	X			0	0
(44) BARBARA VARLEY........................................................................ DIRECTOR	2.00 .......................0.00	X			0	0
(45) DARREN WELLS........................................................................ DIRECTOR	4.00 .......................0.00	X			0	0
(46) ROBERT WELLS........................................................................ DIRECTOR	4.00 .......................0.00	X			0	0
(47) SARAH ROSSI........................................................................ DIRECTOR	12.00 .......................0.00	X			0	0
(48) STEPHEN MYERS........................................................................ VICE CHAIRMAN FOR FINANCE	8.00 .......................0.00	X			0	0

(A) Name and business address	(B) Description of services	(C) Compensation
MARCUS THOMAS LLC 4781 RICHMOND ROAD CLEVELAND,OH44128	BROADCAST MEDIA	6,856,335
PEDIATRIC & ADOLESCENT UROLOGY 215 W BOWERY ST AKRON,OH44308	PHYSICIAN SERVICES	3,414,149
QUALIVIS LLC 2000 CENTER POINT DR SUITE 2360 COLUMBIA,SC29210	CLINICAL TEMP SVCS	2,241,050
PEDIATRICS OF AKRON INC 215 W BOWERY ST AKRON,OH44308	MEDICAL SERVICES	1,791,732
COMPHEALTH SOUTH BINGHAM JUNCTION BLVD MIDVALE,UT84047	MEDICAL SERVICES	1,691,636
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 67

- TIN:

SCHEDULE A
(Form 990)

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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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

CHILDREN'S HOSPITAL MEDICAL CENTER OF
AKRON

Employer identification number

34-0714357

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 12, 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).)

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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% 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 33 1/3% 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 on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2021

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 5 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 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 5 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2021

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2021

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 (explain in Part VI). 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 0.015 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 0.035	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) 2021

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

CHILDREN'S HOSPITAL MEDICAL CENTER OF
AKRON

Employer identification number

34-0714357

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. Don't 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 isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON

Part I Contributors	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) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON		Employer identification number 34-0714357

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) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON			Employer identification number 34-0714357
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) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

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

CHILDREN'S HOSPITAL MEDICAL CENTER OF
AKRON

Employer identification number

34-0714357

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. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

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.

Cat. No. 50084S

Schedule C (Form 990) 2021

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) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

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

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

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

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

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

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

Yes

109,913

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

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

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

Yes

102,733

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

212,646

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
PART II-B, LINE 1:	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON ("CHMCA") PAID A TOTAL OF $109,913 RELATED TO VARIOUS LOBBYING EXPENSES AND $102,733 WAS PAID FOR LOBBYING EFFORTS AND VARIOUS COMMUNICATIONS ON BEHALF OF CHMCA WITH GOVERNMENTAL AUTHORITIES. THOSE COMMUNICATIONS AND LOBBYING EFFORTS INVOLVE THE FOLLOWING: * MONTHLY LEGISLATIVE CONFERENCE CALLS WITH CHMCA STAFF * PARTICIPATED IN MEETINGS WITH LEGISLATORS AND CONGRESSIONAL STAFF TO PROVIDE ORGANIZATIONAL UPDATES AND DISCUSS LEGISLATIVE INITIATIVES * COMMUNICATED WITH MEMBERS REQUESTING SUPPORT FOR CHILDREN'S HOSPITAL GRADUATE MEDICAL EDUCATION (CHGME) THE FOLLOWING ARE 2021 LOBBYING EXPENSES: $30,286 NATIONAL ASSOCIATION OF CHILDREN' S HOSPITALS $12,549 AMERICAN HOSPITAL ASSOCIATION $59,467 OHIO CHILDREN'S HOSPITAL ASSOCIATION $7,611 OHIO HOSPITAL ASSOCIATION $50,000 LOBBYIST CAPITAL CONSULTING GROUP $52,733 INTERNAL COSTS $212,646 TOTAL CHILDREN'S HOSPITALS ASSOCIATION (CHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA) ARE NATIONAL ORGANIZATIONS TO WHICH CHMCA IS A MEMBER ALONG WITH OTHER HOSPITALS. AS MEMBERS, THESE NATIONAL ORGANIZATIONS EXPRESS CONCERNS OF HEALTHCARE PROVIDERS IN ADVOCACY AND REPRESENTATION TO NATIONAL AND/OR STATE LEGISLATURES ON HEALTHCARE ISSUES THAT AFFECT CHMCA AND THE DELIVERY OF HEALTH CARE TO CHILDREN AND OTHER PATIENTS. AS AN EXAMPLE, CHA AND AHA HAVE BEEN A CONSTANT AND PERSUASIVE VOICE IN CHAMPIONING THE NEEDS OF CHILDREN AND THE HOSPITALS THAT CARE FOR THEM. THE OHIO CHILDREN'S HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION ARE STATE OF OHIO ORGANIZATIONS THAT PROMOTE THE VIEWS OF OHIO CHILDREN'S HOSPITALS FOR MEDICAID AND CHILD HEALTHCARE ISSUES. LOCAL AGENCIES IN SUMMIT COUNTY, OHIO, ALSO PROVIDE SERVICES TO RESIDENTS. THE IMPACT OF HEALTHCARE LEGISLATION HAS IMPLICATIONS ON OUR BUSINESS, OUR PATIENTS AND FAMILIES, AND THE SERVICES THAT WE PROVIDE.

Return Reference

Explanation

PART II-B, LINE 1:

CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON ("CHMCA") PAID A TOTAL OF $109,913 RELATED TO VARIOUS LOBBYING EXPENSES AND $102,733 WAS PAID FOR LOBBYING EFFORTS AND VARIOUS COMMUNICATIONS ON BEHALF OF CHMCA WITH GOVERNMENTAL AUTHORITIES. THOSE COMMUNICATIONS AND LOBBYING EFFORTS INVOLVE THE FOLLOWING: * MONTHLY LEGISLATIVE CONFERENCE CALLS WITH CHMCA STAFF * PARTICIPATED IN MEETINGS WITH LEGISLATORS AND CONGRESSIONAL STAFF TO PROVIDE ORGANIZATIONAL UPDATES AND DISCUSS LEGISLATIVE INITIATIVES * COMMUNICATED WITH MEMBERS REQUESTING SUPPORT FOR CHILDREN'S HOSPITAL GRADUATE MEDICAL EDUCATION (CHGME) THE FOLLOWING ARE 2021 LOBBYING EXPENSES: $30,286 NATIONAL ASSOCIATION OF CHILDREN' S HOSPITALS $12,549 AMERICAN HOSPITAL ASSOCIATION $59,467 OHIO CHILDREN'S HOSPITAL ASSOCIATION $7,611 OHIO HOSPITAL ASSOCIATION $50,000 LOBBYIST CAPITAL CONSULTING GROUP $52,733 INTERNAL COSTS $212,646 TOTAL CHILDREN'S HOSPITALS ASSOCIATION (CHA) AND AMERICAN HOSPITAL ASSOCIATION (AHA) ARE NATIONAL ORGANIZATIONS TO WHICH CHMCA IS A MEMBER ALONG WITH OTHER HOSPITALS. AS MEMBERS, THESE NATIONAL ORGANIZATIONS EXPRESS CONCERNS OF HEALTHCARE PROVIDERS IN ADVOCACY AND REPRESENTATION TO NATIONAL AND/OR STATE LEGISLATURES ON HEALTHCARE ISSUES THAT AFFECT CHMCA AND THE DELIVERY OF HEALTH CARE TO CHILDREN AND OTHER PATIENTS. AS AN EXAMPLE, CHA AND AHA HAVE BEEN A CONSTANT AND PERSUASIVE VOICE IN CHAMPIONING THE NEEDS OF CHILDREN AND THE HOSPITALS THAT CARE FOR THEM. THE OHIO CHILDREN'S HOSPITAL ASSOCIATION AND THE OHIO HOSPITAL ASSOCIATION ARE STATE OF OHIO ORGANIZATIONS THAT PROMOTE THE VIEWS OF OHIO CHILDREN'S HOSPITALS FOR MEDICAID AND CHILD HEALTHCARE ISSUES. LOCAL AGENCIES IN SUMMIT COUNTY, OHIO, ALSO PROVIDE SERVICES TO RESIDENTS. THE IMPACT OF HEALTHCARE LEGISLATION HAS IMPLICATIONS ON OUR BUSINESS, OUR PATIENTS AND FAMILIES, AND THE SERVICES THAT WE PROVIDE.

Schedule C (Form 990) 2021

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.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL MEDICAL CENTER OF
AKRON

Employer identification number

34-0714357

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 7/25/06, 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 FASB 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 FASB 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 FASB 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) 2021

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 ....	30,205,732	24,391,406	19,888,825	20,908,929	19,743,581
b	Contributions ...	4,390,474	1,246,737	851,929	1,312,133	560,495
c	Net investment earnings, gains, and losses	1,918,829	3,213,212	3,133,097	-2,263,920	853,513
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...			291,024	557,496	459,309
f	Administrative expenses ....	-1,490,812	-1,354,377	-808,577	-489,179	-210,649
g	End of year balance ......	38,005,847	30,205,732	24,391,404	19,888,825	20,908,929

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

Board designated or quasi-endowment SchDMd Bullet

3.226 %

Permanent endowment SchDMd Bullet

16.601 %

Term endowment SchDMd Bullet

80.173 %

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 .....	17,056,491		17,056,491
b	Buildings ....	838,492,603	383,082,443	455,410,160
c	Leasehold improvements	56,009,985	17,908,364	38,101,621
d	Equipment ....	443,954,264	357,226,660	86,727,604
e	Other .....	26,485,477	4,540,302	21,945,175
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				619,241,051

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other 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

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

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

Part IX

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

(a) Description				(b) Book value
(1)BENEFICIAL INT IN FOUNDATION				223,069,139
(2)UNAMORT HEALTHCARE SERVICE				38,397,047
(3)HTC TRANASFER FROM UNRESTRICTED				8,640,248
(4)OTHER ASSETS				1,270,423
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				271,376,857

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
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	148,314,358
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) 2021

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

PART V, LINE 4:

ENDOWMENT FUNDS RELATING TO AKRON CHILDREN'S HOSPITAL FOUNDATION AND CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON ARE RELATED TO BOARD DESIGNATED FUNDS WHICH INCLUDE FUNDS FROM UNRESTRICTED SOURCES THAT HAVE BEEN INTERNALLY DESIGNATED BY THE BOARD OF DIRECTORS TO FUNCTION AS ENDOWMENTS. THESE FUNDS ARE TO BE USED FOR THE SOLE PURPOSE FOR WHICH THEY WERE DESIGNED. CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON DOES HAVE A POLICY IN PLACE TO MONITOR ALL UNRESTRICTED, TEMPORARILY AND PERMANENTLY RESTRICTED FUNDS.

PART X, LINE 2:

CHMCA PREPARES CONSOLIDATED FINANCIAL STATEMENTS INCLUDING ITS AFFILIATED SUBSIDIARIES. CHMCA ADOPTED ACCOUNTING STANDARDS CODIFICATION 740 (ASC 740) IN 2007 WHICH REQUIRES BUSINESSES TO ANALYZE AND DISCLOSE INCOME TAX RISKS. NO DISCLOSURES WERE REQUIRED UNDER GAAP AS CHMCA DOES NOT HAVE ANY MATERIAL TAX CONTINGENCIES THAT ARE REQUIRED DISCLOSURES IN THE FOOTNOTES.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization
CHILDREN'S HOSPITAL MEDICAL CENTER OF
AKRON

Employer identification number

34-0714357

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 10 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) 2021

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 HOLIDAY TREE FESTIVAL (event type)	(b) Event #2 CHARITY BALL (event type)	(c) Other events 5 (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	285,992	112,175	188,561	586,728
2	Less: Contributions . . . .	214,494	84,131	162,686	461,311
3	Gross income (line 1 minus line 2) . . . . . .	71,498	28,044	25,875	125,417

4	Cash prizes . . . . .
5	Noncash prizes . . . .
6	Rent/facility costs . . . .
7	Food and beverages . . .
8	Entertainment . . . .
9	Other direct expenses . . .	264,885	6,789	53,185	324,859
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .				324,859
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .				-199,442

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 . . .

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) 2021

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 provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990) 2021

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

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL MEDICAL CENTER OF
AKRON

Employer identification number

34-0714357

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

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

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

Yes

100% 150% 200% Other %

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

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

Yes

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

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

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

Yes

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

Yes

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

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) . . .	4,532,270		4,532,270	0.450 %
b	Medicaid (from Worksheet 3, column a) . . . . .	552,491,012	408,156,073	144,334,939	14.360 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .	978,714	978,714
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	558,001,996	409,134,787	148,867,209	14.810 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	6,230,787	10	6,230,777	0.620 %
f	Health professions education (from Worksheet 5) . . .	25,330,681	15,265,209	10,065,472	1.000 %
g	Subsidized health services (from Worksheet 6) . . . .	112,571,369	54,672,685	57,898,684	5.760 %
h	Research (from Worksheet 7) .	9,045,588	106,433	8,939,155	0.890 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	199,778		199,778	0.020 %
j	Total. Other Benefits . .	153,378,203	70,044,337	83,333,866	8.290 %
k	Total. Add lines 7d and 7j .	711,380,199	479,179,124	232,201,075	23.100 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

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

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	25,503	25,503	0 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	718	718	0 %
7	Community health improvement advocacy	396,274	396,274	0.040 %
8	Workforce development	41,067	41,067	0 %
9	Other
10	Total	463,562	463,562	0.040 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

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

6,936,715

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).....

11,730,221

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

14,326,161

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

-2,595,940

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) 2021

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?2Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON ONE PERKINS SQUARE AKRON,OH44308 WWW.AKRONCHILDRENS.ORG	X	X	X	X
2	CHILDREN'S - BEEGHLY CAMPUS 6505 MARKET STREET YOUNGSTOWN,OH44512 WWW.AKRONCHILDRENS.ORG	X	X	X	X

Schedule H (Form 990) 2021

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)

	FACILITY GROUP A - AKRON
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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

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): HTTPS://TINYURL.COM/Y6EHZS8C

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 20

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

Yes

If "Yes" (list url): HTTPS://TINYURL.COM/Y6EHZS8C

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) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	FACILITY GROUP A - AKRON
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 200.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

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)

Was widely publicized 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):

HTTPS://TINYURL.COM/2S4FT6X5

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

HTTPS://TINYURL.COM/2S4FT6X5

A plain language summary of the FAP was widely available on a website (list url):
HTTPS://TINYURL.COM/2S4FT6X5

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)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	FACILITY GROUP A - AKRON
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

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

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

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

	FACILITY GROUP A - AKRON
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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) 2021

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)

	FACILITY GROUP B - MAHONING VALLEY
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?........................

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

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

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): HTTPS://TINYURL.COM/Y6EHZS8C

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 20

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

Yes

If "Yes" (list url): HTTPS://TINYURL.COM/Y6EHZS8C

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

10b

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) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	FACILITY GROUP B - MAHONING VALLEY
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 200.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

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

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)

Was widely publicized 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):

HTTPS://TINYURL.COM/2S4FT6X5

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

HTTPS://TINYURL.COM/2S4FT6X5

A plain language summary of the FAP was widely available on a website (list url):
HTTPS://TINYURL.COM/2S4FT6X5

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)

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

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	FACILITY GROUP B - MAHONING VALLEY
Name of hospital facility or letter of facility reporting group

Yes

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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

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

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

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):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Yes

If "No," indicate why:

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

The hospital facility’s policy was not in writing

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

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

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

	FACILITY GROUP B - MAHONING VALLEY
Name of hospital facility or letter of facility reporting group

Yes

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 a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a prospective Medicare or Medicaid method

