4A (Expenses $ 471885938 including grants of $ 345688) (Revenue $ 533758861)
"Hospital program services: Families look to Children's Hospitals and Clinics of Minnesota for the finest in pediatric care. With two pediatric hospital facilities and 339 staffed beds, we champion the special health needs of children and their families and are committed to providing high-quality, family centered pediatric services.The Leapfrog Group's annual list of top hospitals named Children's Hospitals and Clinics of Minnesota's Minneapolis and St. Paul hospitals as two of the top seven pediatric hospitals in the country for quality and efficiency. This is the second year in a row Children's has been recognized by the Leapfrog Group. Children's was the only pediatric hospital in the five-state-region to receive a 2010 Leapfrog award. See Schedule O.For the fifth year in a row, Children's Hospitals and Clinics of Minnesota has been named one of the top pediatric hospitals in the nation according to the 2011-2012 U.S. News Media Group's Best Children's Hospitals rankings. This year Children's ranked in four categories - cancer, cardiology and heart surgery, neonatology and pulmonology. The U.S. News rankings give Children's high marks for patient volumes, safety, and overall outcomes in each of the clinical areas. Children's also received high marks for nurse-to-patient staffing levels that continue to be among the nation's highest, and for its designation as a Magnet hospital for excellence in nursing, bestowed by the American Nurses Credentialing Center.We are Minnesota's largest provider of care to children with complex surgical conditions, heart disease, cancer, diabetes, and extreme pre-maturity. In 2010, Children's cared for 12,484 inpatient admissions representing 79,769 patient days, performed 20,276 surgical cases, treated 80,094 emergency room visits and cared for 129,932 outpatient clinic visits, many of which provided to inner city Minneapolis and St. Paul residents. Children's continues to serve a diverse population with 57,702 family encounters for language interpretation utilizing 45 different languages interpreted.Children's designates certain major programs as a ""Cornerstone program."" These programs meet rigorous criteria for excellence, including outstanding use of evidence-based practices, clinical research, and advanced technologies. These Cornerstone programs include:Cardiovascular - Children's pediatric cardiovascular program is one of the largest in the region with some of the most impressive outcomes in the U.S. Team members care for thousands of the region's sickest children with heart conditions, including fetuses, newborns, infants, children, adolescents, and adult, long-term patients with pediatric cardiovascular conditions. Neonatal Intensive Care - Children's specializes in caring for multiples, babies with congenital anomalies, very premature and very low birth weight babies, and infants born with other complex diagnoses. We offer exceptional tertiary and quaternary care for babies, with survival outcomes among the best in the world. Children's neonatal program is the fourth-largest in the U.S., with more than 1,900 neonatal admissions per year. Our neonatal team includes highly-trained and experienced professionals from a full spectrum of medical specialties. Hematology/Oncology - The hematology/oncology program at Children's is the largest in the upper Midwest with treatment outcomes that consistently rank Children's as one of the top ten programs in the U.S. In our nationally unique model, your child's or teen's care is spearheaded and coordinated by a board-certified hematologist/oncologist, who leads a highly experienced team of multidisciplinary professionals.Cystic Fibrosis - The Cystic Fibrosis (CF) Center at Children's of Minnesota diagnoses and treats children in all stages of CF. Our dedication to family-centered care and education helps children and their families learn to live with CF. Care at Children's for patients with CF ranks among the top 10 programs nationally in key outcomes measured by the National Cystic Fibrosis Registry. Children's provides a continuum of care through coordinated inpatient and outpatient services, from diagnosis through long-term follow-up. The Cystic Fibrosis Center of Children's provides state-of-the art comprehensive care for children with CF.Diabetes/Endocrinology - The McNeely Pediatric Diabetes Center is the only diabetes center in the region to specialize in working solely with children and teens. The staff provide expert health care to help maintain a child's targeted blood sugar ranges. Most children seen in the diabetes center have Type 1 diabetes. A small but growing number have Type 2. In addition to diabetes, the clinic provides diagnostic services and treatment for children with disorders of growth, advanced or delayed sexual development, pituitary disorders, thyroid abnormalities, disorders of calcium balance, adrenal disorders, and hypoglycemia. The McNeely Pediatric Diabetes Center has received recognition for its diabetes education program from the American Diabetes Association, by meeting the association's high educational standards.In addition to the Cornerstone programs, Children's provides other high quality programs such as Surgery. Children's surgery teams deliver next-generation care in an award-winning environment that is exclusively dedicated to pediatrics. Health professionals of many disciplines work together to provide children with the best possible surgery experience. Children's bodies are different than adult's. For example, they often require specially-sized surgical equipment. They react differently to anesthesia and to pain. Their bodies respond differently to illness and treatment, in part because they are still growing. That's why children benefit from our highly accomplished, pediatric-specific surgery teams. At Children's, over 20,000 surgeries are performed each year on fetuses, newborns, children, adolescents, and young adults from throughout the Upper Midwest. Surgical treatment results rank Children's among the top hospitals in the U.S. in pediatric surgical care. Children's has some of the lowest rates in the U.S. of post-surgery complications and some of the highest rates of patient and family satisfaction. As a charitable organization, Children's Hospitals & Clinics of Minnesota also provides a broad spectrum of benefits to the communities we serve. These services and donations account for a measureable portion of the hospitals' costs and help to promote healthy lifestyles, community development, health education, and affordable access to care. Please see IRS Form 990, Schedule H for a summary of these community benefits."

