4A (Expenses $ 1264694407 including grants of $ 608800) (Revenue $ 1524146221)
ROUTINE INPATIENT SERVICES; ANCILLARY INPATIENT SERVICES SUCH AS LAB, RADIOLOGY, OPERATING ROOM, RECOVERY ROOM, CENTRAL SUPPLIES, ETC.; OUTPATIENT SERVICES SUCH AS EMERGENCY ROOM, MULTI-SPECIALTY AMBULATORY SERVICES INCLUDING ORTHO CLINIC, ONCOLOGY CLINIC, ETC. SEE SCHEDULE O FOR ADDITIONAL INFORMATION.

Schedule H, Part V, Section B, Line 3E
"CHCO - Colorado Springs was placed into service in May 2019. A single Schedule H, Part V, Section B was completed for facility reporting group A. The following hospital facilities are included in facility reporting Group A: (1) Children's Hospital Colorado (CHCO) - Anschutz (2) CHCO - South Campus (3) CHCO - At Parker Adventist Hospital (4) CHCO - Colorado Springs In 2021, Children's Hospital Colorado conducted two Community Health Needs Assessments (CHNA's). A joint assessment was conducted for licensed hospital facilities in the Denver Metro area, which included CHCO -Anschutz Medial Campus, CHCO - South Campus, and CHCO - AT Parker Adventist (hospital unit license). A second CHNA was conducted for the CHCO - Colorado Springs hospital, licensed in 2019. This meets the requirement that newly licensed hospital facilities complete a CHNA by the last day of the second taxable year. Both CHNA's were approved by the Children's Hospital Colorado Board of Directors on December 16, 2021. Children's Hospital Colorado included in each of the CHNA's reports a prioritized list and description of the community's significant health needs identified through the CHNA process. In both the Anschutz and Colorado Springs CHNA's, child mental health emerged as the top community concern through every method of data collection included in the assessments. Children's Hospital Colorado will address this community driven priority through a commitment of resources with specific programs and services as outlined in the corresponding implementation plans. ""2021 CHNA's: https://www.childrenscolorado.org/community/community-health/community-health-needs-assessment/"""