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) 2021

Page 8

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, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 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
FACILITY GROUP A - AKRON	PART V, SECTION B, LINE 5: IN ADDITION TO EXAMINING COUNTY-LEVEL EPIDEMIOLOGIC DATA, INTERVIEWS WERE CONDUCTED WITH COMMUNITY LEADERS REPRESENTING THE BROAD INTERESTS OF A SEVEN-COUNTY AREA FROM MARCH 2019 - MAY 2019 TO GAIN INSIGHT ON WHAT THEY THOUGHT WERE SIGNIFICANT HEALTH NEEDS OF CHILDREN IN THEIR COMMUNITIES, THE FACTORS THAT IMPACT THOSE HEALTH NEEDS, OTHER EXISTING COMMUNITY HEALTH NEEDS ASSESSMENTS, POSSIBLE COLLABORATION OPPORTUNITIES, AND TO GET SUGGESTIONS ON WHAT THE HOSPITALS CAN DO TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (HEREAFTER CHNA). LEADERS FROM THE FOLLOWING COMMUNITY ORGANIZATIONS WERE INTERVIEWED: THESE COMMUNITY LEADERS REPRESENT THE BROAD INTEREST OF THE COMMUNITIES SERVED BY THE HOSPITAL FACILITIES INCLUDING THE MEDICALLY UNDERSERVED, LOW-INCOME PERSONS, THOSE WITH CHRONIC DISEASE NEEDS AND LEADERS FROM LOCAL PUBLIC HEALTH AGENCIES AND DEPARTMENTS WHO HAVE SPECIAL KNOWLEDGE AND EXPERTISE IN PUBLIC HEALTH AND CHILDREN'S HEALTH. THEY ARE ORGANIZED BY COUNTY. ASHLAND: ASHLAND COUNTY JOB AND FAMILY SERVICES ASHLAND PARENTING PLUS MENTAL HEALTH AND RECOVERY BOARD OF ASHLAND COUNTY MEDINA: ALTERNATIVE PATHS BOARD OF DEVELOPMENT DISABILITIES MEDINA COUNTY ALCOHOL AND DRUG ADDICTION AND MENTAL HEALTH (ADAMH) BOARD MEDINA COUNTY CHILDREN SERVICES MEDINA COUNTY HEALTH DISTRICT MEDINA COUNTY JUVENILE COURT UNITED WAY OF MEDINA COUNTY PORTAGE: KENT STATE UNIVERSITY LESBIAN, GAY, BISEXUAL, TRANSGENDER, QUEER AND QUESTIONING PLUS (LGBTQ+) CENTER PORTAGE COUNTY HEALTH DEPARTMENT PORTAGE COUNTY MENTAL HEALTH AND RECOVERY BOARDRICHLAND: RICHLAND COUNTY CHILDREN SERVICES RICHLAND COUNTY HEALTH DEPARTMENT RICHLAND COUNTY MENTAL HEALTH AND RECOVERY SERVICES STARK: CANTON CITY HEALTH DEPARTMENT MASSILLON HEALTH DEPARTMENT STARK COUNTY HEALTH DEPARTMENT STARK COUNTY JOB AND FAMILY SERVICES STARK MENTAL HEALTH & ADDICTION RECOVERY (STARKMHAR) SUMMIT: AKRON CHAPTER, NATIONAL ASSOCIATION FOR THE ADVANCEMENT OF COLORED PEOPLE (NAACP) AKRON FIRE DEPARTMENT, PUBLIC EDUCATION AKRON METROPOLITAN HOUSING AUTHORITY AKRON YMCA AXESSPOINTE FEDERALLY QUALIFIED HEALTH CENTER CITY OF AKRON/FULL TERM FIRST BIRTHDAY GREATER AKRON INITIATIVE COMMUNITY LEGAL AID SERVICES - AKRON GAR FOUNDATION INTERNATIONAL INSTITUTE OF AKRON OHIO HOUSE OF REPRESENTATIVES - STATE REP. TAVIA GALONSKI SUMMA HEALTH SYSTEM SUMMIT COUNTY EXECUTIVE SUMMIT COUNTY ALCOHOL, DRUG AND MENTAL HEALTH (ADM) BOARD SUMMIT COUNTY CHILDREN SERVICES SUMMIT COUNTY COURT OF COMMON PLEAS SUMMIT COUNTY PUBLIC HEALTH SUMMIT EDUCATION INITIATIVE WAYNE: UNITED WAY OF WAYNE COUNTY WAYNE COUNTY COMBINED GENERAL HEALTH DISTRICT WAYNE COUNTY FAMILY AND CHILDREN FIRST COUNCIL COMMUNITY RESIDENT FOCUS GROUPS: IN ADDITION TO INPUT FROM COMMUNITY LEADERS, FOCUS GROUPS WERE CONDUCTED WITH 118 COMMUNITY RESIDENTS IN THE SAME SEVEN-COUNTY AREA FROM FEBRUARY - APRIL 2019. A QUESTIONNAIRE WAS DISTRIBUTED TO THE FOCUS GROUP PARTICIPANTS TO GATHER DEMOGRAPHIC INFORMATION AND BASIC PERCEPTIONS OF COMMUNITY HEALTH. DUE TO THE OBSERVED INFORMATION GAP IN THE EPIDEMIOLOGIC DATA ON CHILD AND YOUTH MENTAL HEALTH ISSUES, HEALTH BEHAVIORS, AS WELL AS FAMILY DYNAMICS, SOCIAL DETERMINANTS OF HEALTH AND TRAUMA, QUESTIONS WERE ASKED TO PROBE MORE DEEPLY ON THESE ISSUES. THE FACILITATION GUIDE AND QUESTIONNAIRE WERE DEVELOPED IN PARTNERSHIP WITH THE CENTER FOR COMMUNITY SOLUTIONS, WHO CONDUCTED CHNA RESEARCH AND ANALYSES. COMMUNITY RESIDENTS WERE RECRUITED TO PARTICIPATE IN THE FOCUS GROUPS THROUGH RELATIONSHIPS WITH COMMUNITY AGENCIES AND INDIVIDUALS REPRESENTING THOSE AGENCIES. WE CONDUCTED FOCUS GROUPS IN SITES WITH COMMUNITY RECOGNITION/FAMILIARITY AND EASE OF ACCESS, INCLUDING A LOCAL PARISH, PUBLIC LIBRARY, COMMUNITY ACTION AGENCY, HOMELESS SHELTER, UNITED WAY OFFICE, NEIGHBORHOOD DEVELOPMENT CORPORATION, TWO FAMILY RESOURCE CENTERS (INCLUDING ONE FOR FOSTER FAMILIES), COMMUNITY LEARNING CENTER AND CHMCA HEALTH CENTER. 57.6% OF PARTICIPANTS WERE FROM SUMMIT COUNTY, AS SESSIONS WERE PLANNED WITH NON-ENGLISH SPEAKING (NEPALI AND KAREN) IMMIGRANTS AS WELL AS HOUSING INSECURE POPULATIONS IN THIS COMMUNITY. THE ADDITIONAL COUNTY BREAKDOWN WAS AS FOLLOWS: 10.2% FROM ASHLAND COUNTY, 8.5% FROM RICHLAND COUNTY, 8.5% FROM STARK COUNTY, 5.9% FROM MEDINA COUNTY, 5% FROM WAYNE COUNTY AND 4.2% FROM PORTAGE COUNTY.
FACILITY GROUP B - MAHONING VALLEY	PART V, SECTION B, LINE 5: - IN ADDITION TO EXAMINING COUNTY-LEVEL EPIDEMIOLOGIC DATA INTERVIEWS WERE CONDUCTED WITH COMMUNITY LEADERS REPRESENTING THE BROAD INTEREST OF A THREE-COUNTY AREA FROM MARCH - MAY 2019 TO GAIN INSIGHT ON WHAT THEY THOUGHT WERE SIGNIFICANT HEALTH NEEDS OF CHILDREN AND FAMILIES IN THEIR COMMUNITIES, THE FACTORS THAT AFFECT THOSE HEALTH NEEDS, OTHER EXISTING COMMUNITY HEALTH NEEDS ASSESSMENTS, POSSIBLE COLLABORATION OPPORTUNITIES, AND TO GET SUGGESTIONS ON WHAT CHMCA CAN DO TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (HEREAFTER CHNA). LEADERS FROM THE FOLLOWING COMMUNITY ORGANIZATIONS WERE INTERVIEWED AND ARE ORGANIZED BY THOSE SERVING THE TRI-COUNTY REGION AND INDIVIDUAL COUNTIES WITHIN. MAHONING VALLEY (TRI-COUNTY REGION) COMMUNITY FOUNDATION OF THE MAHONING VALLEY UNITED WAY OF YOUNGSTOWN AND THE MAHONING VALLEY COLUMBIANA COLUMBIANA COUNTY EDUCATIONAL SERVICE CENTER COLUMBIANA COUNTY HEALTH DEPARTMENT COLUMBIANA COUNTY FAMILY AND CHILDREN FIRST COUNCIL SALEM REGIONAL MEDICAL CENTER MAHONING CITY OF YOUNGSTOWN MAHONING COUNTY CHILDREN SERVICES MAHONING COUNTY JUVENILE COURT DIVISION MAHONING COUNTY MENTAL HEALTH & RECOVERY BOARD MERCY HEALTH - YOUNGSTOWN REGION YOUNGSTOWN CITY HEALTH DISTRICT YOUNGSTOWN NEIGHBORHOOD DEVELOPMENT CORPORATION TRUMBULL CITY OF WARREN TRUMBULL COUNTY BOARD OF DEVELOPMENTAL DISABILITIES (FAIRHAVEN) TRUMBULL COUNTY CHILDREN SERVICES TRUMBULL COUNTY HEALTH DEPARTMENT TRUMBULL COUNTY MENTAL HEALTH & RECOVERY BOARD COMMUNITY RESIDENT FOCUS GROUPS IN ADDITION TO INPUT FROM COMMUNITY LEADERS, FOCUS GROUPS WERE CONDUCTED WITH 23 COMMUNITY RESIDENTS IN THE SAME THREE-COUNTY AREA FROM MARCH - APRIL 2019. IN ADDITION, A QUESTIONNAIRE WAS DISTRIBUTED TO THE FOCUS GROUP PARTICIPANTS TO GATHER DEMOGRAPHIC INFORMATION AND BASIC PERCEPTIONS OF COMMUNITY HEALTH. DUE TO THE OBSERVED INFORMATION GAP IN THE EPIDEMIOLOGIC DATA ON CHILD AND YOUTH MENTAL HEALTH ISSUES, HEALTH BEHAVIORS, AS WELL AS FAMILY DYNAMICS, SOCIAL DETERMINANTS OF HEALTH AND TRAUMA, QUESTIONS WERE ASKED TO PROBE MORE DEEPLY ON THESE ISSUES. THE FACILITATION GUIDE AND QUESTIONNAIRE WERE DEVELOPED IN PARTNERSHIP WITH THE CENTER FOR COMMUNITY SOLUTIONS, WHO CONDUCTED CHNA RESEARCH AND ANALYSES. COMMUNITY RESIDENTS WERE RECRUITED TO PARTICIPATE IN THE FOCUS GROUPS THROUGH RELATIONSHIPS WITH COMMUNITY AGENCIES AND INDIVIDUALS REPRESENTING THOSE AGENCIES. WE CONDUCTED FOCUS GROUPS IN SITES WITH COMMUNITY RECOGNITION AND EASE OF ACCESS, INCLUDING A WIC OFFICE, PUBLIC LIBRARY AND JOB & FAMILY SERVICES COMMUNITY ROOM. 52.2% OF PARTICIPANTS WERE FROM MAHONING COUNTY, 26.1% FROM COLUMBIANA COUNTY, AND 21.7% FROM TRUMBULL COUNTY.
FACILITY GROUP A - AKRON	PART V, SECTION B, LINE 11: THE MEASURED INDICATORS IN THE 2019 CHNA HAVE BEEN ADDRESSED FOR MANY YEARS THROUGH CHMCA'S CLINICAL AND PROGRAMMATIC EFFORTS. OUR HIGHLY QUALIFIED MEDICAL STAFF AND PROFESSIONALS PROVIDE WORLD-CLASS PATIENT CENTERED CARE TO ADDRESS EACH OF THESE INDICATORS THROUGH OUR LOIS AND JOHN ORR FAMILY BEHAVIORAL HEALTH CENTER, CENTER FOR ORTHOPEDICS AND SPORTS MEDICINE, CENTER FOR DIABETES AND ENDOCRINOLOGY, ROBERT T. STONE, MD, RESPIRATORY CENTER, HEART CENTER, DIVISION OF PEDIATRIC PSYCHIATRY AND PSYCHOLOGY, AND THE SHOWERS FAMILY CENTER FOR CHILDHOOD CANCER AND BLOOD DISORDERS. THE 2019 CHNA IDENTIFIED AND PRIORITIZED SEVERAL COMMUNITY HEALTH NEEDS. OUR BOARD OF DIRECTORS APPROVED COMPREHENSIVE IMPLEMENTATION STRATEGIES THAT FOCUSED ON ADDRESSING CONDITIONS RELATED TO BEHAVIORAL HEALTH WITH A FOCUS ON ADVERSE CHILDHOOD EXPERIENCES, ASTHMA, AND INFANT MORTALITY. THE REMAINING IDENTIFIED NEEDS FROM THE CHNA, INCLUDING CONDITIONS RELATED TO CHILD LIFESTYLE FACTORS, CRIME AND VIOLENCE, ACCESS TO HEALTH CARE AND ENVIRONMENTAL FACTORS, WERE NOT FORMALLY SELECTED AS PRIORITIES, BUT WILL BE ADDRESSED AS RELEVANT THROUGH STRATEGIES ASSOCIATED WITH THE THREE PRIORITIES NAMED ABOVE. WE WILL CONTINUE TO LOOK TO CHNA DATA, AS WELL AS OTHER DATA SOURCES, ON THESE CONDITIONS TO GUIDE OUR EFFORTS AND ADVANCE OUR MISSION OF IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. SPECIFIC NEEDS NOT ADDRESSED ALTHOUGH ALL OF THE COMMUNITY HEALTH NEEDS IDENTIFIED BY THE CHNA ARE IMPORTANT, HOSPITAL TEAMS DELIBERATED AND PRIORITIZED THREE HIGH-PRIORITY AREAS BASED ON THE HOSPITAL'S CURRENT ACTIVITIES, THE POTENTIAL FOR COMMUNITY IMPACT, AND AVAILABLE RESOURCES. CONSEQUENTLY, SEVERAL AREAS WILL NOT BE ADDRESSED THROUGH FORMAL IMPLEMENTATION STRATEGIES. THESE INCLUDE HEALTH AREAS THAT RANKED LOWER DURING THE PRIORITIZATION PROCESS. ADDITIONALLY, CERTAIN HEALTH AREAS WERE BEYOND THE SCOPE OF THE HOSPITAL, WITH SOME HEALTH AREAS REQUIRING MORE RESOURCES THAN WHAT WAS AVAILABLE: - ACCESS TO HEALTH CARE - ORAL HEALTH - CHILD WELL BEING AND BEHAVIOR - FOOD ACCESS & NUTRITION - OBESITY & SCREEN TIME - UNINTENTIONAL INJURIES - OTHER SOCIAL AND ENVIRONMENTAL FACTORS - AFFORDABLE HOUSING & EVICTION - TRANSPORTATION CHMCA CLINICIANS DO NOT PROVIDE CARE SERVICES FOR PREGNANT WOMEN, OTHER THAN THOSE WHOSE BABIES HAVE BEEN DIAGNOSED BEFORE BIRTH OR PRENATALLY WITH A CONDITION OR DISEASE THAT MUST BE MONITORED BY OUR MATERNAL FETAL MEDICINE (MFM) CENTER OR GENETICS CENTER. THEREFORE, OUR EFFORTS TO IMPACT BIRTH OUTCOMES SUCH AS PREMATURITY AND LOW BIRTH WEIGHT ARE BEING CARRIED OUT IN RELATION TO COALITION WORK WITH COMMUNITY AGENCIES AND LOCAL BIRTHING HOSPITALS. THESE INCLUDE ACTIVITIES SUCH AS EDUCATION AND MARKETING OF APPROPRIATE BIRTH SPACING AND LONG-ACTING REVERSIBLE CONTRACEPTION (LARC) PROMOTION. WE DO CARE FOR BABIES BORN AT LOW AND VERY LOW BIRTH WEIGHTS AND PRETERM INFANTS REQUIRING HOSPITALIZATION IN THE NICU ON THE AKRON CAMPUS OR OTHER NICU LOCATIONS THAT WE OPERATE AT CLEVELAND CLINIC - AKRON GENERAL, SUMMA HEALTH SYSTEM, ST. ELIZABETH HOSPITAL IN YOUNGSTOWN AND AULTMAN HOSPITAL IN CANTON, AND THE SPECIAL CARE NURSERY AT OUR MAHONING VALLEY CAMPUS IN BOARDMAN AND WOOSTER. DATA LIMITATIONS AND GAPS DUE TO LIMITED RESOURCES AND TIME CONSTRAINTS, COMPLETE DATA WERE NOT AVAILABLE FOR EVERY VULNERABLE POPULATION, SUCH AS THE HOMELESS OR REFUGEE POPULATIONS. WHERE AVAILABLE, THE MOST CURRENT DATA WERE USED TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY. ALTHOUGH THE DATA AVAILABLE ARE RICH WITH INFORMATION, DATA GAPS AND LIMITATIONS EXISTED THAT IMPACTED THE ABILITY TO CONDUCT A MORE THOROUGH AND RIGOROUS ASSESSMENT. THESE INCLUDE: 1. LAG TIME FOR DATA TO BE REPORTED BY THE STATE AND SOME LOCAL SOURCES. 2. PEDIATRIC DATA RELATED TO SUBSTANCE ABUSE, SEXUAL BEHAVIORS, AND OTHER LIFESTYLE FACTORS SUCH AS DIET AND EXERCISE, WERE NOT CONSISTENT ACROSS COUNTIES IN OUR PRIMARY SERVICE AREA. IN ADDITION, THESE DATA ARE LIMITED AND UNDER SAMPLED, NOT ADEQUATELY REPRESENTING THE COMMUNITIES OR SPECIFIC POPULATIONS. 3. ONLY TWO COMPLETE YEARS OF HOSPITAL ENCOUNTER DATA WERE AVAILABLE DUE TO A TRANSITION IN Q4 OF 2015 FROM ICD-9 TO ICD-10 DIAGNOSIS CODES.4. COUNTY AND STATEWIDE CHRONIC DISEASE DATA ARE NOT AVAILABLE FOR CHILDREN. ASTHMA, DIABETES AND OTHER CHRONIC DISEASE DATA REPORTED IN THE CHNA WERE GLEANED FROM OHIO HOSPITAL ASSOCIATION (OHA) HOSPITAL ENCOUNTER DATA. THESE DATA ARE REPORTED BY THE PRIMARY DIAGNOSIS CODE FOR THE ENCOUNTER AND BY PRODUCT GROUP (AN ITEM THAT IS TIED TO BILLING). BECAUSE DIAGNOSIS CODES DO NOT ALWAYS REFLECT UNDERLYING CONDITIONS, THESE DATA ALMOST CERTAINLY UNDERREPRESENT THE TRUE BURDEN OF CHRONIC DISEASE IN THE PEDIATRIC POPULATION.
FACILITY GROUP B - MAHONING VALLEY	PART V, SECTION B, LINE 11: THE MEASURED INDICATORS IN THE 2019 CHNA HAVE BEEN ADDRESSED FOR MANY YEARS THROUGH CHMCA'S CLINICAL AND PROGRAMMATIC EFFORTS. OUR HIGHLY QUALIFIED MEDICAL STAFF AND PROFESSIONALS PROVIDE WORLD-CLASS PATIENT CENTERED CARE TO ADDRESS EACH OF THESE INDICATORS THROUGH OUR LOIS AND JOHN ORR FAMILY BEHAVIORAL HEALTH CENTER, CENTER FOR ORTHOPEDICS AND SPORTS MEDICINE, CENTER FOR DIABETES AND ENDOCRINOLOGY, ROBERT T. STONE, MD RESPIRATORY CENTER, HEART CENTER, DIVISION OF PEDIATRIC PSYCHIATRY AND PSYCHOLOGY, AND THE SHOWERS FAMILY CENTER FOR CHILDHOOD CANCER AND BLOOD DISORDERS. THE 2019 CHNA IDENTIFIED AND PRIORITIZED SEVERAL COMMUNITY HEALTH NEEDS. OUR BOARD OF DIRECTORS APPROVED COMPREHENSIVE IMPLEMENTATION STRATEGIES THAT FOCUSED ON ADDRESSING THE CONDITIONS OF ASTHMA, BEHAVIORAL HEALTH AND ADVERSE CHILDHOOD EXPERIENCES (ACES), AND INFANT MORTALITY. THE REMAINING IDENTIFIED NEEDS FROM THE CHNA, INCLUDING CONDITIONS RELATED TO CHILD LIFESTYLE FACTORS, HEALTH ACCESS, AND ENVIRONMENTAL FACTORS, WERE NOT FORMALLY ADDRESSED THROUGH IMPLEMENTATION STRATEGIES. REASONS FOR THIS VARY. IN SOME CASES, OTHER COMMUNITY AGENCIES WERE DETERMINED TO BE BETTER POSITIONED TO ADDRESS THESE CONDITIONS; OR THERE WERE INSUFFICIENT HOSPITAL RESOURCES (INCLUDING BUDGET, STAFF AND/OR PARTNERSHIPS) IN PLACE. OVERALL, ALIGNMENT WITH HOSPITAL STRATEGIC PRIORITIES AND INVOLVEMENT WITH EXISTING COMMUNITY INITIATIVES PLACED SOME ISSUES ABOVE OTHERS IN TERMS OF FEASIBILITY TO MAKE A MEASURABLE IMPACT. WE WILL CONTINUE TO LOOK TO CHNA AND OTHER DATA ON HEALTH CONDITIONS AND SOCIAL DETERMINANTS OF HEALTH TO GUIDE OUR EFFORTS AND ADVANCE OUR MISSION OF IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE.SPECIFIC NEEDS NOT ADDRESSED:ALTHOUGH ALL OF THE COMMUNITY HEALTH NEEDS IDENTIFIED BY THE CHNA ARE IMPORTANT, AN AD HOC COMMITTEE OF HOSPITAL STAFF DELIBERATED AND PRIORITIZED THREE HIGH-PRIORITY AREAS BASED ON THE HOSPITAL'S CURRENT ACTIVITIES, AVAILABLE RESOURCES AND POTENTIAL FOR COMMUNITY IMPACT. CONSEQUENTLY, SEVERAL AREAS WILL NOT BE ADDRESSED THROUGH FORMAL IMPLEMENTATION STRATEGIES. THESE INCLUDE HEALTH AREAS THAT RANKED LOWER DURING THE PRIORITIZATION PROCESS. ADDITIONALLY, CERTAIN HEALTH AREAS WERE BEYOND THE SCOPE OF THE HOSPITAL, WITH SOME HEALTH AREAS REQUIRING MORE RESOURCES THAN WHAT WAS AVAILABLE. THESE INCLUDED:- ACCESS TO HEALTH CARE - ORAL HEALTH - CHILD WELL BEING AND BEHAVIOR - FOOD ACCESS & NUTRITION - OBESITY & SCREEN TIME - UNINTENTIONAL INJURIES - OTHER SOCIAL AND ENVIRONMENTAL FACTORS - AFFORDABLE HOUSING & EVICTION - TRANSPORTATION ADDITIONALLY, CHMCA'S CLINICIANS DO NOT PROVIDE CARE SERVICES FOR PREGNANT WOMEN, OTHER THAN THOSE WHOSE BABIES HAVE BEEN DIAGNOSED BEFORE BIRTH OR PRENATALLY WITH A CONDITION OR DISEASE THAT MUST BE MONITORED BY OUR MATERNAL FETAL MEDICINE (MFM) CENTER OR GENETICS CENTER. THEREFORE, OUR EFFORTS TO IMPACT BIRTH OUTCOMES SUCH AS PREMATURITY AND LOW BIRTH WEIGHT WILL BE CARRIED OUT IN RELATION TO COLLABORATIONS WITH COMMUNITY AGENCIES AND BIRTHING HOSPITALS. THESE INCLUDE ACTIVITIES SUCH AS EDUCATION AND MARKETING OF APPROPRIATE BIRTH SPACING AND LONG-ACTING REVERSIBLE CONTRACEPTION (LARC) PROMOTION, AND SMOKING CESSATION SUPPORT. WE DO CARE FOR BABIES BORN AT LOW AND VERY LOW BIRTH WEIGHTS AND PRETERM INFANTS REQUIRING HOSPITALIZATION IN THE NICU ON THE AKRON CAMPUS OR NICUS THAT WE OPERATE AT CLEVELAND CLINIC - AKRON GENERAL, SUMMA HEALTH SYSTEM AND ST. ELIZABETH HOSPITAL IN YOUNGSTOWN, AND THE SPECIAL CARE NURSERY AT OUR MAHONING VALLEY CAMPUS IN BOARDMAN. DATA LIMITATIONS AND GAPS:DUE TO LIMITED RESOURCES AND TIME CONSTRAINTS, COMPLETE DATA WERE NOT AVAILABLE FOR EVERY VULNERABLE POPULATION, SUCH AS THE HOMELESS OR REFUGEE POPULATIONS. WHERE AVAILABLE, THE MOST CURRENT DATA WERE USED TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY. ALTHOUGH THE DATA AVAILABLE ARE RICH WITH INFORMATION, DATA GAPS AND LIMITATIONS EXISTED THAT IMPACTED THE ABILITY TO CONDUCT A MORE THOROUGH AND RIGOROUS ASSESSMENT. THESE INCLUDE: 1. LAG TIME FOR DATA TO BE REPORTED BY THE STATE AND SOME LOCAL SOURCES.2. PEDIATRIC DATA RELATED TO SUBSTANCE ABUSE, SEXUAL BEHAVIORS, AND OTHER LIFESTYLE FACTORS SUCH AS DIET AND EXERCISE, WERE NOT CONSISTENT ACROSS COUNTIES IN OUR PRIMARY SERVICE AREA. IN ADDITION, THESE DATA ARE LIMITED AND UNDER SAMPLED, NOT ADEQUATELY REPRESENTING THE COMMUNITIES OR SPECIFIC POPULATIONS. 3. ONLY TWO COMPLETE YEARS OF HOSPITAL ENCOUNTER DATA WERE AVAILABLE DUE TO A TRANSITION IN Q4 OF 2015 FROM ICD-9 TO ICD-10 DIAGNOSIS CODES. 4. COUNTY AND STATEWIDE CHRONIC DISEASE DATA ARE NOT AVAILABLE FOR CHILDREN. ASTHMA, DIABETES AND OTHER CHRONIC DISEASE DATA REPORTED IN THE CHNA WERE GLEANED FROM OHIO HOSPITAL ASSOCIATION (OHA) HOSPITAL ENCOUNTER DATA. THESE DATA ARE REPORTED BY THE PRIMARY DIAGNOSIS CODE FOR THE ENCOUNTER AND BY PRODUCT GROUP (AN ITEM THAT IS TIED TO BILLING). BECAUSE DIAGNOSIS CODES DO NOT ALWAYS REFLECT UNDERLYING CONDITIONS, THESE DATA ALMOST CERTAINLY UNDERREPRESENT THE TRUE BURDEN OF CHRONIC DISEASE IN THE PEDIATRIC POPULATION.
FACILITY GROUP A - AKRON	PART V, SECTION B, LINE 13H: PATIENTS OR FAMILIES WHO MAY NOT QUALIFY FOR FINANCIAL ASSISTANCE BASED ON RESIDENCE AND INCOME MAY STILL QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON DOCUMENTED EXTENUATING CIRCUMSTANCES WHERE PURSUIT OF PAYMENT WOULD CAUSE UNDUE HARDSHIP ON THE PATIENT/FAMILY. EXTENUATING CIRCUMSTANCES MAY BE BROUGHT TO THE ATTENTION OF THE DIRECTOR, REVENUE CYCLE, AND REVIEWED BY THE FINANCIAL ASSISTANCE COMMITTEE, CHAIRED BY THE CHIEF FINANCIAL OFFICER AND CHIEF MEDICAL OFFICER.
FACILITY GROUP B - MAHONING VALLEY	PART V, SECTION B, LINE 13H: PATIENTS OR FAMILIES WHO MAY NOT QUALIFY FOR FINANCIAL ASSISTANCE BASED ON RESIDENCE AND INCOME MAY STILL QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON DOCUMENTED EXTENUATING CIRCUMSTANCES WHERE PURSUIT OF PAYMENT WOULD CAUSE UNDUE HARDSHIP ON THE PATIENT/FAMILY. EXTENUATING CIRCUMSTANCES MAY BE BROUGHT TO THE DIRECTOR, REVENUE CYCLE, AND REVIEWED BY THE FINANCIAL ASSISTANCE COMMITTEE, CHAIRED BY THE CHIEF FINANCIAL OFFICER AND CHIEF MEDICAL OFFICER.
FACILITY GROUP A - AKRON	PART V, SECTION B, LINE 15E: FINANCIAL COUNSELORS ARE EMPLOYED AT THE HOSPITAL TO DISCUSS THE AVAILABILITY AND APPLICATION FOR ALL FINANCIAL ASSISTANCE FOR ALL PATIENTS.
FACILITY GROUP B - MAHONING VALLEY	PART V, SECTION B, LINE 15E: FINANCIAL COUNSELORS ARE EMPLOYED AT THE HOSPITAL TO DISCUSS THE AVAILABILITY AND APPLICATION FOR FINANCIAL ASSISTANCE FOR ALL PATIENTS.
FACILITY GROUP A - AKRON	PART V, SECTION B, LINE 20E: YES - THIRD PARTY COLLECTION AGENCIES WILL EXPLAIN THE AVAILABILITY OF FREE CARE AND CHARITY CARE AND THE FINANCIAL ASSISTANCE APPLICATION.
FACILITY GROUP B - MAHONING VALLEY	PART V, SECTION B, LINE 20E: YES - THIRD-PARTY COLLECTION AGENCIES WILL EXPLAIN THE AVAILABILITY FOR FREE CARE AND CHARITY CARE AND THE FINANCIAL ASSISTANCE APPLICATION.