4B (Expenses $ 3801192 including grants of $ 0) (Revenue $ 2395766)
Research: In 2010 Children's conducted 457 research projects, 186 of which were clinical trials to examine the effectiveness of diagnostic, therapeutic, and preventive services. In addition 70 peer-reviewed manuscripts were published. Children's was awarded more than $10 million in funding from government, industry, foundation, and academic sub-awards for its research initiatives. See Schedule O. In the past year we have seen a 38 percent increase in research funding at Children's. We continue to participate in multiple prestigious national collaborations and clinical trials. We are also generating landmark investigator-initiated research, aimed at novel ways to deliver life-saving treatments, manage pain and symptoms and develop new methods for preventing or treating childhood diseases. Every day, Children's researchers express their commitment to building better outcomes for our children. These outcomes will have both immediate and lasting impact for children receiving state of the science care at our specialty centers. Children with cardiac disease, cancer, genetic and blood disorders, diabetes, cystic fibrosis, and other life-impacting conditions all have benefited from research at Children's. The vision and strategic innovation of our research leaders have brought us to impressive milestones in the past year. We continue to take steps toward advancing our research and committed to thriving into the future with our children and families.

4C (Expenses $ 4722623 including grants of $ 0) (Revenue $ 1442044)
Education: Many efforts to improve the health and well being of children and youth require long-term investment in their future. Children's provides education and training programs for providers, health care students, and other health professionals in the following areas:i. Community medical education for community physicians: During the 2010 calendar year, Children's provided training and education to 44.6 full time equivalent (FTE) residents, and 6.1 FTE fellows. These FTE numbers result from 380 individual residents and 35 individual fellows who performed one or more rotations at Children's - Minneapolis, Children's St. Paul, or both locations. See Schedule O. The rotations were performed in Children's Emergency Departments, inpatient medical/surgical, PICU and neonatal inpatient care units, surgery and anesthesia, ENT surgery, urology, and subspecialty clinics. The residents and fellows came from 36 different medical educational programs: 27 from the University of Minnesota, 3 from Mayo Clinic, 2 from Regions Hospital, 1 from United Hospital, 1 from HCMC, 1 from Rapid City Regional Hospital, and 1 from UW Eau Claire. Additionally, 380 medical students rotated to Children's - Minneapolis, Children's - St Paul, or both locations.ii. Education and training of health care and other providers of services to children:1. The Midwest Regional Children's Advocacy Center at Children's is a leader in improving the care of abused and neglected children whose goal is to improve services for abused children in local communities throughout the region. The Center offers information, consultation, technical assistance, and training to physicians, nurses, and non-medical members of community child abuse teams, including law enforcement personnel, attorneys and child protection workers.2. Recognized, as the nation's leader in palliative care education, Children's Institute for Palliative Care (CIPC) developed a model for a regional training and consultation center. CIPC develops and leads training seminars using recognized curriculum for pediatric palliative care, provides hospital-based consultation to children who are in need of hospice or palliative care while they are hospitalized, offers a regional 24/7 telephone consultation program providing education, support, and guidance to families and professional providers, and serves as a resource center for pediatric palliative care. 3. The Minnesota Sudden Infant Death Syndrome (SID) Center is a statewide program that provides information, counseling, and support to anyone experiencing a sudden and unexpected infant death from any cause. The SID Center is the state's resource for information on Sudden Infant Death Syndrome (SIDS) and SIDS risk reduction. The Center conducts training and educational programs for health care providers, child-care workers, and other professional and community groups. The Center also tracks and reports infant mortality trends in Minnesota and participates in local, state, and national initiatives to reduce the risk of sudden, unexpected infant death. The Minnesota SID Center collaborates with the Minnesota Department of Health, county public health nurses, and medical examiners in every county throughout Minnesota.4. The Emergency Medical Services for Children (EMSC) Resource Center housed at Children's creates awareness regarding the special needs of children in emergency medical situations. EMSC educational programs are designed to train pre-hospital personnel, first responders, physicians, nurses, and school nurses in the unique needs of infants and children in emergency situations. The EMSC Resource Center also provides technical assistance, participates in statewide pediatric emergency/disaster preparedness planning, develops and disseminates pediatric emergency are guidelines, and conducts mortality reviews and research.ii. Education and employment - Because disparities in child health are so closely associated with low educational attainment and poor job skills, Children's is engaged in several key community partnerships to improve educational success and earning potential among youth and adults. Examples include the Roosevelt High School Health Careers Program that provides students interested in health care careers the opportunity to receive health care specific education and obtain internships with health care organizations, the Achieve Minneapolis/Step-up Summer Jobs Program that places youth in supervised summer internships at participating companies and organizations, and a partnership with Project for Pride in Living that recognizes that a healthy, sustainable community requires residents with well-paying jobs.