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - THE FOLLOWING DESCRIPTION FOR SCHEDULE H, PART V, SECTION B, LINE 5 APPLIES TO ALL FACILITIES INCLUDED IN GROUP A. Children's Colorado embraced the opportunity to engage with our community, better understand their interests and concerns, and design programs that directly respond to community needs. The primary purpose of the assessment is to fulfill our mission of improving the health of all Colorado children. The assessments connect us with communities and identifies priorities for our community-focused health goals and programs. Our methods for the 2021 CHNA's were informed by previous CHNAs and feedback we received on our 2018 CHNA from key stakeholders. We gathered both primary and secondary data for our communities and, when possible, gathered data that would demonstrate the impact of the COVID pandemic on community health and well-being. Additionally, in response to our 2018 CHNA feedback, Children's Colorado revised our prior data collection approach in two main ways: 1) gathered secondary data first to inform our primary data collection strategy and 2) developed a more dedicated approach to equity in our data collection process. For the first revision, we used our secondary data to inform what primary data we would collect that could provide context to and fill gaps from the secondary data. For the second revision, we examined our practices for data collection, analysis and communication with an awareness of the historical impacts, potential biases, and explored more demographic data, such as race, ethnicity, sexual orientation, and intersectionality to better understand the disparate impacts of health across populations. We then embarked on a significant community engagement process to understand prevailing interests and concerns in the neighborhoods and counties our hospitals serve. We prioritized input from families of color, families that speak diverse languages, and families facing barriers to care due to socioeconomic conditions. Through collaborations, caregiver surveys, stakeholder interviews, and community meetings, we were able to gain input from a diverse cross-section of the community. Data collection instruments are in the appendix of each of the CHNA's. Stakeholder Interviews: Stakeholders provide critical insights regarding the root causes of community health needs, as well as context and nuance that is often missed in secondary data. Stakeholders included leaders and representatives of ethnically diverse, medically underserved populations, as well as local health departments and agencies that gather data and other information relevant to current community health needs. We conducted a total of 54 interviews. A detailed list of stakeholder names, roles, and organizations are listed in each of the CHNA's. Caregiver Survey: This survey provided an opportunity to hear from parents and caregivers of children aged 0 to 25 living in counties where we have facilities and most of our patient population resides. To ensure that a broad cross-section of the community had an opportunity to respond, we had the survey reviewed through several channels to assess literacy level and cultural responsiveness. The survey was translated into eight languages: Amharic, Arabic, Burmese, English, French, Karen, Somali and Spanish to gain greater input from the community. For the Anschutz (Denver Metro area) CHNA, we hired four cultural connectors to collect caregiver survey data in Burmese, Karen, Nepali, Spanish, Swahili and French. For our Colorado Springs CHNA, we partnered with Catholic Charities to gather caregiver surveys to expand accessibility from diverse community members. In total, we collected 498 caregiver surveys to inform our work. Health Care Worker Survey: This survey was administered to pediatric providers: physicians, nurses and allied health professionals. Approximately 30% of respondents were physicians and 25% were registered nurses. Community Meetings: We held a series of community meetings to present the data we'd gathered from internal and external sources, as well as the results of our interviews and surveys. Participants asked questions and advocated for the issues they found most compelling, then voted for their top health and social issues. Details on these community meetings can be found in each of the CHNA's. Prioritization of Health Needs: Once our teams completed collection of primary and secondary data, including input from seven community meetings, the final step of the assessment was to seek input on how to prioritize the needs identified. Our Population Health committee, comprising both clinical and nonclinical leaders at Children's Colorado, carefully considered prioritization criteria and agreed on six key factors: impact, community importance, viability, sustainability, scale, and health equity. Mental health emerged as the top community concern through every method of data collection included in this assessment. Caregivers, health care team members, and community leaders all reported that mental of children in our community is a critical issue. Internal utilization data and public health surveillance data demonstrate a continued and increasing need for mental health and suicide prevention services for children and youth in Colorado, including services that address disparities in mental health outcomes within populations. Mental health has long been identified as a health priority among our community stakeholders as persistent systemic challenges have prevented mental health parity from being achieved. As Children's Colorado joins our community partners in embracing whole child, whole health approaches to child health, we recognize the need to place a consistent focus on mental health to meaningfully integrate mental health into our holistic approaches to care. Children's Colorado recognizes that the public health needs of the community are extensive, and many needs are not explicitly addressed through our priority and goals. Access to health care, including mental health services, and several social determinants of health were identified as top needs by the community and within the data, such as food insecurity, housing, access to benefits, mother and infant health, and economic issues. Work will continue to address other needs as identified by the community and highlighted throughout this reporting.

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - THE FOLLOWING DESCRIPTION FOR SCHEDULE H, PART V, SECTION B, LINE 6a APPLIES TO ALL FACILITIES INCLUDED IN GROUP A. For the joint 2021 CHNA, Children's Colorado defined community as all children aged 0 to 25 living in the four-county area from which most of the hospital's patient population resides and in which we have facilities: Adams, Arapahoe, Denver, and Douglas Counties. Within these counties, Children's Colorado has three licensed hospital facilities located at the Anschutz Medical Campus, South Campus, and Parker Adventist Campus and our associated networks of care. The Colorado Springs Hospital CHNA defined community as all children aged 0 to 25 living in the El Paso County area from which most of the hospital's patient population resides and in which we have facilities.

Schedule H, Part V, Section B, Line 7 Facility A, 1
Facility A, 1 - THE FOLLOWING DESCRIPTION FOR SCHEDULE H, PART V, SECTION B, LINE 7D APPLIES TO ALL FACILITIES INCLUDED IN GROUP A. The CHNA is posted on the hospital's external facing website and is made available upon request either digitally or written format. As part of the CHNA communication plan, results of the CHNA and the subsequent implementation plan are shared at various stakeholder meetings and community forums with the goal of identifying opportunities to engage in collaborative efforts to address areas of need. A dedicated community benefit email also provides an opportunity for input and questions. In 2019, the State of Colorado enacted HB19-1320, Hospital Community Benefit Accountability. A pivotal requirement of the legislation is an annual community benefit public meeting. The purpose of the public meeting is to inform the community of the hospital's community benefit expenditures, provide an opportunity for the community to learn about the most recent CHNA and the strategies that address the identified priority needs. The community is also provided the opportunity to advise on health and social service needs that continue to be of concern for the community.