Schedule H (Form 990) 2021

Page 9

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?59
Name and address		Type of Facility (describe)
1	1 - AULTMAN HOSPITAL 2600 6TH ST SW CANTON,OH447101702	NICU AND PEDIATRIC UNIT
2	2 - ST ELIZABETH'S BOARDMAN HEALTH CENTER NIC 8401 MARKET ST BOARDMAN,OH445126725	NICU NURSERY
3	3 - SUMMA AKRON CITY HOSPITAL 525 E MARKET ST AKRON,OH443041619	NICU NURSERY
4	4 - NORTH CANTON 6076 WHIPPLE 6076 WHIPPLE AVE NORTH CANTON,OH44720	PEDIATRIC OUTPATIENT SERVICES
5	5 - WARREN URGENT CARE 5000 E MARKET ST WARREN,OH444842259	PEDIATRIC OUTPATIENT SERVICES
6	6 - MANSFIELD HEALTH CENTER 1029 SOUTH TRIMBLE ROAD MANSFIELD,OH44906	PEDIATRIC OUTPATIENT SERVICES
7	7 - BOSTON HEIGHTS 328 EAST HINES HILL ROAD HUDSON,OH44236	PEDIATRIC OUTPATIENT SERVICES
8	8 - CLEVELAND CLINIC AKRON GENERAL MEDICAL CEN 1 AKRON GENERAL AVE AKRON,OH443072432	NICU NURSERY
9	9 - MEDINA REHAB AND SPECIALTY SERVICES 3443 MEDINA RD MEDINA,OH442565965	PEDIATRIC OUTPATIENT SERVICES
10	10 - GREEN 1622 EAST TURKEYFOOT LAKE RD SUITE 100 AKRON,OH443125277	PEDIATRIC OUTPATIENT SERVICES
11	11 - NEW PHILADELPHIA 1045 W HIGH AVE NEW PHILADELPHIA,OH446632071	PEDIATRIC OUTPATIENT SERVICES
12	12 - MASSILLON 1149 LINCOLN WAY E MASSILLON,OH44646	PEDIATRIC OUTPATIENT SERVICES
13	13 - FAIRLAWN 701 WHITE POND DR SUITE 100 AKRON,OH443201193	PEDIATRIC OUTPATIENT SERVICES
14	14 - ST JOSEPH'S HOSPITAL MERCY HEALTH 667 EASTLAND AVE SE WARREN,OH444844503	PEDIATRIC OUTPATIENT SERVICES
15	15 - HEALTH CENTER - PORTAGE 2497 STATE ROUTE 59 RAVENNA,OH44266	PEDIATRIC OUTPATIENT SERVICES
16	16 - WOOSTER COMMUNITY HOSPITAL 1761 BEALL AVE WOOSTER,OH446912342	NICU NURSERY
17	17 - ALLIANCE 1826 S ARCH AVE ALLIANCE,OH446014332	PEDIATRIC OUTPATIENT SERVICES
18	18 - WOOSTER 128 EAST MILLTOWN RD 209 WOOSTER,OH446911276	PEDIATRIC OUTPATIENT SERVICES
19	19 - BARBERTON 566 ROBINSON AVENUE BARBERTON,OH442039002	PEDIATRIC OUTPATIENT SERVICES
20	20 - HUDSON 1365 CORPORATE DR SUITE A HUDSON,OH442364432	PEDIATRIC OUTPATIENT SERVICES
21	21 - WADSWORTH 323 HIGH ST SUITE A WADSWORTH,OH442811869	PEDIATRIC OUTPATIENT SERVICES
22	22 - AKRON EAST 891 E EXCHANGE ST AKRON,OH443061127	PEDIATRIC OUTPATIENT SERVICES
23	23 - PERRY TOWNSHIP 125 WHIPPLE AVE SW CANTON,OH447101374	PEDIATRIC OUTPATIENT SERVICES
24	24 - AUSTINTOWN 5480 NORQUEST BLVD AUSTINTOWN,OH445151820	PEDIATRIC OUTPATIENT SERVICES
25	25 - ASHLAND 2212 MIFFLIN AVE SUITE 235 ASHLAND,OH448058847	PEDIATRIC OUTPATIENT SERVICES
26	26 - ELLET 1463 CANTON RD SUITE A AKRON,OH443124022	PEDIATRIC OUTPATIENT SERVICES
27	27 - CUYAHOGA FALLS-PSA 1100 PORTAGE TRAILS CUYAHOGA FALLS,OH44223	PEDIATRIC OUTPATIENT SERVICES
28	28 - FAMILY CHILD LEARNING CENTER (FCLC) 143 NORTHWEST AVE TALLMADGE,OH442781806	PEDIATRIC OUTPATIENT SERVICES
29	29 - MONTROSE URGENT CARE 4125 MEDINA RD AKRON,OH443332483	URGENT CARE
30	30 - LISBON 400 N MARKET ST LISBON,OH444321146	PEDIATRIC OUTPATIENT SERVICES
31	31 - TWINSBURG SPECIALTY CARE 8054 DARROW RD SUITE 3 TWINSBURG,OH440872387	PEDIATRIC OUTPATIENT SERVICES
32	32 - WADSWORTH PSA 1225 HIGH ST WADSWORTH,OH44281	PEDIATRIC OUTPATIENT SERVICES
33	33 - LIBERTY 3530 BELMONT AVE YOUNGSTOWN,OH44505	PEDIATRIC OUTPATIENT SERVICES
34	34 - WOOSTER SPECIALTY CARE 546 WINTER ST SUITE 110 WOOSTER,OH446912339	PEDIATRIC OUTPATIENT SERVICES
35	35 - MERCY LORAIN HOSPITAL 3700 KOLBE RD LORAIN,OH44053	NICU NURSERY & PEDIATRIC OUTPATIENT
36	36 - BRECKSVILLE 7001 S EDGERTON RD SUITE 500 BRECKSVILLE,OH441414206	PEDIATRIC OUTPATIENT SERVICES
37	37 - WARREN DOWNTOWN 661 MAHONING AVE NW WARREN,OH444834607	PEDIATRIC OUTPATIENT SERVICES
38	38 - STREETSBORO 9150 MARKET SQUARE SUITE 203 STREETSBORO,OH442415224	PEDIATRIC OUTPATIENT SERVICES
39	39 - BEACHWOOD HEART CENTER CLEVELAND 23250 CHAGRIN BLVD SUITE325 BEACHWOOD,OH441225417	PEDIATRIC OUTPATIENT SERVICES
40	40 - EAST LIVERPOOL ACHP 15655 STATE ROUTE 170 EAST LIVERPOOL,OH43920	PEDIATRIC OUTPATIENT SERVICES
41	41 - STOW GRAHAM RD 3019 GRAHAM ROAD STOW,OH44224	PEDIATRIC OUTPATIENT SERVICES
42	42 - NORTH CANTON SPECIALTY CARE 6100 WHIPPLE AVE NW NORTH CANTON,OH447207618	PEDIATRIC OUTPATIENT SERVICES
43	43 - AMHERST ACHP 47185 COOPER FOSTER PARK RD AMHERST,OH44053	PEDIATRIC OUTPATIENT SERVICES
44	44 - FISHER TITUS MEDICAL CENTER 272 BENEDICT AVE NORWALK,OH448572374	PEDIATRIC OUTPATIENT SERVICES
45	45 - OBERLIN ACHP 224 W LORAIN ST OBERLIN,OH44704	PEDIATRIC OUTPATIENT SERVICES
46	46 - HUDSON URGENT CARE & SPECIALTY OFFICE 5655 HUDSON DRIVE HUDSON,OH442364451	URGENT CARE & PEDIATRIC OUTPATIENT SERVICES
47	47 - CHILD ADVOCACY CENTER 213 MARKET AVE N SUITE 200 CANTON,OH447021440	PEDIATRIC OUTPATIENT SERVICES
48	48 - TRIPOINT MEDICAL CENTER - THE PHYSICIAN PA 7580 AUBURN RD SUITE 214 PAINESVILLE,OH440779176	PEDIATRIC OUTPATIENT SERVICES
49	49 - MERCY MEDICAL CENTER MATERNAL FETAL MEDIC 1330 MERCY DR NW SUITE 506 CANTON,OH447082625	PEDIATRIC OUTPATIENT SERVICES
50	50 - WOOSTER HEALTH CENTER 3807 FRIENDSVILLE ROAD WOOSTER,OH44691	PEDIATRIC OUTPATIENT SERVICES
51	51 - MARIETTA MEMORIAL 401 MATTHEW STREET MARIETTA,OH45750	PEDIATRIC OUTPATIENT SERVICES
52	52 - NORWALK MEDICAL PARK II 282 BENEDICT AVE NORWALK,OH448572712	PEDIATRIC OUTPATIENT SERVICES
53	53 - BEACHWOOD ACHP 3733 PARK EAST DR STE 102 BEACHWOOD,OH44122	PEDIATRIC OUTPATIENT SERVICES
54	54 - MILLERSBURG HEMOPHILIA CLINIC MULTI-SPECI 1261 WOOSTER RD SUITE 220 MILLERSBURG,OH446541570	PEDIATRIC OUTPATIENT SERVICES
55	55 - HATTIE LARLHAM FOUNDATION 9772 DIAGONAL RD MANTUA,OH442559128	PEDIATRIC OUTPATIENT SERVICES
56	56 - SHARON HEART CENTER 740 E STATE ST SHARON,PA16146	PEDIATRIC OUTPATIENT SERVICES
57	57 - SANDUSKY 2800 HAYES AVENUE SANDUSKY,OH44870	PEDIATRIC OUTPATIENT SERVICES
58	58 - LIFE CENTER PLUS 5133 DARROW RD HUDSON,OH442364003	PEDIATRIC OUTPATIENT SERVICES
59	59 - WAYNE COUNTY CHILDREN'S ADVOCACY CENTER 1734 GASCHE STREET WOOSTER,OH44691	PEDIATRIC OUTPATIENT SERVICES

