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)
(1) JAMES D DAHLING...................................................................... PRESIDENT/DIRECTOR	1.00 ................. 42.00	X	X	1,156,661	45,921
(2) ROBERT OBERMEYER MD...................................................................... DIRECTOR	1.00 ................. 41.00	X		650,822	39,423
(3) AKHIL JAIN...................................................................... CHAIRMAN/DIRECTOR	2.00 ................. 2.00	X	X	0	0
(4) EDWARD WHITMORE...................................................................... TREASURER/DIRECTOR	2.00 ................. 2.00	X	X	0	0
(5) ELLY BRADSHAW SMITH...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(6) JOHN R LAWSON II...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(7) JULIA CHILDRESS BECK...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(8) KATHRYN M VAN BUREN...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(9) KIM GEORGES...................................................................... SECRETARY/DIRECTOR	2.00 ................. 2.00	X	X	0	0
(10) MARTA SATIN-SMITH...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(11) MARTHA COLEN...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(12) MILES LEON...................................................................... DIRECTOR	1.00 ................. 1.00	X	X	0	0
(13) R JUSTIN FULTON...................................................................... VICE CHAIRMAN/DIRECTOR	2.00 ................. 2.00	X	X	0	0
(14) SVINDER S TOOR MD...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(15) KIERAN POULOS...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(16) STACEY VELLINES...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0
(17) OWEN GRIFFEN...................................................................... DIRECTOR	1.00 ................. 1.00	X		0	0

(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
(18) KEVIN MURPHY........................................................................ DIRECTOR	1.00 .......................1.00	X				0	0	0
(19) SCOTT NOTTINGHAM MD........................................................................ DIRECTOR	1.00 .......................41.00	X				0	340,274	40,423
(20) BRIAN SKINNER........................................................................ DIRECTOR	1.00 .......................1.00	X				0	0	0
(21) DENNIS RYAN........................................................................ CFO & ASSISTANT SECRETARY/TREASURER	1.00 .......................42.00		X			0	2,165,943	88,462
(22) KATHRYN ABSHIRE........................................................................ VP - FINANCE & ASST. SECR/TREAS.	1.00 .......................41.00		X			0	318,815	184,096
(23) DEBORAH BARNES........................................................................ VP - IS OPERATIONS	0.00 .......................40.00			X		0	787,512	428,062
(24) KAREN MITCHELL........................................................................ VP - PATIENT CARE SERVICES	40.00 .......................0.00			X		500,080	0	27,761
(25) JOHN HARDING........................................................................ CHIEF OPERATING OFFICER	0.00 .......................40.00			X		0	809,035	431,478
(26) ALLISON SILVA........................................................................ VP - ANCILLARY SERVICES	40.00 .......................0.00			X		435,420	0	185,834
(27) JALANA MCCASLAND........................................................................ VP - PHYSICIAN PRACTICE MGMT	40.00 .......................0.00			X		378,572	0	192,397
(28) TAMIKA HARRIS........................................................................ VP - FACILITIES & SUPPORT SERV	40.00 .......................0.00			X		273,907	0	97,429
(29) SANDIP GODAMBE MD........................................................................ VP - QUALITY & PATIENT SAFETY	40.00 .......................0.00				X	465,499	0	282,970
(30) SUZANNE BRIXEY........................................................................ PHYSICIAN	40.00 .......................0.00				X	330,151	0	14,838
(31) JOHN WARBURTON........................................................................ VP - MENTAL HEALTH	40.00 .......................0.00				X	329,131	0	85,353
(32) MICHELLE CLAYTON........................................................................ MEDICAL DIRECTOR CHILD ADVOCACY	40.00 .......................0.00				X	217,185	0	34,344
(33) JOHN HARRINGTON........................................................................ VP - QUALITY/SAFETY & CLINICAL INTG.	20.00 .......................20.00				X	140,658	218,505	98,793

(A) Name and business address	(B) Description of services	(C) Compensation
W M JORDAN 11010 JEFFERSON AVE NEWPORT NEWS,VA23601	CONSTRUCTION	76,562,420
CHILDREN'S SPECIALTY GROUP PO BOX 11049 NORFOLK,VA23517	MEDICAL	33,178,241
EASTERN VIRGINIA MED SCHOOL PO BOX 1980 NORFOLK,VA235011980	MEDICAL	13,226,062
THE WHITING-TURNER CONTRACTING COMPANY 300 E JOPPA ROAD BALTIMORE,MD212863048	CONSTRUCTION	9,160,733
COMPASS ONE PO BOX 1022289 ATLANTA,GA30368	FOOD SERVICES	8,747,211
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 128

- 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.
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 OF THE KING'S
DAUGHTERS

Employer identification number

54-0506321

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.") ..	15,064,465	15,669,332	46,947,279	99,087,320	88,572,506	265,340,902
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	15,064,465	15,669,332	46,947,279	99,087,320	88,572,506	265,340,902
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.						265,340,902

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..	15,064,465	15,669,332	46,947,279	99,087,320	88,572,506	265,340,902
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...	8,097,824	10,139,234	10,070,432	7,246,160	9,745,593	45,299,243
9	Net income from unrelated business activities, whether or not the business is regularly carried on..	363,689	349,255	397,998	392,485	495,419	1,998,846
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						312,638,991

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

2,332,561,540

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)) .........

84.870 %

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

80.830 %

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 OF THE KING'S
DAUGHTERS

Employer identification number

54-0506321

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 OF THE KING'S DAUGHTERS

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 OF THE KING'S DAUGHTERS		Employer identification number 54-0506321

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 OF THE KING'S DAUGHTERS			Employer identification number 54-0506321
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 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 OF THE KING'S
DAUGHTERS

Employer identification number

54-0506321

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 ....	29,093,174	25,741,292	25,731,316	25,265,775	25,040,857
b	Contributions ...	600,675	482,624	322,831	546,670	359,017
c	Net investment earnings, gains, and losses	-2,262,495	3,489,607	754,876	1,056,618	992,800
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	1,260,810	620,349	1,067,731	1,137,747	1,126,899
f	Administrative expenses ....
g	End of year balance ......	26,170,544	29,093,174	25,741,292	25,731,316	25,265,775

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

100.000 %

Term endowment SchDMd Bullet

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

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

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

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

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 .....	18,417,162		18,417,162
b	Buildings ....	510,799,937	146,238,169	364,561,768
c	Leasehold improvements	15,981,432	8,231,155	7,750,277
d	Equipment ....	247,018,486	193,972,423	53,046,063
e	Other .....	31,464,206	273,714	31,190,492
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				474,965,762

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

Part X

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

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	19,327,475
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 ARE USED ACCORDING TO SPECIFIC WRITTEN REQUESTS OF THE DONOR ENDOWMENT AGREEMENT. IF NO DIRECT REQUESTS ARE MADE, FUNDS ARE USED IN ACCORDANCE WITH THE OVERALL MISSION OF THE ORGANIZATION.

PART X, LINE 2:

ASC 740 FOOTNOTE FROM CONSOLIDATED AUDIT REPORT CHS RECOGNIZES ANY BENEFITS FROM AN UNCERTAINTY IN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. IF APPLICABLE, THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION WOULD BE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE RESOLUTION. CHS DOES NOT BELIEVE ITS CONSOLIDATED FINANCIAL STATEMENTS INCLUDE ANY UNCERTAIN TAX POSITIONS.

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 OF THE KING'S
DAUGHTERS

Employer identification number

54-0506321

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)		(ii) Activity	(iii) Did fundraiser have custody or control of contributions?		(iv) Gross receipts from activity	(v) Amount paid to (or retained by) fundraiser listed in col. (i)	(vi) Amount paid to (or retained by) organization
			Yes	No
	CHILDREN'S MIRACLE NETWORK 205 WEST 700 SOUTH SALT LAKE CITY, UT84101	CONSULTING		No	1,684,447	185,382	1,499,065
	HEALTH GIVING 3996 N HAMPTON DRIVE POWELL, OH43065	CONSULTING		No	0	38,077	-38,077








Total . . . . . . . . . . . . . . . . . . . .					1,684,447	223,459	1,460,988

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.

AL, AR, CA, CO, CT, DC, FL, GA, HI, IL, KS, KY, LA, ME, MD, MA, MI, MN, MO, NV, NJ, NY, NC, OH, OK, PA, RI, SC, TN, UT, VA, WA, WV, WI

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 (event type)	(b) Event #2 (event type)	(c) Other events (total number)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .
2	Less: Contributions . . . .
3	Gross income (line 1 minus line 2) . . . . . .

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

Part III

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

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

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

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 OF THE KING'S
DAUGHTERS

Employer identification number

54-0506321

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 17500.0000000000 %

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) . . .	2,206,820		2,206,820	0.430 %
b	Medicaid (from Worksheet 3, column a) . . . . .	250,183,656	219,663,543	30,520,113	5.900 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	252,390,476	219,663,543	32,726,933	6.330 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	79,493,741	11,031,489	68,462,252	13.230 %
f	Health professions education (from Worksheet 5) . . .	14,194,795	7,358,520	6,836,275	1.320 %
g	Subsidized health services (from Worksheet 6) . . . .	57,415,915	33,778,800	23,637,115	4.570 %
h	Research (from Worksheet 7) .	396,249	10,500	385,749	0.070 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .
j	Total. Other Benefits . .	151,500,700	52,179,309	99,321,391	19.190 %
k	Total. Add lines 7d and 7j .	403,891,176	271,842,852	132,048,324	25.520 %

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.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

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. ......

16,067,789

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. ......

5,693,613

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).....

2,614,696

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

7,032,534

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

-4,417,838

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?3Name, 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)								Other (describe)	Facility reporting group
1	CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS 601 CHILDRENS LANE NORFOLK,VA23507 H1843	X	X	X	X	X	X	MEDICAID DSH HOSPITAL	A
2	CHKD HEALTH AND SURGERY CENTER 2021 CONCERT DRIVE VIRGINIA BEACH,VA23456 OH713	X						OUTPATIENT SURGICAL HOSPITAL	A
3	CHKD HEALTH AND SURGERY CENTER 11783 ROCK LANDING DRIVE NEWPORT NEWS,VA23608 OH694	X						OUTPATIENT SURGICAL HOSPITAL	A

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 REPORTING GROUP - A
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 21

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

Yes

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): WWW.CHKD.ORG

Other website (list url):

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

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 22

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

Yes

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

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

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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

12a

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

12b

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

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	FACILITY REPORTING GROUP - A
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 175.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

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):

WWW.CHKD.ORG

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

WWW.CHKD.ORG

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

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

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

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

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 REPORTING GROUP - A
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 REPORTING GROUP - A
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 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
PART V, SECTION B	FACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF:	- FACILITY 1: CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, - FACILITY 2: CHKD HEALTH AND SURGERY CENTER, - FACILITY 3: CHKD HEALTH AND SURGERY CENTER
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:	CHKD'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS INCLUDED COLLECTING DATA FROM SEVERAL DIFFERENT SOURCES: A COMMUNITY HEALTH SURVEY (IN COLLABORATION WITH OTHER AREA HOSPITAL SYSTEMS), FOCUS GROUPS AND KEY STAKEHOLDER INTERVIEWS AND HEALTH INDICATOR ANALYSIS.TWO VERSIONS OF THE SURVEY WITH SIMILAR QUESTIONS WERE CIRCULATED ACROSS CHKD'S SERVICE AREA. THE FIRST VERSION WAS A STAKEHOLDER SURVEY IN WHICH MANY PARTICIPANTS PROVIDED (OR HAD KNOWLEDGE OF) HEALTH, PREVENTIVE AND SUPPORT SERVICES, AS WELL AS THE NEEDS OF LOW INCOME AND MINORITY RESIDENTS. THE SECOND VERSION WAS A COMMUNITY SURVEY THAT WAS CIRCULATED MORE BROADLY TO COMMUNITY MEMBERS. THERE WERE A TOTAL OF 11,744 COMMUNITY MEMBERS WHO COMPLETED THE SURVEY QUESTIONS. THERE WERE 1,099 RESPONSES TO THE STAKEHOLDER SURVEY.GIVEN THE PREVIOUSLY IDENTIFIED PRIORITY OF MENTAL AND BEHAVIORAL HEALTH AND AN INTEREST IN HEARING FROM STAKEHOLDERS FROM ACROSS THE REGION WHO WERE FAMILIAR WITH THESE ISSUES, KEY STAKEHOLDER INTERVIEWS AND FOCUS GROUPS WERE CONDUCTED. A TOTAL OF 51 PEOPLE PARTICIPATED IN KEY STAKEHOLDER INTERVIEWS AND FOCUS GROUPS. THERE WERE 4 FOCUS GROUPS CONDUCTED BY VOICES (VIRGINIA ORGANIZATION FOR INCLUSIVE CONCEPTS AND EQUITABLE SOLUTIONS), A THINK TANK THAT FOCUSES ON PROVIDING BEST PRACTICE AND GUIDANCE ON FAIR AND EQUAL TREATMENT, SYSTEMIC AND INSTITUTIONAL RACISM, SOCIO-ECONOMIC ISSUES, AND SOCIAL DETERMINANTS OF HEALTH THAT CREATE IMPEDIMENTS FOR MARGINALIZED AND UNDERSERVED PEOPLE. TWENTY-FOUR PARTICIPANTS FROM ACROSS THE REGION TOOK PART IN THE GROUP DISCUSSIONS ON THE FOLLOWING TOPICS: (1) A HEALTHY WORKPLACE, (2) ACCESS TO HEALTHCARE, (3) ACCESS TO FOOD, (4) EMERGENCIES AND FINANCES.THE 27 KEY STAKEHOLDER INTERVIEWS TARGETED LOCAL PUBLIC HEALTH AND SOCIAL SERVICE DEPARTMENT REPRESENTATIVES, INDIVIDUALS OR ORGANIZATIONS SERVING MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS IN THE COMMUNITY, SCHOOL NURSES FROM LOCAL SCHOOL SYSTEMS PARTICULARLY IN RURAL AND PREDOMINANTLY LOW INCOME AREAS, AND HEALTHCARE AND MENTAL/BEHAVIORAL HEALTHCARE PROVIDERS WHO OFFER SERVICES FOR CHILDREN AND FAMILIES. ORGANIZATIONAL PARTICIPANTS INCLUDED HOSPITALS, COMMUNITY HEALTH CENTERS, SCHOOL SYSTEMS, SOCIAL SERVICES, NON-PROFIT AND OTHER COMMUNITY-BASED ORGANIZATIONS.NATIONAL, STATE AND PRIVATE DATA SOURCES WERE USED IN THE HEALTH INDICATOR ANALYSIS. KEY HEALTH ISSUES WERE IDENTIFIED WHEN MULTIPLE LOCALITIES HAD WORSE RATES OR PERCENTAGES IN COMPARISON TO STATE AVERAGES.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A:	A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED FOR CHKD'S THREE LICENSED FACILITIES LISTED IN PART V, SECTION A.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11:	AFTER COMPILING ALL OF THE RESULTS FROM THE STAKEHOLDER AND COMMUNITY SURVEYS, FOCUS GROUPS, KEY STAKEHOLDER INTERVIEWS AND HEALTH INDICATOR ANALYSIS, COMMON THEMES AND SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED ACROSS DATA SOURCES. THESE THEMES EITHER AROSE AS PRIORITIES IN AT LEAST TWO OF THE DATA SOURCES OR IF DATA FROM ONE OF THE SOURCES REVEALED OVERWHELMING NEED. THE FOLLOWING SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED: MENTAL/BEHAVIORAL HEALTH, HEALTHY EATING AND ACCESS TO HEALTHY FOODS, ALCOHOL/SUBSTANCE ABUSE, SAFE AND AFFORDABLE HOUSING, PEDIATRIC ASTHMA, INFANT HEALTH, SEXUALLY TRANSMITTED INFECTIONS, AND CHILD ABUSE.CHKD LEADERS REVIEWED RESULTS FROM ALL THREE DATA SOURCES TO BETTER UNDERSTAND THE SIGNIFICANT HEALTH NEEDS AND PRIORITIES TO DETERMINE THE BEST FOCUS FOR ITS IMPLEMENTATION PLAN. INDIVIDUALS AND GROUPS INVOLVED IN THIS PROCESS INCLUDED THE FOLLOWING: THE HOSPITAL'S SENIOR LEADERSHIP TEAM, WHICH INCLUDES ITS CEO, PRESIDENT AND VICE PRESIDENTS; CHKD PHYSICIAN LEADERS; AND CHKD'S PARENT AND FAMILY ADVISORY COUNCIL.GIVEN THE SCOPE AND DEPTH OF THE NEED FOR MENTAL HEALTH CARE AND THE SIGNIFICANT RESOURCES CHKD HAS DEVOTED TO EXPANDING ITS MENTAL HEALTH SERVICES, CHKD IS PRIORITIZING THIS ISSUE IN ITS IMPLEMENTATION PLAN STRATEGY FROM 2022 TO 2024. SINCE THE 2019 CHNA, CHKD HAS MADE SIGNIFICANT PROGRESS TOWARD DEVELOPING A COORDINATED, REGIONAL CONTINUUM OF INPATIENT, OUTPATIENT AND DAY TREATMENT PROGRAMS FOR CHILDREN WITH MENTAL HEALTH CHALLENGES. ADDRESSING PEDIATRIC MENTAL/BEHAVIORAL HEALTH WOULD HAVE A POSITIVE EFFECT ON PEDIATRIC HEALTH AND WELL-BEING OVERALL, AFFECTING MULTIPLE OTHER IDENTIFIED HEALTH NEEDS, SUCH AS VIOLENCE AND ALCOHOL/SUBSTANCE ABUSE. CHKD WILL CONTINUE ITS COMMITMENT TO PREVIOUSLY IMPLEMENTED PROGRAMS INCLUDING ITS EXISTING CHILD ADVOCACY CENTER THAT ADDRESSES CHILD ABUSE.MENTAL/BEHAVIORAL HEALTH: CHKD OPENED CHKD'S CHILDREN PAVILION, A 60-BED PEDIATRIC MENTAL HEALTH HOSPITAL AND OUTPATIENT CENTER IN LATE 2022. THE NEW FACILITY WILL INCLUDE THOUGHTFUL PATIENT AND FAMILY-CENTERED DESIGN, EVIDENCE-BASED TREATMENTS, ACADEMIC TRAINING PROGRAMS, AND CLINICAL RESEARCH TO GUIDE INNOVATION. CHKD'S MENTAL HEALTH IMPLEMENTATION STRATEGY INCLUDES ESTABLISHING A PARTIAL HOSPITALIZATION PROGRAM THAT OFFERS FULL-DAY MENTAL HEALTH TREATMENT, OFFERING AND EXPANDING INTENSIVE OUTPATIENT PROGRAMMING, WORKING WITH OUR COMMUNITY TO ESTABLISH PARTNERSHIPS AND SUPPORT CHILDREN AND ADOLESCENTS IN THEIR TYPICAL ENVIRONMENTS, AND CONTINUING TO OFFER TELEHEALTH FOR OUTPATIENT CARE. CHKD HAS ESTABLISHED 2 OUTPATIENT MENTAL HEALTH FACILITIES FOCUSING ON MENTAL HEALTH THERAPY, PSYCHOLOGICAL ASSESSMENT, AND PSYCHIATRY SERVICES: NEWPORT NEWS HEALTH CENTER AT TECH CENTER AND VIRGINIA BEACH HEALTH CENTER AT LANDSTOWN. IN AN ANSWER TO THE PEDIATRIC MENTAL HEALTH CARE FRAGMENTATION DUE TO THE LACK OF COMMUNICATION BETWEEN A CHILD'S VARIOUS MEDICAL AND MENTAL HEALTH PROVIDERS, CHKD'S GOAL IS TO DEVELOP A COORDINATED CONTINUUM OF CARE ACROSS ITS FACILITIES. WITH ITS BROAD NETWORK OF MORE THAT 300 PEDIATRICIANS, SPECIALISTS, AND SURGEONS IN MORE THAN 40 LOCATIONS THROUGHOUT THE REGION, CHKD HEALTH SYSTEM IS IN A UNIQUE POSITION TO ADDRESS AND IMPROVE CARE FRAGMENTATION. CHKD IS THE REGION'S PARTNER FOR THE VIRGINIA MENTAL HEALTH ACCESS PROGRAM (VMAP), A STATEWIDE INITIATIVE THAT OFFERS PEDIATRICIANS REAL-TIME PHONE CONSULTATIONS WITH BOARD-CERTIFIED CHILD AND ADOLESCENT PSYCHIATRISTS. VMAP ALSO SERVES AS A RESOURCE FOR PEDIATRICIANS WHO ARE LOOKING FOR MENTAL HEALTH CARE AND BEHAVIORAL CONSULTATION FOR A CHILD IN THEIR CARE.CHKD PLANS TO CONTINUE TO COMMIT PROGRAMMING AND RESOURCES TO ITS ONGOING INITIATIVES TO ADDRESS OBESITY, CHILD ABUSE AND INFANT HEALTH. OTHER SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE CHNA ARE NOT BEING SPECIFICALLY ADDRESSED IN THE CURRENT IMPLEMENTATION ARE ALCOHOL/SUBSTANCE ABUSE, SAFE AND AFFORDABLE HOUSING, PEDIATRIC ASTHMA, AND SEXUALLY TRANSMITTED INFECTIONS, THESE ARE ALL CONDITIONS THAT CHKD EITHER CURRENTLY PROVIDES CARE FOR AND/OR COLLABORATES WITH OTHER COMMUNITY AGENCIES TO ADDRESS. CHKD REGULARLY AND ROUTINELY OFFERS ITS EXPERTISE AND ASSISTANCE AS WELL AS COMMUNITY RESOURCES TO ADDRESS A BROAD RANGE OF ISSUES RELATING TO THE HEALTH AND WELFARE OF CHILDREN.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13H:	PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE:1. STATE-FUNDED PRESCRIPTION PROGRAMS;2. HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC;3. PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);4. FOOD STAMP ELIGIBILITY;5. SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY;6. ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT AREUNFUNDED (E.G., MEDICAID SPEND-DOWN);7. LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; AND8. PATIENT IS DECEASED WITH NO KNOWN ESTATE.