Part I, Line 3c: FPG is the primary measurement used to determine eligibility for charity care. However, policy exceptions may be granted for families who either have income exceeding the guidelines established or who with the sliding scale discount continue to have insufficient means to pay. Asset tests and other thresholds can be used.Part I line 6a: Children's Hospitals and Clinics of Minnesota prepares an annual community benefits report. The community benefits report is available to the public.

Part I, Line 7: Subsidized health services benefits include the subsidized costs of two physician clinics. A clinic is located on both the Minneapolis and St. Paul campuses. These clinics serve the local communities that include a high percentage of minorities and low-income families. Net community benefit expenses related to these clinics were $1,119,000 for the twelve months of 2010.Part I, line 7, column (f): Bad debt expense of $9,022,620 was subtracted for purposes of calculating the percentage in Schedule H, Part I, line 7, column (f).Part I, line 7: : A ratio of patient care cost to charges, as calculated using Form 990, Schedule H, Worksheet 2 - Ratio of Patient Care Cost to Charges, was used to calculate community benefit costs for Schedule H, Part I, Line 7, rows (a)(c). Community benefit costs for rows (b)(e)(f)(g)(h)(i)(j) were calculated using a full-absorption costing model that combines direct costing and the allocation of indirect costs through an activity-based costing methodology.

Part III, Line 4: Bad debt is defined as the unpaid obligation for care provided to patients who have been determined to be able to pay, but have not demonstrated a willingness to pay. The amounts attributable to patients eligible under the organizations charity care policy are determined by a patient's willingness to pay with a documented inability to pay per measures established by our policy. Both amounts are estimated by applying the ratio of patient care cost to charges, as calculated on Form 990, Schedule H, Worksheet 2, to the actual patient charges. The organization estimates that twenty-five percent of bad debt expenses are attributable to patients who likely would qualify for financial assistance under the organization's charity care policy if sufficient information had been available to make a determination of their eligibility. The estimate of twenty-five percent is based on historical trends and the experience of area supervisors. Footnote from 2010 audited financials:Patient Accounts Receivable - Patient accounts receivable represent amounts due from federal and state agencies, managed health care plans, commercial insurance companies, employers, and patients. Children's grants credit to patients, most of whom are insured under third-party payer agreements, without collateral or any other security to support amounts due. Children's determines an allowance for doubtful accounts by considering a number of factors, including, but not limited to, the length of time accounts receivable are past due, its previous loss history, the existence of a third-party payer, reimbursement trends, and other collection indicators. Accounts are written off when all reasonable internal and external collection efforts have been performed and payments subsequently received on such receivables are credited to the allowance. Children's recognizes that revenues and receivables from government agencies are significant to its operations, but do not believe there are significant credit risks associated with these government agencies. In 2010, net revenue from the top four third-party payers accounted for 42%, 25%, 14%, and 8% of net patient service revenue. In 2009, net revenue from the top four third-party payers accounted for 39%, 24%, 14%, and 9% of net patient service revenue.

Part III, Line 8: The organization primarily serves pediatric patients and does not generate significant Medicare revenues. As a result, a low utilization Medicare cost report is filed. Form 990, Schedule H, Worksheet 3 - Unreimbursed Medicaid and Other Means-Tested Government Programs was used to calculate the costs associated with Medicare charges reported in Part III, Line 6. The organization does not report any amounts from Part III, Line 7 as community benefit.