Schedule H (Form 990) 2021

Page 10

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
PART I, LINE 7:	WE BELIEVE THAT APPLYING A COST-TO-CHARGE RATIO DEVELOPED FOR THE HOSPITAL FACILITY FROM THE OHIO MEDICAID COST REPORT TO HOSPITAL CHARITY CHARGES, AS REPORTED IN DETAIL SCHEDULES USED IN THE PREPARATION OF THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS AND OTHER INFORMATION IS THE MOST ACCURATE COSTING METHODOLOGY TO CALCULATE GROSS CHARITY CARE AT COST FOR THE PERIOD. TOTAL HOSPITAL COSTS FROM THE OHIO MEDICAID COST REPORT USED IN THIS CALCULATION INCLUDE ONLY ALLOWABLE AND REIMBURSABLE COSTS. THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP) IS OHIO'S METHODOLOGY TO PROVIDE ADDITIONAL PAYMENTS TO HOSPITALS THAT PROVIDE A DISPROPORTIONATE SHARE OF UNCOMPENSATED CARE TO THE INDIGENT AND UNINSURED. THE ESTIMATED HCAP AMOUNT APPLICABLE TO CHARITY CARE IS REPORTED AS DIRECT OFFSETTING REVENUE TO CHARITY CARE EXPENSE.PART I, LINE 7 (B) UNREIMBURSED MEDICAID & 7 (C) OTHER MEANS TESTED WE BELIEVE THAT REPORTING PROGRAM CHARGES, COSTS AND PAYMENTS DIRECTLY FROM CHMCA'S OHIO MEDICAID COST REPORT ALONG WITH SIMILAR CALCULATIONS FOR SERVICES RENDERED BY HOSPITAL EMPLOYED PHYSICIANS AND OTHER PROFESSIONAL PROVIDERS AND SERVICES RENDERED TO OUT-OF-STATE MEDICAID ENROLLEES IS THE MOST ACCURATE METHODOLOGY TO CALCULATE UNREIMBURSED MEDICAID AND OTHER MEANS-TESTED GOVERNMENT PROGRAM COSTS. MEDICAID COSTS REPORTED AS TOTAL COMMUNITY BENEFIT EXPENSE HAVE BEEN REDUCED BY ESTIMATED HEALTH PROFESSIONAL COSTS INCLUDED IN THE OHIO MEDICAID COST REPORT AND MEDICAID REVENUES REPORTED AS DIRECT OFFSETTING REVENUE HAS BEEN REDUCED BY ESTIMATED MEDICAID REVENUES RELATED TO HEALTH PROFESSIONAL EDUCATION. TO AVOID DOUBLE COUNTING OF COSTS REPORTED ELSEWHERE IN THIS SCHEDULE, GROSS COSTS FOR OTHER REPORTABLE ITEMS HAVE BEEN REDUCED BY THE TOTAL GOVERNMENT PAYOR MIX PERCENTAGE OF (54.8%) AS REPORTED ON OUR INTERNAL PAYOR MIX REPORT.
PART I, LINE 7G:	OUR EXPRESSIVE THERAPY CENTER WAS BUILT TO ENABLE CHILDREN FACING ILLNESS AND THEIR FAMILIES TO EXPERIENCE WHAT IT MEANS TO BE HUMAN THROUGH WHATEVER CREATIVE ART INSPIRES THEM. THE CHILDREN UTILIZING THESE SERVICES DO NOT NEED TO BE A HOSPITAL PATIENT. THIS SERVICE IS NOT REIMBURSED BY INSURANCE AND IS A NON-REIMBURSABLE COST CENTER FOR MEDICARE. WE RECOGNIZE THIS AS A SUBSIDIZED HEALTH SERVICE. ATHLETIC TRAINERS HELP CHILDREN DEAL WITH SPORTS RELATED INJURIES AND ARE AVAILABLE FOR HIGH SCHOOL SPORTING EVENTS IN CASE OF A SPORTS RELATED INJURY. THE CHILDREN UTILIZING THESE SERVICES DO NOT NEED TO BE A HOSPITAL PATIENT. THIS SERVICE IS NOT REIMBURSED BY INSURANCE AND IS A NON-REIMBURSABLE COST CENTER FOR MEDICARE. WE RECOGNIZE THIS AS A SUBSIDIZED HEALTH SERVICE. THE CHALLENGES THAT ALL HOSPITALS FACED IN 2020 DUE TO THE COVID-19 PANDEMIC CARRIED OVER INTO 2021. VOLUMES, REVENUES, AND REIMBURSEMENTS WERE STILL BELOW PRE-PANDEMIC LEVELS. MANY OF THE ESSENTIAL CHILDREN'S SERVICES PROVIDED WERE STILL REIMBURSED AT LESS THAN COST. CALCULATED SUBSIDIZED HEALTH SERVICES WERE CALCULATED USING OUR MEDICARE COST REPORT RATIO OF COSTS TO CHARGES APPLIED TO OR COMMERCIAL POPULATION TO AVOID DOUBLE COUNTING FOR MEDICAID AND OTHER GOVERNMENT PAYERS. THIS CALCULATED COST WAS THEN REDUCED BY THE AMOUNT AKRON CHILDREN'S RECEIVED FOR PROVIDER RELIEF FUNDING.
PART I, LINE 7, COLUMN (F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 17,214,790.
PART II, COMMUNITY BUILDING ACTIVITIES:	STAYING TRUE TO OUR MISSION, EVERYTHING DONE BY CHMCA IS INTENDED TO BENEFIT THE COMMUNITIES WE SERVE. OUR PRIMARY BENEFIT TO EACH COMMUNITY IS PROVIDING ACCESS TO WORLD-CLASS HEALTH CARE TO THE CHILDREN IN THE REGIONS WE SERVE. ADDITIONALLY, WE PARTICIPATE IN A VARIETY OF OTHER INTERNAL AND COMMUNITY BASED EFFORTS TO IMPROVE THE SOCIAL AND ENVIRONMENTAL CONDITIONS SURROUNDING HEALTH. OUR EFFORTS INCLUDE: LEADERSHIP DEVELOPMENT, UNDER WHICH WE SUPPORT VARIOUS COMMUNITY-BASED PROGRAMS THAT SPECIFICALLY DEVELOP COMMUNITY LEADERS, INCLUDING SUCH PROGRAMS AS LEADERSHIP AKRON (FOR COMMUNITY LEADERSHIP) AND THE CHILD & FAMILY LEADERSHIP EXCHANGE (FOR CLINICAL AND SOCIAL SERVICE LEADERSHIP). WE SUPPORT AND ARE ACTIVELY INVOLVED IN INITIATIVES SUCH AS TORCHBEARERS, WHICH IS FOCUSED ON DEVELOPING AND RETAINING STRONG COMMUNITY LEADERSHIP; COALITIONS AND PARTNERSHIPS, IN WHICH CHMCA IS STRONGLY REPRESENTED IN COMMITTEES AND TASK FORCES ASSIGNED TO ADDRESS SPECIFIC HEALTH INDICATORS AND CONDITIONS, IN ADDITION TO CERTAIN DIVERGENT POPULATIONS LOCATED THROUGHOUT OUR REGION, STATE, AS WELL AS NATIONALLY AND INTERNATIONALLY.AS A TEACHING HOSPITAL, WE PARTNER WITH DOZENS OF HIGHER EDUCATION INSTITUTIONS IN PROVIDING TRAINING AND HANDS-ON INSTRUCTION AND SHADOWING OPPORTUNITIES FOR STUDENTS WHO EMBARK ON HEALTH CARE CAREER TRAJECTORIES. CHMCA PROVIDES FINANCIAL AND IN-KIND STAFF SUPPORT FOR VARIOUS COMMUNITY-BASED ORGANIZATIONS AND INITIATIVES WHOSE MISSIONS ARE AIMED AT IMPROVING CONDITIONS SURROUNDING HEALTH AND WELLBEING FOR CHILDREN AND THEIR FAMILIES WITHIN OUR SERVICE AREA. WE EVALUATE SPONSORSHIP REQUESTS AND DESIGNATE A PORTION OF FUNDS TO ORGANIZATIONS THAT ARE WORKING TO ENHANCE DIVERSITY, EQUITY, AND INCLUSION, PROMOTE YOUTH ENGAGEMENT IN HEALTHY ACTIVITIES, AND OFFER SERVICES THAT HELP TO CLOSE GAPS IN ACCESS. WE ENGAGE IN WORKFORCE DEVELOPMENT EFFORTS THROUGH INITIATIVES SUCH AS THE COLLEGE AND CAREER ACADEMY OF HEALTH AND HUMAN SERVICES AT NORTH HIGH SCHOOL, ESTABLISHED THROUGH A PARTNERSHIP WITH AKRON PUBLIC SCHOOLS. THIS PROGRAM OFFERS HIGH-SCHOOLERS CAREER-FOCUSED PATHWAYS IN HEALTHCARE OPERATIONS, EARLY CHILDHOOD EDUCATION, BIOMEDICAL SCIENCE AND ALLIED HEALTH. THROUGH THE ACADEMY, WE ALSO ASSIST TEACHERS IN TAILORING THEIR CURRICULA TO HEALTH CARE APPLICATIONS.
PART III, LINE 2:	WE BELIEVE THAT APPLYING A COST-TO-CHARGE RATIO DEVELOPED FOR THE HOSPITAL FACILITY FROM THE OHIO MEDICAID COST REPORT TO CHMCA'S PROVISION FOR BAD DEBTS IS THE MOST ACCURATE COSTING METHODOLOGY TO CALCULATE BAD DEBT AT COST FOR THE PERIOD. TOTAL HOSPITAL COSTS FROM THE OHIO MEDICAID COST REPORT USED IN THIS CALCULATION INCLUDE ONLY ALLOWABLE AND REIMBURSABLE COSTS. THEREFORE, THE COST TO CHARGE RATIO MULTIPLIED BY THE BAD DEBT EXPENSE RESULTS IN THE COST OF BAD DEBT. THE HOSPITAL CARE ASSURANCE PROGRAM (HCAP) IS OHIO'S METHODOLOGY TO PROVIDE ADDITIONAL PAYMENTS TO HOSPITALS THAT PROVIDE A DISPROPORTIONATE SHARE OF UNCOMPENSATED CARE TO THE INDIGENT AND UNINSURED. GROSS BAD DEBT EXPENSE HAS BEEN REDUCED BY THE ESTIMATED HCAP AMOUNT APPLICABLE TO BAD DEBT EXPENSE. THE ESTIMATED AMOUNT OF BAD DEBT AT COST ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY POLICY IS $-0-. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE AS DESCRIBED IN PART VI, ITEM 3 - PATIENT EDUCATION FOR ASSISTANCE IS PROVIDED. SEE PAGES 12 & 13 TO THE FOOTNOTES TO CHMCA'S AUDITED FINANCIAL STATEMENTS THAT DESCRIBE CHARITY CARE AND IMPLICIT PRICE CONCESSIONS (BAD DEBT). CHMCA RESPECTIVELY SUBMITS THAT SINCE WE ACCEPT ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, THAT BAD DEBTS AT COST, AS REPORTED HEREIN, REPRESENT AN UNREIMBURSED COST OF PROVIDING CARE TO THE PATIENTS WE SERVE.
PART III, LINE 8:	WE BELIEVE THAT REPORTING PROGRAM CHARGES, COSTS, AND PAYMENTS DIRECTLY FROM CHMCA'S MEDICARE COST REPORT ALONG WITH SIMILAR CALCULATIONS FOR SERVICES RENDERED TO PATIENTS ENROLLED IN MEDICARE ADVANTAGE PLANS AND PATIENTS ENROLLED IN TRICARE IS THE MOST ACCURATE METHODOLOGY TO CALCULATE UNREIMBURSED MEDICARE AND OTHER MEANS-TESTED GOVERNMENT PROGRAM COSTS. TO AVOID DOUBLE COUNTING OF COSTS REPORTED ELSEWHERE IN THE SCHEDULE, GROSS COSTS FOR OTHER REPORTABLE ITEMS HAVE BEEN REDUCED BY THE TOTAL GOVERNMENT PAYOR MIX PERCENTAGE (54.8%) AS REPORTED ON OUR INTERNAL PAYOR MIX REPORT.IN REGARD TO MEDICARE, CHMCA RESPECTFULLY SUBMITS THAT INCLUDED IS ITS UNREIMBURSED INPATIENT COSTS INCURRED IN EXCESS OF THE 1982 TAX EQUITY AND FISCAL RESPONSIBILITY ACT (TEFRA) PER DISCHARGE LIMIT WAS $656,046, UNREIMBURSED OUTPATIENT COSTS INCURRED IN TREATING PATIENTS QUALIFYING FOR MEDICARE END STAGE RENAL DISEASE (ESRD), COMPOSITE REIMBURSEMENT WAS $566,528, UNREIMBURSED COSTS OF PROVIDING CARE TO MEDICARE ADVANTAGE PLAN ENROLLEES WAS $223,167. THE UNREIMBURSED INPATIENT COSTS ARE COSTS INCURRED PRIMARILY IN THE TREATMENT OF BURN VICTIMS WHO ARE MEDICARE ENROLLEES. THE UNREIMBURSED ESRD COSTS ARE COSTS INCURRED IN EXCESS OF THE COMPOSITE RATE REIMBURSEMENT APPLICABLE TO PATIENTS WHO RECEIVE OUTPATIENT MAINTENANCE DIALYSIS. SINCE THESE PROGRAMS ARE GOVERNMENT MEAN TESTED PROGRAMS THAT TYPICALLY REIMBURSE CHMCA LESS THEN IT COSTS TO PROVIDE THAT CARE, WE BELIEVE THAT IT QUALIFIES AS COMMUNITY BENEFIT IN THE SAME REGARD AS MEDICAID.
PART III, LINE 9B:	CHMCA'S POLICY APPLIES TO ALL PATIENTS - INSURED, UNDERINSURED AND UNINSURED. THE POLICY OUTLINES THE STATEMENT CYCLE, ONCE A SELF-PAY BALANCE IS REACHED, A PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE MAY BE IDENTIFIED ANY TIME DURING THE REVENUE CYCLE. IF A PATIENT HAS BEEN DETERMINED TO MEET FINANCIAL ASSISTANCE GUIDELINES, FREE OR DISCOUNTED CARE, THE ACCOUNT WILL NOT BE TRANSFERRED TO A COLLECTION AGENCY.
PART VI, LINE 2:	AKRON (#1); BEEGHLY (#2). CHMCA CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2019 TO ASSESS THE PRIMARY SERVICE AREAS SURROUNDING OUR AKRON HOSPITAL CAMPUS IN COLLABORATION WITH CLEVELAND CLINIC - AKRON GENERAL AND SUMMA HEALTH SYSTEM.ALONG WITH CHNAS, WE REGULARLY PERFORM STRATEGIC PLANNING AS AN ONGOING PROCESS WITH ANNUAL UPDATES. AS PART OF THE ANNUAL UPDATE, WE REVIEW POPULATION AND DEMOGRAPHIC CHANGES IN OUR LARGER SERVICE AREA, FOCUSING PARTICULARLY ON CHILDREN AND FAMILIES. WE GIVE ATTENTION TO THE PROVISION OF HEALTH CARE SERVICES THROUGHOUT OUR REGION, LOOKING AT OUR OWN AND THOSE PROVIDED BY OTHER HEALTH CARE ORGANIZATIONS, USING STATEWIDE DATA INCLUDING ALL PEDIATRIC HOSPITAL DISCHARGES BY ZIP CODE OF PATIENT RESIDENCE. WE ALSO CAREFULLY TRACK THE DEMAND FOR AND SUPPLY OF PHYSICIANS, NURSES, AND ALLIED HEALTH PROVIDERS, AND EVALUATE THE NEED FOR PRIMARY, SECONDARY AND TERTIARY SERVICES THROUGHOUT OUR SERVICE AREA. IN ADDITION, WE ENGAGE IN MULTIPLE EFFORTS TO GAUGE THE NEEDS OF OUR COMMUNITY THROUGH PERIODIC SURVEYS OF THE POPULATION, FOCUSING ON PARENTAL AWARENESS AND PREFERENCE OF PEDIATRIC HEALTH CARE SERVICES, AND ESTIMATING ACTUAL USE OF SERVICES FROM ALL PROVIDERS. WE ARE ACTIVELY REPRESENTED IN DOZENS OF COMMUNITY GROUPS AND GATHER INPUT FROM THESE GROUPS BOTH BY ACTIVE PARTICIPATION AND BY COLLECTING AND REVIEWING COMPREHENSIVE DATA SETS AND STUDIES PRODUCED BY SUCH GROUPS, INCLUDING SCHOOL DISTRICTS, HEALTH AND HUMAN SERVICE AGENCIES, AND CHARITABLE AND ADVOCACY GROUPS. WE MAKE AN EFFORT TO LISTEN TO OUR STAFF, SEEKING AND RECEIVING FEEDBACK FROM OUR 6,600+ STAFF AND THOUSANDS OF VOLUNTEERS AND PHYSICIANS, WHO COLLECTIVELY PROVIDE A RICH SOURCE OF INFORMATION REGARDING COMMUNITY NEEDS AND OPPORTUNITIES. FINALLY, WE ACTIVELY SOLICIT INPUT FROM OUR PATIENTS AND THEIR PARENTS FROM OUR PARENT ADVISORY COMMITTEE AND GATHER FEEDBACK THROUGH PATIENT SURVEY RESULTS AND VIA MULTIPLE WRITTEN AND ELECTRONIC (WEB-BASED) TOOLS.
PART VI, LINE 3:	PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - A & B:CHMCA PROVIDES EDUCATION TO PATIENTS TO INFORM THEM THAT THEY MAY QUALIFY FOR CARE AT NO CHARGE OR AT A REDUCED CHARGE IN A VARIETY OF WAYS: - CHMCA HAS SIGNAGE AT ITS REGISTRATION SITES TO INFORM PATIENTS THAT THEY MAY QUALIFY FOR FREE HOSPITAL CARE. APPLICATIONS FOR FREE CARE ARE AVAILABLE AT REGISTRATION SITES AND THROUGHOUT THE HOSPITAL (REQUIRED BY THE OHIO MEDICAID HOSPITAL CARE ASSURANCE (HCAP) RULES).- CHMCA HAS INFORMATION REGARDING ELIGIBILITY FOR FREE CARE ON BILLING STATEMENTS MAILED TO PATIENTS AND THEIR GUARANTORS. - CHMCA EMPLOYS FINANCIAL COUNSELORS TO EXPLAIN THE HOSPITAL'S FREE CARE, CHARITY CARE, AND THE VARIOUS PUBLIC ASSISTANCE PROGRAMS TO UNINSURED AND UNDERINSURED PATIENTS. - CHMCA'S WEBSITE PROVIDES PATIENTS WITH INFORMATION RELATING TO THE HOSPITAL'S FREE CARE, CHARITY CARE AND VARIOUS PUBLIC ASSISTANCE PROGRAMS AVAILABLE. - CHMCA CONTRACTS WITH AN INDEPENDENT VENDOR TO SCREEN PATIENTS FOR PUBLIC ASSISTANCE ELIGIBILITY AND COMPLETION AS WELL AS SUBMISSION OF PUBLIC ASSISTANCE APPLICATIONS.
PART VI, LINE 4:	COMMUNITY INFORMATION - GROUP A:CHMCA IS A WORLD-CLASS PEDIATRIC HEALTH CARE INSTITUTION SERVING A REGION OF MORE THAN 25 COUNTIES SPREAD ACROSS NORTHEAST AND NORTH-CENTRAL OHIO, IN ADDITION TO TWO COUNTIES ON THE BORDER OF WESTERN PENNSYLVANIA. THE PERCENTAGE OF PATIENTS WE TREAT THAT ARE ON MEDICAID IS 54.8%. ADDITIONALLY, WE SERVE AS THE MEDICAL HOME FOR CHILDREN WHO ARE PART OF PRIORITY POPULATIONS OR COMMUNITIES THAT ARE CONSIDERED VULNERABLE. THESE INCLUDE FAMILIES LIVING IN POVERTY, BOTH WITHIN THE URBAN CORE AND THE RURAL FRINGE; CHILDREN WHO ARE PART OF THE CHILD WELFARE AND JUVENILE JUSTICE SYSTEMS; CHILDREN FROM NON-ENGLISH-SPEAKING FAMILIES (SUCH AS RECENT IMMIGRANTS AND REFUGEES FROM SOUTHEAST ASIA, THE MIDDLE EAST, AND PARTS OF AFRICA); AND THE AMISH. FOR THE PURPOSES OF THE 2019 CHNA, WE FOCUSED ON A 10-COUNTY REGION REPRESENTATIVE OF WHERE THE MAJORITY OF PATIENTS RESIDE. SEVEN OF THE 10 COUNTIES COMPRISE THE REGION THAT IS SERVED BY OUR AKRON HOSPITAL FACILITY. DEMOGRAPHIC INFORMATION ON THESE COUNTIES IS DETAILED BELOW.HTTPS://WWW.CENSUS.GOV/QUICKFACTS/FACT/TABLE/OH/PST045221ASHLAND COUNTY THERE ARE APPROXIMATELY 52,316 PEOPLE LIVING IN ASHLAND COUNTY, WHICH IS A 0.2% DECREASE SINCE THE 2020 CENSUS. IT HAS 1 CITY, 8 VILLAGES, AND 15 TOWNSHIPS, WITH THE LARGEST BEING THE CITY OF ASHLAND. COMPARED TO THE STATE OF OHIO, ASHLAND COUNTY HAS A SLIGHTLY LARGER PROPORTION OF CHILDREN (UNDER 18 YEARS OLD) AND A LARGER PROPORTION OF OLDER ADULTS (65 YEARS AND OLDER). 3.5% OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. EDUCATIONAL ATTAINMENT IS LOWER THAN THE STATE OF OHIO, WITH 90.1% HAVING A HIGH SCHOOL DIPLOMA (COMPARED TO 90.8%) AND 22% HAVING A BACHELOR'S DEGREE OR HIGHER (COMPARED TO 28.9%). ANNUAL PER CAPITA INCOME IS LOWER THAN THE STATE AVERAGE BY ABOUT $5,000 PER YEAR, AND THE PERCENTAGE OF ASHLAND COUNTY RESIDENTS LIVING IN POVERTY IS 1.2% LOWER THAN THAT OF THE STATE. MEDINA COUNTY THERE ARE APPROXIMATELY 183,092 PEOPLE LIVING IN MEDINA COUNTY, WHICH IS AN INCREASE OF 0.3% SINCE THE 2020 CENSUS. IT HAS 3 CITIES, 6 VILLAGES, AND 17 TOWNSHIPS, WITH THE LARGEST BEING BRUNSWICK AND THE COUNTY SEAT BEING THE CITY OF MEDINA. COMPARED TO THE STATE OF OHIO, MEDINA COUNTY HAS A SLIGHTLY LARGER PROPORTION OF CHILDREN AND OLDER ADULTS. 