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?15
Name and address		Type of Facility (describe)
1	1 - CHKD HEALTH CENTER AT OAKBROOKE 500 DISCOVERY DRIVE CHESAPEAKE,VA23320	OUTPATIENT SERVICES
2	2 - CHKD HLTH CTR & URGENT CARE AT LOEHMAN'S 3960 VIRGINIA BEACH BLVD VIRGINIA BEACH,VA23452	URGENT CARE & OUTPATIENT SERVICES
3	3 - CHKD HLTH CTR & URGENT CARE AT TECH CNTR 680 OYSTER POINT ROAD NEWPORT NEWS,VA23602	URGENT CARE & OUTPATIENT SERVICES
4	4 - CHKD URGENT CARE AT VOLVO 817 VOLVO PARKWAY CHESAPEAKE,VA23320	URGENT CARE & OUTPATIENT SERVICES
5	5 - HEALTH CENTER AT MEDICAL CENTER CAMPUS 850 SOUTHAMPTON AVENUE NORFOLK,VA23510	OUTPATIENT SERVICES
6	6 - CHKD HEALTH CENTER AT HARBOUR VIEW 5834 HARBOUR VIEW BLVD SUFFOLK,VA23435	OUTPATIENT SERVICES
7	7 - CHKD HLTH CTR & URGENT CARE AT LANDSTOWN 1924 LANDSTOWN WAY VIRGINIA BEACH,VA23456	URGENT CARE & OUTPATIENT SERVICES
8	8 - SATELLITE AT MEDICAL TOWER 400 GRESHAM DRIVE NORFOLK,VA23507	OUTPATIENT SERVICES
9	9 - CHKD HEALTH CENTER AT LIGHTFOOT 6425 RICHMOND ROAD WILLIAMSBURG,VA23188	OUTPATIENT SERVICES
10	10 - SPORTS MEDICINE IN GHENT 702 WEST 21ST STREET NORFOLK,VA23517	OUTPATIENT SERVICES
11	11 - CHKD CHILD ADVOCACY CENTER 935 REDGATE AVENUE NORFOLK,VA23507	OUTPATIENT SERVICES
12	12 - CHKD HEALTH CENTER AT KEMPSVILLE 171 KEMPSVILLE ROAD NORFOLK,VA23510	OUTPATIENT SERVICES
13	13 - CHKD AT BUTLER FARM ROAD 421 BUTLER FARM ROAD HAMPTON,VA23666	OUTPATIENT SERVICES
14	14 - FORT NORFOLK PLAZA MEDICAL BUILDING 301 RIVERVIEW AVENUE NORFOLK,VA23510	OUTPATIENT SERVICES
15	15 - HEALTH CENTER AT BURNETT'S WAY 152 BURNETTS WAY SUFFOLK,VA23456	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(E):	THE AMOUNT REPORTED ON PART I, LINE 7(E) INCLUDES $57,312,685 OF COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS.PART I, LINE 7(F):THE AMOUNT OF BAD DEBT INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) THAT WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENT OF TOTAL EXPENSE IN PART I, LINE 7, COLUMN (F) IS $16,067,789.
PART I, LINE 7:	A HYBRID APPROACH WAS USED FOR DETERMINING COSTS RELATED TO COMMUNITY BENEFIT. ACTUAL COSTS FROM ALL PATIENT SEGMENTS ARE IDENTIFIED BY DEPARTMENT IN THE GENERAL LEDGER AND THEN WERE GROUPED INTO LIKE COMMUNITY BENEFIT PROGRAMS. INDIRECT COSTS WERE ADJUSTED FOR COSTS ATTRIBUTABLE TO UNREIMBURSED MEDICAID COSTS REPORTED ELSEWHERE, MARKETING AND GRANT WRITING EXPENSES. THE MEDICAID COSTS ADJUSTMENT WAS CALCULATED USING A COST TO CHARGE RATIO OF APPLICABLE EXPENSES DIVIDED BY TOTAL APPLICABLE CHARGES APPLIED TO MEDICAID REVENUE. THE REMAINING INDIRECT COSTS WERE ALLOCATED PROPORTIONATELY TO THE DIRECT COSTS REPORTED BY DEPARTMENT. IN ADDITION, EXPENSES WERE CALCULATED AT COST AND THEN COSTS RELATED TO CHARITY CARE, BAD DEBT AND MEDICAID WERE REMOVED BEFORE ARRIVING AT THE AMOUNTS FOR COMMUNITY BENEFIT AT COST.
PART III, LINE 2:	BAD DEBT REPORTED IN PART III LINE 2 IS BASED ON THE AMOUNT REPORTED AS BAD DEBT IN THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. THE AMOUNT DOES NOT INCLUDE DISCOUNTS OR OTHER ADMINISTRATIVE WRITE OFFS. IF A PATIENT ACCOUNT HAS BEEN WRITTEN OFF TO BAD DEBT AND IS SUBSEQUENTLY COLLECTED, BAD DEBT EXPENSE IS REDUCED IN THAT PERIOD BY THE PAYMENT.PART III, LINE 3:THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS CALCULATED BASED OFF THE PERCENTAGE OF CHARITY CARE EXPENSES AS A PERCENTAGE OF SELF-PAY REVENUE. CHKD DOES NOT MAINTAIN RECORDS THAT TRACK PATIENTS WHO COULD HAVE QUALIFIED FOR CHARITY CARE. THIS AMOUNT IS AN ESTIMATE OF PATIENTS WHO LIKELY WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE CHARITY CARE POLICY IF SUFFICIENT INFORMATION HAD BEEN AVAILABLE TO DETERMINE THEIR ELIGIBILITY. THIS AMOUNT IS NOT INCLUDED AS COMMUNITY BENEFIT.
PART III, LINE 4:	CHKD PRESENTS BAD DEBT PROVISION ON THE FINANCIAL STATEMENTS AS A DEDUCTION FROM NET PATIENT SERVICE REVENUE PER ACCOUNTING STANDARDS UPDATE (ASU) 2011-07. THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES IS MANAGEMENT'S BEST ESTIMATE OF THE AMOUNT OF PROBABLE CREDIT LOSSES IN THE HOSPITAL'S EXISTING RECEIVABLES. THE HOSPITAL DETERMINES THE ALLOWANCE BASED ON HISTORICAL WRITE-OFF EXPERIENCE. ACCOUNT BALANCES ARE CHARGED OFF AGAINST THE ALLOWANCE, NET OF PAYMENTS AND DISCOUNTS, AFTER ALL MEANS OF COLLECTION HAVE BEEN EXHAUSTED AND THE POTENTIAL FOR THE RECOVERY IS CONSIDERED REMOTE. FOR ADDITIONAL DETAILS SEE FOOTNOTE 17 ON PAGE 32 OF AUDITED FINANCIAL STATEMENTS.PART III, LINE 8:AS A CHILDREN'S HOSPITAL, THE HOSPITAL HAS A SMALL POPULATION OF MEDICARE PATIENTS AND IS PAID LESS THAN COST DUE TO THE REIMBURSEMENT METHODOLOGY USED BY MEDICARE. THE SHORTFALL WAS CALCULATED USING THE HOSPITAL'S OVERALL COST TO CHARGE RATIO APPLIED TO MEDICARE GROSS CHARGES. THIS SHORTFALL IS NOT SEPARATELY INCLUDED AS A COMMUNITY BENEFIT AS 100% OF IT HAS ALREADY BEEN CAPTURED IN THE APPROPRIATE CATEGORY ON PART I, LINE 7.
PART III, LINE 9B:	ACCOUNTS WITH AN UNPAID BALANCE OR WITHOUT AN ESTABLISHED PAYMENT PLAN ARE REFERRED TO A COLLECTION AGENCY OR ATTORNEY FOR CONTINUED COLLECTION EFFORTS. CHKD MAKES REASONABLE EFFORTS TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE/CHARITY CARE BEFORE REFERRING TO A COLLECTION AGENCY OR AN ATTORNEY. REASONABLE EFFORT INCLUDES AND IS NOT LIMITED TO NOTIFICATION ABOUT THE FINANCIAL ASSISTANCE - CHARITY CARE/COLLECTION POLICY POSTED IN ADMISSIONS, EMERGENCY DEPARTMENT OR OTHER DESIGNATED AREAS. THE INFORMATION REGARDING THE POLICY IS INCLUDED IN THE ADMISSION PACKAGE AND ON THE PATIENT BILL. THE HEALTH BENEFITS ANALYST AND CUSTOMER SERVICE REPRESENTATIVE WHO MAY SPEAK WITH THE GUARANTOR BY PHONE PROVIDE THEM WITH FINANCIAL ASSISTANCE INCLUDING CHARITY CARE INFORMATION. THE FINANCIAL ASSISTANCE-CHARITY CARE/COLLECTION POLICY IS AVAILABLE UPON REQUEST AND VIA WWW.CHKD.ORG. CHKD ENSURES ALL COLLECTION PROTOCOLS ARE MET PRIOR TO REFERRAL TO COLLECTIONS AGENCY OR ATTORNEY. APPROVED CHARITY CARE AMOUNT WILL NOT BE SUBJECT TO COLLECTION ACTIVITIES. THE REMAINING BALANCE WILL BE SUBJECT TO CHKD'S STANDARD COLLECTION PROTOCOLS.PART VI, LINE 2:NEEDS ASSESSMENT:AS THE ONLY HEALTHCARE PROVIDER IN VIRGINIA DEVOTED EXCLUSIVELY TO THE NEEDS OF CHILDREN, CHKD ASSUMES THE RESPONSIBILITY OF LEADING THE REGION IN THE PROVISION OF PEDIATRIC CARE AND THE PROMOTION OF CHILDREN'S HEALTH AND IS TRUSTED THROUGHOUT ITS COMMUNITY TO ADDRESS ESTABLISHED AND EMERGENT PEDIATRIC NEEDS WHEREVER AND HOWEVER THEY ARE IDENTIFIED. CHKD USES A VARIETY OF METHODS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. NEEDS ARE IDENTIFIED THROUGH A FORMAL COMMUNITY HEALTH NEEDS ASSESSMENT, PARTNERSHIPS AND COLLABORATIONS WITH OTHER MEDICAL, NON PROFIT AND PUBLIC HEALTH AGENCIES AND ORGANIZATIONS AND THROUGH REGIONAL, STATE AND NATIONAL DATA. FROM NOVEMBER 2021 TO APRIL 2022, CHKD CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WITH SUPPORT FROM TOXCEL, LLC, A GAINESVILLE, VIRGINIA-BASED SCIENCE, ENGINEERING AND HEALTH RESEARCH AND CONSULTING FIRM. THIS JOINT CHNA COVERS ALL THREE LICENSED FACILITIES ASSOCIATED WITHIN THE CHKD HEALTH SYSTEM: CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS (CHKD) LOCATED IN NORFOLK AND CHKD'S TWO HEALTH AND SURGERY CENTERS, ONE AT OYSTER POINT IN NEWPORT NEWS AND ONE AT PRINCESS ANNE IN VIRGINIA BEACH. CHKD'S CHNA PROVIDES AN OVERVIEW OF THE PRIMARY AND SECONDARY DATA USED TO IDENTIFY KEY HEALTH ISSUES WITHIN THE CHKD COMMUNITY. IT COMBINES AND COMPARES RESULTS FROM THREE SOURCES: A COMMUNITY HEALTH SURVEY, FOCUS GROUPS, AND KEY STAKEHOLDER INTERVIEWS. CHKD'S CURRENT COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY CAN BE FOUND AT WWW.CHKD.ORG/COMMUNITYBENEFIT.PART VI, LINE 3:PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE:CHKD'S CHARITY CARE ELIGIBILITY CRITERIA AND PROCEDURES FOR APPLYING ARE PROVIDED TO ALL PATIENTS. CHARITY CARE INFORMATION IS INCLUDED IN EVERY INPATIENT ADMISSION PACKET AND DISTRIBUTED TO THE OUTPATIENT DURING THE OUTPATIENT REGISTRATION PROCESS. AN APPLICATION FOR CHARITY CARE, ALONG WITH A LETTER EXPLAINING THE PROCESS, IS SENT TO ANY PATIENT OR GUARANTOR WHO REQUESTS INFORMATION ON ANY PROGRAMS OR PROVISIONS THE HOSPITAL MAY HAVE TO HELP ASSIST PATIENTS OR GUARANTORS IN PAYING THEIR HOSPITAL BILL. THE CHARITY CARE POLICY AND APPLICATION ARE PROMINENTLY DISPLAYED ON THE MAIN "BILLING" PAGE OF THE HOSPITAL WEBSITE, JUST ONE CLICK FROM THE HOME PAGE, AT WWW.CHKD.ORG/BILLING/FINANCIAL-ASSISTANCE. PRINTED COPIES ARE ALSO AVAILABLE AT EACH REGISTRATION WORKSTATION. ALL BILLING STATEMENTS MAILED TO GUARANTORS INCLUDE A NOTICE OF THE AVAILABILITY OF CHARITY AND HOW TO OBTAIN THE INFORMATION/APPLICATION. ASSISTANCE WITH THE APPLICATION PROCESS IS AVAILABLE THROUGH THE HEALTH BENEFITS ANALYST (HBA). THE HBA SENDS OUT APPLICATIONS VIA MAIL AND REFERS FAMILIES TO THE HOSPITAL'S WEBSITE. THE UNIT SOCIAL WORKER IS AVAILABLE TO PROVIDE INFORMATION OR REFERRAL TO THE HBA DURING AN INPATIENT STAY.PART VI, LINE 4:COMMUNITY INFORMATION:CHKD IS THE REGIONAL PEDIATRIC REFERRAL CENTER FOR SOUTHEASTERN VIRGINIA, THE EASTERN SHORE OF VIRGINIA AND NORTHEASTERN NORTH CAROLINA. CHKD SERVES THE FOLLOWING REGIONS IN VIRGINIA: ACCOMACK COUNTY, CHESAPEAKE CITY, FRANKLIN CITY, GLOUCESTER COUNTY, HAMPTON CITY, ISLE OF WIGHT COUNTY, JAMES CITY COUNTY, MATHEWS COUNTY, NEWPORT NEWS CITY, NORFOLK CITY, NORTHAMPTON COUNTY, POQUOSON CITY, PORTSMOUTH CITY, PRINCE GEORGE COUNTY, SOUTHAMPTON COUNTY, SUFFOLK CITY, SURRY COUNTY, SUSSEX COUNTY, VIRGINIA BEACH CITY, WILLIAMSBURG CITY AND YORK COUNTY. WITHIN NORTH CAROLINA, CHKD SERVES THE FOLLOWING REGIONS: BERTIE COUNTY, CAMDEN COUNTY, CHOWAN COUNTY, CURRITUCK COUNTY, DARE COUNTY, GATES COUNTY, HERTFORD COUNTY, PASQUOTANK COUNTY AND PERQUIMANS COUNTY. AS REFLECTED IN OUR 2022 CHNA, THIS SERVICE REGION INCLUDED 458,649 PERSONS AGE 0-19. CHKD'S SERVICE AREA COMPRISES A DIVERSE MIX OF URBAN, SUBURBAN AND RURAL COMMUNITIES, AS WELL AS 10 MILITARY INSTALLATIONS. CHKD IS WELL VERSED IN THE SPECIAL NEEDS OF MILITARY FAMILIES AND HAS ONE OF THE HIGHEST TRICARE PAYER PERCENTAGES AMONG THE CHILDREN'S HOSPITALS IN THE NATION.PART VI, LINE 5:PROMOTION OF COMMUNITY HEALTHCHKD PLAYS A UNIQUE ROLE IN ITS COMMUNITY BY PROVIDING PEDIATRICHEALTHCARE SERVICES AVAILABLE NOWHERE ELSE IN THE REGION AND, AT THE SAME TIME, SERVING AS THE SAFETY NET PROVIDER TO THE REGION'S INDIGENT CHILDREN. IN FY 2022, CHKD HAD 4,834 ADMISSIONS RESULTING IN 49,261 PATIENT DAYS. APPROXIMATELY 55 PERCENT OF THESE DAYS, WERE COVERED BY MEDICAID, WHICH IS THE HIGHEST PERCENTAGE BY FAR OF ANY ACUTE-CARE HOSPITAL IN VIRGINIA. CHKD LEADS THE REGION IN EFFORTS TO ADDRESS PUBLIC HEALTH CONCERNS LIKE CHILD ABUSE AND CHILDHOOD OBESITY. IT IS THE SOLE PROVIDER OF PEDIATRIC SUBSPECIALTY CARE FOR CHILDREN WITH CHRONIC ILLNESSES LIKE CANCER AND DIABETES AND EMPLOYS THE REGION'S ONLY PEDIATRIC SURGEONS. THE HOSPITAL'S VIBRANT COMMUNITY OUTREACH PROGRAM COORDINATES PARENT, PROFESSIONAL AND STUDENT PROGRAMS THAT BRING IMPORTANT HEALTH, SAFETY AND WELLNESS INFORMATION TO THOUSANDS OF PARTICIPANTS. CHKD ALSO TAKES AN ACTIVE ROLE IN THE EDUCATION OF PEDIATRICIANS.COMPREHENSIVE INFORMATION ON CHKD'S EFFORTS TO IMPROVE THE HEALTH OF CHILDREN IS AVAILABLE AT WWW.CHKD.ORG/COMMUNITYBENEFIT
PART VI, LINE 6:	AFFILIATED HEALTH CARE SYSTEM:CHKD IS PART OF CHILDREN'S HEALTH SYSTEM, A 501(C)(3) ORGANIZATION GOVERNED BY A BOARD OF DIRECTORS COMPRISED OF COMMUNITY MEMBERS. A MAJORITY OF THE ORGANIZATION'S GOVERNING BODY ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. CHKD EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY FOR SOME OR ALL OF ITS DEPARTMENTS. SURPLUS FUNDS ARE USED TO MEET THE NEEDS OF THE ORGANIZATION AS DETERMINED BY CHKD SENIOR MANAGEMENT AND THE CHS BOARD OF DIRECTORS. HISTORICALLY, SURPLUS FUNDS HAVE BEEN USED FOR A VARIETY OF PURPOSES INCLUDING PATIENT CARE PROGRAMS, CAPITAL IMPROVEMENT NEEDS, RESERVES, ETC.ROLES OF ORGANIZATION AND ITS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED: THE CHILDREN'S HEALTH SYSTEM IS COMPRISED OF SEVERAL ORGANIZATIONS. CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS IS A FREESTANDING CHILDREN'S HOSPITAL THAT PROVIDES A BROAD SPECTRUM OF INPATIENT AND OUTPATIENT CARE SERVICES ACROSS MANY PEDIATRIC SPECIALTIES, INCLUDING EVERYTHING FROM PRIMARY CARE AND WELLNESS INITIATIVES TO NEONATAL AND PEDIATRIC INTENSIVE CARE. OTHER ENTITIES UNDER THE CHILDREN'S HEALTH SYSTEM UMBRELLA INCLUDE:* CHILDREN'S HEALTH FOUNDATION, WHICH MANAGES INVESTMENTS AND FUNDS EDUCATION, RESEARCH AND OTHER PROGRAMS FOR CHILDREN'S HEALTH SYSTEM* CHILDREN'S MEDICAL GROUP, INC., A VIRGINIA STOCK CORPORATION, WHICH OWNS AND OPERATES PEDIATRIC PHYSICIAN PRACTICES* CMG OF NORTH CAROLINA, INC., A NORTH CAROLINA STOCK CORPORATION, WHICH OWNS AND OPERATES A PEDIATRIC PHYSICIAN PRACTICE IN NORTHEASTERN NORTH CAROLINA* CHILDREN'S SURGICAL SPECIALTY GROUP, INC., A VIRGINIA STOCK CORPORATION, WHICH OWNS AND OPERATES PEDIATRIC SURGICAL SUBSPECIALTY PRACTICES, INCLUDING PEDIATRIC GENERAL SURGERY, PEDIATRIC UROLOGY, PEDIATRIC CARDIAC SURGERY, PEDIATRIC ORTHOPEDIC SURGERY, PEDIATRIC NEUROSURGERY AND PEDIATRIC PLASTIC SURGERY.* CHILDREN'S HEALTH INSURANCE, LLC, A CAPTIVE INSURANCE COMPANY INCORPORATED IN SOUTH CAROLINA IS A DISREGARDED ENTITY OF CHKD.* CHKD THRIFT STORES, LLC, A DISREGARDED ENTITY ORGANIZED TO SUPPORT THE CHARITABLE MISSION AND PURPOSE OF CHILDREN'S HEALTH SYSTEM.* CHILDREN'S REAL ESTATE, LLC, IS A DISREGARDED ENTITY ORGANIZED TO SUPPORT THE CHARITABLE MISSION AND PURPOSE OF CHILDREN'S HEALTH SYSTEM.* CHILDREN'S RESEARCH HOLDING, LLC, A DISREGARDED ENTITY ORGANINZED TO SUPPORT THE CHARITABLE MISSION AND PURPOSE OF CHILDREN'S HEALTH SYSTEM.* CHILDREN'S QUALITY CARE, LLC, A DISREGARDED ENTITY ORGANINZED TO SUPPORT THE CHARITABLE MISSION AND PURPOSE OF CHILDREN'S HEALTH SYSTEM.PART VI, LINE 7:FACILITY REPORTING GROUP(S):FACILITY REPORTING GROUP A INCLUDES CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, CHKD HEALTH AND SURGERY CENTER IN NEWPORT NEWS AND CHKD HEALTH AND SURGERY CENTER IN VIRGINIA BEACH. STATE FILING OF COMMUNITY BENEFIT REPORT:VA