Part III, Line 9b: When collecting medical debt, Children's Hospitals and Clinics of Minnesota treats its patient families with honor, dignity, and courtesy; demonstrate compassion; and be good stewards of health care resources. There is a zero tolerance for abusive, harassing, oppressive, false, deceptive, or misleading language or collections conduct by Children's employees who collect medical debt from patient families. This policy applies broadly to all patient families we serve. Components of Children's collection policy include:During the pre-registration, registration, or admission process, Children's attempts to identify and inform patient families who may be eligible for charity care or discounted care through the uninsured discount or charity care policy.All Children's employees and contracted staff who have direct contact with patients will be educated on an annual basis of Children's financial assistance policies. The education informs staff of programs available and how a patient family may obtain more information and submit an application for financial assistance.A financial assistance application is sent with the initial letter explaining the process for obtaining financial assistance to all self pay patient families or patient families who indicate at registration an inability to pay.All correspondence seeking collection of medical debts contains a reference to the availability of financial assistance.Minnesota hospital providers have jointly developed consistent collection guidelines set out in formal agreements with the Minnesota Attorney General's Office. This agreement is consistent with Children's collection policy. The Audit Committee of our Board of Directors annually reviews this policy and all policies concerning collection of medical debt, uninsured discount, and charity care. The Audit Committee also reviews the results of an annual audit related to these areas in accordance with the Minnesota Attorney General's Agreement.

Part V, Section A: Children's also operates specialty and rehabilitation clinics in the following locations: Woodbury,MN; Maple Grove, MN; Minnetonka, MN and Roseville, MN and operates pediatric clinics in Eagan, MN, West St. Paul, MN and Vadnais Heights, MN. These clinics are operated under the Children's hospital license.

Part VI, Line 1: Community building activities:
Children's provided the following community building activities in 2010:- STEP-UP and Health Careers at Roosevelt High School: the mission of this program is to provide educational opportunities to a diverse body of students from the local community who are interested in preparing for a career in health care.- Project for Pride in Living: this is a nonprofit agency working with lower-income individuals and families throughout the Twin Cities metro area to achieve greater self-sufficiency through housing, employment training, education, and support services.- Midwest Regional Outreach: The Midwest Children's Resource Center (MCRC) is a regional center providing specialty services for children who are possibly abused, their families, and the professionals who work with them. MCRC brings together a multi-disciplinary team of child abuse specialists who provide a broad range of services, including medical and psychological consultation. The center works as an advocate for the children who have been abused, seeking to significantly advance protection, treatment, and healing of these children.

Part VI, Line 2: Needs Assessment: The health care needs of the community served by Children's Hospitals & Clinics of Minnesota are determined as follows: a. Board of Directors: the organization's governing body, comprised of community members who reside locally, provides governance that includes the health care services provided to the local community.b. Children's employed physicians, independent physicians who provide care at Children's, and numerous clinical care providers assess community needs daily through the pediatric care provided throughout the community.c. The Family Advisory Council: a diverse group of families whose children are present or past patients of Children's provide input as to Children's services. Council members represent a wide range of inpatient and outpatient experiences to help enhance the quality of child and family care experiences at Children's. Council responsibilities include:- Develop, implement, and evaluate service and facility standards.- Communicate to management the recommendations and concerns expressed by parents, family members, parent associations, and others.- Advise on policy review, promote family-centered care, and support program development.d. Community partnerships: partnerships with groups such as the Minnesota Hospital Association Policy and Advocacy Committee and the Hennepin County Health Department Community Advisory Group helps the organization identify community needs. Children's also partners with Raise it for Health, a tobacco cessation coalition, as well as with the Minnesota Prematurity Coalition, a group devoted to increasing awareness of the unique health and development issues premature infants face through advocating for access to quality health care, and identification, consolidation, and dissemination of resources for parents and families.e. Youth Advisory Council (YAC): is a dedicated group of patients, ages 10 to 18, who help hospital staff, leaders, doctors, and parents understand what is important to children, teens, and siblings during hospital stays, clinic visits, and emergency care. YAC brings a valuable perspective and voice to Children's by participating in activities that promote discussion and thought about health care services for pediatric and young adult patients. The council also brings great perspective to let other children know how to make their stay at Children's a more comfortable and positive experience.f. Children's maintains an advocacy department that is responsible for identifying community health needs and leading efforts that advocate for pediatric health needs. Children's advocacy department maintains an advocacy database of over 400 members, all of whom can share advocacy input with the Children's Advocacy team. The advocacy department is also currently partnering with Minneapolis/St. Paul metro public health departments and statewide health care providers to potentially create a strategically-aligned community health needs assessment. The assessment is in its planning stages, and will be complete by the IRS deadline.g. Other methods include and are not limited to: partnerships and projects with third party-payers and other community physicians and hospitals, monitoring and reporting of infectious disease data, disaster readiness efforts, research and education, support groups, and others.