4.8% OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. EDUCATIONAL ATTAINMENT IS HIGHER THAN THE STATE OF OHIO, WITH 94.7% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 33.9% HAVING A BACHELOR'S DEGREE OR HIGHER. SIMILARLY, ANNUAL PER CAPITA INCOME IN MEDINA COUNTY IS HIGHER THAN THE STATE AVERAGE, AND THE PERCENTAGE OF MEDINA COUNTY RESIDENTS LIVING IN POVERTY IS LESS THAN HALF OF THAT OF THE STATE, ALTHOUGH LODI MEETS MEDICALLY UNDERSERVED POPULATION (MUP) DESIGNATION CRITERIA FOR LOW INCOME RESIDENTS. PORTAGE COUNTY THERE ARE APPROXIMATELY 162,382 PEOPLE LIVING IN PORTAGE COUNTY. THIS NUMBER HAS INCREASED BY 0.4% SINCE THE 2020 CENSUS. PORTAGE COUNTY IS COMPRISED OF 29 CITIES, VILLAGES, AND TOWNSHIPS, WITH THE LARGEST BEING THE CITY OF KENT AND THE COUNTY SEAT BEING RAVENNA. COMPARED TO THE STATE OF OHIO, PORTAGE COUNTY HAS A SMALLER PROPORTION OF CHILDREN AND OLDER ADULTS. IN PORTAGE COUNTY, 9.7% OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. EDUCATIONAL ATTAINMENT IS SLIGHTLY HIGHER IN PORTAGE COUNTY THAN OHIO, WITH 92.5% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 29.9% HAVING A BACHELOR'S DEGREE OR HIGHER. ANNUAL PER CAPITA INCOME IN PORTAGE COUNTY IS SLIGHTLY LOWER THAN THE STATE, AND THE PERCENTAGE OF RESIDENTS LIVING IN POVERTY IS 2.7% LOWER THAN THAT OF THE STATE. EAST KENT CITY HAS A MUP (LOW INCOME) DESIGNATION.RICHLAND COUNTY THERE ARE APPROXIMATELY 125,195 PEOPLE LIVING IN RICHLAND COUNTY, WHICH IS A 0.2% INCREASE FROM THE 2020 CENSUS. THERE ARE 29 CITIES, VILLAGES, AND TOWNSHIPS IN RICHLAND COUNTY, WITH THE LARGEST BEING MANSFIELD. COMPARED TO THE STATE OF OHIO, RICHLAND COUNTY HAS A SLIGHTLY LARGER PROPORTION OF CHILDREN AND OLDER ADULTS. IN RICHLAND COUNTY, 13.1% OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. THE PERCENTAGE OF RESIDENTS WITH A HIGH SCHOOL DIPLOMA OR HIGHER IS LOWER IN RICHLAND COUNTY THAN IN THE STATE OVERALL, AS IS THE PERCENTAGE OF RESIDENTS WITH A BACHELOR'S DEGREE OR HIGHER. ANNUAL PER CAPITA INCOME IS LOWER AND THE PERCENTAGE OF RESIDENTS LIVING IN POVERTY IN RICHLAND COUNTY 0.1% HIGHER THAN OHIO. THE CITY OF MANSFIELD HAS A MUP (LOW INCOME) DESIGNATION. STARK COUNTY THERE ARE APPROXIMATELY 373,834 PEOPLE LIVING IN STARK COUNTY, WHICH IS A 0.3% DECREASE FROM THE 2020 CENSUS. THERE ARE 36 CITIES, VILLAGES, AND TOWNSHIPS IN STARK COUNTY, WITH THE LARGEST BEING THE CITY OF CANTON. COMPARED TO THE STATE OF OHIO, STARK COUNTY HAS A LARGER PROPORTION OF OLDER ADULTS, AND THE PROPORTION OF CHILDREN COMPARED TO THE STATE IS NEARLY EQUAL. IN STARK COUNTY, 12.5% OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. THE PERCENTAGE OF RESIDENTS WITH A HIGH SCHOOL DIPLOMA OR HIGHER IS SLIGHTLY HIGHER IN STARK COUNTY COMPARED TO THE STATE, BUT THE PERCENTAGE OF RESIDENTS WITH A BACHELOR'S DEGREE OR HIGHER IS LOWER THAN THE STATE. ANNUAL PER CAPITA INCOME IS LOWER AND PERCENTAGE OF RESIDENTS LIVING IN POVERTY IN STARK COUNTY IS 0.6% HIGHER THAN THE STATE. THERE ARE TWO FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREAS (MUAS) IN STARK COUNTY: MASSILLON AND EAST CANTON. IN ADDITION, NORTHEAST ALLIANCE WAS DESIGNATED IN 2016 AS A MUP, MEETING THE MEDICAID ELIGIBILITY CRITERION.SUMMIT COUNTY THERE ARE APPROXIMATELY 537,633 PEOPLE LIVING IN SUMMIT COUNTY. SINCE THE 2020 CENSUS, THE POPULATION HAS DECREASED SLIGHTLY, BY 0.5%. THERE ARE 31 CITIES, VILLAGES, AND TOWNSHIPS IN SUMMIT COUNTY, WITH THE LARGEST BEING THE CITY OF AKRON. COMPARED TO THE STATE OF OHIO, SUMMIT COUNTY HAS A SLIGHTLY SMALLER PROPORTION OF CHILDREN AND A SLIGHTLY LARGER PROPORTION OF OLDER ADULTS. IN SUMMIT COUNTY, 22.7 % PERCENT OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. EDUCATIONAL ATTAINMENT IS SLIGHTLY HIGHER IN SUMMIT COUNTY THAN IN THE STATE OF OHIO, WITH 92.1% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 32.8% HAVING A BACHELOR'S DEGREE OR HIGHER. SIMILARLY, ANNUAL PER CAPITA INCOME IN SUMMIT COUNTY IS SLIGHTLY HIGHER THAN THE STATE OF OHIO, AND THE PERCENTAGE OF SUMMIT COUNTY RESIDENTS LIVING IN POVERTY IS 0.5% LOWER THAN THAT OF THE STATE. TWO FEDERALLY DESIGNATED MUAS ARE PRESENT IN SUMMIT COUNTY: THE SOUTHEAST AKRON AND SUMMIT SERVICE AREAS.WAYNE COUNTY THERE ARE APPROXIMATELY 116,710 PEOPLE LIVING IN WAYNE COUNTY, WHICH IS AN DECREASE OF 0.2% SINCE THE 2020 CENSUS. THERE ARE 35 CITIES, VILLAGES, TOWNSHIPS, AND UNINCORPORATED COMMUNITIES IN WAYNE COUNTY, WITH THE LARGEST BEING THE CITY OF WOOSTER. COMPARED TO THE STATE OF OHIO, WAYNE COUNTY HAS A HIGHER PROPORTION OF CHILDREN AND OLDER ADULTS. IN WAYNE COUNTY, 4.7% OF THE POPULATION IS NON-WHITE, COMPARED TO 18.8% IN THE STATE. EDUCATIONAL ATTAINMENT IS LOWER IN WAYNE COUNTY COMPARED TO THE STATE OF OHIO, WITH 86.8% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 22.5% HAVING A BACHELOR'S DEGREE OR HIGHER. THE ANNUAL PER CAPITA INCOME IN WAYNE COUNTY IS LOWER THAN THE STATE OF OHIO, AS IS THE PERCENTAGE OF WAYNE COUNTY RESIDENTS LIVING IN POVERTY. THERE ARE NO FEDERALLY DESIGNATED MUA/PS PRESENT IN THIS COMMUNITY, ALTHOUGH A LARGE NUMBER OF AMISH RESIDING IN WAYNE COUNTY ARE CONSIDERED UNINSURED BECAUSE THEY DO NOT PARTICIPATE IN TRADITIONAL HEALTH INSURANCE PROGRAMS.COMMUNITY INFORMATION - GROUP B:CHMCA IN THE MAHONING VALLEY HAS AND CONTINUES TO SERVE PATIENTS AND FAMILIES FROM MANY COMMUNITIES ACROSS THE REGION. MOST PEOPLE WHO RECEIVE SERVICES FROM THE HOSPITAL ARE RESIDENTS OF MAHONING, TRUMBULL, OR COLUMBIANA COUNTIES. PRIOR TO THE OPENING OF THIS FACILITY, THE APPALACHIAN REGIONAL DEVELOPMENT ACT OF 2008 (S. 496) WAS SIGNED INTO LAW. ONE OF THE COMPONENTS OF THIS LEGISLATION WAS ADDITION OF MAHONING AND TRUMBULL COUNTIES TO THE APPALACHIAN REGION. MAHONING, TRUMBULL, AND COLUMBIANA COUNTIES REPRESENT MOST OF THE PRIMARY SERVICE AREA OF THE BEEGHLY CAMPUS, AND NOW, WITH THIS ACT BECOMING LAW, ALL THREE COUNTIES THAT MAKE UP THE PRIMARY SERVICE AREA OF THIS FACILITY ARE LOCATED WITHIN THE APPALACHIAN REGION. TRUMBULL, MAHONING, AND COLUMBIANA COUNTIES ARE CLASSIFIED BY THE APPALACHIAN REGIONAL COMMISSION AS BEING TRANSITIONAL - THEY HAVE WORSE ECONOMIC RATES THAN THE NATIONAL AVERAGE FOR ONE OR MORE OF THREE ECONOMIC INDICATORS (THREE-YEAR AVERAGE UNEMPLOYMENT, PER CAPITA MARKET INCOME, AND POVERTY), BUT DON'T RATE LOW ENOUGH TO BE CLASSIFIED AS DISTRESSED. IN ADDITION, THESE COUNTIES HAVE SHORTAGES OF PRIMARY CARE HEALTH SERVICES BY THE HEALTH RESOURCES AND SERVICES ADMINISTRATION (HRSA) AND THEIR SPECIFIC DESIGNATIONS ARE INDICATED WITHIN THE DESCRIPTIONS BELOW.
HTTPS://WWW.CENSUS.GOV/QUICKFACTS/FACT/TABLE/OH/PST045221	TRUMBULL COUNTY THERE ARE APPROXIMATELY 201,335 PEOPLE LIVING IN TRUMBULL COUNTY, WHICH IS A DECREASE OF 0.2% SINCE THE 2020 CENSUS. THERE ARE 7 CITIES AND 5 VILLAGES IN TRUMBULL COUNTY, WITH THE COUNTY SEAT BEING WARREN. COMPARED TO THE STATE OF OHIO, TRUMBULL COUNTY HAS A SLIGHTLY SMALLER PROPORTION OF CHILDREN (UNDER 18 YEARS OLD) AND A LARGER PROPORTION OF OLDER ADULTS (65 YEARS AND OLDER). IN TRUMBULL COUNTY, 8.8% OF THE POPULATION IS BLACK OR AFRICAN-AMERICAN AND 2.1%IS HISPANIC OR LATINO, COMPARED TO 13.2% AND 4.3%, RESPECTIVELY, IN THE STATE OF OHIO. EDUCATIONAL ATTAINMENT IN TRUMBULL COUNTY IS LOWER THAN THE STATE OF OHIO, WITH 89.4% HAVING A HIGH SCHOOL DIPLOMA OR HIGHER AND 19.2% HAVING A BACHELOR'S DEGREE OR HIGHER. SIMILARLY, ANNUAL PER CAPITA INCOME IN TRUMBULL COUNTY IS LOWER THAN THE STATE OF OHIO AND THE PERCENTAGE OF RESIDENTS LIVING IN POVERTY IS HIGHER THAN THAT OF THE STATE. IN ADDITION, TRUMBULL COUNTY IS FEDERALLY DESIGNATED AS A MEDICALLY UNDERSERVED AREA (MUA). MAHONING COUNTY THERE ARE APPROXIMATELY 228,762 PEOPLE LIVING IN MAHONING COUNTY, WHICH IS A DECREASE OF 0.8% SINCE THE 2020 CENSUS. THERE ARE 7 CITIES AND 7 VILLAGES IN MAHONING COUNTY, WITH THE LARGEST BEING YOUNGSTOWN. COMPARED TO THE STATE OF OHIO, MAHONING COUNTY HAS A SMALLER PROPORTION OF CHILDREN AND A LARGER PROPORTION OF OLDER ADULTS. APPROXIMATELY 16% OF THE POPULATION IN MAHONING COUNTY IS BLACK OR AFRICAN-AMERICAN AND 7% IS HISPANIC OR LATINO, COMPARED TO 13.2% AND 4.3%, RESPECTIVELY, IN THE STATE OF OHIO. THE PERCENTAGE OF MAHONING COUNTY RESIDENTS WITH A HIGH SCHOOL DIPLOMA OR HIGHER IS A BIT HIGHER THAN THE STATE OF OHIO, BUT THE PERCENTAGE WITH A BACHELOR'S DEGREE OR HIGHER IS LOWER THAN THE STATE. THE ANNUAL PER CAPITA INCOME IN MAHONING COUNTY IS LOWER THAN THE STATE OF OHIO AND THE PERCENTAGE OF RESIDENTS LIVING IN POVERTY IS HIGHER THAN THE STATE AVERAGE. THERE ARE THREE FEDERALLY DESIGNATED MUAS WITHIN MAHONING COUNTY, BOTH RURAL AND NON-RURAL. COLUMBIANA COUNTY THERE ARE APPROXIMATELY 101,310 PEOPLE LIVING IN COLUMBIANA COUNTY, WHICH IS A DECREASE OF 0.6% SINCE THE 2020 CENSUS. THERE ARE 3 CITIES, 11 VILLAGES, AND 18 TOWNSHIPS IN COLUMBIANA COUNTY, WITH THE LARGEST BEING SALEM. COMPARED TO THE STATE OF OHIO, COLUMBIANA COUNTY HAS A SMALLER PROPORTION OF CHILDREN AND A LARGER PROPORTION OF OLDER ADULTS. APPROXIMATELY 2.6% PERCENT OF THE POPULATION IN COLUMBIANA COUNTY IS BLACK OR AFRICAN-AMERICAN AND 2.1% IS HISPANIC OR LATINO, COMPARED TO 13.2% AND 4.3%, RESPECTIVELY, IN THE STATE OF OHIO. THE PERCENTAGE OF COLUMBIANA COUNTY RESIDENTS WITH A HIGH SCHOOL DIPLOMA OR HIGHER IS LOWER THAN THE STATE OF OHIO AND THE PERCENTAGE WITH A BACHELOR'S DEGREE OR HIGHER IS NEARLY HALF THE STATE AVERAGE (14.5% VERSUS 28.9%). THE ANNUAL PER CAPITA INCOME IN COLUMBIANA COUNTY IS LOWER THAN THE STATE OF OHIO AND THE PERCENTAGE OF COLUMBIANA COUNTY RESIDENTS LIVING IN POVERTY IS HIGHER THAN THE STATE AVERAGE. COLUMBIANA IS DESIGNATED AS AN MUA (MEDICAID ELIGIBLE POPULATION) THROUGH A GOVERNOR'S EXCEPTION. ELIGIBLE POPULATION) THROUGH A GOVERNOR'S EXCEPTION. THROUGH A GOVERNOR'S EXCEPTION.
PART VI, LINE 5:	PROMOTION OF COMMUNITY HEALTH - GROUPS A & B:CHMCA INTENDS THAT ALL OF ITS ACTIVITIES EITHER DIRECTLY PROVIDE HEALTH CARE TO ALL CHILDREN WHO REQUEST OUR SERVICES OR PROMOTE THE HEALTH OF THE COMMUNITY, BOTH BY DIRECT INVESTMENTS IN THE DELIVERY OF PEDIATRIC HEALTHCARE SERVICES AND IN PROVIDING SPECIALIZED INPATIENT AND OUTPATIENT CARE FOR PATIENTS OF ALL AGES THROUGHOUT NORTHEAST OHIO. CHMCA WAS FOUNDED ON THE PRINCIPLE OF SERVING THE NEEDS OF OUR COMMUNITY. WITHIN OUR DOORS, THIS MEANS TREATING ALL CHILDREN AS IF THEY WERE OUR OWN, TURNING NO CHILD OR FAMILY AWAY BASED ON THEIR ABILITY TO PAY. CHMCA'S GOVERNING BOARD OF DIRECTORS IS COMPRISED OF MEMBERS OF THE COMMUNITY THAT MAKES UP THE HOSPITAL'S PRIMARY SERVICE AREA. THEY ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. CHMCA EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITIES WE SERVE. CHMCA'S EXCELLENT REPUTATION IS THE RESULT OF THE SKILLS AND EXPERIENCE OF OUR MEDICAL STAFF AND THE HEALTH PROFESSIONALS WITH WHOM WE COLLABORATE. WE VALUE OUR PARTNERSHIP WITH PRIMARY CARE PHYSICIANS AND REFERRING PROVIDERS AND WORK TOGETHER TO COORDINATE THE CARE OF CHILDREN.WE ALSO MAKE MAJOR INVESTMENTS OF OUR FUNDS AND OTHER RESOURCES IN THE PROVISION OF EDUCATION FOR LAY AND PROFESSIONAL PERSONS, AND IN RESEARCH THAT WILL IMPROVE HEALTH CARE FOR ALL CHILDREN. WE TAKE AN ACTIVE ROLE IN ADVOCATING FOR IMPROVED HEALTH AND IMPROVED ACCESS TO HEALTH CARE FOR ALL. SERVICES AND ACTIVITIES PROVIDED BY CHMCA BENEFIT AND/OR PROMOTE HEALTH TO THE RESIDENTS IN THE COMMUNITIES WE SERVE. THE PRIMARY BENEFIT TO OUR COMMUNITIES IS PROVIDING HEALTH CARE FOR MORE THAN 1,000,000 CHILDREN ANNUALLY. IN ADDITION, WE ENGAGE IN COMMUNITY BUILDING ACTIVITIES, AS DEPICTED IN PART II OF THIS SCHEDULE. CHMCA BRINGS PEDIATRIC PRIMARY CARE FOR BABIES, CHILDREN AND TEENS TO MANY NORTHEAST OHIO NEIGHBORHOODS THROUGH OUR NETWORK OF PEDIATRICIAN OFFICES. EACH OFFICE IS STAFFED WITH BOARD-CERTIFIED PEDIATRICIANS AND EXPERIENCED STAFF. CHMCA ALSO OPERATES REGIONAL HEALTH CENTERS THAT BRING PRIMARY CARE, A RANGE OF SPECIALTY CARE SERVICES, AND AT SOME LOCATIONS, URGENT CARE, UNDER THE SAME ROOF. ANNUALLY, THE AKRON CAMPUS SAW THE FOLLOWING PATIENT ENCOUNTERS IN 2021: 8,309 INPATIENT ADMISSIONS (WHICH INCLUDES OTHER SITES EXCEPT BEEGHLY), 14,933 SURGERIES, 55,340 EMERGENCY ROOM VISITS, AND 238,618 SPECIALIST VISITS.CHMCA'S PAUL AND CAROL DAVID FOUNDATION BURN INSTITUTE PROVIDES SPECIALIZED INPATIENT AND OUTPATIENT CARE FOR BURN VICTIMS OF ALL AGES THROUGHOUT NORTHEAST OHIO. CHMCA IS ONE OF ONLY TWO PEDIATRIC HOSPITALS IN THE COUNTRY THAT TREATS ADULT BURN PATIENTS. EACH YEAR THE BURN INSTITUTE LEADS DOZENS OF OUTREACH AND EDUCATION ACTIVITIES ON FIRE SAFETY, IN ADDITION TO BURN SURVIVORSHIP SUPPORT GROUPS AND CAMPS. THE REBECCA D. CONSIDINE RESEARCH INSTITUTE IS THE HUB FOR RESEARCH ACTIVITY. THE INSTITUTE FACILITATES SPONSORED CLINICAL STUDIES AS WELL AS INTERNAL INVESTIGATOR-INITIATED RESEARCH PROGRAMS ACROSS A SPECTRUM OF RESEARCH SUBJECTS. THE INSTITUTE ALSO OFFERS RESEARCH-ORIENTED EDUCATIONAL OPPORTUNITIES FOR FELLOWS, STUDENTS AND FACULTY FROM AROUND THE GLOBE. ADULT CONGENITAL HEART SERVICE PROVIDES ONGOING MONITORING AND SPECIALIZED CARE FOR ADULTS WITH CONGENITAL HEART DISEASE. AS CHILDREN WITH CONGENITAL HEART DISEASE (CHD) BECOME ADULTS, THEY CAN ACCESS LIFETIME CARE THROUGH OUR CENTER.THE CYSTIC FIBROSIS CENTER PROVIDES DIAGNOSIS AND TREATMENT TO CHILDREN AND ADULTS WITH CYSTIC FIBROSIS (CF), INCLUDING RESPIRATORY THERAPY, PHYSICAL THERAPY, GENETIC COUNSELING AND NUTRITION COUNSELING. THE CENTER ALSO ACTIVELY PARTICIPATES IN CLINICAL TRIALS TO RESEARCH NEW DRUG THERAPIES TO MANAGE CF. THE GENETIC CENTER OFFERS DIAGNOSTIC EVALUATION AND MEDICAL MANAGEMENT OF GENETIC CONDITIONS, BIRTH DEFECTS AND DEVELOPMENTAL DELAYS, AS WELL AS GENETIC TESTING AND GENETIC COUNSELING FOR PEDIATRIC AND ADULT PATIENTS. OUR MATERNAL FETAL TREATMENT CENTER PROVIDES GENETIC COUNSELING AND OBSTETRIC/DELIVERY SERVICES TO HIGH-RISK PREGNANT WOMEN IN THE REGION. TELEHEALTH, WAS A PARTICULARLY GOOD FIT FOR BEHAVIORAL HEALTH SERVICES; IN FACT, THE LOIS AND JOHN ORR FAMILY BEHAVIORAL HEALTH CENTER WAS ONE OF JUST A FEW AREAS THAT PROVIDED MORE UNITS OF SERVICE IN 2021 THAN THE PREVIOUS YEAR. DATA INDICATES THAT CHILDREN STRUGGLED WITH WORSENING MENTAL HEALTH AS A RESULT OF THE PANDEMIC, DUE NOT ONLY TO FEAR AND ANXIETY AROUND THE VIRUS ITSELF, BUT ALSO ITS IMPACT ON SOCIAL CONNECTIVITY AND HOUSEHOLD DYNAMICS. TELEHEALTH BECAME A PIVOTAL PIECE OF FACILITATING ACCESS FOR THOSE SEEKING CARE.THE BEHAVIORAL HEALTH CENTER ALSO LEADS SEVERAL EFFORTS ALIGNED WITH THE CHNA IDENTIFIED NEED OF MENTAL/BEHAVIORAL HEALTH AND ADVERSE CHILDHOOD EXPERIENCES, OR ACES. CHMCA HAS EMBEDDED BEHAVIORAL HEALTH SERVICES WITHIN OUR NETWORK OF PRIMARY CARE OFFICES, THROUGH A COMBINATION OF INTERNAL STAFFING AND FORMAL RELATIONSHIPS WITH COMMUNITY AGENCIES PROVIDING BEHAVIORAL HEALTH SERVICES.OUR CRISIS CARE SERVICE LINE, PSYCHIATRIC INTAKE RESPONSE CENTER (PIRC) OPERATES A 24/7 TELEPHONE TRIAGE SERVICE FOR HIGH-ACUITY BEHAVIORAL HEALTH CONCERNS AND IS HOUSED IN THE EMERGENCY DEPARTMENT AT OUR AKRON CAMPUS. PIRC IS STAFFED BY MASTER'S LEVEL MENTAL HEALTH THERAPISTS WHO PERFORM RISK ASSESSMENTS USING EVIDENCED BASED SCREENING AND ASSESSMENT TOOLS TO DETERMINE PATIENTS' OVERALL LEVEL OF RISK OF HARM TO SELF OR OTHERS ALONG WITH THE APPROPRIATE TREATMENT DISPOSITION. THESE RECOMMENDATIONS ARE THEN SHARED WITH THE ATTENDING PHYSICIAN AND THE PSYCHIATRIST ON CALL IF AN INPATIENT ADMISSION IS INDICATED. SAFETY PLANNING IS FACILITATED WITH THE PATIENT AND PARENT OR LEGAL GUARDIAN, AND REFERRALS MAY BE MADE TO AKRON CHILDREN'S SERVICES OR THOSE AVAILABLE IN THE COMMUNITY AS APPROPRIATE. CHMCA'S PUBLIC SAFETY DEPARTMENT SUPPORTS OUR FOCUS ON MENTAL HEALTH BY PROMOTING CRISIS INTERVENTION TRAINING (CIT) FOR ITS OFFICERS AND OTHER LOCAL LAW ENFORCEMENT. WE ESTABLISHED A SPECIALIZED UNIT CALLED BEHAVIORAL RESPONSE AGAINST VIOLENCE ESCALATION (B.R.A.V.E.) WHICH INCORPORATES CIT CORE PRINCIPLES AND UTILIZES COLLABORATION, DE-ESCALATION, EDUCATION, AND UNDERSTANDING, WHILE TAKING A TRAUMA INFORMED APPROACH. AS A RESULT OF THIS PROGRAM THE COMMUNITY IN WHICH THESE OFFICERS SERVE HAS SEEN A REDUCTION OF VIOLENT BEHAVIOR IN THE MENTALLY ILL POPULATION, SPECIFICALLY JUVENILES, AND REDUCTION IN USE OF FORCE ENCOUNTERS ACROSS ALL DEMOGRAPHICS.CHMCA'S CENTER FOR GENDER AFFIRMING MEDICINE, OPENED IN 2019, PROVIDES SERVICES TO CHILDREN AND ADOLESCENTS WHO IDENTIFY AS TRANSGENDER. THIS VULNERABLE POPULATION IS AT GREATER RISK FOR SUICIDE AND HOMELESSNESS. OUR CLINICIANS IN THE CENTER PROVIDE COMPASSIONATE, COORDINATED CARE THAT INCLUDES PUBERTAL SUPPRESSION, GENDER AFFIRMING HORMONES, MENTAL HEALTH TREATMENT, WELL CHECKS, EDUCATION, AND SUPPORTIVE SERVICES FOR LGBTQ+ YOUTH AND THEIR FAMILIES.CHMCA'S NEONATOLOGY DEPARTMENT OFFERS INTENSIVE CARE TO SICK AND PREMATURE NEWBORNS. ON ANY GIVEN DAY, THERE ARE 45 TO 60 BABIES RECEIVING CARE IN OUR NEONATAL INTENSIVE CARE UNIT (NICU). ABOUT 1/4 OF THESE INFANTS HAVE BEEN IN UTERO FOR FEWER THAN 32 WEEKS, 5 WEEKS LESS THAN WHAT IS CONSIDERED NECESSARY FOR FULL GESTATION. SOME OF THEM ARE AS YOUNG AS 24 WEEKS AND WEIGH IN AT LESS THAN A KILOGRAM. CHMCA'S NEONATAL TEAM IS COMMITTED TO PROVIDING THE MOST EFFECTIVE AND EFFICIENT CARE FOR OUR TINIEST PATIENTS, AS WELL AS PROVIDING PARENTS WITH THE EMOTIONAL AND PRACTICAL SUPPORT THEY NEED. TO THIS END, CHMCA IS PART OF THE VERMONT OXFORD NETWORK, A COLLABORATION OF HEALTH PROFESSIONALS FROM MORE THAN 1,200 NICUS AROUND THE WORLD WHO FOCUS ON RESEARCH, EDUCATION AND PROJECTS THAT IMPROVE THE QUALITY AND SAFETY OF MEDICAL CARE FOR NEWBORNS AND THEIR FAMILIES. CHMCA'S NEONATAL EXPERTISE EXPANDS BEYOND THE LEVEL III NICU AT OUR AKRON CAMPUS. WE ALSO OWN AND OPERATE NEWBORN SPECIAL CARE NURSERIES AT AKRON GENERAL MEDICAL CENTER AND SUMMA HEALTH'S AKRON CITY HOSPITAL IN AKRON; CHMCA'S BEEGHLY CAMPUS IN BOARDMAN; AND ST. ELIZABETH BOARDMAN HEALTH CENTER. A SPECIALLY EQUIPPED AMBULANCE AND PEDIATRIC TRANSPORT TEAM HANDLES THE TRANSFER OF THE NEWBORNS REQUIRING THE LEVEL III NEONATAL INTENSIVE CARE PROVIDED AT CHMCA IN DOWNTOWN AKRON.CHMCA IS A CONTRACTED CARE COORDINATION AGENCY OF THE SUMMIT COUNTY PATHWAYS COMMUNITY HUB. THROUGH THIS RELATIONSHIP, CHMCA AND THE HUB PROVIDE BIDIRECTIONAL REFERRALS OF WOMEN WHO ARE PREGNANT AND UP TO ONE YEAR POSTPARTUM, INCREASING THEIR ACCESS TO RESOURCES SUCH AS PRENATAL CARE, FOOD AND HOUSING ASSISTANCE, ADULT EDUCATION, TOBACCO CESSATION SERVICES, AND OTHERS. COMMUNITY HEALTH WORKERS HELP TO NAVIGATE THESE WOMEN THROUGH THE SYSTEM, ENSURING THEY RECEIVE THE RESOURCES NEEDED TO PROVIDE A HEALTHY ENVIRONMENT FOR THEMSELVES AND THEIR CHILDREN.