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 OF THE KING'S
DAUGHTERS

Employer identification number
54-0506321

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	(f) Method of valuation (book, FMV, appraisal, other)	(h) Purpose of grant or assistance
(1) CHILDREN'S HEALTH FOUNDATION INC 601 CHILDRENS LANE NORFOLK,VA23507	54-1278865	501(C)(3)	4,829,234	CASH	GENERAL SUPPORT
(2) CHILDREN'S HEALTH SYSTEM INC 601 CHILDRENS LANE NORFOLK,VA23507	54-1278830	501(C)(3)	9,700,000	CASH	GENERAL SUPPORT
(3) OLD DOMINION UNIVERSITY RESEARCH FOUNDATION PO BOX 6369 NORFOLK,VA23508	54-6068198	501(C)(3)	41,321	CASH	CHEST WALL STUDY
(4) FRIENDS OF THE ELIZABETH RIVER TRAIL FOUNDATION PO BOX 3042 NORFOLK,VA23514	81-4431199	501(C)(3)	20,000	CASH	GENERAL SUPPORT

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

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

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

Cat. No. 50055P

Schedule I (Form 990) 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)
(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:

PROCESS FOR AWARDS AWARDS ARE MADE TO INVESTIGATORS/PHYSICIANS BY CHKD (CHILDREN'S HOSPITAL THE KING'S DAUGHTERS) FOR SPECIFIC PROJECT OR RESEARCH ENDEAVORS. FUNDING REQUESTS ARE COMPLETED AND SUBMITTED WHERE THEY ARE REVIEWED BY THE FINANCE DEPARTMENT, THE CEO AND THE APPLICABLE BOARD. AFTER AN AWARD IS MADE, THE AWARDEE MUST FILE QUARTERLY FINANCIAL SUMMARIES AND A FINAL REPORT TO BE SUBMITTED TO THE CEO AT THE END OF THE FUNDING PERIOD. ADDITIONALLY, CHKD GIVES CONTRIBUTIONS TO ITS PARENT ORGANIZATION, CHILDREN'S HEALTH SYSTEM, AND TO CHILDREN'S HEALTH FOUNDATION.

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 OF THE KING'S
DAUGHTERS

Employer identification number

54-0506321

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

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)
1DENNIS RYAN CFO & ASSISTANT SECRETARY/TREASURER	(i) (ii)	0 ------------- 542,407	0 ------------- 18,500	0 ------------- 1,605,036	0 ------------- 48,929	0 ------------- 39,533	0 ------------- 2,254,405	0 ------------- 989,535
2JOHN HARDING CHIEF OPERATING OFFICER	(i) (ii)	0 ------------- 596,477	0 ------------- 0	0 ------------- 212,558	0 ------------- 386,685	0 ------------- 44,793	0 ------------- 1,240,513	0 ------------- 198,524
3DEBORAH BARNES VP - IS OPERATIONS	(i) (ii)	0 ------------- 410,910	0 ------------- 0	0 ------------- 376,602	0 ------------- 398,390	0 ------------- 29,672	0 ------------- 1,215,574	0 ------------- 343,904
4JAMES D DAHLING PRESIDENT/DIRECTOR	(i) (ii)	0 ------------- 1,048,470	0 ------------- 0	0 ------------- 108,191	0 ------------- 11,600	0 ------------- 34,321	0 ------------- 1,202,582	0 ------------- 0
5SANDIP GODAMBE MD VP - QUALITY & PATIENT SAFETY	(i) (ii)	358,046 ------------- 0	0 ------------- 0	107,453 ------------- 0	261,007 ------------- 0	21,963 ------------- 0	748,469 ------------- 0	92,065 ------------- 0
6ROBERT OBERMEYER MD DIRECTOR	(i) (ii)	0 ------------- 647,158	0 ------------- 3,250	0 ------------- 414	0 ------------- 11,600	0 ------------- 27,823	0 ------------- 690,245	0 ------------- 0
7ALLISON SILVA VP - ANCILLARY SERVICES	(i) (ii)	281,246 ------------- 0	0 ------------- 0	154,174 ------------- 0	170,154 ------------- 0	15,680 ------------- 0	621,254 ------------- 0	124,426 ------------- 0
8JALANA MCCASLAND VP - PHYSICIAN PRACTICE MGMT	(i) (ii)	323,508 ------------- 0	0 ------------- 0	55,064 ------------- 0	151,304 ------------- 0	41,093 ------------- 0	570,969 ------------- 0	39,690 ------------- 0
9KAREN MITCHELL VP - PATIENT CARE SERVICES	(i) (ii)	356,052 ------------- 0	0 ------------- 0	144,028 ------------- 0	11,600 ------------- 0	16,161 ------------- 0	527,841 ------------- 0	25,029 ------------- 0
10KATHRYN ABSHIRE VP - FINANCE & ASST. SECR/TREAS.	(i) (ii)	0 ------------- 246,781	0 ------------- 0	0 ------------- 72,034	0 ------------- 148,496	0 ------------- 35,600	0 ------------- 502,911	0 ------------- 55,499
11JOHN HARRINGTON VP - QUALITY/SAFETY & CLINICAL INTG.	(i) (ii)	135,815 ------------- 217,989	0 ------------- 0	4,843 ------------- 516	59,992 ------------- 8,956	11,270 ------------- 18,575	211,920 ------------- 246,036	0 ------------- 0
12JOHN WARBURTON VP - MENTAL HEALTH	(i) (ii)	320,431 ------------- 0	0 ------------- 0	8,700 ------------- 0	56,930 ------------- 0	28,423 ------------- 0	414,484 ------------- 0	0 ------------- 0
13SCOTT NOTTINGHAM MD DIRECTOR	(i) (ii)	0 ------------- 340,025	0 ------------- 0	0 ------------- 249	0 ------------- 11,600	0 ------------- 28,823	0 ------------- 380,697	0 ------------- 0
14TAMIKA HARRIS VP - FACILITIES & SUPPORT SERV	(i) (ii)	235,877 ------------- 0	0 ------------- 0	38,030 ------------- 0	62,342 ------------- 0	35,087 ------------- 0	371,336 ------------- 0	17,761 ------------- 0
15SUZANNE BRIXEY PHYSICIAN	(i) (ii)	299,337 ------------- 0	30,400 ------------- 0	414 ------------- 0	11,600 ------------- 0	3,238 ------------- 0	344,989 ------------- 0	0 ------------- 0
16MICHELLE CLAYTON MEDICAL DIRECTOR CHILD ADVOCACY	(i) (ii)	215,773 ------------- 0	0 ------------- 0	1,412 ------------- 0	6,900 ------------- 0	27,444 ------------- 0	251,529 ------------- 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	IN CONNECTION WITH A RETIREMENT PROGRAM, TAX GROSS-UP PAYMENTS ARE PROVIDED TO CERTAIN EMPLOYEES WHOSE EMPLOYER FUNDED CONTRIBUTIONS ARE IMMEDIATELY BENEFITS OF PARTICIPANTS WHOSE CONTRIBUTIONS ARE NOT IMMEDIATELY TAXABLE.
PART I, LINE 4B	CHILDREN'S HEALTH SYSTEM SPONSORS TWO SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS ("THE PLANS"). THE PLANS ARE DESIGNED TO RETAIN EXECUTIVES IN POSITIONS ESSENTIAL TO THE SUCCESS OF CHILDREN'S HEALTH SYSTEM. DURING THE YEAR, THE FOLLOWING INDIVIDUALS WERE PARTICIPANTS IN ONE OF THE SPONSORED SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS AND RECEIVED THE FOLLOWING ANNUAL ACTUARIAL INCREASE OR DEFERRED CONTRIBUTION (INCLUDED IN SCHEDULE J, PART II, COLUMN (C)) AND/OR PAYMENT (INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III)). AMOUNTS REPORTED IN SCHEDULE J, PART II, COLUMN (B)(III) MAY DIFFER FROM AMOUNTS PAID DUE TO TIMING DIFFERENCES IN VESTING AND PAYMENTS. NAME: KAREN MITCHELL ACT. INCREASE $0 AMT. PAID $65,678 NAME: ALLISON SILVA ACT. INCREASE $138,546 AMT. PAID $47,253 NAME: JOHN HARDING ACT. INCREASE: $332,509 AMT. PAID: $71,224 NAME: DEBORAH BARNES ACT. INCREASE: $369,586 AMT. PAID: $147,291 NAME: KATHY ABSHIRE ACT. INCREASE $133,959 AMT. PAID: $22,674 NAME: TAMIKA HARRIS ACT. INCREASE $32,075 AMT. PAID: $0 NAME: DENNIS RYAN ACT. INCREASE: $ 416,894 AMT. PAID: $3,045,669 NAME: JOHN WARBURTON ACT. INCREASE: $46,751 AMT. PAID: $0 NAME: SANDIP GODAMBE ACT INCREASE: $244,414 AMT PAID: $33,751 NAME: JALANA MCCASLAND ACT INCREASE: $113,808 AMT PAID: $7,284 NAME: JOHN HARRINGTON ACT. INCREASE: $57,348 AMT PAID: $0
PART I, LINE 7	OFFICERS AND VICE PRESIDENTS MAY RECEIVE ADDITIONAL COMPENSATION BASED ON CRITERIA SET UP BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. DEPARTMENT DIRECTORS MAY RECEIVE ADDITIONAL COMPENSATION BASED ON CRITERIA SET BY MANAGEMENT AND APPROVED BY THE BOARD OF DIRECTORS.

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 OF THE KING'S
DAUGHTERS

Employer identification number
54-0506321

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	VA SMALL BUSINESS FINANCING AUTHORITY	54-1300845		12-01-2015	100,000,000	FINANCING OF HEALTH CARE FACILITIES		X		X		X
B	VA SMALL BUSINESS FINANCING AUTHORITY	54-1300845		06-10-2020	100,000,000	FINANCING OF HOSPITAL FACILITIES		X		X		X
C	VA SMALL BUSINESS FINANCING AUTHORITY	54-1300845		11-09-2021	91,958,991	REFINANCE 2012 SERIES BONDS & FIN. OF HOSP. FACILITIES		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	2,461,713				2,800,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	48,650,000		100,000,000		91,958,991
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	48,650,000		100,000,000		91,958,991
11 Other spent proceeds .............
12 Other unspent proceeds .............
13 Year of substantial completion .............	2018		2022
	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?	X		X		X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0.330 %		0 %		0.590 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............	0.330 %		0 %		0.590 %
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
DATE REBATE COMPUTATION PERFORMED	ISSUER NAME: VA SMALL BUSINESS FINANCING AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 05/12/2021
PART II, LINE 10, COLUMN A:	LINE 10 - CAPITAL EXPENDITURES FROM PROCEEDS ALLOCATED CURRENTLY TOTAL $99,950,000, OF WHICH $51,300,000 WAS ALLOCATED TO CHILDREN'S HEALTH SYSTEM AND $48,650,000 WAS ALLOCATED TO CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS.
PART II, LINES 3 AND 10, COLUMN B:	LINE 3 - FUNDS WERE DRAWN BY CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS FROM THE TOTAL ISSUE PRICE OF THE BOND. FINAL PROCEEDS WERE DRAWN TOTALLING $100,000,000.
PART II, LINE 3 AND 10, COLUMN C:	LINE 3: FUNDS WERE DRAWN BY CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS FROM THE TOTAL ISSUE PRICE OF THE BOND. ALL PROCEEDS WERE DRAWN TOTALLING $91,958,991. LINE 10: CAPITAL EXPENDITURES FROM PROCEEDS TOTALLED $91,958,991.
PART III, LINE 4:	COLUMN A: WE HAVE CONCLUDED THAT OUT OF THE ACTIVITIES CONDUCTED IN THIS BOND FINANCED SPACE, WE HAVE NOTED THAT 0.33% OF THE SPACE WAS PRIVATE BUSINESS USE. THE REMAINING SPACE DID NOT RESULT IN PRIVATE BUSINESS USE DUE TO EQUITY PROVIDED OR A REGULATORY SAFE HARBOR. COLUMN C: WE HAVE CONCLUDED THAT OUT OF THE ACTIVITIES CONDUCTED IN THIS BOND FINANCED SPACE, WE HAVE NOTED THAT 0.5863% OF THE SPACE WAS PRIVATE BUSINESS USE. THE REMAINING SPACE DID NOT RESULT IN PRIVATE BUSINESS USE DUE TO EQUITY PROVIDED OR A REGULATORY SAFE HARBOR. PNC BANK, NATIONAL ASSOCIATION AND BANK OF AMERICA, N.A. AND TOWNE BANK, EACH HOLD PARITY NOTES OF CHKD'S OBLIGATED GROUP (INCLUDING CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, INCORPORATED; CHILDREN'S HEALTH SERVICES, INC.; AND CHILDREN'S HEALTH FOUNDATION, INC.) ISSUED UNDER THE MASTER TRUST INDENTURE. ACCORDINGLY, PNC AND BANK OF AMERICA AND TOWNE BANK HAVE THE BENEFIT, ON A PARITY BASIS, OF A VALID AND PERFECTED, FIRST PRIORITY SECURITY INTEREST HELD BY THE MASTER TRUSTEE IN THE TOTAL REVENUES PLEDGED UNDER THE MASTER TRUST INDENTURE AND IN ANY OTHER SECURITY INTEREST GRANTED BY THE MASTER TRUST INDENTURE. THE MASTER TRUST INDENTURE AND THE FINANCING DOCUMENTS WITH PNC AND BANK OF AMERICA AND TOWNE BANK PLACE CERTAIN RESTRICTIONS UPON CHKD'S OBLIGATED GROUP RELATIVE TO OPERATING RATIOS, INCURRENCE OF ADDITIONAL INDEBTEDNESS, MAINTENANCE OF TAX-EXEMPT STATUS AND FINANCIAL REPORTING REQUIREMENTS.