Part VI, Line 3: Patient Education of Eligibility for Assistance: Components of Children's collection policy include:During the pre-registration, registration, or admission process, Children's will attempt to identify and inform patient families who may be eligible for charity care or discounted care through the uninsured discount or charity care policy.All Children's employees and contracted staff who have direct contact with patients will be educated on an annual basis of Children's financial assistance policies. The education will inform staff of programs available and how a patient family may obtain more information and submit an application for financial assistance.A financial assistance application will be sent with the initial letter explaining the process for obtaining financial assistance to all self pay patient families or patient families who indicate at registration an inability to pay.All correspondence seeking collection of medical debts will contain a reference to the availability of financial assistance.Minnesota hospital providers have jointly developed consistent collection guidelines set out in formal agreements with the Minnesota Attorney General's Office. This agreement is consistent with Children's collection policy. The Board of Directors (Audit Committee) performs an annual review of this policy and all policies concerning collection of medical debt, uninsured discount, and charity care. The Audit Committee shall also review the results of an annual audit related to these areas in accordance with the Minnesota Attorney General's Agreement.

Part VI, Line 4: Community information (communities we serve):Children's Hospitals & Clinics of Minnesota serves the five state area of the upper Midwest (Minnesota, North Dakota, South Dakota, Iowa, and Wisconsin). Approximately eighty percent of inpatient admissions are from the three-million individuals residing in the eleven county metropolitan areas of the Twin Cities. The remaining twenty percent of inpatient admissions are from outstate Minnesota and the surrounding states. These patients represented one-hundred percent of Minnesota counties and fifty-nine percent of total counties in the five state area. The age of patients reflects the pediatric health services provided with seventy-five percent of patients under the age of ten and ninety percent under the age of fifteen. Patient diversity at Children's significantly exceeds the diversity of the local population with non-white patients representing over fifty percent of patients served as compared to less than twenty percent for the local community. Children's provides interpreter services for forty-five languages with the most frequent languages being Spanish, Somali, and Hmong. Children's also serves a disproportionate share of economically disadvantaged patients with forty-two percent of patient revenues from government programs. The Minneapolis campus is located within the Phillips-Powderhorn neighborhood (MUA), home to one of the most ethnically diverse communities in Minnesota.

Part VI, Line 6: Other Information:As a charitable organization, Children's provides a broad spectrum of benefits to the communities it serves that would otherwise be unavailable or insufficient to meet patient demand for the express purpose of improving the health status of children in the community. These include programs such as free clinics, health screenings, support counseling for patients and families, crisis intervention, disaster readiness and the cost of providing community health partnerships and educations. These services and donations account for a measurable portion of the hospital's costs and help to promote healthy lifestyles, community development, health education, and affordable access to care. Example programs include:- Children's is one of the local hospitals and health plans in the Twin Cities that advises Portico Healthnet on issues related to program services and provides funding for medical services to participants. Portico Healthnet, a nonprofit health and human services organization, serves the community by assisting children, parents, and individuals who are uninsured with applications to health care programs and by offering a primary and preventive health care access program for people ineligible for public programs. Since 1995, 9,000 uninsured children and adults have enrolled in Portico's safety-net coverage program, and another 14,000 have been enrolled in public coverage programs with assistance from Portico Healthnet.- Women, Infants & Children (WIC) Program. WIC is a nutrition program provided by Children's that helps eligible pregnant women, new mothers, babies and young children eat well, learn about nutrition, and stay healthy. An important component of this funding is that it will provide health care to underserved populations in Minneapolis, particularly those in the Latino and Somali communities.- The EMSC Resource Center provides technical assistance to agencies to improve pediatric emergency care. The EMSC works to reduce child morbidity and mortality due to trauma and critical illness and is the only statewide program that focuses on improving pediatric components of medical care.- The Sudden Infant Death Center provides support to families and promotes awareness within both the medical and lay communities of SIDS and other causes of sudden infant death. The center works to identify causes of sudden, unexpected infant death throughout Minnesota; reaches out with information and support to families; educates professionals and the public; and participates in research.- The Simulation Center is a motor coach outfitted with simulation equipment and staffed with Children's trainers, travels throughout the Midwest to train staff from hospitals in the best practices when responding to pediatric or neonatal medical emergencies.

Part VI, Line 7:

Reports Filed With States Part VI, Line 7
MN