CHMCA IS A LEVEL II PEDIATRIC TRAUMA CENTER AND PARTICIPATES IN SEVERAL	RESEARCH AND QUALITY/PERFORMANCE IMPROVEMENT EFFORTS TO BETTER UNDERSTAND AND ADDRESS THE NEEDS OF CRITICALLY ILL OR INJURED PATIENTS. THE PEDIATRIC INTENSIVE CARE UNIT (PICU) IS AN ALPHA SITE FOR THE VIRTUAL PICU PERFORMANCE SYSTEM, OR VPS, A CLINICAL QUALITY COLLABORATIVE AIMED AT STANDARDIZING DATA SHARING FOR IMPROVED PATIENT CARE AMONG CRITICAL CARE UNITS.WHILE THE PANDEMIC CONTINUED TO DRAMATICALLY IMPACT CHMCA OPERATIONS IN 2021, WE DEDICATED SIGNIFICANT RESOURCES TO MOBILIZING FOR AND EXECUTING COMMUNITY-BASED COVID-19 VACCINE DELIVERY ONCE IT BECAME AVAILABLE. WITH THE SUPPORT OF THE STATE OF OHIO AND LOCAL HEALTH DEPARTMENTS, OUR TEAMS WORKED WITH LOCAL BUSINESSES, CHURCHES, SOCIAL SERVICE AGENCIES AND SCHOOL DISTRICTS TO CARRY OUT COMMUNITY AND SCHOOL-BASED VACCINE CLINICS FOR ADULTS AND PEDIATRIC PATIENTS ELIGIBLE TO RECEIVE THE VACCINE, SUCH AS THOSE WITH MEDICAL COMPLEXITY. THROUGH THESE CLINICS, WE ADMINISTERED NEARLY 40,000 DOSES OF THE COVID-19 VACCINE. TO SUPPORT THE SAFE REOPENING OF SCHOOLS, WE VACCINATED AKRON-AREA SCHOOL PERSONNEL AND MOVED QUICKLY TO SET UP DRIVE-THRU COVID-19 TESTING AT OUR SITES FOR OUR PATIENTS AS WELL AS OTHER CHILDREN AND YOUTH IN THE COMMUNITY. CHMCA'S EXTERNAL AFFAIRS DEPARTMENT OFFERS A VARIETY OF COMMUNITY HEALTH EDUCATION AND OUTREACH PROGRAMS TO CHILDREN AND FAMILIES THROUGHOUT THE SERVICE AREA. THESE INCLUDE INJURY PREVENTION PROGRAMS ON CHILD PASSENGER SAFETY, AND REACH OUT AND READ, A PROGRAM THAT PROMOTES EARLY CHILDHOOD LITERACY BY DISTRIBUTING BOOKS TO CHMCA PRIMARY CARE OFFICES TO PROVIDE CHILDREN DURING WELL VISITS. WE ALSO COORDINATE OUTREACH EVENTS AND OUTREACH KIT DISTRIBUTIONS IN OUR COMMUNITIES BASED ON IDENTIFIED NEEDS AND ALIGNMENT WITH STRATEGIC PRIORITIES. IN 2021, WE CONTINUED TO SERVE FAMILIES IN-PLACE AND IN CURBSIDE AND OUTDOOR FORMATS TO REDUCE EXPOSURE TO COVID-19. ADDITIONALLY, OUR EDUCATORS DELIVERED THE 7-WEEK, FAMILY-CENTERED AND TRAUMA INFORMED NURTURING FAMILIES PROGRAM CURRICULUM VIRTUALLY, SERVING 105 CLIENTS. OUR POPULATION HEALTH INITIATIVES DEPARTMENT PROVIDES CASE MANAGEMENT AND CARE COORDINATION SERVICES THROUGHOUT THE HOSPITAL'S SERVICE AREA, WORKING WITH PATIENTS ON A "HIGH RISK" REGISTRY TO IMPROVE HEALTH OUTCOMES AND ENHANCE QUALITY OF LIFE. THESE PATIENTS ARE GENERALLY INCOME LIMITED AND MEDICALLY COMPLEX, AND OFTEN HAVE A HIGH NO-SHOW RATE TO THEIR SCHEDULED APPOINTMENTS AND/OR NUMEROUS HOSPITALIZATIONS AND EMERGENCY DEPARTMENT VISITS IN A 12 MONTH PERIOD. CHMCA'S SCHOOL HEALTH SERVICES SUPPORTS THE ACADEMIC SUCCESS OF CHILDREN THROUGH HEALTH PROMOTION, EDUCATION AND CHILD ADVOCACY. SCHOOL HEALTH SERVES AS A LIAISON AMONG SCHOOL STAFF, FAMILY, COMMUNITY AND HEALTHCARE PROVIDERS. CHMCA'S PEDIATRIC REGISTERED NURSES WORK CLOSELY WITH SCHOOL STAFF TO ENSURE A COMPREHENSIVE SCHOOL HEALTH PROGRAM IS IN PLACE. WITH IMMEDIATE ACCESS TO PEDIATRIC HEALTHCARE PROFESSIONALS AT CHMCA, SCHOOLS ARE ASSURED THEIR PROGRAM WILL EFFECTIVELY ADDRESS THE NEEDS OF THEIR STAFF AND STUDENTS. OUR SCHOOL HEALTH SERVICES LETS SCHOOLS FOCUS ON EDUCATING STUDENTS, WHILE WE MANAGE THEIR DISTRICT'S MEDICAL NEEDS.IN ADDITION, AS PART OF A PILOT PROGRAM IN 2019, CHMCA IMPLEMENTED A SCHOOL-BASED HEALTH CENTER MODEL IN THE KENMORE-GARFIELD CLUSTER OF AKRON PUBLIC SCHOOLS. SERVICES INCLUDE WELL-CHILD EXAMS (IN PERSON) AND EVALUATION FOR ILLNESS (BY TELEHEALTH TECHNOLOGY) WITH A NURSE PRACTITIONER, AS WELL AS VARIOUS SCREENINGS, WELLNESS ADVICE AND SPORTS PHYSICALS. PARENTS AND MEMBERS OF CHMCA'S FAMILY-CENTERED CARE COMMITTEE ESTABLISHED THE PARENT ADVISORY COUNCIL IN 1995. IT PROVIDES A WAY FOR PARENTS AND GUARDIANS TO OFFER INPUT ON ISSUES THAT IMPACT THE CARE OF CHILDREN. THE COUNCIL INCLUDES PARENTS WHOSE CHILDREN HAVE RECEIVED CARE AT CHMCA. ADVISORS WORK WITH HOSPITAL LIAISONS TO REPRESENT THE VOICE OF FAMILIES AS WE WORK TOGETHER TO ENHANCE THE DELIVERY OF FAMILY-CENTERED CARE.
PROMOTION OF COMMUNITY HEALTH - GROUP B:	CHMCA INTENDS THAT ALL OF ITS ACTIVITIES EITHER DIRECTLY PROVIDE HEALTH CARE TO ALL CHILDREN WHO REQUEST OUR SERVICES OR PROMOTE THE HEALTH OF THE COMMUNITY, BOTH BY DIRECT INVESTMENTS IN THE DELIVERY OF PEDIATRIC HEALTHCARE SERVICES AND IN PROVIDING SPECIALIZED INPATIENT AND OUTPATIENT CARE FOR PATIENTS OF ALL AGES THROUGHOUT NORTHEAST OHIO. CHMCA WAS FOUNDED ON THE PRINCIPLE OF SERVING THE NEEDS OF OUR COMMUNITY. WITHIN OUR DOORS, THIS MEANS TREATING ALL CHILDREN AS IF THEY WERE OUR OWN, TURNING NO CHILD OR FAMILY AWAY BASED ON THEIR ABILITY TO PAY. CHMCA'S GOVERNING BOARD OF TRUSTEES IS COMPRISED OF MEMBERS OF THE COMMUNITY THAT MAKES UP THE HOSPITAL'S PRIMARY SERVICE AREA. THEY ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. CHMCA EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITIES WE SERVE. CHMCA'S EXCELLENT REPUTATION IS THE RESULT OF THE SKILLS AND EXPERIENCE OF OUR MEDICAL STAFF AND THE HEALTH PROFESSIONALS WITH WHOM WE COLLABORATE. WE VALUE OUR PARTNERSHIP WITH PRIMARY CARE PHYSICIANS AND REFERRING PROVIDERS AND WORK TOGETHER TO COORDINATE THE CARE OF CHILDREN. CHMCA ALSO OPERATES REGIONAL HEALTH CENTERS THAT BRING PRIMARY CARE, A RANGE OF SPECIALTY CARE SERVICES, AND AT SOME LOCATIONS, URGENT CARE, UNDER THE SAME ROOF. CURRENTLY, OUR HEALTH CENTER SERVING THE MAHONING VALLEY IS LOCATED IN THE CITY OF WARREN. WE ALSO MAKE MAJOR INVESTMENTS OF OUR FUNDS AND OTHER RESOURCES IN THE PROVISION OF EDUCATION FOR LAY AND PROFESSIONAL PERSONS, AND IN RESEARCH THAT WILL IMPROVE HEALTH CARE FOR ALL CHILDREN. WE TAKE AN ACTIVE ROLE IN ADVOCATING FOR IMPROVED HEALTH AND IMPROVED ACCESS TO HEALTH CARE FOR ALL. SERVICES AND ACTIVITIES PROVIDED BY CHMCA BENEFIT AND/OR PROMOTE HEALTH TO THE RESIDENTS IN THE COMMUNITIES WE SERVE. THE PRIMARY BENEFIT TO OUR COMMUNITIES IS PROVIDING HEALTH CARE FOR MORE THAN 1,000,000 CHILDREN ANNUALLY. IN ADDITION, WE ENGAGE IN COMMUNITY BUILDING ACTIVITIES, AS DEPICTED IN PART II OF THIS SCHEDULE. THE AREA'S ONLY PEDIATRIC HOSPITAL, CHMCA'S BEEGHLY CAMPUS OPENED IN DECEMBER 2008. THIS 43-BED PEDIATRIC HOSPITAL OFFERS A FULL RANGE OF PEDIATRIC SERVICES TO THE CHILDREN OF THE MAHONING VALLEY AND SURROUNDING AREAS. THE HOSPITAL PROVIDES ACCESS TO A 24/7 EMERGENCY DEPARTMENT, LABORATORY, RADIOLOGY, OUTPATIENT SURGICAL CENTER, ENDOCRINOLOGY, REHABILITATION AND EEG/ECHO/EKG SERVICES, AS WELL AS A BEHAVIORAL HEALTH CENTER, HEMATOLOGY/ONCOLOGY CLINIC AND INFUSION CENTER AND CHILD ADVOCACY CENTER. CHMCA OPENED A BEHAVIORAL HEALTH CENTER AT BEEGHLY CAMPUS IN 2019 TO BETTER SERVE A GROWING NEED FOR MENTAL AND BEHAVIORAL HEALTH SERVICES FOR YOUTH IN THE MAHONING VALLEY. THE NEW 9,000 SQUARE FOOT BUILDING HAS NINE INDIVIDUAL THERAPY ROOMS AND OPEN SERVICES PREVIOUSLY UNAVAILABLE IN THIS COMMUNITY, INCLUDING A PARTIAL HOSPITALIZATION PROGRAM THAT OFFERS TWO WEEKS OF INTENSIVE INDIVIDUAL AND GROUP THERAPY BUT DOES NOT REQUIRE INPATIENT ADMISSION. IN ADDITION, SOME OUTPATIENT BEHAVIORAL HEALTH SERVICES CAN BE ACCESSED THROUGH CHMCA'S PRIMARY CARE OFFICES THROUGHOUT THE MAHONING VALLEY. ANNUALLY, THE BEEGHLY CAMPUS SAW THE FOLLOWING PATIENT ENCOUNTERS IN 2021: 1,054 INPATIENT ADMISSIONS, 2,012 SURGERIES, 33,271 EMERGENCY ROOM VISITS, AND 42,221 SPECIALIST VISITS. WHILE THE PANDEMIC CONTINUED TO IMPACT CHMCA OPERATIONS IN 2021, WE DEDICATED SIGNIFICANT RESOURCES TO MOBILIZING FOR AND EXECUTING COMMUNITY-BASED COVID-19 VACCINE DELIVERY ONCE IT BECAME AVAILABLE. TO SUPPORT THE SAFE REOPENING OF SCHOOLS, WE MOVED QUICKLY TO SET UP DRIVE-THRU COVID-19 TESTING AT OUR SITES FOR ANY CHILDREN 18 AND UNDER WHETHER OR NOT THEY WERE OUR PATIENTS. CHMCA OWNS AND OPERATES A 19-BED LEVEL II SPECIAL CARE NURSERY AT THE HOSPITAL'S BEEGHLY CAMPUS AND A 25-BED LEVEL IIIB NEONATAL INTENSIVE CARE UNIT AT ST. ELIZABETH HEALTH CENTER. CHMCA'S NEONATAL TEAM IS COMMITTED TO PROVIDING THE MOST EFFECTIVE AND EFFICIENT CARE FOR OUR TINIEST PATIENTS, AS WELL AS PROVIDING PARENTS WITH THE EMOTIONAL AND EDUCATIONAL SUPPORT THEY NEED. CHMCA'S NEONATOLOGY DEPARTMENT OFFERS INTENSIVE CARE TO SICK AND PREMATURE NEWBORNS. ABOUT 1/4 OF THESE INFANTS HAVE BEEN IN UTERO FOR FEWER THAN 32 WEEKS, 5 WEEKS LESS THAN WHAT IS CONSIDERED NECESSARY FOR FULL GESTATION. SOME OF THEM ARE AS YOUNG AS 24 WEEKS AND WEIGH IN AT LESS THAN A KILOGRAM. TO THIS END, CHMCA IS PART OF THE VERMONT OXFORD NETWORK, A COLLABORATION OF HEALTH PROFESSIONALS FROM MORE THAN 1,200 NICUS AROUND THE WORLD WHO FOCUS ON RESEARCH, EDUCATION AND PROJECTS THAT IMPROVE THE QUALITY AND SAFETY OF MEDICAL CARE FOR NEWBORNS AND THEIR FAMILIES. CHMCA'S NEONATAL EXPERTISE EXPANDS BEYOND THE LEVEL III NICU AT OUR AKRON CAMPUS. WE ALSO OWN AND OPERATE NEWBORN SPECIAL CARE NURSERIES AT AKRON GENERAL MEDICAL CENTER AND SUMMA HEALTH'S AKRON CITY HOSPITAL IN AKRON; CHMCA'S BEEGHLY CAMPUS IN BOARDMAN; ST. ELIZABETH BOARDMAN HOSPITAL AND ST. JOSEPH WARREN HOSPITAL. A SPECIALLY EQUIPPED AMBULANCE AND PEDIATRIC TRANSPORT TEAM HANDLES THE TRANSFER OF THE NEWBORNS REQUIRING THE LEVEL III NEONATAL INTENSIVE CARE PROVIDED AT CHMCA IN DOWNTOWN AKRON. CHMCA HAS PRIORITIZED INFANT MORTALITY REDUCTION AS A SIGNIFICANT HEALTH ISSUE IN THE COMMUNITY. WE ARE A CONTRACTED CARE COORDINATION AGENCY OF THE MAHONING VALLEY PATHWAYS COMMUNITY HUB. THROUGH THIS RELATIONSHIP, CHMCA AND THE HUB PROVIDE BIDIRECTIONAL REFERRALS OF WOMEN WHO ARE PREGNANT AND UP TO ONE YEAR POSTPARTUM, INCREASING THEIR ACCESS TO RESOURCES SUCH AS PRENATAL CARE, FOOD AND HOUSING ASSISTANCE, ADULT EDUCATION, TOBACCO CESSATION SERVICES, AND OTHERS. COMMUNITY HEALTH WORKERS HELP TO NAVIGATE THESE WOMEN THROUGH THE SYSTEM, ENSURING THEY RECEIVE THE RESOURCES NEEDED TO PROVIDE A HEALTHY ENVIRONMENT FOR THEMSELVES AND THEIR CHILDREN. CHMCA IS ALSO A NURSE-FAMILY PARTNERSHIP SERVICE PROVIDER, WITH CHILDREN'S HOME CARE GROUP NURSES PROVIDING HOME VISITS TO PREGNANT WOMEN AND THEIR BABIES UP TO TWO YEARS POSTPARTUM. CHMCA BRINGS PEDIATRIC PRIMARY CARE FOR BABIES, CHILDREN AND TEENS TO MANY NORTHEAST OHIO NEIGHBORHOODS THROUGH OUR NETWORK OF PEDIATRICIAN OFFICES, WHICH INCLUDES OFFICES IN AUSTINTOWN, BOARDMAN, EAST LIVERPOOL, LIBERTY TOWNSHIP, LISBON, AND DOWNTOWN WARREN. EACH OFFICE IS STAFFED WITH BOARD-CERTIFIED PEDIATRICIANS AND EXPERIENCED STAFF. REGIONAL HEALTH CENTERS IN WARREN AND NEW PHILADELPHIA OFFER BOTH PRIMARY AND NUMEROUS SPECIALTY CARE SERVICES; AND URGENT CARE IN WARREN.CHMCA'S EXTERNAL AFFAIRS DEPARTMENT OFFERS A VARIETY OF COMMUNITY HEALTH EDUCATION AND OUTREACH PROGRAMS TO CHILDREN AND FAMILIES THROUGHOUT THE SERVICE AREA. THESE INCLUDE INJURY PREVENTION PROGRAMS ON CHILD PASSENGER SAFETY, AND REACH OUT AND READ, A PROGRAM THAT PROMOTES EARLY CHILDHOOD LITERACY BY DISTRIBUTING BOOKS TO CHMCA PRIMARY CARE OFFICES TO PROVIDE CHILDREN DURING WELL VISITS. WE ALSO COORDINATE OUTREACH EVENTS AND OUTREACH KIT DISTRIBUTIONS IN OUR COMMUNITIES BASED ON IDENTIFIED NEEDS AND ALIGNMENT WITH STRATEGIC PRIORITIES. OUR POPULATION HEALTH INITIATIVES DEPARTMENT PROVIDES CASE MANAGEMENT AND CARE COORDINATION SERVICES THROUGHOUT THE HOSPITAL'S SERVICE AREA, WORKING WITH PATIENTS ON A "HIGH RISK" REGISTRY TO IMPROVE HEALTH OUTCOMES AND ENHANCE QUALITY OF LIFE. THESE PATIENTS ARE GENERALLY INCOME LIMITED AND MEDICALLY COMPLEX, AND OFTEN HAVE A HIGH NO-SHOW RATE TO THEIR SCHEDULED APPOINTMENTS AND/OR NUMEROUS HOSPITALIZATIONS AND EMERGENCY DEPARTMENT VISITS IN A 12 MONTH PERIOD.ALSO LOCATED IN THE MAHONING VALLEY IS THE DEPARTMENT OF CHRONIC CARE EDUCATION AND SUPPORT, WHICH DELIVERS CHRONIC DISEASE PREVENTION AND SELF-MANAGEMENT PROGRAMMING TO CHILDREN AND THEIR FAMILIES, AS WELL AS DISEASE-SPECIFIC CAMPS AND SUPPORT GROUPS. THE DEPARTMENT DOES NOT GENERATE ANY REVENUE FOR THESE SERVICES, AND PROGRAMS MEET SPECIFIED CRITERIA OF NATIONALLY ACCREDITED DISEASE MANAGEMENT PROGRAMS, AS WELL AS CHMCA CRITERIA AND MONITORING REQUIREMENTS. CHMCA'S SCHOOL HEALTH SERVICES SUPPORTS THE ACADEMIC SUCCESS OF CHILDREN THROUGH HEALTH PROMOTION, EDUCATION AND CHILD ADVOCACY. SCHOOL HEALTH SERVES AS A LIAISON AMONG SCHOOL STAFF, FAMILY, COMMUNITY AND HEALTHCARE PROVIDERS. CHMCA'S PEDIATRIC REGISTERED NURSES WORK CLOSELY WITH SCHOOL STAFFS TO ENSURE A COMPREHENSIVE SCHOOL HEALTH PROGRAM IS IN PLACE. WITH IMMEDIATE ACCESS TO PEDIATRIC HEALTHCARE PROFESSIONALS AT CHMCA, SCHOOLS ARE ASSURED THEIR PROGRAM WILL EFFECTIVELY ADDRESS THE NEEDS OF THEIR STAFF AND STUDENTS. OUR SCHOOL HEALTH SERVICES LETS SCHOOLS FOCUS ON EDUCATING STUDENTS, WHILE WE MANAGE THEIR DISTRICT'S MEDICAL NEEDS.IN ADDITION, CHMCA IMPLEMENTED A SCHOOL-BASED HEALTH CENTER MODEL WITH WARREN CITY SCHOOLS AS PART OF A PILOT PROGRAM IN 2019. SERVICES INCLUDE WELL-CHILD EXAMS (IN PERSON) AND EVALUATION FOR ILLNESS (BY TELEHEALTH TECHNOLOGY) WITH A NURSE PRACTITIONER, AS WELL AS VARIOUS SCREENINGS, WELLNESS ADVICE AND SPORTS PHYSICALS.
PARENTS AND MEMBERS OF CHMCA'S FAMILY-CENTERED CARE COMMITTEE	ESTABLISHED THE PARENT ADVISORY COUNCIL (PAC) IN 1995. IT PROVIDES A WAY FOR PARENTS AND GUARDIANS TO OFFER INPUT ON ISSUES THAT IMPACT THE CARE OF CHILDREN. THE COUNCIL INCLUDES PARENTS WHOSE CHILDREN HAVE RECEIVED CARE AT CHMCA. ADVISORS WILL WORK WITH HOSPITAL LIAISONS TO REPRESENT THE VOICE OF FAMILIES AS WE WORK TOGETHER TO ENHANCE THE DELIVERY OF FAMILY-CENTERED CARE.
PART VI, LINE 6:	AFFILIATED HEALTH CARE SYSTEM - GROUPS A & B:N/A
PART VI, LINE 7:	STATE FILING OF COMMUNITY BENEFIT REPORT - GROUPS A & B:OHIO
PART VI ADDITIONAL INFORMATION:	IN ADDITION TO THE LOCATIONS LISTED IN PART V, SECTION A AND C, CHMCA HAS PHYSICIANS PROVIDING A VARIETY OF SUBSPECIALTY SERVICES AT MANY OTHER LOCATIONS THROUGHOUT NORTHEAST OHIO AND WESTERN PENNSYLVANIA. NOTE: CENSUS AND OTHER DATA REPORTED IN SECTION PART VI IS THE MOST RECENT INFORMATION AVAILABLE.