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 OF THE KING'S
DAUGHTERS

Employer identification number

54-0506321

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) WM JORDAN CO INC	SEE PART V	48,868,406	CONSTRUCTION SERVICES		No

Part V

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

Return Reference	Explanation
INTERESTED PERSON AND THE ORGANIZATION	ENTITY MORE THAN 35% OWNED BY JOHN LAWSON II, CURRENT BOARD MEMBER.

Schedule L (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

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 OF THE KING'S
DAUGHTERS

Employer identification number

54-0506321

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..	X	4	5,700	CASH ON SALE
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .	X	49	1,785,467	AVG FMV ON DATE REC
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( OTHER )	X	10	58,446	AVG FMV ON DATE REC
26 Other ( )
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

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

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

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

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

32a

Yes

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2021)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 32B:	CHKD PAYS ABC VIRGINIA AUTO AUCTION, LLC A FEE TO AUCTION CARS FOR THE BENEFIT OF THE ORGANIZATION. SCHEDULE M, PART I: COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS, NOT THE NUMBER OF ITEMS RECEIVED.

Schedule M (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 OF THE KING'S
DAUGHTERS

Employer identification number

54-0506321

Return Reference	Explanation
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS:	FOR SIX DECADES, CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS (CHKD) HAS BEEN THE ONLY FACILITY OF ITS KIND IN VIRGINIA, SERVING THE MEDICAL AND SURGICAL NEEDS OF CHILDREN THROUGHOUT THE STATE. ITS PRIMARY SERVICE AREA ENCOMPASSES GREATER HAMPTON ROADS, THE EASTERN SHORE OF VIRGINIA AND NORTHEASTERN NORTH CAROLINA, A REGION THAT IS HOME TO APPROXIMATELY 460,000 CHILDREN UNDER THE AGE OF 20. CHKD WAS ESTABLISHED AS AN 88-BED, NOT-FOR-PROFIT HOSPITAL IN 1961 BY THE KING'S DAUGHTERS, A WOMEN'S SERVICE ORGANIZATION DEDICATED TO THE HEALTH AND WELL BEING OF THE COMMUNITY'S INDIGENT CHILDREN. THE HOSPITAL HAS ALWAYS UPHELD THE CHARITABLE MISSION OF ITS FOUNDERS, AND IN FY2022, OVER 55 PERCENT OF ITS INPATIENT DAYS WERE COVERED BY MEDICAID. OVER THE PAST 60 YEARS, CHKD'S HOSPITAL HAS GROWN INTO AN EXTENSIVE PEDIATRIC HEALTH CARE SYSTEM THAT INCLUDES A 206-BED TEACHING HOSPITAL, AND A NEW MENTAL HEALTH TOWER, CHILDREN'S PAVILION, THAT WILL ACCOMMODATE 60 INPATIENT PSYCHIATRIC BEDS. THE SYSTEM PROVIDES COMPREHENSIVE MEDICAL CARE TO CHILDREN AT THE MAIN HOSPITAL, CHILDREN'S PAVILION, AND MULTI-SERVICE HEALTH CENTERS IN VIRGINIA BEACH, NEWPORT NEWS, CHESAPEAKE, HAMPTON, SUFFOLK, NORFOLK AND WILLIAMSBURG. ITS SERVICES INCLUDE EVERYTHING FROM WELLNESS AND PREVENTION INITIATIVE TO PRIMARY CARE, SURGERY AND REHABILITATION. MANY OF ITS UNIQUE SERVICES AND PROGRAMS ADDRESS PRESSING PUBLIC HEALTH NEEDS THAT WOULD OTHERWISE GO UNMET. CHKD COMPLETED CONSTRUCTION OF A $224 MILLION MENTAL HEALTH FACILITY IN 2022 IN RESPONSE TO THE GROWING NEED FOR PEDIATRIC PSYCHIATRIC CARE - IN APRIL OF 2022 CHILDREN'S PAVILION OPENED TO OUTPATIENT MENTAL HEALTH SERVICES, PRIMARY PEDIATRIC CARE, SPORTS MEDICINE, AND LABORATORY AND RADIOLOGY SERVICES. IN OCTOBER OF 2022 THE FIRST 12 OF 60 PRIVATE INPATIENT MENTAL HEALTH BEDS OPENED. THE 14-STORY MENTAL HEALTH CENTER ALSO HAS INDOOR AND OUTDOOR EXERCISE AREAS, AND ROOMS FOR OUTPATIENT SERVICES. A FULL CONTINUUM OF MENTAL HEALTH CARE, FROM OUTPATIENT THERAPY TO MORE INTENSIVE INPATIENT TREATMENT IS NOW AVAILABLE AND ALL 60 BEDS ARE EXPECTED TO OPEN BY MID 2023. AS THE PREMIER PROVIDER OF HEALTHCARE SERVICES TO THE REGION'S CHILDREN, CHKD HAS SECURED A PLACE IN THE HEART OF THE COMMUNITY. THE HOSPITAL IS AN EAGER COLLABORATOR WITH OTHER COMMUNITY ORGANIZATIONS AND INSTITUTIONS THAT SHARE ITS CONCERN FOR THE WELL-BEING OF YOUNG PEOPLE AND OFFERS A VARIETY OF EDUCATION, RESEARCH AND HEALTH INITIATIVES TO IMPROVE THE HEALTH AND WELL BEING OF CHILDREN IN THIS COMMUNITY AND BEYOND. THE HEALTH SYSTEM'S PRIMARY SERVICES CENTER ON INPATIENT AND OUTPATIENT CARE, COMMUNITY OUTREACH PROGRAMS AND MEDICAL EDUCATION/RESEARCH. SECTION ONE: INPATIENT CARE CHILDREN WITH A VAST RANGE OF MEDICAL PROBLEMS INCLUDING LIFE-THREATENING ILLNESSES AND INJURIES TURN TO CHKD FOR INPATIENT CARE. IN FY22, CHKD HAD 4,834 ADMISSIONS RESULTING IN 49,261 PATIENT DAYS. APPROXIMATELY 55 PERCENT OF THESE DAYS WERE COVERED BY MEDICAID. CHKD HAS 206 INPATIENT BEDS AND ALMOST HALF OF THOSE ARE FOR PEDIATRIC INTENSIVE CARE. THE HOSPITAL IS HOME TO THE REGION'S HIGHEST LEVEL NEONATAL INTENSIVE CARE UNIT, WHERE EACH YEAR CRITICALLY ILL NEWBORNS, SOME AS YOUNG AS 22 WEEKS GESTATION, BENEFIT FROM A UNIQUE COMBINATION OF ADVANCED MEDICAL TECHNOLOGY, DEVELOPMENTAL CARE, FAMILY SUPPORT, AND PALLIATIVE CARE. IN SEPTEMBER 2020, A RENOVATION OF THE NICU WAS COMPLETED CREATING 50 PRIVATE ROOMS AND 10 SEMI-PRIVATE ROOMS TO CREATE A MORE INDIVIDUALIZED AND FAMILY CENTERED APPROACH, GIVING FAMILIES MORE PRIVACY TO BOND WITH THEIR BABIES. THERE WERE APPROXIMATELY 526 ADMISSIONS TO THE NICU IN FY22. THE REGION'S LARGEST AND MOST EXPERIENCED PEDIATRIC INTENSIVE CARE UNIT IS AT CHKD. IN THIS UNIT, A FULL-TIME STAFF OF BOARD-CERTIFIED PEDIATRIC INTENSIVE CARE PHYSICIANS, CRITICAL CARE NURSES AND RESPIRATORY THERAPISTS PROVIDE EXTREMELY SOPHISTICATED, TECHNOLOGICALLY-ADVANCED CARE TO CHILDREN WITH LIFE-THREATENING INJURIES AND ILLNESSES. MEDICAL CARE IS SUPPLEMENTED WITH SUPPORT FROM CHILD LIFE SPECIALISTS, SOCIAL WORKERS AND CHAPLAINS WHO HAVE EXTENSIVE EXPERIENCE HELPING FAMILIES THROUGH THE TRAUMA AND STRESS OF A SEVERE ILLNESS OR INJURY IN A CHILD. THERE WERE 899 ADMISSIONS TO THE PICU IN FY22. MANY PATIENTS ARE BROUGHT FROM OTHER AREA HOSPITALS TO CHKD BY THE HOSPITAL'S NEONATAL/PEDIATRIC TRANSPORT PROGRAM, WHICH OPERATES OUT OF FOUR FULLY-EQUIPPED MOBILE INTENSIVE CARE UNITS. TWO EMT CERTIFIED CRITICAL CARE TRANSPORT TEAMS ARE AVAILABLE 24 HOURS A DAY, SEVEN DAYS A WEEK TO ALL AREA MEDICAL FACILITIES THAT NEED TO SEND SICK OR INJURED CHILDREN TO CHKD. CHKD TRANSPORT TEAMS ARE EQUIPPED AND TRAINED TO TRANSPORT ALL TRAUMA PATIENTS UNDER THE AGE OF 15 TO CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS FOR SPECIALIZED PEDIATRIC TRAUMA CARE. ONE ACUTE CARE TRANSPORT TEAM IS STAFFED DAILY WITH TWO PARAMEDICS TO PROVIDE TRANSPORT TO PEDIATRIC PATIENTS THROUGHOUT THE COMMUNITY, SERVING URGENT CARE FACILITIES AS WELL AS EMERGENCY ROOMS WITHIN THE TIDEWATER REGION. EACH CRITICAL CARE TRANSPORT CALL IS ANSWERED BY A NEONATAL/PEDIATRIC CRITICAL CARE NURSE, A REGISTERED RESPIRATORY THERAPIST AND A CERTIFIED EMT PARAMEDIC TRAINED IN NEONATAL/PEDIATRIC CARE. IN FY22, THE TEAM TRANSPORTED 1,531 PATIENTS. OF THOSE, 387 WERE NEWBORNS IN NEED OF NEONATAL INTENSIVE CARE. CHKD'S TRANSPORT SERVICE IS ALSO UNDER CONTRACT TO THE NAVAL MEDICAL CENTER, PORTSMOUTH, TO PROVIDE ALL NEONATAL AND PEDIATRIC MILITARY TRANSPORTS IN THE REGION. BESIDES GROUND TRANSPORTS IN OUR MOBILE ICUS OR ACUTE CARE TRANSPORT, THE TEAM CAN RESPOND VIA FIXED WING AIRCRAFT OR HELICOPTER TRANSPORT WHEN MEDICALLY NECESSARY. CHKD TRANSFER CENTER IS STAFFED WITH PARAMEDICS WHO OPERATE TO ENSURE APPROPRIATE DISPATCH SERVICES TO THE TRANSPORT TEAM AS WELL AS TO DELIVER ASSISTANCE AND SUPPORT FOR REFERRAL FACILITIES AND STAFF THROUGHOUT THE COMMUNITY.
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	CHKD OPERATES THE REGION'S ONLY PEDIATRIC SURGERY PROGRAM, OFFERING YOUNG PEOPLE STATE-OF-THE-ART TREATMENT IN A SUPPORTIVE, NON-THREATENING ENVIRONMENT CREATED EXCLUSIVELY TO MEET THEIR NEEDS. IN FY22, SURGEONS PERFORMED 12,189 SURGERIES AT CHKD FACILITIES FOR A VAST RANGE OF PROBLEMS, FROM THE SIMPLEST OUTPATIENT PROCEDURES TO COMPLEX CRANIOFACIAL, ORTHOPEDIC AND CHEST WALL SURGERIES. CHKD'S CARDIAC SURGERY PROGRAM IS PART OF A REGIONAL COLLABORATIVE BETWEEN CHKD AND THE UNIVERSITY OF VIRGINIA. CHKD AND UVA COMBINE THE EFFORTS OF PEDIATRIC CARDIOLOGISTS, CARDIAC SURGEONS, CARDIAC ANESTHESIOLOGISTS, INTENSIVE CARE PHYSICIANS AND CARDIAC SUPPORT PROFESSIONALS FROM BOTH INSTITUTIONS WITH THE GOAL OF IMPROVING OUTCOMES FOR CHILDREN WITH COMPLEX CONGENTIAL HEART DEFECTS. (SEE OUTPATIENT SERVICES AND PROGRAMS FOR MORE INFORMATION OF CHKD'S SURGERY PROGRAM.) CHKD EMPLOYS DOZENS OF PROFESSIONALS WHO PROVIDE EMOTIONAL, RECREATIONAL, SPIRITUAL AND PRACTICAL SUPPORT TO CHILDREN AND FAMILIES DURING HOSPITALIZATIONS. THE WORK OF THESE PROFESSIONALS COMPLEMENTS OUR EXPERT MEDICAL CARE TO CREATE A UNIQUE TREATMENT AND HEALING ENVIRONMENT FOR CHILDREN AND THEIR FAMILIES. OUR CHAPLAINCY SERVICES PROVIDE EMOTIONAL SUPPORT, SPIRITUAL CARE, ETHICAL REFLECTION, BEREAVEMENT CARE/RESOURCES/FOLLOW-UP (INCLUDING PARENT AND CHILD SUPPORT GROUP), SPIRITUAL ASSESSMENT AND GUIDANCE TO PATIENTS, FAMILIES AND STAFF WITH IN-HOSPITAL PRESENCE SEVEN DAYS A WEEK AND 24 HOURS A DAY. ADDITIONALLY, A CHAPLAIN IS ASSIGNED TO CHILDREN'S PAVILION TO PROVIDE FOR PATIENTS ON OUR INPATIENT MENTAL HEALTHCARE FLOORS. CHAPLAINS ASSIST WITH ADVANCE DIRECTIVES, ADVANCE CARE PLANS AND SERVE ON THE TRAUMA TEAM AS PRIMARY PROVIDERS OF FAMILY SUPPORT. THE HOSPITAL EMPLOYS A CHAPLAINCY MANAGER, SIX FULL-TIME CHAPLAINS, ONE FULL-TIME FAMILY/STAFF SUPPORT COORDINATOR, AND THREE PER-DIEM CHAPLAINS WHO REFLECT THE DIVERSITY OF THE COMMUNITY. ALL CHAPLAINS ARE PROFESSIONALLLY TRAINED TO MEET THE VARIED SPIRITUAL NEEDS OF FAMILIES AND STAFF WITH RESPECT AND COMPASSION. CHAPLAINCY SERVICES HAS NUMEROUS CONNECTIONS WITH COMMUNITY CLERGY TO ENSURE MOST RELIGIOUS NEEDS CAN BE MET. THE CHAPLAINS PROVIDE AN ANNUAL MEMORIAL SERVICE TO REMEMBER AND CELEBRATE THE LIVES OF THE CHILDREN WHO HAVE PASSED ON DURING THE PREVIOUS YEAR. THE CHAPLAINS ALSO FACILITATE EDUCATIONAL AND WELLNESS PROGRAMS FOR HOSPITAL STAFF AND PHYSICIANS, AS WELL AS PLANNING AND PARTICIPATING IN OUTREACH TO THE COMMUNITY. THE HOSPITAL EMPLOYS 17 CHILD LIFE STAFF MEMBERS, INCLUDING AN ART THERAPIST AND A MUSIC THERAPIST, WHO HELP CHILDREN ADJUST AND COPE DURING HOSPITALIZATION. THEIR GOAL IS TO MAKE THE CHILD'S HOSPITAL EXPERIENCE AS NORMAL AS POSSIBLE BY DEVELOPING SUPPORTIVE RELATIONSHIPS WITH PATIENTS AND FAMILIES, PROVIDING AGE-APPROPRIATE PREPARATION FOR MEDICAL PROCEDURES AND SURGERIES, COPING STRATEGIES AND PLAY OPPORTUNITIES FOR CHILDREN TO RELIEVE STRESS. WITH THE OPENING OF CHILDREN'S PAVILION IN 2022, EIGHT NEW CHILD LIFE POSITIONS WERE ADDED FOR THAT FACILITY, INCLUDING CERTIFIED THERAPEUTIC RECREATION SPECIALISTS, CERTIFIED CHILD LIFE SPECIALISTS, AND AN ART AND MUSIC THERAPIST. THERE ARE FOUR POPULAR ACTIVITY AREAS, INCLUDING A TEEN ROOM, IN THE MAIN HOSPITAL, PROVIDING HOSPITALIZED CHILDREN OPPORTUNITIES FOR SOCIALIZATION AND CREATIVE PLAY. CHILD LIFE ASSISTANTS WORK WITH CHKD'S VOLUNTEER SERVICES DIVISION TO MANAGE THE HOSPITAL'S POPULAR PET THERAPY PROGRAM -- THE BUDDY BRIGADE -- WHICH BRINGS VISITS OF DOG/HANDLER TEAMS TO THE HOSPITAL SEVERAL TIMES EACH WEEK AND ALSO PROVIDES VIRTUAL VISITS. CHKD ALSO HAS A FACILITY DOG THAT WORKS ALONGSIDE A CHILD LIFE STAFF MEMBER. CHILD LIFE STAFF MEMBERS COLLABORATE WITH OTHER HOSPITAL STAFF TO PROVIDE SUPPORT FOR PARENTS AND SIBLINGS, OFFERING AN ANNUAL TEDDY BEAR CLINIC, WEEKLY CLOSED-CIRCUIT TV BINGO, INPATIENT DEVELOPMENTAL SCREENINGS, AND A KIDS-AS-PARTNERS ADVISORY COUNCIL.
STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS	CHKD'S MENTAL HEALTH SERVICE LINE IS COMPRISED OF ONE MANAGER, ONE OFFICE SUPERVISOR, 20 FULL-TIME MEDICAL SOCIAL WORKERS AND THREE PER DIEM SOCIAL WORKERS. ALL OF THE MEDICAL SOCIAL WORKERS ARE REQUIRED TO HAVE A MASTER'S DEGREE IN SOCIAL WORK. THERE ARE THREE LICENSED CLINICAL SOCIAL WORKERS IN THE DEPARTMENT WITH AN ADDITIONAL 19 SOCIAL WORKERS WORKING TOWARD CLINICAL LICENSURE. THE PRIMARY FOCUS OF THE MEDICAL SOCIAL WORK TEAM IS BIOPSYCHOSOCIAL EVALUATION, SUPPORT TO FAMILIES, CRISIS INTERVENTION, CONNECTION TO RESOURCES AND SUPPORTING ADJUSTMENT TO ILLNESSES AND HELPING TO MITIGATE THE STRESS OF HOSPITALIZATION. THE MEDICAL SOCIAL WORK TEAM PROVIDES MANY SERVICES, INCLUDING: * CONDUCT BIOPSYCHOSOCIAL AND BEHAVIORAL ASSESSMENTS. * PROVIDE SUPPORT DURING HOSPITALIZATION TO CHKD PATIENTS AND FAMILIES DEALING WITH TRAUMA, CHRONIC ILLNESS AND LOSS. * REFER TO CHKD'S ELIGIBILITY WORKERS TO COMPLETE APPLICATIONS FOR INSURANCE COVERAGE FOR MEDICAL CARE, PRESCRIPTIONS, AND MEDICAL SUPPLIES. * COORDINATE REFERRALS AND ONGOING COMMUNICATIONS TO OTHER COMMUNITY RESOURCES FOR ASSISTANCE WITH NEEDS SUCH AS HOUSING, MENTAL HEALTH COUNSELING, EDUCATIONAL ADVOCACY, LEGAL ASSISTANCE AND MUCH MORE. * AID IN COMMUNICATION WITH FAMILIES WITH THE MEDICAL TREATMENT TEAMS BY COORDINATING PATIENT CARE CONFERENCES AND TEAM MEETINGS. * EVALUATE AND REPORT SUSPICION FOR CHILD ABUSE/NEGLECT. IN JULY 2021, A GRANT WAS AWARDED TO THE MEDICAL SOCIAL WORK TEAM UNDER THE HOSPITAL VIOLENCE INTERVENTION PROGRAM INITIATIVE. THIS PROGRAM IS NOW IDENTIFIED AS "SAFER FUTURES AND IS MANAGED BY AN IDENTIFIED LICENSED ELIGIBLE COORDINATOR AND ONE FULL TIME MEDICAL SOCIAL WORKER. ADDITIONALLY, MEDICAL SOCIAL WORKERS ALSO FACILITATE A VARIETY OF SUPPORT GROUPS THAT HELP PATIENTS AND FAMILIES CONNECT WITH OTHERS IN THE COMMUNITY WHO SHARE THEIR CHALLENGES. SOME EXAMPLES ARE SIBSHOPS, HEALTHY MOMMY HEALTHY BABY, DINE AND DISCOVER FOR NICU FAMILIES. THE MEDICAL SOCIAL WORK TEAM MANAGES THE HALO FUND,BUTTERFLY BLESSINGS FUND, AND SAM'S WARRIORS FUNDS, MONETARY FUNDS DESIGNATED TO ASSIST PATIENTS/FAMILIES ENCOUNTERING BARRIERS SUCH AS TRANSPORTATION, MEALS, MEDICATION/PRESCRIPTION ASSISTANCE AND OTHER DISCHARGE-RELATED COSTS. THESE DONATED FUNDS MAY ALSO BE USED IN EMERGENCY SITUATIONS TO ASSIST WITH SPECIAL HEALTHCARE CHALLENGES, LOST MONEY DUE TO PARENT'S INABILITY TO WORK DURING CHILDREN'S INPATIENT STAY, AND PARTIAL OR ONE-TIME PAYMENTS FOR UTILITIES OR RENT FEES POST DISCHARGE. THE MSW TEAM ALSO COORDINATES HOLIDAY FUNDS FOR FAMILIES IN NEED. THESE FUNDS ASSISTED MORE THAN 41 FAMILIES, TOTALING 174 PEOPLE, WITH $5,250 SPENT IN FY22. THE MENTAL HEALTH TEAM PROVIDES OUTPATIENT AND HOSPITAL-BASED MENTAL HEALTH SERVICES TO PATIENTS WHO PRESENT TO OUR ED OR WHO ARE ADMITTED TO CHKD FOR MEDICAL REASONS BUT ALSO HAVE A CONCURRENT MENTAL HEALTH CONDITION. IN ADDITION, WE PROVIDE OUTPATIENT EVIDENCE BASED THERAPY AT FIVE LOCATIONS IN VIRGINIA BEACH, CHESAPEAKE, NORFOLK, AND NEWPORT NEWS. IN 2018, CHKD HAD ONE CHILD AND ADOLESCENT PSYCHIATRIST. TODAY, IN THE SECOND QUARTER OF FY23, WE HAVE 19 CHILD AND ADOLESCENT PSYCHIATRISTS WITH RECRUITMENT ONGOING AS WE CONTINUE TO RECRUIT TO EXPAND OUR SERVICES AND PROGRAMS. WE HAVE TWELVE PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONERS ON THE TEAM, UP FROM TWO IN 2022. IN SEPTEMBER OF 2019, WE BROKE GROUND FOR A 14-STORY MEDICAL BUILDING WHICH WILL PROVIDE 60 INPATIENT BEDS FOR ACUTE MENTAL HEALTH CARE, EXPANDED OUTPATIENT SERVICES, INCLUDING PARTIAL HOSPITALIZATION PROGRAMS AND INTENSIVE OUTPATIENT SERVICES. THE NEW MENTAL HEALTH HOSPITAL OPENED OUTPAITENT ON SCHEDULE IN APRIL OF 2022 AND OUR FIRST INPATIENT BEDS OPENED IN OCTOBER 2022. WE ARE OPERATING A COMPREHENSIVE MENTAL HEALTH CONSULT SERVICE AT THE MAIN HOSPITAL FOR MEDICALLY COMPROMISED CHILDREN WITH A MENTAL HEALTH DIAGNOSIS. WE CONTINUE TO OPERATE OUR OUTPATIENT CRISIS "BRIDGE" CLINIC, WHICH EXTENDS OUR SERVICES TO KIDS WHO ARE NOT CONNECTED TO A PROVIDER AS THEY ARE WAITING TO CONNECT TO OUTPATIENT SERVICES. WE CONTINUE TO EXPAND OUR OUTPATIENT WORKFORCE BY ADDING ADDITIONAL PSYCHOLOGISTS AND MENTAL HEALTH THERAPISTS AND THE NEED CONTINUES TO BE OVERWHELMING WITH MORE THAN 5,000 CHILDREN WAITING FOR OUTPATIENT MENTAL HEALTH CARE. WE HAVE A FULL COMPLEMENT OF LEADERS FOR OUR PROGRAMS AND SERVICES, WE OPENED INTENSIVE OUTPATIENT PROGRAMMING IN JULY 2022 AND OPENED OUR SECOND TRACK IN OCTOBER FOR INTENSIVE OUTPATIENT PROGRAMMING. WE INTEND TO OPEN PARTIAL HOSPITAL PROGRAMMING EARLY IN 2023 AT CHILDREN'S PAVILION. WE CONTINUE TO TRAIN AND EDUCATE OUR TEAM ON EVIDENCE-BASED RESEARCH AND SUPPORTED-CARE DELIVERY. WE'VE ADDED MATCH THERAPY IN ADDITION TO TRAINING SEVERAL MORE CLINICIANS IN OTHER EVIDENCE-BASED TREATMENTS. WE HAVE ALSO PARTNERED WITH OUR COMMUNITY ON SEVERAL FOUNDATION GRANTS TO SUPPORT SCHOOLS AND PEDIATRIC INTEGRATION OF CARE FOR EARLY CHILDHOOD CONSULTATION. WE ARE THE EASTERN REGION'S PARTNER FOR THE VIRGINIA MENTAL HEALTH ACCESS PROGRAM, WHICH WAS FULLY FUNDED THROUGH THE STATE BUDGET. WE CONTINUE TO EXPAND OUR REACH INTO OUR COMMUNITY WITH SCHOOL-BASED PARTNERSHIPS, WITH A RECENT ADD OF STAFF TO VIRGINIA BEACH CITY PUBLIC SCHOOLS TO PROVIDE CRISIS SERVICES TO STUDENTS IDENTIFIED BY SCHOOL (MIDDLE AND HIGH SCHOOL). WE ARE ALSO IN OUR SECOND YEAR ON-SITE TELLOHAB FOR OUR 3RD YEAR AT GOVERNOR'S SCHOOL FOR THE ARTS. WE HAVE OPENED A MENTAL HEALTH RESEARCH CENTER AND HAVE A CHILD AND ADOLESCENT PSYCHIATRY FELLOWSHIP PROGRAM STARTING IN THE SUMMER OF 2023 UNDER THE DIRECTION OF DR. MARY MARGARET GLEASON. WE HAVE ALSO STARTED A HOSPITAL VIOLENCE INTERVENTION PROGRAM HERE AT CHKD WITH THE HELP OF STATE FUNDING TO SUPPORT THE PROGRAM'S MISSION. THERAPISTS IN THIS PROGRAM HAVE BEEN TRAINING IN AN INTERVENTION CALLED CFTSI (CHILD AND FAMILY TRAUMATIC STRESS INTERVENTION), WHICH WHEN DELIVERED WITHIN 45 DAYS OF TRAUMATIC EXPERIENCE GREATLY REDUCES THE LIKELIHOOD OF PTSD. WE HAVE THREE STAFF IN THIS PROGRAM. THE TEAM COLLABORATES WITH THE CHILD'S PEDIATRICIAN, PSYCHIATRIC PROVIDER, SPECIALIST AND FAMILY TO ENSURE THE CHILD RECEIVES COMPREHENSIVE AND INTEGRATED SUPPORT. AMONG THE SERVICES OUR MENTAL HEALTH TEAM PROVIDES ARE THE FOLLOWING: * CONDUCT PSYCHOSOCIAL HISTORY AND MENTAL HEALTH ASSESSMENTS OF PATIENTS: OUTPATIENT, ED, AND IN-HOUSE. * UTILIZE EVIDENCE-BASED PRACTICES TO OFFER BRIEF THERAPY TO IN-HOUSE PATIENTS BY PHYSICIAN REFERRAL TO ADDRESS ACUTE OR CHRONIC MENTAL HEALTH ISSUES. * OFFER INDIVIDUALIZED BEHAVIOR PLANS FOR CHILDREN WITH MEDICAL AND BEHAVIORAL ISSUES ADMITTED TO CHKD FOR THEIR MEDICAL CONDITION. * PROVIDE OUTPATIENT MENTAL HEALTH SERVICES UTILIZING EVIDENCE-BASED TREATMENT (COGNITIVE BEHAVIORAL THERAPY, PARENT CHILD INTERACTION THERAPY, TRAUMA-FOCUSED COGNITIVE BEHAVIORAL THERAPY, FAMILY BASED THERAPY FOR ANOREXIA NERVOSA, BEHAVIORAL THERAPY FOR CHILDREN WITH AUTISM SPECTRUM DISORDER AND OTHER NEURODEVELOPMENTAL CONDITIONS, EMDR, AND A GROUP THERAPY IN ORDER TO PROVIDE MENTAL HEALTH SKILLS FOR PATIENTS. * HELP PATIENTS AND FAMILIES DEAL WITH SITUATIONAL CRISES RESULTING FROM ACCIDENT, ILLNESS OR TRAUMA. * 24-HOUR COVERAGE BY A LICENSED CLINICIAN OR SUPERVISEE FOR NIGHTS, WEEKENDS AND HOLIDAYS. THE CHKD'S CULTURAL/LANGUAGE SERVICES DEPARTMENT MEETS THE NEEDS OF PATIENTS AND FAMILIES WITH LIMITED ENGLISH PROFICIENCY BY COORDINATING ACCESS TO LANGUAGE INTERPRETATION VIA FACE-TO-FACE, OVER THE PHONE AND VIDEO REMOTE INTERPRETATION THROUGHOUT THE HEALTH SYSTEM. THE PROGRAM'S GOAL IS TO IMPROVE CUSTOMER SERVICE, CONSISTENCY OF CARE AND PATIENT SAFETY. WE RECOGNIZE THAT IT IS CRITICAL TO HAVE ACCESS TO INTERPRETERS AND CAREGIVERS WHO CAN PROVIDE CULTURALLY SENSITIVE AND ACCURATE INFORMATION SO THEY CAN UNDERSTAND AND PARTICIPATE IN THE CHILDREN'S TREATMENT AND DISCHARGE PROCESS AND HELP PREVENT POTENTIAL MEDICAL ERRORS. IT ALSO CONTRIBUTES TO OVERALL SATISFACTION, WHICH IS VITALLY IMPORTANT. WE MEET THIS GOAL THROUGH THE ACTIVITIES DESCRIBED BELOW: CHKD PROVIDED INTERPRETATION SERVICES IN 34 DIFFERENT LANGUAGES FOR OUR LIMITED ENGLISH POPULATION THROUGH 13,542 OUTPATIENT VISITS IN FY22. TO MEET THE NEEDS OF THESE FAMILIES HOSPITAL STAFF USED OVER THE PHONE INTERPRETATION, VIDEO REMOTE INTERPRETATION AND THREE FULL TIME SPANISH MEDICAL INTERPRETERS IN THE LANGUAGE SERVICES DEPARTMENT COVERING THE MAIN HOSPITAL AND THE GENERAL ACEDEMIC PEDIATRICS CLINIC. ADDITIONALLY, THE HEALTH SYSTEM HAD 24 DUAL ROLE BILINGUAL STAFF MEMBERS WHO WERE AVAILABLE TO PROVIDE MEDICAL INTERPRETATION IN THEIR ASSIGNED AREAS. FOR WRITTEN DOCUMENT TRANSLATION, THE HEALTH SYSTEM RELIED ON ONE REMOTE PRN DOCUMENT TRANSLATOR IN ADDITION TO TWO OF THE LANGUAGE SERVICES FULL-TIME SPANISH MEDICAL INTERPRETERS.
DURING FY22, THE LANGUAGE SERVICES DEPARTMENT ASSISTED WITH IN-PERSON AND	OVER THE PHONE INTERPRETATION FOR 10,496 PATIENT ENCOUNTERS AT THE MAIN HOSPITAL AND AT THE GAP CLINIC, TRANSLATED 299 DOCUMENTS FROM ENGLISH TO SPANISH AND CONDUCTED 19 LANGUAGE PROFICIENCY ASSESSMENTS (10 FOR BASIC SPANISH AND 9 FOR MEDICAL SPANISH). LANGUAGE PROFICIENCY ASSESSMENTS ARE CONDUCTED BY THE LANGUAGE SERVICES DEPARTMENT TO ENSURE BILINGUAL STAFF THROUGHOUT THE CHKD HEALTH SYSTEM HAVE THE SKILLS NECESSARY TO COMMUNICATE EFFECTIVELY WITH PATIENTS AND FAMILIES IN SPANISH, OR BEFORE THEY ARE ALLOWED TO PROVIDE MEDICAL INTERPRETATION IN SPANISH. AS THE REGIONAL PROVIDER OF PEDIATRIC CARE, CHKD IS AN INTEGRAL PART OF THE COMMUNITY'S NATURAL OR MAN-MADE DISASTER PLANNING EFFORTS. CHKDHS RECOGNIZES THE IMPORTANCE OF A NATIONAL INCIDENT MANAGEMENT SYSTEM(NIMS) COMMUNITY-INTEGRATED, ALL-HAZARD EMERGENCY OPERATIONS PLAN. THIS PLAN IS PREPARED, EXERCISED AND SHARED INTERNALLY AND EXTERNALLY WITH COMMUNITY, STATE AND FEDERAL EMERGENCY RESPONSE AGENTS. STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS SECTION TWO: OUTPATIENT SERVICES AND PROGRAMS CHKD HEALTH SYSTEM ALSO OFFERS THE COMMUNITY MANY IMPORTANT PEDIATRIC SERVICES ON AN OUTPATIENT BASIS. IN FY22, CHILDREN MADE APPROXIMATELY 631,587 (THIS IS CMG, CSSG VISITS, AND OUTPATIENT CLINIC VISITS) OUTPATIENT VISITS TO CHKD PEDIATRICIANS, SURGEONS AND SUBSPECIALTY SPECIALTY CLINICS. THEY MADE 389,329 VISITS TO THE PRIMARY CARE PEDIATRICIANS OF CHKD'S MEDICAL GROUP, WHICH OFFERS CARE IN 20 PRACTICES AND 32 OFFICES THROUGHOUT OUR SERVICE AREA. CHKD'S SURGICAL SPECIALTY GROUP MAKES THE SERVICES OF THE REGION'S ONLY PEDIATRIC GENERAL, UROLOGICAL, CARDIAC, NEUROSURGICAL, PLASTIC AND ORTHOPEDIC SURGEONS AVAILABLE TO THOUSANDS OF CHILDREN WHO MIGHT OTHERWISE HAVE TO TRAVEL OUTSIDE OF THE AREA FOR SURGERY. CHILDREN MADE 46,512 VISITS TO THE SURGICAL GROUP PRACTICES IN FY22. THE SURGEONS PERFORMED 5,444 SURGICAL CASES. THE HOSPITAL ALSO PROVIDES CARE TO CHILDREN FACING HEALTH CONDITIONS SUCH AS CANCER, GENETIC DISORDERS, OBESITY, HEART PROBLEMS, DEVELOPMENTAL DISABILITIES, ASTHMA/ALLERGIES AND DIABETES THROUGH MORE THAN 50 OUTPATIENT SPECIALTY CLINICS OFFERING SPECIALIZED PEDIATRIC CARE. IN FY22, CHILDREN MADE 242,258 VISITS TO OUR OUTPATIENT CLINICS. CHILDREN'S HOSPITAL WAS FOUNDED ON THE PREMISE THAT ALL CHILDREN DESERVE EQUAL ACCESS TO QUALITY PEDIATRIC CARE. AS OUR POPULATION GREW AND SETTLED INTO THE FAR CORNERS OF OUR BRIDGE-AND TUNNEL-LACED REGION, TRAVEL TO CHKD'S MAIN FACILITY IN NORFOLK BECAME MORE OF A HARDSHIP FOR FAMILIES. TO EASE THAT BURDEN AND IMPROVE CHILDREN'S ACCESS TO CARE IN EVERY CORNER OF OUR SERVICE AREA, CHKD HAS ESTABLISHED MULTI-SERVICE HEALTH CENTERS IN STRATEGIC LOCATIONS. THESE INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING: * THE CHKD HEALTH AND SURGERY CENTER AT OYSTER POINT OFFERS FAMILIES WHO LIVE NORTH OF THE HAMPTON ROADS BRIDGE TUNNEL A WEALTH OF IMPORTANT SERVICES IN A CONVENIENT LOCATION. THE CENTER IS HOME TO THE REGION'S FIRST PEDIATRIC AMBULATORY SURGERY CENTER. OTHER SERVICES OFFERED AT THE SITE INCLUDE PRIMARY, SURGICAL AND SUB-SPECIALTY PEDIATRICS; LAB AND RADIOLOGY (INCLUDING ULTRASOUND AND MRI), AUDIOLOGY TESTING AND OCCUPATIONAL, SPEECH AND PHYSICAL THERAPY. AQUATIC THERAPY AND CHILD ABUSE PROGRAM SERVICES ARE ALSO AVAILABLE THERE. * THE CHKD HEALTH CENTER AND URGENT CARE AT TECH CENTER IS HOME TO THE PENINSULA'S ONLY PEDIATRIC URGENT CARE AS WELL AS THE CENTER FOR PEDIATRIC SLEEP MEDICINE, X-RAY, LAB, PHYSICAL MEDICINE AND REHABILITATION, RHEUMATOLOGY, AND SPORTS MEDICINE PRIMARY CARE, PHYSICAL THERAPY, AND PERFORMANCE TRAINING. * THE CHKD HEALTH CENTER AT OAKBROOKE SERVES FAMILIES IN CHESAPEAKE AND NORTHEASTERN NORTH CAROLINA. IT IS HOME TO A PRIMARY CARE PEDIATRIC PRACTICE; PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY; X-RAY AND LAB SERVICES, A SPORTS MEDICINE GYM, SLEEP STUDIES UNIT AND THERAPY POOL, AS WELL AS CLINIC SPACE FOR A VARIETY OF PEDIATRIC SPECIALISTS AND SURGEONS PROVIDING EVALUATION, TREATMENT AND FOLLOW-UP. * THE CHKD HEALTH AND SURGERY CENTER AT PRINCESS ANNE SERVES THE GROWING MEDICAL NEEDS OF FAMILIES IN VIRGINIA BEACH. THE CENTER IS HOME TO VIRGINIA BEACH'S FIRST AMBULATORY SURGERY CENTER EXCLUSIVELY FOR CHILDREN. BEACH FAMILIES CAN ALSO FIND PRIMARY CARE PEDIATRICIANS AND IN-HOUSE LAB AND RADIOLOGY SERVICES - INCLUDING MRI - AT THE CENTER. OTHER SERVICES INCLUDE SPECIALTY CARE PEDIATRICS FOR HELP WITH CHRONIC PROBLEMS SUCH AS DIABETES. THIS YEAR, A THIRD OPERATING ROOM WAS ADDED TO THIS LOCATION TO SUPPORT THE PEDIATRIC DENTAL NEEDS OF THE COMMUNITY. IT WAS BUILT AND DESIGNED ACCORDING TO THE INPUT FROM COMMUNITY DENTISTS. * THE CHKD HEALTH CENTER AT LANDSTOWN IS LOCATED JUST DOWN THE ROAD FROM CONCERT DRIVE AND OFFERS DEDICATED VIRGINIA BEACH SPACE FOR SERVICES SUCH AS SPORTS MEDICINE, DERMATOLOGY AND GYNECOLOGY. * THE CHKD HEALTH CENTER AND URGENT CARE AT LOEHMANN'S SERVES THE NORTHERN AND MIDDLE VIRGINIA BEACH REGION AND IS HOME TO CHKD URGENT CARE, SPORTS MEDICINE (PRIMARY CARE) AND THERAPY, SPORTS PERFORMANCE TRAINING AND PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY. * THE CHKD HEALTH CENTER AT BUTLER FARM OFFERS PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, AND SPORTS MEDICINE PHYSICAL THERAPY TO CHILDREN AND TEENS ON THE PENNISULA. DEVELOPMENTAL PEDIATRICS ALSO HOSTS A WHEELCHAIR CLINIC AT THIS LOCATION. * THE CHKD HEALTH CENTER AT HARBOUR VIEW NORTH OFFERS SPECIALIZED PEDIATRIC CARE TO FAMILIES IN SUFFOLK. THE SITE OFFERS APPOINTMENTS IN PEDIATRIC DERMATOLOGY, ALLERGY, GASTROENTEROLOGY, CARDIOLOGY AND NEPHROLOGY, AS WELL AS DEVELOPMENTAL PEDIATRICS. * THE CHKD HEALTH CENTER AT LIGHTFOOT OFFERS FAMILIES IN THE NORTHERN CORNER OF OUR SERVICE