Schedule H (Form 990) 2021

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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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
CHILDREN'S HOSPITAL MEDICAL CENTER OF
AKRON

Employer identification number
34-0714357

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 noncash assistance	(h) Purpose of grant or assistance
(1) NPH USA 134 N LASALLE SUITE 500 CHICAGO,IL60602	65-1229309	501(C)(3)	50,000	0			TO PROVIDE SUPPORT SERVICES FOR CHILDREN IN HAITI
(2) OHIO & ERIE CANALWAY COALITION 47 W EXCHANGE ST AKRON,OH44308	34-1636766	501(C)(3)	2,500,000	0			PLAYGROUND AS PART OF CITY OF AKRON REVITALIZATION

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) 2021

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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) SPONSORSHIPS	33	367,920
(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
PART I, LINE 2	CHMCA DONATES MONEY OCCASIONALLY TO PROGRAMS THROUGHOUT SUMMIT COUNTY THAT ARE ALSO 501(C)(3) ORGANIZATIONS. THE AMOUNTS DONATED TO THESE ORGANIZATIONS ARE MOSTLY IN SUPPORT OF MEDICAL AND NURSING EXCELLENCE IN THE COMMUNITY, ALONG WITH MEDICAL RESEARCH.

Schedule I (Form 990) 2021

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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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL MEDICAL CENTER OF
AKRON

Employer identification number

34-0714357

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

Yes

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

Yes

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

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

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

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

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

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

Yes

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

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

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

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

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

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

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

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

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

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

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

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
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) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1GRACE WAKULCHIK BOD/OFFICER - PRESIDENT & CEO	(i) (ii)	994,234 ------------- 0	360,000 ------------- 0	85,669 ------------- 0	268,072 ------------- 0	9,515 ------------- 0	1,717,490 ------------- 0	0 ------------- 0
2JOHN CROW MD ASST. CHIEF MEDICAL OFFICER	(i) (ii)	1,090,390 ------------- 0	0 ------------- 0	5,544 ------------- 0	20,300 ------------- 0	9,034 ------------- 0	1,125,268 ------------- 0	0 ------------- 0
3ABDELAZIZ SALEH MD PERINATOLOGIST	(i) (ii)	771,076 ------------- 0	289,998 ------------- 0	6,096 ------------- 0	19,549 ------------- 0	26,155 ------------- 0	1,112,874 ------------- 0	0 ------------- 0
4TSULEE CHEN MD DIRECTOR OF PEDIATRIC NEUROSURGERY	(i) (ii)	849,015 ------------- 0	196,378 ------------- 0	840 ------------- 0	17,400 ------------- 0	9,499 ------------- 0	1,073,132 ------------- 0	0 ------------- 0
5MARK WULKAN MD DEPARTMENT CHAIR - SURGERY	(i) (ii)	802,006 ------------- 0	233,000 ------------- 0	3,612 ------------- 0	16,460 ------------- 0	14,972 ------------- 0	1,070,050 ------------- 0	0 ------------- 0
6JODI REGAN MD PERINATOLOGIST	(i) (ii)	742,486 ------------- 0	289,998 ------------- 0	1,488 ------------- 0	17,400 ------------- 0	9,648 ------------- 0	1,061,020 ------------- 0	0 ------------- 0
7SHAWN LYDEN CHIEF STRATEGY OFFICER	(i) (ii)	682,279 ------------- 0	135,667 ------------- 0	32,046 ------------- 0	116,015 ------------- 0	18,149 ------------- 0	984,156 ------------- 0	0 ------------- 0
8ROBERT MCGREGOR MD CHIEF MEDICAL OFFICER	(i) (ii)	564,438 ------------- 0	153,005 ------------- 0	26,662 ------------- 0	102,307 ------------- 0	18,149 ------------- 0	864,561 ------------- 0	0 ------------- 0
9MICHAEL BIGHAM MD CHIEF QUALITY OFFICER	(i) (ii)	416,425 ------------- 0	120,724 ------------- 0	192,593 ------------- 0	91,894 ------------- 0	24,858 ------------- 0	846,494 ------------- 0	190,656 ------------- 0
10SPENCER KOWAL CFO/TREASURER - PART YEAR	(i) (ii)	555,242 ------------- 0	147,002 ------------- 0	108,519 ------------- 0	15,803 ------------- 0	12,421 ------------- 0	838,987 ------------- 0	107,233 ------------- 0
11LISA AURILIO CHIEF OPERATING OFFICER	(i) (ii)	560,396 ------------- 0	150,003 ------------- 0	22,715 ------------- 0	89,036 ------------- 0	9,889 ------------- 0	832,039 ------------- 0	0 ------------- 0
12RHONDA LARIMORE CHIEF OF HUMAN RESOURCES	(i) (ii)	358,656 ------------- 0	96,002 ------------- 0	173,383 ------------- 0	78,037 ------------- 0	20,134 ------------- 0	726,212 ------------- 0	171,945 ------------- 0
13HARUN RASHID CHIEF INFORMATION OFFICER	(i) (ii)	423,082 ------------- 0	102,005 ------------- 0	2,928 ------------- 0	88,190 ------------- 0	24,624 ------------- 0	640,829 ------------- 0	0 ------------- 0
14ANTHEA DANIELS CHIEF LEGAL OFFICER/ ASST. SECRETARY	(i) (ii)	418,860 ------------- 0	123,100 ------------- 0	1,863 ------------- 0	87,537 ------------- 0	1,497 ------------- 0	632,857 ------------- 0	0 ------------- 0
15CRAIG MCGHEE CHIEF NON HOSP SRVCS OFFICER	(i) (ii)	315,343 ------------- 0	85,800 ------------- 0	121,435 ------------- 0	65,822 ------------- 0	15,228 ------------- 0	603,628 ------------- 0	110,002 ------------- 0
16CHRISTINE YOUNG CHIEF NURSING OFFICER	(i) (ii)	362,305 ------------- 0	90,006 ------------- 0	1,419 ------------- 0	77,715 ------------- 0	17,390 ------------- 0	548,835 ------------- 0	0 ------------- 0
17MICHAEL FORBES MD INTERIM CHAIR DEPT. OF PEDS	(i) (ii)	320,656 ------------- 0	169,047 ------------- 0	5,243 ------------- 0	10,995 ------------- 0	19,836 ------------- 0	525,777 ------------- 0	0 ------------- 0
18ALICIA LAMANCUSA INTERIM CHIEF FINANCIAL OFFICER	(i) (ii)	371,808 ------------- 0	50,927 ------------- 0	4,636 ------------- 0	-1,743 ------------- 0	17,678 ------------- 0	443,306 ------------- 0	0 ------------- 0
19SHEFALI MAHESH MD DIRECTOR - DEPARTMENT CHAIR - NEPHRO	(i) (ii)	287,518 ------------- 0	75,776 ------------- 0	428 ------------- 0	17,400 ------------- 0	14,362 ------------- 0	395,484 ------------- 0	0 ------------- 0
20CHRISTOPHER GESSNER PRESIDENT - CEO	(i) (ii)	173,077 ------------- 0	0 ------------- 0	34,193 ------------- 0	44,384 ------------- 0	3,648 ------------- 0	255,302 ------------- 0	0 ------------- 0
21WILLIAM CONSIDINE FORMER CEO EMERITUS	(i) (ii)	179,070 ------------- 0	90,386 ------------- 0	139 ------------- 0	231 ------------- 0	646 ------------- 0	270,472 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

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

Return Reference	Explanation
PART I, LINE 1A	THE FOLLOWING INDIVIDUALS HAD A 2021 COUNTRY CLUB MEMBERSHIP THAT WAS USED BY THEM FOR BUSINESS PURPOSES: CHRISTOPHER GESSNER ROBERT MCGREGOR M.D. GRACE WAKULCHIK LISA AURILIO SHAWN LYDEN
PART I, LINE 4B	THE FOLLOWING INDIVIDUALS BECAME PARTICIPANTS IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS DURING 2018, WHEREBY THEY BECOME VESTED PER THE TERMS OF THEIR EMPLOYMENT AGREEMENT. CHMCA IS ACCRUING FOR THE BENEFIT THAT WILL OCCUR, THEREFORE THESE AMOUNTS ARE INCLUDED IN THEIR DEFERRED COMPENSATION. DISTRIBUTIONS WERE MADE IN 2021 IN THE FOLLOWING AMOUNTS: LISA AURILIO - $0 RHONDA LARIMORE - $171,945 ROBERT MCGREGOR M.D. - $0 GRACE WAKULCHIK - $0 SHAWN LYDEN - $0 HARUN RASHID - $0 MICHAEL BIGHAM M.D. - $190,656 SPENCER KOWAL - $107,233 ANTHEA DANIELS - $0 CRAIG MCGEE - $110,002
PART I, LINE 7	CHMCA DOES HAVE CONTRACTS WITH CERTAIN PHYSICIANS THAT EARN BONUSES BASED ON WORK RELATIVE VALUE UNITS (WRVU'S). PHYSICIANS WORK RVU: THE RELATIVE LEVEL OF TIME, SKILL, TRAINING, AND INTENSITY TO PROVIDE A GIVEN SERVICE. EACH CURRENT PROCEDURAL TERMINOLOGY (CPT) CODE IS TARGETED FOR REVIEW AT LEAST EVERY FIVE YEARS TO DETERMINE THE WORK RVU FOR A PARTICULAR SERVICE. A CODE WITH A HIGHER RVU WORK TAKES MORE TIME, MORE INTENSITY OR SOME COMBINATION OF THE TWO. BONUSES ARE BASED ON PERFORMANCE AND OTHER METRICS BUT FINAL DECISIONS ARE DISCRETIONARY BY THE BOARD. THE CEO'S BONUS IS APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD. STAFF BONUSES ARE APPROVED BY THE CEO.

Schedule J (Form 990) 2021

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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 Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
CHILDREN'S HOSPITAL MEDICAL CENTER OF
AKRON

Employer identification number
34-0714357

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	AKRON BATH AND COPLEY JOINT TWSP HOSP DISTRICT	34-1448680	009730MY5	05-15-2012	102,559,004	REFUND PRIOR ISSUE TO CONSTRUCT NE		X		X		X
B	AKRON BATH AND COPLEY JOINT TWSP HOSP DISTRICT	34-1448680	009730NB4	05-05-2013	101,377,818	CONSTRUCTION OF CRITICAL CARE TOWE		X		X		X
C	AKRON BATH AND COPLEY JOINT TWSP HOSP DISTRICT	34-1448680	000000000	11-14-2013	27,405,000	REFUND PRIOR ISSUE		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	80,432,921
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	102,559,004		101,377,818		27,405,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............	1,010,250		10,229,217		280,035
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	1,116,463		1,148,601
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	20,000,000		90,000,000
11 Other spent proceeds .............	80,432,291				27,124,965
12 Other unspent proceeds .............
13 Year of substantial completion .............	2013		2015		2013
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........	X			X	X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X		X		X
16 Has the final allocation of proceeds been made? ..........	X		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

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
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X		X
c Are there any research agreements that may result in private business use of bond-financed property? .............		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?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %		0 %		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 .........	0 %		0 %		0 %
6 Total of lines 4 and 5 .............	0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? ...		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
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X		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
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X		X
b Exception to rebate? ........		X		X		X
c No rebate due? .........	X		X			X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X		X		X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	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

Part Ⅵ

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

Return Reference	Explanation
PART 1(F)A	FROM THE $102,559,004 PROCEEDS, $80,432,921 WAS USED TO REFUND THE SERIES 2001 BONDS IN 2020 AND $20,000,000 WAS USED FOR CONSTRUCTION OF A NEW PARKING DECK ON THE AKRON CAMPUS CONTAINING APPROXIMATELY 1200 SPACES AND CONNECTED TO THE KAY JEWELERS PAVILION. THE DATE THE REBATE COMPUTATION WAS PERFORMED WAS 02/13/2017
PART 1(F)B	$101,377,818 WAS USED TO CONSTRUCT AN APPROXIMATELY 366,000 SQUARE FOOT KAY JEWELERS PAVILION ON THE AKRON CAMPUS. THE DATE THE REBATE COMPUTATION WAS PERFORMED WAS 03/13/2017
PART 1(F)C	$27,405,000 OF BOND PROCEEDS REFUNDED THE SERIES 2003 BONDS AND IS HELD BY KEY GOVERNMENT FINANCE, INC.