AREA APPOINTMENTS IN PEDIATRIC CARDIOLOGY, NEPHROLOGY, GYNECOLOGY, PHYSICAL MEDICINE AND REHABILITATION, REHABILITATIVE THERAPIES, SPORTS MEDICINE AND UROLOGY. CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS OPERATES THE REGION'S ONLY PEDIATRIC URGENT CARE. PARENTS OF CHILDREN WITH URGENT, BUT NOT EMERGENT MEDICAL NEEDS, NOW HAVE ACCESS TO QUALITY MEDICAL CARE JUST FOR KIDS AFTER-HOURS, ON WEEKENDS AND HOLIDAYS. IN FY22, CHILDREN MADE 106,811 VISITS TO CHKD URGENT CARE CENTERS IN CHESAPEAKE, VIRGINIA BEACH AND NEWPORT NEWS. CHKD'S CHILD ADVOCACY CENTER (CAC) COORDINATES THE REGION'S EFFORTS TO ACCURATELY IDENTIFY, TREAT AND SUPPORT CHILDREN WHO HAVE BEEN SUSPECTED OF ABUSE OR NEGLECT. IN ADDITION TO THE MAIN PROGRAM IN NORFOLK, SERVICES ARE ALSO AVAILABLE AT CHKD'S OUTPATIENT CENTERS IN VIRGINIA BEACH AND NEWPORT NEWS. THE CAC PROVIDES COMPREHENSIVE ASSESSMENT, EVALUATION AND TREATMENT SERVICES, INCLUDING CASE MANAGEMENT AND ADVOCACY, AN ARRAY OF EVIDENCE-BASED MENTAL HEALTH SERVICES, FORENSIC INTERVIEWING, FORENSIC MEDICAL EXAMINATIONS AND CONSULTATIONS, WHICH INCLUDE 24/7 COVERAGE OF ACUTE SEXUAL ASSAULTS OF CHILDREN. THE CAC ALSO HELPS COORDINATE THE EFFORTS OF INVESTIGATIVE AGENCIES INVOLVED IN THE INVESTIGATION AND PROSECUTION OF CHILD MALTREATMENT AND FACILITATES THE COLLABORATION OF 11 MULTIDISCIPLINARY TEAMS (MDTS). THESE TEAMS DISCUSS ALL CHILDREN REFERRED TO THE PROGRAM TO HELP ENSURE THE BEST OUTCOMES CAN BE REALIZED. WITH STRONG COMMUNITY SUPPORT, CHKD'S CHILD ADVOCACY CENTER HELPED 2,282 CHILDREN AND THEIR FAMILIES IN FY22 A 38% INCREASE OVER FY21. FOR ALMOST 25 YEARS, INVESTIGATIVE AGENCIES ACROSS SOUTHEASTERN VIRGINIA HAVE TRUSTED THIS SPECIALIZED PROGRAM FOR ASSESSMENT AND TREATMENT SERVICES AFTER A CHILD IS SUSPECTED OF HAVING EXPERIENCED ALL FORMS OF CHILD MALTREATMENT. A SPECIALTY PROGRAM WITHIN THE CAC HELPS ACCURATELY IDENTIFY AND PROVIDE ASSISTANCE AND TREATMENT TO COMMERCIALLY SEXUALLY EXPLOITED CHILDREN (CSEC). SINCE LAUNCHING OUR PROGRAM AND CSEC MDT WE HAVE SEEN A SHARP INCREASE IN THE NEED FOR SERVICES FOR CHILDREN WHO NEED SUPPORT. OUR TEAM OFTEN COORDINATES WITH FEDERAL AND LOCAL INVESTIGATORS AS WELL AS JUVENILE COURT SERVICES AND MEDICAL AND MENTAL HEALTH PROVIDERS TO BEST SERVE THE UNIQUE NEEDS OF EACH CHILD. THE CAC IS ALSO THE BACKBONE AGENCY FOR THE HAMPTON ROADS TRAUMA INFORMED COMMUNITY NETWORK (HRTICN). THE NETWORK EXISTS TO PROMOTE AN UNDERSTANDING OF HOW TRAUMA AFFECTS INDIVIDUALS AND COMMUNITIES, AND TO ADVOCATE PRACTICES THAT HELP ALL PEOPLE REACH THEIR FULL POTENTIAL. THE HRTICN WORKED WITH THE VIRGINIA CHAPTER OF AMERICAN ACADEMY OF PEDIATRICS THIS YEAR TO TRAIN PEDIATRICIANS ON APPROACHES TO SCREENING, REFERRAL, AND FOLLOW-UP FOR MATERNAL DEPRESSION, SOCIAL DETERMINANTS OF HEALTH AND SOCIAL-EMOTIONAL DEVELOPMENT DURING WELL VISITS. ALMOST 15% OF THE CHILDREN SERVED AT OUR CAC HAVE A MILITARY AFFILIATION; HAVING A RECENTLY ADDED CASE MANAGER DEDICATED TO THESE FAMILIES HAS BEEN AN IMPORTANT PROGRAM ENHANCEMENT. THE PROGRAM MAINTAINS THREE MILITARY MULTIDISCIPLINARY TEAMS THAT COVER ALL BRANCHES OF THE MILITARY, AND WE STRIVE TO CONTINUALLY IMPROVE OUR RESPONSE TO MILITARY FAMILIES, LINK THEM TO OTHER MILITARY RESOURCES AVAILABLE TO THEM, AND PROVIDE EDUCATIONAL OPPORTUNITIES TO OUR MDT PARTNERS WE WORK WITH.
THE EPIDEMIC OF CHILDHOOD OBESITY CONTINUES TO BE A CONCERN AND FOCUS AREA	FOR CHKD. IN ORDER TO ADDRESS THIS CRITICAL ISSUE, IN 2001, CHKD ESTABLISHED A COMPREHENSIVE PROGRAM CALLED HEALTHY YOU FOR LIFE THAT IS OFFERED TO CHILDREN AGES 3 THROUGH HIGH SCHOOL. HEALTHY YOU FOR LIFE OFFERS A MULTIDISCIPLINARY TEAM APPROACH THAT PROVIDES CLINICAL AND PSYCHOLOGICAL EVALUATION AND TREATMENT PLANNING FOR INDIVIDUALS EITHER IN PERSON OR BY TELEMEDICINE VISITS. THE PROGRAM'S STAFF INCLUDES PHYSICIANS, NURSE PRACTITIONERS, REGISTERED DIETITIANS, LICENSED CLINICAL SOCIAL WORKERS, A MEDICAL ASSISTANT,AND EXERCISE PHYSIOLOGIST. THE HEALTHY YOU FOR LIFE PROGRAM ALSO OFFERS INDIVIDUAL COUNSELING SESSIONS. IN FY22 THE TEAM CONDUCTED NEARLY 1,500 VISITS COVERING 81 ZIP CODES. MOVING INTO THE NEW FISCAL YEAR, THE TEAM IS CONTINUING TO USE TELEMEDICINE AS A WAY TO IMPROVE ACCESS TO A BEHAVIORAL HEALTH COUNSELOR TO ADDRESS PSYCHO-SOCIAL STRESSORS MANY PATIENTS EXPERIENCE. MIDDLE SCHOOL AND HIGH SCHOOL GROUP THERAPY SESSIONS HAVE BEEN INITIATED VIA TELEHEALTH TO HELP PRE-TEEN AND TEENAGERS FEEL CONNECTED AND SUPPORTED DURING THE PANDEMIC. PERSONAL TRAINING IS ALSO OFFERED FOR INTERESTED PATIENTS. HEALTHY YOU CONTINUES TO PARTNER WITH VARIOUS COMMUNITY ORGANZIATIONS TO EDUCATE AND ENCOURAGE HEALTHY LIFESTYLES FOR CHRONICALLY OBESE CHILDREN AND THEIR FAMILIES IN HAMPTON ROADS. CHKD'S DIABETES EDUCATION PROGRAM HELPS APPROXIMATELY 1,600 LOCAL CHILDREN WHO LIVE WITH THE CHRONIC DISEASE. THREE CERTIFIED DIABETES EDUCATORS, A SOCIAL WORKER, A REGISTERED DIETITIAN AND OFFICE COORDINATOR HELP PATIENTS AND FAMILIES AT THE ONSET OF THE DISEASE AND UNTIL ADULTHOOD. THE DIABETES CENTER PROVIDES INPATIENT AND OUTPATIENT CLINICAL MANAGEMENT, DIABETES EDUCATION, SUPPORT GROUPS, AND PROFESSIONAL AND COMMUNITY EDUCATION PROGRAMS. A TRANSITION PROGRAM HELPS THE OLDER TEENS AND YOUNG ADULTS BEGIN TRANSFERRING CARE TO ADULT PROVIDERS IN THE COMMUNITY. CHILDREN MADE 619 VISITS TO THE DIABETES CENTER IN FY22. THE CHILDREN'S CANCER AND BLOOD DISORDERS CENTER PROVIDES CARE TO YOUNG PEOPLE WITH CANCER, SICKLE CELL DISEASE, BLEEDING AND OTHER BLOOD DISORDERS THROUGH TREATMENT PROGRAMS THAT ENCOMPASS CHILDREN'S PHYSICAL, EMOTIONAL AND EDUCATIONAL NEEDS AND INCORPORATES THE WHOLE FAMILY. PATIENTS MADE 8,579 VISITS TO THE CENTER IN FY22. CHKD IS THE ONLY EMERGENCY DEPARTMENT AND LEVEL 1 TRAUMA CENTER EXCLUSIVELY SERVING CHILDREN AND THEIR FAMILIES IN THE SOUTHEAST REGION OF VIRGINIA. IN FY22, CHILDREN MADE 60,690 VISITS TO OUR EMERGENCY CENTER. CHKD PROVIDES CARE FOR PATIENTS AND THEIR FAMILIES FROM BIRTH TO YOUNG ADULTHOOD WITH VARIED LEVELS OF ACUITY FROM TRAUMA AND RESUSCITATIONS TO URGENT CARE TYPE PATIENTS. OUR COLLABORATIVE TEAM INCLUDES PEDIATRIC BOARD-CERTIFIED EMERGENCY PHYSICIANS, NURSE PRACTITIONERS, NURSES, ED TECHS, NURSING CARE PARTNERS, BEHAVIORAL HEALTH TECHS, PHARMACISTS, SOCIAL WORKERS, CHILD LIFE SPECIALISTS, CHAPLAINS, RESPIRATORY THERAPISTS AND MORE. CHKD OFFERS THE ONLY PEDIATRIC RENAL DIALYSIS SERVICE IN THE AREA. DIALYSIS IS A TIME-CONSUMING PROCESS AND CHILDREN APPRECIATE THE CHANCE TO HAVE THE SERVICE IN A SETTING WHERE THEY CAN MEET WITH FRIENDS THEIR OWN AGES AS WELL AS HOSPITAL SUPPORT STAFF AND SCHOOL TEACHERS. DURING FY22 CHILDREN MADE 2,359 CHRONIC AND ACUTE DIALYSIS VISITS, AND 5,672 VISITS TO THE RENAL CLINIC AND RECEIVED 485 RENAL INFUSIONS. CHKD IS A STAND-ALONE PEDIATRIC TRANSPLANT HOSPITAL. SINCE 2005, CHKD HAS PERFORMED 91 KIDNEY TRANSPLANTS FROM LIVING DONORS AS WELL AS DECEASED DONORS. LIVING DONATION OPTIONS INCLUDE A PARTNERSHIP WITH SENTARA NORFOLK GENERAL HOSPITAL AND THE NATIONAL KIDNEY REGISTRY (NATIONWIDE LIVING DONOR PAIRED-EXCHANGE PROGRAM). ONE MARK OF CHKD'S DISTINCTIVE PEDIATRIC CARE HAS ALWAYS BEEN CHILD-CENTERED DIAGNOSTIC SERVICES, SUCH AS RADIOLOGY AND LABORATORY. OVER THE PAST SEVERAL YEARS, CHKD HAS WORKED HARD TO MAKE THESE UNIQUE SERVICES MORE ACCESSIBLE TO FAMILIES THROUGHOUT OUR SERVICE REGION. IN ADDITION TO THE LAB AT THE MAIN HOSPITAL, CHKD NOW HAS LAB SERVICES AT ITS OYSTER POINT, HARBOUR VIEW, CONCERT DRIVE, OAKBROOKE, LOEHMANN'S AND TECH CENTER LOCATIONS AS WELL AS THE VOLVO URGENT CARE CENTER. THE LABORATORY ALSO OPERATES A COURIER SERVICE THAT FACILITATES QUICK TURNAROUND OF SPECIMENS. OF THE 1,042,282 LAB TESTS PERFORMED IN FY22, APPROXIMATELY 72 PERCENT WERE FOR OUTPATIENTS. CHKD RADIOLOGY SERVICES ARE ALSO AVAILABLE TO FAMILIES AT OUR CHKD FACILITIES IN NEWPORT NEWS, CHESAPEAKE, SUFFOLK, HAMPTON, NORFOLK AND VIRGINIA BEACH. THE RADIOLOGY DEPARTMENT IS A FULLY INTEGRATED DIGITAL IMAGING CENTER THAT ALLOWS DIAGNOSTIC IMAGES AND REPORTS TO BE TRANSMITTED AND VIEWED ELECTRONICALLY. IN FY22, 110,621 DIAGNOSTIC EXAMS WERE PERFORMED, INCLUDING X-RAYS, FLUOROSCOPIC TESTS, URODYNAMICS AND BONE DENSITY TESTS, CT AND MRI SCANS, ULTRASOUND, PVL AND NUCLEAR MEDICINE STUDIES. APPROXIMATELY 80 PERCENT WERE OUTPATIENT BASED. CHKD'S REHABILITATIVE THERAPY SERVICES ARE OFFERED IN LOCATIONS THROUGHOUT THE COMMUNITY, INCLUDING NORFOLK, CHESAPEAKE, VIRGINIA BEACH, SUFFOLK, WILLIAMSBURG AND NEWPORT NEWS. IN ADDITION TO ITS HIGHLY SPECIALIZED PEDIATRIC PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY, THE DEPARTMENT ALSO OFFERS: * AQUATIC THERAPY - PHYSICAL AND OCCUPATIONAL THERAPISTS WORK WITH CHILDREN IN THE WATER TO HELP RELAX TIGHT MUSCULATURE, INCREASE RANGE OF MOTION AND IMPROVE STRENGTH, BALANCE AND ENDURANCE. * ASSISTIVE TECHNOLOGY/AUGMENTATIVE PROGRAM - SERVICES PROVIDED FOR CHILDREN WHO ARE UNABLE TO COMMUNICATE VERBALLY OR THROUGH GESTURES DUE TO VARIOUS MEDICAL CONDITIONS, THEREBY ALLOWING THEM AN ALTERNATIVE WAY TO INCREASE THEIR PARTICIPATION AND INCLUSION IN DAILY ACTIVITIES. IN FY22, WE DID 192 AUGMENTATIVE COMMUNICATION EVALUATIONS. * CAR SEAT PROGRAM - SPECIALLY TRAINED THERAPISTS OFFER CAR SEAT SAFETY RESTRAINT EVALUATIONS FOR PATIENTS WITH SPECIAL NEEDS. IN FY22, WE DID 225 CAR SEAT EVALUATIONS, DISTRIBUTED 54 CAR SEATS DURING THOSE EVALUATIONS, DISTRIBUTED AN ADDITIONAL 156 STANDARD CAR SEATS, AND PARTICIPATED IN ONE COMMUNITY-BASED CAR SEAT SAFETY CHECKS THROUGH THIS PROGRAM. * WHEELCHAIR CLINIC - CERTIFIED THERAPISTS COMPLETE A COMPREHENSIVE EVALUATION TO DETERMINE AND PRESCRIBE THE APPROPRIATE WHEELCHAIR AND SEATING SYSTEM. CHILDREN MADE ALMOST 665 VISITS TO THIS CLINIC IN FY22 FOR EVALUATION AND TECHNICAL ADJUSTMENTS. SECTION THREE: COMMUNITY OUTREACH CHKD REACHED FAMILIES IN THEIR HOMES, DOCTORS' OFFICES, SCHOOLS, NEIGHBORHOODS AND COMMUNITY CENTERS WITH A WIDE VARIETY OF PROGRAMS, SOCIAL MEDIA AND PUBLICATIONS THAT PROMOTE MENTAL WELLNESS, PREVENT INJURIES, AND STRENGTHEN FAMILIES. USING CREATIVE AND INNOVATIVE WAYS WITH OUR STRONG COMMUNITY PARTNERS, OUR COMMUNITY OUTREACH AND ENGAGEMENT (CORE) PROGRAM CONDUCTED 193 OUTREACH EVENTS REACHING 31,475 FAMILIES. DESPITE COVID-19 LIMITATIONS, CORE WAS ABLE TO ADJUST AND CONTINUE TO PROVIDE QUALITY PARENT EDUCATION AND RESOURCES. EFFORTS FOCUSED ON MENTAL HEALTH, TRAUMA, AND SOCIAL EMOTIONAL LEARNING FOR BOTH PARENTS AND PROFESSIONALS AND DEVELOPING PROGRAMS ON DEMAND. OUR STRONG COMMUNITY PARTNERS ASSISTED WITH PROGRAM MARKETING AND COLLABORATION TO PROVIDE A VARIETY OF TIMELY PRESENTATIONS TO EQUIP PARENTS, PROFESSIONALS AND CHILDREN IN OUR COMMUNITY. CHKD IS A SITE OF THE NATIONAL "REACH OUT AND READ" LITERACY PROGRAM, WHICH ENCOURAGES READING BY DISTRIBUTING FREE BOOKS TO CHILDREN AT THEIR WELL CHILD VISITS BY THEIR PEDIATRICIANS. THROUGH THE DONOR-FUNDED PROGRAM, CHKD PRIMARY CARE PEDIATRICIANS GAVE APPROVIMATELY 65,571 BOOKS TO CHILDREN IN FY22. CHKD ALSO HAS A "REACH OUT AND READ" PROGRAM IN OUR NICU, WHERE 786 BOOKS WERE DISTRIBUTED IN FY22. CHKD'S WEBSITE, WWW.CHKD.ORG, CONTINUES TO BE A POPULAR AND EFFECTIVE METHOD OF COMMUNICATION. IN FY22, CHKD.ORG HAD MORE THAN 3 MILLION VISITS. NEARLY 2 MILLION NEW AND RETURNING VISITORS VIEWED 5,477,596 PAGES ON OUR SITE. THE CONTENT MANAGEMENT SYSTEM THAT IS IN PLACE ALLOWS MULTIPLE USERS TO CREATE AND UPDATE CONTENT AS NEEDED. CHKD.ORG IS A RESPONSIVE DESIGN SITE AND AUTOMATICALLY FORMATS ITSELF TO ANY DEVICE (PC, TABLET OR SMARTPHONE)- NO APP NEEDED. CLICKABLE PHONE NUMBERS AND INTERACTIVE MAPS MAKE IT EASY FOR OUR PATIENTS TO CALL OR FIND ANY PRACTICE, AND FAMILIES HAVE EASY ACCESS TO TEST RESULTS, SHOT RECORDS, AND CAN EVEN REQUEST PRESCRIPTION REFILLS AND MAKE APPOINTMENTS ONLINE STRAIGHT FROM THE HOMEPAGE BY ACCESSING THE MYCHKD PATIENT PORTAL. ENHANCED PHYSICIAN PROFILES, INCLUDING CLICKABLE PHONE NUMBERS, INTERACTIVE MAPS, BIOGRAPHICAL INFORMATION AND A LINK TO THE PHYSICIAN'S PRACTICE MAKE IT EASIER THAN EVER TO CHOOSE THE DOCTOR THAT'S RIGHT FOR YOU. CHKD CONTINUES TO UTILIZE SOCIAL MEDIA OUTLETS SUCH AS FACEBOOK, TWITTER, LINKEDIN, PINTEREST AND INSTAGRAM TO INCREASE DIRECT INTERACTION WITH OUR PATIENTS AND THEIR FAMILIES. THE WEBSITE CONTINUES TO BE A RESOURCE FOR OUR SERVICES AND HEALTH INFORMATION.
CHKD IS ONE OF SIX LOCATIONS IN THE STATE FOR THE CARE CONNECTION FOR	CHILDREN (CCC), THE STATE-FUNDED TITLE V PROGRAM THAT PROVIDES COMPREHENSIVE CARE COORDINATION, INFORMATION AND REFERRAL FOR CHILDREN AND YOUTH WITH SPECIAL HEALTH CARE NEEDS. THERE ARE APPROXIMATELY 12,000 CHILDREN WITH SPECIAL HEALTH CARE NEEDS IN THE REGION'S PUBLIC HEALTH DISTRICTS. IN FY22, CCC ASSISTED WITH 580 INFORMATION AND REFERRAL CALLS AND PROVIDED COMPREHENSIVE CASE MANAGEMENT SERVICES TO 525 FAMILIES. FINANCIAL ASSISTANCE WAS PROVIDED FOR 26 CHILDREN AND YOUTH WHO WERE UNINSURED OR UNDERINSURED AND 70 FAMILIES WERE ASSISTED IN APPLYING FOR STATE HEALTH PROGRAMS, TO INCLUDE VIRGINIA'S WAIVER SERVICES. THE PROGRAM PROVIDED ONGOING BILINGUAL CARE COORDINATION SERVICES TO 85 CLIENTS AND FAMILY MEMBERS AND ASSISTED THEM WITH ACCESS TO COMMUNITY RESOURCES AND FINANCIAL ASSISTANCE. WE MAINTAINED AN UPDATED LOCAL AND REGIONAL COMMUNITY DATABASE WITH CATALOGED RESOURCES FOR ALL 21 CITIES AND COUNTIES IN OUR REGION. THIS RESOURCE DIRECTORY WAS MADE AVAILABLE TO THE HEALTH SYSTEM AS WELL AS LOCAL AGENCIES AND THE COMMUNITY. THE PARENT EDUCATORS FROM THE FAMILIES AS EDUCATORS PROGRAM (SHARING OF CHALLENGES AND POSITIVE EXPERIENCES IN RAISING CHILDREN AND YOUTH WITH SPECIAL HEALTHCARE NEEDS), WHICH PROVIDES COMMUNIY BASED EXPERIENCES TO PARTICIPATING RESIDENTS WAS TEMPORARILY DISCONTINUED BECAUSE OF COVID-19 BUT IS ACTIVE AGAIN. 2021-2022 HIGHLIGHTS DEVELOPED, IMPLEMENTED AND CONTINUED TO MODERATE A LISTSERV FOR THE COMMUNITY ON DISABILITY TOPICS WITH MORE THAN 500 PEOPLE REGISTERED. MEMBERS ARE PATIENTS, PARENTS, CAREGIVERS, AND PROVIDERS. ONGOING COLLABORATION WITH CHKD, FORTIFY CLINICALLY INTEGRATED NETWORK AND CMG TO INTEGRATE CARE COORDINATION ACTIVITIES WITHIN THE ELECTRONIC RECORD TO IMPROVE COMMUNICATION WITH PATIENT CENTERED MEDICAL HOME. HAMPTON ROADS CYSN CONSORTIUM MEMBERS DEVELOPED AND IMPLEMENTED FIVE VIRTUAL TRAININGS ATTENDED BY 200 COMMUNITY MEMBERS BOTH PROFESSIONALS AND FAMILY MEMBERS. TRAININGS ARE RECORDED AND EMBEDDED IN CHKD WEBSITE FOR ANYONE TO ACCESS. ACTIVELY ENGAGED IN HOME VISITING COLLABORATION (9 TO 5 EVMS PROGRAM), AUTISM COLLABORATIVE, EDHI LEARNING COLLABORATIVE, CINCH, TRICC, PEATC, FAPT TEAMS, SEAC STATE REPRESENTATIVE FOR MEDICAID ADVISORY GROUP. NEW PROJECT WHICH OFFERS A VIRTUAL SPANISH SPEAKING SUPPORT GROUP. OTHER TRANINGS PLANNED, COORDINATED, AND REPORTED ON QUARTERLY, BASED ON NEEDS IDENTIFIED THROUGH NETWORKDS WE ARE INVOLVED IN WITH THE COMMUNITY AND OUR FAMILIES AS EDUCATORS GROUP. FOR ALL STAFF A TRACKING TOOL FOR ALL STAFF WAS DEVELOPED FOR MONITORING AND OPENING AND CLOSING OF CASES AND RELATED ACTIVITIES REQUIRED FOR COMPLETION AS SOME DOES NOT HAVE A TASK LIST NOR CALENDAR. THIS EXCEL DOCUMENT IS UPDATED AND STORED IN A CENTRAL SHARE DIRECTORY TO ALLOW STAFF ACCESS TO VIEW WHAT NEEDS TO BE UPDATED FOR CASE. IN PROCESS OF DEVELOPING JOB AIDS AS A STANDARD METHODOLOGY WITH DOCUMENT CONTROL INITIATIVES PER DNV/ISO STANDARDS. ROBUST RESEARCH AND UPDATING RESOURCES IN OUR COMMUNITY ASSET MAPPING TOOL. COLLABORATE ACROSS THE CCC NETWORK TO IDENTIFY RESOURCES. IMPLEMENTED A MONTHLY VIRTUAL BILINGUAL SUPPORT GROUP WITH OUR PARENT COORDINATOR AND OUR BILINGUAL SOCIAL WORK CARE COORDINATOR. DEVELOPED A NEW TRAINING MODULE ON SAFETY AND HOME/AGENCY VISITING INCORPORATING COVID CDC GUIDANCE FOR STAFF SAFETY. * ACTIVELY ENGAGED WITH INTERCENTER WORK GROUP MEETINGS, TRAININGS, EMAIL COLLABORATIONS AND TELECONFERENCE SESSIONS. GROUP MEMBERS SUPPORT ONE ANOTHER TO IDENTIFY RESOURCES WHEN WE FACE CHALLENGES. WE ALSO ADVOCATE TO CLOSE GAPS IN SERVICES. * CONTINUE TO OFFER EDUCATIONAL CONSULTANT SERVICES PER VDOE REGULATIONS. PROVIDE INFORMATION AND REFERRAL SERVICES FOR HEALTH SYSTEM RELATED TO EDUCATIONAL CONCERNS (IEP/IFSP). SECTION FOUR: MEDICAL EDUCATION AND RESEARCH CHKD INVESTS IN THE PRESENT AND FUTURE HEALTH OF OUR CHILDREN THROUGH A VARIETY OF RESEARCH PROGRAMS AND EDUCATIONAL ACTIVITIES. CHILDREN'S HOSPITAL IS HOME TO EASTERN VIRGINIA MEDICAL SCHOOL'S PEDIATRIC RESIDENCY PROGRAM, WHERE NEW PHYSICIANS BECOME SPECIALISTS IN THE FIELD OF PEDIATRICS. MANY OF OUR RESIDENTS ELECT TO STAY AND PRACTICE PEDIATRICS IN THIS COMMUNITY OR IN THE STATE OF VIRGINIA. CHKD ALSO SERVES AS THE EXCLUSIVE PEDIATRIC TEACHING SITE FOR PHYSICIAN ASSISTANTS AND RESIDENTS IN FAMILY MEDICINE, EMERGENCY MEDICINE, OBSTETRICS-GYNECOLOGY, ENT, PLASTIC SURGERY, AND GENERAL SURGERY. CHKD PARTICIPATES IN THE EDUCATION OF ALL EVMS MEDICAL STUDENTS AND IS THE EXCLUSIVE SITE FOR SOME 150 THIRD-YEAR MEDICAL SCHOOL STUDENTS FOR THEIR SIX-WEEK PEDIATRIC CLERKSHIP ROTATION. CHKD PROVIDES A SETTING FOR MANY CLINICAL RESEARCH TRIALS. HIGHLIGHTS OF THE BASIC SCIENCE RESEARCH INCLUDE NEW GENE THERAPY FOR NEUROMUSCULAR DISORDERS, BREAKTHROUGHS IN TREATMENT OF CYSTIC FIBROSIS, INNOVATIVE THERAPIES IN SPORTS MEDICINE, ADVANCE GROWTH HORMONE TREATMENTS, AND INTERVENTIONS FOR DISORDERED SLEEP. IN ADDITION, RESEARCH INCLUDES NEW MEDICATIONS AND OTHER THERAPIES, CLINICAL OUTCOMES ANALYSES AND EPIDEMIOLOGICAL STUDIES SANCTIONED BY THE EASTERN VIRGINIA MEDICAL SCHOOL INSTITUTIONAL REVIEW BOARD. THERE WERE 214 IRB-APPROVED ACTIVE FUNDED STUDIES IN FY22. TOPICS OF STUDY INCLUDED HEMATOLOGY/ONCOLOGY, ALLERGY/ASTHMA, INFECTIOUS DISEASE, NEUROLOGY, PEDIATRIC SURGERY, CARDIOLOGY, OTOLARYNGOLOGY, PULMONOLOGY, GASTROENTEROLOGY, CHILD ABUSE, ENDOCRINOLOGY, DERMATOLOGY, NEONATOLOGY AND MENTAL HEALTH. MANY OF THESE STUDIES ARE PHASE THREE CLINICAL TRIALS THAT BRING CUTTING-EDGE TREATMENTS TO CHKD PATIENTS YEARS BEFORE THEY ARE AVAILABLE TO THE PUBLIC. THIS FISCAL YEAR THERE WERE ALSO NEW PHASE ONE TRIALS OPENED, WHICH ALLOWED OUR PATIENTS THE EARLIEST POSSIBLE ACCESS TO NOVEL THERAPIES. THERE IS AN INCREASED FOCUS ON REGISTRY STUDIES ACROSS ALL DISCIPLINES. DATA COLLECTED IN THESE REGISTRIES IS INTENDED TO STANDARDIZE OPTIMAL LEVELS OF CARE AND LEAD TO IMPROVED PATIENT OUTCOMES. THERE HAVE ALSO BEEN OPPORTUNITIES TO STUDY THE EFFECTS OF VARIOUS TELEHEALTH TELEMEDICINE INTERVENTIONS, NOT ONLY TO ADAPT TO THE COVID-19 PANDEMIC, BUT TO BE ABLE TO REACH SUBJECTS WHO CANNOT TRAVEL TO THE SITE, SUCH AS SUBJECTS WHO ARE HOMEBOUND OR IN HOSPICE CARE. THE NUSS PROCEDURE FOR THE CORRECTION OF PECTUS EXCAVATUM, DEVELOPED AT CHKD MORE THAN 30 YEARS AGO, CONTINUES TO DRAW NATIONAL ATTENTION FROM BOTH PATIENTS AND SURGEONS. THE CHILDREN'S SURGICAL SPECIAL GROUP SURGEONS CONTINUE TO PUBLISH MANUSCRIPTS AND PRESENT THEIR WORK AT NATIONAL MEETINGS TO REINFORCE AND MAINTAIN OUR REPUTATION OF EXCELLENCE ON AN INTERNATIONAL SCALE. THE NUSS CENTER CONTINUES TO OFFER NON-SURGICAL TREATMENT THERAPIES AS WELL. THE ARGENTINA COMPRESSION BRACE INITIATED IN 2009 HAS HELPED MORE THAN 575 PATIENTS WITH OVER 92% OF THOSE PATIENTS EXPERIENCING A CORRECTION TO THEIR DEFORMITY. THAT TYPE OF TREATMENT WAS EXPANDED IN 2020 BY USING A BRACE KNOWN AS THE EMBRACE, WHICH CHKD HAS USED WITH 32 PATIENTS. IN ADDITION, THE VACUUM BELL TREATMENT FIRST OFFERED IN 2012 HAS HELPED OVER 381 PATIENTS. IN JUNE 2016, CHKD OPENED THE NEW NUSS CENTER, OFFERING A SPACE DEDICATED TO THE EVALUATION AND TREATMENT OF CHEST WALL CONDITIONS. THE HOSPITAL CONTINUES ITS ENDEAVORS ON MULTIPLE RESEARCH STUDIES IN AN EFFORT TO FURTHER UNDERSTAND CHEST WALL DEFORMITIES. TO DATE, MORE THAN 2,601 SURGICAL PATIENTS HAVE UNDERGONE THE NUSS PROCEDURE AT CHKD AND OVER 5,949 PATIENTS HAVE BEEN EVALUATED FOR CHEST WALL CONDITIONS. CHKD IS A MEMBER OF CHILDREN'S ONCOLOGY GROUP (COG), AN INTERNATIONAL RESEARCH GROUP THAT CONDUCTS CLINICAL TRIALS FOR CHILDREN WITH CANCER. AS A MEMBER, CHKD HAS ACCESS TO THE LATEST PROTOCOLS FOR TREATMENT OF CHILDHOOD CANCER, PROVIDING THE COMMUNITY AND REGION WITH THE BEST PRACTICES AND TREATMENT RESULTS FROM MORE THAN 250 (285 TOTAL) COG-MEMBER HOSPITALS IN NORTH AMERICA, AUSTRALIA, NEW ZEALAND, EUROPE, AND SAUDI ARABIA. OUR PRIMARY GOAL IS TO INCREASE PARTICIPATION IN CLINICAL TRIALS WHICH WE FEEL WILL ADVANCE THE FIELD OF PEDIATRIC ONCOLOGY. IN FY22, CHKD HAD APPROXIMATELY 105 COG STUDIES INCLUDING LTF STUDIES OPEN TO ENROLLMENT OR UNDERGOING DATA ANALYSIS. SEVERAL OF THESE STUDIES WERE INCLUDED IN COG'S LONG-TERM FOLLOW-UP STUDY, WHICH COLLECTS DATA ON PATIENTS WHO HAVE PARTICIPATED IN STUDIES THAT ARE NO LONGER OPEN TO ENROLLMENT. IN ALL, OVER 200 CHKD PATIENTS PARTICIPATED IN EITHER OPEN OR FOLLOW-UP COG STUDIES IN FY22. THE HEMATOLOGY ONCOLOGY DIVISION HAD 21 RESEARCH STUDIES OPEN THAT WERE NOT COG STUDIES. IN FY22, CHKD HOSTED 6 CONTINUING MEDICAL EDUCATION EVENTS IN VARIOUS LOCATIONS THROUGHOUT THE REGION. HELPING CHILD HEALTH EXPERTS IN OUR REGION KEEP UP WITH THEIR SKILLS AND THEIR ACCREDITATION. THERE WERE TEN REGULARLY SCHEDULED SERIES FOR A TOTAL OF 158 ACTIVITIES.
FORM 990, PART VI, SECTION A, LINE 6	LINE 6: CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, INCORPORATED, IS A VIRGINIA NON-STOCK CORPORATION WITH A SOLE MEMBER. THE SOLE MEMBER OF CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, INCORPORATED, IS CHILDREN'S HEALTH SYSTEM, INC., A VIRGINIA NON-STOCK NOT-FOR-PROFIT CORPORATION. PURSUANT TO SECTION 13.1-852.1 OF THE CODE OF VIRGINIA, CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, INCORPORATED, IS MANAGED BY ITS SOLE MEMBER, CHILDREN'S HEALTH SYSTEM, INC.
FORM 990, PART VI, SECTION A, LINE 7A	LINE 7A: CHILDREN'S HEALTH SYSTEM, INC., THE SOLE MEMBER OF CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, INCORPORATED, IS A VIRGINIA NON-STOCK NOT-FOR-PROFIT CORPORATION. PURSUANT TO SECTION 13.1-852.1 OF THE CODE OF VIRGINIA, CHILDREN'S HEALTH SYSTEM, INC., THE SOLE MEMBER OF CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, INCORPORATED, MANAGES CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS. ACCORDINGLY, THE BOARD OF DIRECTORS OF CHILDREN'S HEALTH SYSTEM, INC., IS THE GOVERNING BODY FOR CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, INCORPORATED. AS A VIRGINIA NON-STOCK CORPORATION, CHILDREN'S HEALTH SYSTEM, INC., HAS MEMBERS THAT ELECT THE BOARD OF DIRECTORS OF CHILDREN'S HEALTH SYSTEM, INC. THE MEMBERS OF CHILDREN'S HEALTH SYSTEM, INC., THAT ELECT THE BOARD OF DIRECTORS OF CHILDREN'S HEALTH SYSTEM, INC. ARE THE CLASS A MEMBERS OF CHILDREN'S HEALTH SYSTEM, INC. (I.E., THE THEN CURRENT MEMBERS IN GOOD STANDING OF THE NORFOLK CITY UNION OF THE KING'S DAUGHTERS, INC., A VIRGINIA NON-STOCK NOT-FOR-PROFIT CORPORATION) AND THE CLASS B MEMBERS OF CHILDREN'S HEALTH SYSTEM INC. (I.E., THE THEN CURRENT DIRECTORS ON THE BOARD OF DIRECTORS OF CHILDREN'S HEALTH SYSTEM, INC.).
FORM 990, PART VI, SECTION A, LINE 7B	THE FOLLOWING DECISIONS OF THE BOARD OF DIRECTORS OF CHILDREN'S HEALTH SYSTEM, INC., WHICH IS THE GOVERNING BODY FOR CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, INCORPORATED, ARE SUBJECT TO APPROVAL BY THE CLASS A AND CLASS B MEMBERS OF CHILDREN'S HEALTH SYSTEM, INC.: 1) ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE CORPORATION; AND 2) ANY PROPOSED MERGER OR CONSOLIDATION OF THE CORPORATION, OR ANY SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, OF THE PROPERTY AND ASSETS OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11B	THE FOLLOWING DECISIONS OF THE BOARD OF DIRECTORS OF CHILDREN'S HEALTH SYSTEM, INC., WHICH IS THE GOVERNING BODY FOR CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS, INCORPORATED, ARE SUBJECT TO APPROVAL BY THE CLASS A AND CLASS B MEMBERS OF CHILDREN'S HEALTH SYSTEM, INC.: 1) ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OF THE CORPORATION; AND 2) ANY PROPOSED MERGER OR CONSOLIDATION OF THE CORPORATION, OR ANY SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, OF THE PROPERTY AND ASSETS OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 12C	CONFLICT POLICY CONSIDERATIONS: CHKD CONFLICT OF INTEREST POLICY INCLUDES OFFICERS, MEMBERS OF THE BOARD OF DIRECTORS AND BOARD COMMITTEES, KEY EMPLOYEES, ALL OTHER EMPLOYEES, PROFESSIONAL STAFF AND SUBSTANTIAL DONORS. ANNUALLY, A QUESTIONNAIRE IS DISTRIBUTED AND COLLECTED FROM OFFICERS, MEMBERS OF THE BOARD OF DIRECTORS AND BOARD COMMITTEES AND KEY EMPLOYEES. THE QUESTIONNAIRES ARE REVIEWED BY THE LEGAL DEPARTMENT. FOR KNOWN CONFLICTS, THE PERSON INVOLVED RECUSES HIMSELF OR HERSELF FROM DELIBERATIONS REGARDING THE TRANSACTION. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY ARE REPORTED TO THE CHKD BOARD CHAIR OR THE CHKD COMPLIANCE OFFICER, AS APPLICABLE, AND MAY REQUIRE CORRECTIVE ACTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT.
FORM 990, PART VI, SECTION B, LINE 15B	LINE 15A: COMPENSATION PROCESS CONSIDERATIONS: CHILDREN'S HEALTH SYSTEM ESTABLISHES THE COMPENSATION OF THE CEO JAMES DAHLING. LINE 15B: CHILDREN'S HEALTH SYSTEM AND CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS USE THE FOLLOWING PROCESS TO ESTABLISH COMPENSATION FOR OFFICERS AND KEY EMPLOYEES: AN INDEPENDENT COMPENSATION CONSULTANT APPROVED AND RETAINED BY THE COMPENSATION COMMITTEE OF THE BOARD ANNUALLY, USUALLY IN APRIL, PROVIDES EDUCATION AND PRESENTS TO THE FULL BOARD COMPARATIVE SALARIES AND SALARY RANGES FROM A DATABASE COMPRISED OF CHILDREN'S HOSPITALS AND OTHER APPLICABLE HOSPITALS FOR OFFICERS & EXECUTIVES FOR THE BOARD TO REVIEW. THE COMPENSATION COMMITTEE WITH THE AID OF THE CONSULTANT REVIEWS AND MAKES DECISIONS AS TO EXECUTIVE SALARIES OF CHKD AND ITS SUBSIDIARIES. THOSE SALARY CHANGES AND APPROVALS ARE CONTEMPORANEOUSLY DOCUMENTED BY MINUTES MAINTAINED BY THE COMPENSATION COMMITTEE AND SIGNED BY THE CHAIRMAN OF THE BOARD.
FORM 990, PART VI, SECTION C, LINE 19	FINANCIAL STATEMENTS (PART OF THE CONSOLIDATED FINANCIAL STATEMENTS OF CHILDREN'S HEALTH SYSTEM, INC.) ALONG WITH GOVERNING DOCUMENTS OF THE ORGANIZATION INCLUDING THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC THROUGH DIRECT INQUIRY AND REQUEST.
FORM 990, PART XI, LINE 9:	GAIN/LOSS ON DERIVATIVE INVESTMENTS 31,847,903. CHANGE IN DONOR RESTRICTED CONTRIBUTIONS -3,562,683. CHANGE IN TR ENDOWMENT -372,640.