Schedule K (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990)

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL MEDICAL CENTER OF
AKRON

Employer identification number

34-0714357

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 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 the 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) 2021

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) CATHRYN O'MALLEY	FAMILY MEMBER OF WILLIAM CONSIDINE, CHIEF EXECUTIVE OFFICER EMERITUS	60,499	COMPENSATION		No

Part V

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

Return Reference	Explanation

Schedule L (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

CHILDREN'S HOSPITAL MEDICAL CENTER OF
AKRON

Employer identification number

34-0714357

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	THE DULY ELECTED, QUALIFIED AND ACTING DIRECTORS AND THE ACTIVE MEMBERS OF THE WOMEN'S BOARD OF AKRON CHILDREN'S HOSPITAL ARE MEMBERS OF THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7A	ACCORDING TO THE CODE OF REGULATIONS OF CHMCA, FIVE OF THE MEMBERS SHALL CONSIST OF THE WOMEN'S BOARD OF CHMCA AND SHALL HOLD SUCH POSITION FOR A PERIOD OF TWO YEARS OR UNTIL THEIR SUCCESSORS ARE ELECTED AND QUALIFIED. THE HOSPITAL'S CHIEF EXECUTIVE OFFICER AND PRESIDENT, CHIEF MEDICAL OFFICER, CHAIRMAN OF THE DEPARTMENT OF SURGERY, AND THE CURRENTLY SERVING NOAH MILLER CHAIR FOR PEDIATRICS SHALL EACH BE A MEMBER OF THE BOARD OF DIRECTORS. IN ADDITION, THE ELECTED PRESIDENT OF THE MEDICAL STAFF WILL BE A MEMBER OF THE BOARD OF DIRECTORS AND CHAIR OF THE FOUNDATION BOARD. THE REMAINING MEMBERS OF THE BOARD OF DIRECTORS AND CHAIR OF THE FOUNDATION BOARD SHALL BE ELECTED BY THE MEMBERS OF CHMCA. A DIRECTOR SHALL BE ELECTED FOR A THREE-YEAR TERM, BUT A PERSON MAY BE NOMINATED FOR AND ELECTED TO A SHORTER TERM SO THAT THE TERMS OF APPROXIMATELY ONE-THIRD OF THE DIRECTORS SHALL EXPIRE EACH YEAR. EACH DIRECTOR SHALL SERVE UNTIL HIS SUCCESSOR IS ELECTED AND QUALIFIED. A DIRECTOR MAY RENEW UP TO THREE (3) THREE YEAR TERMS. UPON UNANIMOUS RESOLUTION OF THE MEMBERS, A PERSON WHO HAS RENDERED LONG AND OUTSTANDINGSERVICE TO THE HOSPITAL MAY BE ELECTED TO AN EMERITUS STATUS. THE DIRECTOR'S RESPONSIBILITIES INCLUDE: (1) ENSURE HOSPITAL IS MEETING THE COMMUNITY'S HEALTH NEEDS AND IS INFORMED ABOUT THE HOSPITAL'S SERVICES; (2) STRONGLY BELIEVES IN THE HOSPITAL'S MISSION AND SERVE AS ACTIVE PUBLIC ADVOCATES FOR THE HOSPITAL; (3) ESTABLISH GOALS AND POLICIES FOR THE HOSPITAL; (4) WORK WITH THE HOSPITAL PRESIDENT TO DEVELOP AND UPDATE LONG-RANGE PLANS AND PROVIDE FOR FINANCIAL STABILITY; (5) IDENTIFY, RECRUIT AND SELECT NEW DIRECTORS; (6) PERIODICALLY EVALUATE THE PERFORMANCE OF DIRECTOR COMMITTEES, INDIVIDUAL DIRECTORS AND BOARD OF DIRECTORS PERFORMANCE AS A WHOLE; (7) SELECT AND EVALUATE THE PRESIDENT AND CHIEF EXECUTIVE OFFICER; (8) APPROVE MEDICAL STAFF APPOINTMENTS AND PRIVILEGES: (9) MAINTAIN AUTHORITY FOR THE OVERALL FUNCTIONING AND SUPPORT OF A HOSPITAL-WIDEQUALITY ASSURANCE PROGRAM; AND (10) PARTICIPATE IN AND PROVIDE LEADERSHIP FOR HOSPITAL FUND-RAISING PROGRAMS. THE CORPORATE POWERS, PROPERTY, AND AFFAIRS OF CHMCA SHALL BE EXERCISED, CONDUCTED, AND CONTROLLED BY THE DIRECTORS. THE EXECUTIVE COMMITTEE MEMBERSHIP IS DELINEATED IN THE CODE OF REGULATIONS.
FORM 990, PART VI, SECTION A, LINE 7B	SUBJECT TO THE DIRECTION AND CONTROL OF THE DIRECTORS, OR THE EXECUTIVE COMMITTEE OF THE BOARD, THE MANAGEMENT OF THE HOSPITAL SHALL BE VESTED IN THE PRESIDENT AND CHIEF EXECUTIVE OFFICER. THE CHIEF EXECUTIVE OFFICER SHALL, IN ALL MATTERS PERTAINING TO HOSPITAL ADMINISTRATION, REPRESENT THE BOARD OF DIRECTORS AND SHALL BE RESPONSIBLE TO THEM RESPECTIVELY FOR THE PROPER PERFORMANCE OF DUTIES. IT SHALL BE THE DUTY OF THE CHIEF EXECUTIVE OFFICER TO MAKE KNOWN AND ENFORCE ALL RULES AND REGULATIONS WHICH SHALL BE MADE BY AND UNDER THE AUTHORITY OF THE DIRECTORS OR THE EXECUTIVE COMMITTEE OF THE BOARD. IN ALL CASES OF DISPUTED AUTHORITY OR UNCERTAINTY AS TO THE MEANING OF THE REGULATIONS, THE DECISION OF THE CHIEF EXECUTIVE OFFICER IS ABSOLUTE UNTIL A RULING IS RENDERED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 IS PROVIDED TO THE AUDIT COMMITTEE AND CHAIRMAN OF THE BOARD OF DIRECTORS OF CHMCA FOR REVIEW AND DISCUSSION PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE. THE AUDIT COMMITTEE IS A COMMITTEE OF THE BOARD OF DIRECTORS AND EMPOWERED TO COMPLETE THE REVIEW ON BEHALF OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12C	IT IS CHMCA'S POLICY THAT ALL EMPLOYEES, BOARD MEMBERS, AND OFFICERS DISCLOSE REAL AND APPARENT CONFLICTS OF INTEREST AS A CONDITION OF EMPLOYMENT WITH CHMCA. CHMCA ALSO REQUIRES THAT EACH EMPLOYEE, BOARD MEMBER, AND OFFICER DISCLOSE IN WRITING, ANNUALLY, A LIST OF ALL BUSINESSES OR OTHER ORGANIZATIONSIN WHICH HE/SHE (OR AN IMMEDIATE FAMILY MEMBER) IS AN OFFICER, MEMBER, OWNER, SHAREHOLDER, TRUSTEE OR EMPLOYEE FOR WHICH HE/SHE ACTS AS AN AGENT OR MIGHT REASONABLY IN THE FUTURE ENTER INTO A RELATIONSHIP OR TRANSACTION IN WHICH THE EMPLOYEE COULD HAVE A DUALITY OF INTEREST. IF A SITUATION ARISES IN WHICH THERE IS A DUALITY OF INTEREST, OR A QUESTION OF DUALITY OF INTEREST, AND, AS SUCH, POTENTIAL FOR A CONFLICT OF INTEREST, IT IS THE PRIMARY RESPONSIBILITYOF THE INDIVIDUAL DIRECTLY INVOLVED AND RESPONSIBILITY OF OTHER PERSONNEL, TO THE EXTENT THAT THEY BECOME AWARE OF A DUALITY OF INTEREST, TO MAKE IMMEDIATE AND COMPLETE DISCLOSURE TO THE APPROPRIATE VICE PRESIDENT. HE/SHE WILL REVIEW THE SITUATION WITH THE CHIEF HUMAN RESOURCES OFFICER WHO WILL PRESENT IT TO THE PRESIDENT & CEO OR THEIR DESIGNEE. IT IS THE RESPONSIBILITYOF THE PRESIDENT & CEO OR THE DESIGNEE TO EVALUATE ANY CIRCUMSTANCES IN WHICH A DUALITY OF INTEREST EXISTS, (IF KNOWN, WHEN DISCLOSED OR UNDISCLOSED), TO DETERMINE WHETHER SUCH CONFLICT IS SO SUBSTANTIAL THAT IT IS DEEMED TO BE DETRIMENTAL TO CHMCA. ANY EMPLOYEE WHO IS DIRECTLY OR INDIRECTLY INVOLVED IN A SITUATION WHICH REPRESENTS A DUALITY OF INTEREST, AND AS SUCH, A POTENTIAL CONFLICT OF INTEREST, WILL ABIDE BY THE FOLLOWING POLICIES: (1) INDIVIDUAL WILL NOT BE PERMITTED ACCESS TO ANY INFORMATION WHICH MAY PROVIDE AN UNFAIR ADVANTAGE TO THAT INDIVIDUAL OR THE FIRM HE/SHE REPRESENTS. (2) INDIVIDUAL WILL BE REQUIRED TO WITHDRAW FROM ANY MEETING IN WHICH THE MATTER IS DISCUSSED. (3) INDIVIDUAL WILL NOT BE PERMITTED TO PARTICIPATE IN DELIBERATION OR VOTE ON THE MATTER AND WILL BE REQUIRED TO LEAVE THE ROOM DURING VOTING. (4) ANY EMPLOYEE IS EXPRESSLY PROHIBITED FROM RELEASING ANY "SENSITIVE INFORMATION"REGARDING A DECISION MADE OR BEING CONSIDERED TO ANY PERSON WHO MAY HAVE A DUALITY OF INTEREST, AND AS SUCH, A POTENTIAL CONFLICT OF INTEREST. (5) ANY ATTEMPT ON THE PART OF AN EMPLOYEE TO UNFAIRLY INFLUENCE OR IMPACT THE DECISION-MAKING PROCESS IN FAVOR OF PERSONAL INTEREST MAY BE CONSIDERED BREACH OF TRUST AND MAY BE CAUSE FOR REMOVAL FROM HIS/HER POSITION OF RESPONSIBILITYOR OTHER DISCIPLINARY ACTION UP TO AND INCLUDING DISCHARGE.
FORM 990, PART VI, SECTION B, LINE 15	CHMCA'S EXECUTIVE TOTAL COMPENSATION PROGRAM IS GOVERNED BY THE COMPENSATION COMMITTEE (COMMITTEE) OF THE BOARD OF DIRECTORS. KEY COMMITTEE RESPONSIBILITIES INCLUDE: (A) ENSURE EXECUTIVE TOTAL COMPENSATION IS APPROPRIATE IN LIGHT OF CHMCA'S MISSION AND VALUES, AND (B) APPROVE AN EXECUTIVE COMPENSATION PHILOSOPHY, THE ASSOCIATED PROGRAMS, AND ALL COMPENSATION ACTIONS FOR INDIVIDUAL EXECUTIVES. THE COMMITTEE IS COMPRISED OF INDEPENDENT MEMBERS OF CHMCA'S BOARD WHO HAVE NO PERSONAL INTEREST IN ANY EXECUTIVE COMPENSATION TRANSACTION. SHOULD A POTENTIAL CONFLICT OF INTEREST BE IDENTIFIED, THE COMMITTEE DETERMINES THE EXTENT OF THE CONFLICT AND THE MEANS TO ADDRESS IT. IN CERTAIN CASES, A COMMITTEE MEMBER MAY BE ASKED NOT TO PARTICIPATE IN DISCUSSIONS OF, OR VOTE ON, A PARTICULAR COMPENSATION TRANSACTION. THE COMMITTEE FOLLOWS ALL STEPS REQUIRED BY THE INTERNAL REVENUE SERVICE TO QUALIFY FOR THE SAFE HARBOR UNDER THE INTERMEDIATE SANCTIONS REGULATIONS. THE COMMITTEE REVIEWS MARKET COMPENSATION DATA FOR COMPARABLE POSITIONS AT SIMILAR ORGANIZATIONS WHICH ARE COMPILED BY AN INDEPENDENT CONSULTANT. THE COMMITTEE USES THE DATA TO MAKE EXECUTIVE DECISIONS AND DOCUMENTS ITS COMPENSATION DELIBERATIONS AND DECISIONS IN A TIMELY MANNER. AN INDEPENDENT SALARY SURVEY WAS COMPLETED IN 2021 AND RECOMMENDATIONS WERE PROVIDED AND PRESENTED BY THE INDEPENDENT CONSULTANT TO THE COMMITTEE FOR APPROVAL.
FORM 990, PART VI, SECTION C, LINE 19	CHMCA MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, CERTAIN GOVERNING DOCUMENTS ARE LOCATED ON THE OHIO SECRETARY OF STATE'S WEBSITE. THE FINANCIAL STATEMENTS ARE ALSO DISCLOSED ON THE EMMA (ELECTRONIC MUNICIPAL MARKET ACCESS) WEBSITE.
FORM 990, PART XI, LINE 9:	INVESTMENT IN FOUNDATION 28,458,395. OTHER CHANGES IN NET ASSETS 101,130. CHANGE IN PENSION PLAN REQUIREMENTS 15,348,122. CHANGE IN POSTRETIEMENT REQUIREMENTS -538,416.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

CHILDREN'S HOSPITAL MEDICAL CENTER OF
AKRON

Employer identification number

34-0714357

Part I

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

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

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)AKRON CHILDREN'S HOSPITAL FOUNDATION ONE PERKINS SQUARE AKRON,OH44308 23-7114013	FOUNDATION	OH	501(C)(3)	LINE 7	CHMCA	Yes
(2)CHILDREN'S HOME CARE GROUP ONE PERKINS SQUARE AKRON,OH44308 34-1575266	HOME CARE	OH	501(C)(3)	LINE 12A, I	CHMCA	Yes
(3)CHILD DIMENSIONS INSURANCE COMPANY ONE PERKINS SQUARE AKRON,OH44308 03-0317160	INSURANCE	VT	501(C)(3)	LINE 12A, I	CHMCA	Yes
(4)AKRON CHILDREN'S HEALTH COLLABORATIVE ONE PERKINS SQUARE AKRON,OH44308 87-0853487	ACCOUNTABLE CARE ORGANIZATION	OH	501(C)(4)	LINE 12A, I	CHMCA	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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	(k) Percentage ownership

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No

Schedule R (Form 990) 2021

Page 3

Part V

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

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

Yes

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

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

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

Yes

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

Yes

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

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

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

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

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

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

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

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

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

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

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

Yes

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

Yes

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

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

Yes

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

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

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CHILDRENS HOME CARE GROUP	O	4,948,706	ACTUAL PER GL
(2) CHILDRENS HOME CARE GROUP	Q	4,215,058	ACTUAL PER GL
(3) AKRONS CHILDRENS HOSPITAL FOUNDATION	Q	1,332,917	ACTUAL PER GL
(4) AKRONS CHILDRENS HOSPITAL FOUNDATION	C	11,172,177	ACTUAL PER GL
(5) AKRONS CHILDRENS HOSPITAL FOUNDATION	O	3,552,365	ACTUAL PER GL
(6) AKRONS CHILDRENS HOSPITAL FOUNDATION	B	241,450	ACTUAL PER GL

Schedule R (Form 990) 2021

Page 4

Part VI

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

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

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON ("CHMCA") IS DEDICATED TO IMPROVING THE HEALTH OF CHILDREN THROUGH QUALITY PATIENT CARE, RESEARCH & EDUCATION, COMMUNITY SERVICE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	33
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	27
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	7,201
6	Total number of volunteers (estimate if necessary) .............	6	808
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	356,297
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	11,408,657	16,021,034
9	Program service revenue (Part VIII, line 2g) .........	954,919,273	1,123,755,021
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	23,075,485	39,875,247
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	5,448,773	6,715,151
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	994,852,188	1,186,366,453
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	579,246	3,064,040
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)	600,089,599	642,828,864
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	324,947,708	376,634,243
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	925,616,553	1,022,527,147
19	Revenue less expenses. Subtract line 18 from line 12.......	69,235,635	163,839,306
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,822,056,911	2,008,652,850
21	Total liabilities (Part X, line 26).............	576,895,825	564,707,101
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,245,161,086	1,443,945,749

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	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 820,555,461 including grants of $ 3,064,040 ) (Revenue $ 1,123,755,021 )
	CHMCA IS THE LARGEST PEDIATRIC HEALTHCARE SYSTEM IN NORTHEAST OHIO, OPERATING 2 CHILDREN'S HOSPITALS IN NORTHEAST OHIO, INCLUDING INPATIENT AND OUTPATIENT SERVICES, 2 EMERGENCY DEPARTMENTS, 4 URGENT CARES, 35 PEDIATRICIAN OFFICES, AND MORE THAN 60 PRIMARY & SPECIALTY LOCATIONS. DURING 2021, CHMCA SERVED OVER 1,268,000 PATIENTS THROUGH ALL OF ITS PROGRAMS.INPATIENT SERVICES INCLUDE AREAS OF ROUTINE CARE, NEONATAL INTENSIVE CARE, PEDIATRIC INTENSIVE CARE, BEHAVIORAL HEALTH, REGIONAL BURN CENTER, HEMATOLOGY/ONCOLOGY, AND EMERGENCY/TRAUMA SERVICES. OUTPATIENT SERVICES OFFERS UNIQUE SERVICES IN A BROAD RANGE OF PEDIATRIC SUBSPECIALTIES SUCH AS REHABILITATION SERVICES, CARDIOLOGY, PLASTIC SURGERY, GENETICS, MATERNAL FETAL MEDICINE, URGENT AND QUICK CARE, ADOLESCENT MEDICINE, PALLIATIVE CARE, PULMONARY MEDICINE, UROLOGY, OPHTHALMOLOGY, ORTHOPEDICS, NEUROLOGY, ALLERGY, DENTAL, ADDICTION SERVICES, PHYSICAL AND OCCUPATIONAL THERAPY, AND INFECTIOUS SERVICES.

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 expenses820,555,461

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	15,028,637	0	1,540,136

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	461,311
d	Related organizations		1d	11,428,520
e	Government grants (contributions)		1e	2,773,577

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,357,626

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		16,021,034

		Business Code
2a	NET PATIENT SERVICE REVENUE	621110	1,016,705,984	1,016,705,984
b	OTHER PROGRAM SERVICE REVENUE	621110	107,049,037	107,049,037
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		1,123,755,021

3 Investment income (including dividends, interest, and othersimilar amounts) ......			18,016,088		1,730	18,014,358
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	164,000	533,338,679	7a
b	Less: cost or other basis and sales expenses	37,900	511,605,620	7b
c	Gain or (loss)	126,100	21,733,059	7c
d	Net gain or (loss).........			21,859,159			21,859,159
8a	Gross income from fundraising events (not including $ 461,311of contributions reported on line 1c). See Part IV, line 18 ....
			8a	125,417
b	Less: direct expenses ...		8b	324,859
c	Net income or (loss) from fundraising events..			-199,442			-199,442
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	CAFETERIA		722514	4,466,910			4,466,910
b	PARKING DECK		812930	1,165,548			1,165,548
c	GIFT SHOP		621400	927,568			927,568
d	All other revenue ....			354,567		354,567
e	Total. Add lines 11a–11d ......			6,914,593
12	Total revenue. See instructions.....			1,186,366,453	1,123,755,021	356,297	46,234,101

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	2,696,120	2,696,120
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	367,920	367,920
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	5,155,515		5,155,515
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	504,145,573	429,600,581	74,544,992
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	22,679,340	19,495,825	3,183,515
9	Other employee benefits .......	79,348,855	66,672,573	12,676,282
10	Payroll taxes ...........	31,499,581	26,225,044	5,274,537
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	575,454		575,454
c	Accounting ...........	487,911	30,881	457,030
d	Lobbying ...........	212,646		212,646
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	855,652		855,652
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	62,642,017	42,773,796	19,868,221
12	Advertising and promotion ....	9,745,209	116,402	9,628,807
13	Office expenses .......	9,814,600	8,086,708	1,727,892
14	Information technology ......	6,859,191		6,859,191
15	Royalties ..
16	Occupancy ...........	8,090,793	8,502,388	-411,595
17	Travel ............	1,815,469	1,377,149	438,320
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	10,913,749	2,726,215	8,187,534
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	68,673,706	35,605,753	33,067,953
23	Insurance ...	7,666,636	5,147,366	2,519,270
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/SURGICAL SUPPLI	99,576,587	98,790,352	786,235
b	PROVISION FOR FRANCHISE	29,742,196	29,742,196
c	EQUIPMENT RENTAL/MAINTE	24,444,254	16,663,670	7,780,584
d	PROVISION FOR BAD DEBT	17,214,790	17,214,790
e	All other expenses	17,303,383	8,719,732	8,583,651
25	Total functional expenses. Add lines 1 through 24e	1,022,527,147	820,555,461	201,971,686	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			19,410	1	17,632
2	Savings and temporary cash investments .........			145,837,834	2	167,338,564
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			125,237,014	4	164,695,454
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........			9,276,724	7	32,031,800
8	Inventories for sale or use ............			13,567,008	8	13,042,057
9	Prepaid expenses and deferred charges ......			10,416,726	9	10,147,610
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,381,998,820
b	Less: accumulated depreciation	10b	762,757,769	610,272,233	10c	619,241,051
11	Investments—publicly traded securities .			668,296,873	11	709,042,037
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			3,676,616	13	21,719,788
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			235,456,473	15	271,376,857
16	Total assets. Add lines 1 through 15 (must equal line 33)...			1,822,056,911	16	2,008,652,850

17	Accounts payable and accrued expenses .....	141,426,370	17	146,980,967
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	191,982,733	20	188,447,856
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..	99,642,537	24	80,963,920
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	143,844,185	25	148,314,358
26	Total liabilities. Add lines 17 through 25..	576,895,825	26	564,707,101

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	1,132,733,778	27	1,320,265,716
28	Net assets with donor restrictions ...........	112,427,308	28	123,680,033
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	1,245,161,086	32	1,443,945,749
33	Total liabilities and net assets/fund balances ........	1,822,056,911	33	2,008,652,850