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:

1	Briefly describe the organization’s mission or most significant activities: SEE SCHEDULE ODEDICATED TO THE MISSION OF PROVIDING THE BEST POSSIBLE CARE AND SERVICES FOR ALL CHILDREN WHO COME TO US BECAUSE OF SICKNESS AND INJURY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	20
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	16
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	3,622
6	Total number of volunteers (estimate if necessary) .............	6	242
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	495,419
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	240,510

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	99,087,320	88,572,506
9	Program service revenue (Part VIII, line 2g) .........	405,576,468	545,779,845
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	49,345,049	-3,631,860
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	4,363,837	3,906,723
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	558,372,674	634,627,214
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	19,703,670	14,604,433
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	213,621,050	262,614,831
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	200,918	232,113
b	Total fundraising expenses (Part IX, column (D), line 25) 3,144,680
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	232,798,272	256,248,073
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	466,323,910	533,699,450
19	Revenue less expenses. Subtract line 18 from line 12.......	92,048,764	100,927,764
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,001,729,901	1,082,483,548
21	Total liabilities (Part X, line 26).............	328,154,515	312,473,512
22	Net assets or fund balances. Subtract line 21 from line 20.....	673,575,386	770,010,036

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 471,335,905 including grants of $ 14,604,433 ) (Revenue $ 548,781,894 )
	SEE SCHEDULE O

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses471,335,905

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	3,070,603	6,447,567	2,277,584

1a	Federated campaigns..		1a	168,736
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	47,272,331
e	Government grants (contributions)		1e	11,757,950

f	All other contributions, gifts, grants, and similar amounts not included above		1f	29,373,489

g	Noncash contributions included in lines 1a - 1f:$		1g	1,849,613

h Total. Add lines 1a-1f.......		88,572,506

		Business Code
2a	PATIENT SERVICES	900099	516,487,471	516,487,471
b	OTHER RELATED SERVICES	900099	28,796,955	28,796,955
c	LAB SERVICES	621500	371,146		371,146
d	SPORTS RELATED SERVICE	900099	124,273		124,273
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		545,779,845

3 Investment income (including dividends, interest, and othersimilar amounts) ......			6,874,002			6,874,002
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents	22,805	2,848,786	6a
b	Less: rental expenses	2,006	2,460,330	6b
c	Rental income or (loss)	20,799	388,456	6c
d	Net rental income or (loss).......			409,255			409,255
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	85,022	101,697,580	7a
b	Less: cost or other basis and sales expenses	189,930	112,098,534	7b
c	Gain or (loss)	-104,908	-10,400,954	7c
d	Net gain or (loss).........			-10,505,862			-10,505,862
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
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	GRADUATE MEDICAL ED.		900099	3,497,468	3,497,468
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			3,497,468
12	Total revenue. See instructions.....			634,627,214	548,781,894	495,419	-3,222,605

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	14,604,433	14,604,433
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
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 ...........	1,523,468	1,201,888	321,580
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........	222,505,219	203,280,568	17,365,486	1,859,165
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,450,380	4,646,511	1,737,163	66,706
9	Other employee benefits .......	17,680,998	16,437,398	1,045,228	198,372
10	Payroll taxes ...........	14,454,766	13,094,329	1,217,496	142,941
11	Fees for services (non-employees):
a	Management ......	62,500		62,500
b	Legal .........	5,182	5	5,177
c	Accounting ...........	45,900		45,900
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17	232,113			232,113
f	Investment management fees ......	303,681		303,681
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	49,937,832	46,479,482	3,370,349	88,001
12	Advertising and promotion ....	272,488	28,721	242,867	900
13	Office expenses .......	3,271,241	2,208,517	961,547	101,177
14	Information technology ......	2,658,884	2,095,740	485,771	77,373
15	Royalties ..
16	Occupancy ...........	17,409,449	15,353,861	2,039,555	16,033
17	Travel ............	245,968	200,677	39,835	5,456
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	722,906	648,312	74,279	315
20	Interest ...........	4,672,164	4,539,102	133,062
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	27,066,522	24,447,123	2,524,096	95,303
23	Insurance ...	1,904,199	694,218	1,209,849	132
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	SUPPLIES	81,929,784	81,723,507	189,589	16,688
b	EQUIP RENTAL AND MAINT.	23,749,979	21,561,950	2,100,921	87,108
c	PURCHASED SERVICES	20,531,291	15,630,795	4,811,090	89,406
d	CORPORATE SUPPORT	16,310,931		16,310,931
e	All other expenses	5,147,172	2,458,768	2,620,913	67,491
25	Total functional expenses. Add lines 1 through 24e	533,699,450	471,335,905	59,218,865	3,144,680
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 ........				1
2	Savings and temporary cash investments .........			77,981,519	2	64,766,381
3	Pledges and grants receivable, net ......			20,108,722	3	24,150,559
4	Accounts receivable, net .............			83,448,509	4	92,745,444
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 ...........				7
8	Inventories for sale or use ............			11,180,116	8	13,192,307
9	Prepaid expenses and deferred charges ......			9,171,291	9	8,906,221
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	823,681,223
b	Less: accumulated depreciation	10b	348,715,461	419,505,175	10c	474,965,762
11	Investments—publicly traded securities .			319,345,255	11	318,152,363
12	Investments—other securities. See Part IV, line 11 .....			39,639,946	12	45,318,925
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			21,349,368	15	40,285,586
16	Total assets. Add lines 1 through 15 (must equal line 33)...			1,001,729,901	16	1,082,483,548

17	Accounts payable and accrued expenses .....	53,441,384	17	56,567,101
18	Grants payable ...		18
19	Deferred revenue .........	3,236,982	19	1,406,048
20	Tax-exempt bond liabilities .........	198,693,628	20	235,172,888
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 ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	72,782,521	25	19,327,475
26	Total liabilities. Add lines 17 through 25..	328,154,515	26	312,473,512

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	605,246,805	27	713,694,947
28	Net assets with donor restrictions ...........	68,328,581	28	56,315,089
	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 ...........	673,575,386	32	770,010,036
33	Total liabilities and net assets/fund balances ........	1,001,729,901	33	1,082,483,548

(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
(1) CHILDREN'S MEDICAL TOWER LLC 601 CHILDRENS LANE NORFOLK,VA23507 45-2907147	LESSOR	VA	1,525,708	17,092,868	CHKD
(2) CHILDREN'S HEALTH SYSTEM INSURANCE LLC 601 CHILDRENS LANE NORFOLK,VA23507	INSURANCE	SC	940,971	2,532,735	CHKD

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)CHILDREN'S HEALTH SYSTEM INC 601 CHILDRENS LANE NORFOLK,VA23507 54-1278830	HEALTHCARE	VA	501(C)(3)	LINE 12B, II	N/A		No
(2)CHILDREN'S HEALTH FOUNDATION INC 601 CHILDRENS LANE NORFOLK,VA23507 54-1278865	SUPP CHKD	VA	501(C)(3)	LINE 12A, I	N/A		No

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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
(1) FORTIFY CHILDREN'S HEALTH LLC 1330 JEFFERSON PARK AVENUE CHARLOTTESVILLE,VA22903 83-1442745	HEALTHCARE	VA	N/A	RELATED				No			No
(2) REALTA HOLDINGS LLC 601 CHILDRENS LANE NORFOLK,VA23507 82-3954346	RESEARCH	VA	N/A	RELATED				No			No

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CHILDREN'S HEALTH FOUNDATION INC	C	42,772,331	BOOK VALUE
(2) CHILDREN'S MEDICAL GROUP INC	J	501,065	BOOK VALUE
(3) CHILDREN'S HEALTH SYSTEM INC	P	16,310,931	BOOK VALUE
(4) CHILDREN'S HEALTH SYSTEM INC	E	1,915,458	BOOK VALUE
(5) CMG OF NORTH CAROLINA	Q	209,135	BOOK VALUE
(6) CHILDREN'S MEDICAL GROUP INC	Q	5,567,646	BOOK VALUE
(7) CMG OF NORTH CAROLINA	D	48,229	BOOK VALUE
(8) CHILDREN'S HEALTH FOUNDATION INC	B	4,829,234	BOOK VALUE
(9) CHILDREN'S SURGICAL SPECIALTY GROUP INC	D	246,817	BOOK VALUE
(10) CHILDREN'S MEDICAL GROUP INC	D	1,265,373	BOOK VALUE
(11) CHILDREN'S HEALTH SYSTEM INC	B	9,700,000	BOOK VALUE
(12) CHILDREN'S HEALTH SYSTEM INC	C	4,500,000	BOOK VALUE
(13) CHILDREN'S HEALTH SYSTEM INC	L	550,842	BOOK VALUE
(14) CHILDREN'S HEALTH SYSTEM INC	K	3,125,719	BOOK VALUE
(15) CHILDREN'S SURGICAL SPECIALTY GROUP INC	Q	788,069	BOOK VALUE
(16) CHILDREN'S HEALTH FOUNDATION INC	P	151,780	BOOK VALUE

(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