Schedule H, Part V, Section B, Line 11 Facility A, 1
"Facility A, 1 - THE FOLLOWING DESCRIPTION FOR SCHEDULE H, PART V, SECTION B, LINE 11 APPLIES TO ALL FACILITIES INCLUDED IN GROUP A. To create the 2019 implementation plan, Children's Colorado used the information gathered through our 2018 CHNA and incorporated additional insights from five strategic planning sessions with internal and external community partners. A framework was developed that focused on five types of activities which had the most potential to impact child health outcomes: education and training, direct services and support, screening, referrals and navigation, and policy and advocacy. The priority health needs addressed in the 2019 implementation plan are mental and behavioral health, injury prevention, prematurity, asthma and respiratory health, obesity, nutrition, and physical activity. The plan outlines our three-year goals and objectives for each of the priorities and details the strategies that are identified to address these complex needs. Each of these objectives is quantifiable and time-limited, which allows for effective evaluation. The 2019 Community Health Implementation Plan (CHIP) and the 2019-2022 CHIP Evaluation https://www.childrenscolorado.org/community/community-health/community-health-needs-assessment/ Children's Hospital Colorado recognizes that the health needs of children in our community are extensive. As we transition to the 2022 implementation plan the five health priorities identified through the 2018 CHNA process will remain as sustaining priorities. The highlighted activities are examples of work addressing the five priorities and is not all inclusive of our extensive community-level work. Nutrition: Children's Colorado is acutely aware of the inextricable link between access to quality, affordable, nutritious food, and health. This is particularly important in serving communities with higher rates of poverty who struggle with food security. The Food as Medicine initiative at CHCO aims to integrate the importance of nutrition and health by not only providing food, but also education to help connect food to health. This is done by screening families, identifying those who identify as food insecure and providing resources and education to help overcome barriers to access. In 2021, the Healthy Roots Food Clinic received 1,149 referrals from primary care clinics in our Health Pavilion and served 2,851 people (1,237 children and 1,614 adults). One hundred percent of visits were ""successful,"" meaning that all families who sought food were provided nutritious groceries and basic food education. In the summer of 2021, we launched pilot replications of the Healthy Roots Food Clinic and Resource Connect model in two schools within the Aurora Public School district (APS). The program is implemented in partnership with the communities we serve. At Children's Colorado's Aurora Public School food clinic partnership sites, we served approximately 1,185 students in 2021. Both schools are part of the APS ACTION Zone, a network of five schools that serves 4,200+ students, roughly 10% of all APS students, and demographics include: Students come from 50+ different countries and speak over 150 languages, 66% of students are Hispanic, 15% Black, 12% Asian, 1% Native American and 4% White, 82% qualified for Free or Reduced Lunch, 75% English Language Developers. Asthma and Respiratory Health: The community-based asthma programs in the Breathing Institute within Children's Colorado focuses on reducing emergency department visits and inpatient admissions among asthma patients by improving families' ability to appropriately manage their children's asthma at home. Research shows that the incidence of asthma and outcomes for children with asthma are related to the environments in which they live, their social determinants of health, and their ability to make healthy choices. The AsthmaCOMP program has demonstrated significant improvement in clinical asthma outcomes including improved school attendance rates, reduced frequency of asthma symptoms and decreased ER/Urgent Care visits for asthma. The program has also helped train school nurses to become certified asthma educators. In 2021, this team completed 162 visits with students in 41 elementary schools. Of these students, 94% are eligible for free or reduced school lunch, 84% are insured by Medicaid, 87% identify as Black, Indigenous, or other people of color, and one in four have a caregiver who is Spanish speaking only. The Just Keep Breathing program has four community health navigators and a nurse dedicated to conducting asthma education in the home setting. The program focuses on improving care for pediatric patients with high-risk asthma in Metro Denver; this year they were able to serve families in rural communities using telehealth. The navigators conduct multiple home visits with each family, focusing on tailored health education, care coordination, barrier identification and navigation, and environmental assessment and remediation. In 2021, 183 eligible patients were identified, 87 of those patients enrolled in the program, and the team completed 79 home visits. Due to the COVID-19 pandemic, all visits were completed by telehealth. Prematurity: Children's Colorado's Black Health Initiative (BHI), centers around community voices and experiences to develop a framework for interrelated projects and services to improve African American patient and family experiences and health outcomes. At the forefront of this work, Children's Colorado collaborates directly with Black families and community members to conceptualize and pilot programs to address infant mortality. Borne out of the crucial need to have community members' experiences inform how health care providers address issues of healthy equity in health care settings, BHI partnered with the Center for Advancing Professional Excellence (CAPE) within the University of Colorado School of Medicine to develop provider trainings that immerse providers in simulated scenarios developed by community members. These trainings are an effort to shine a light on the challenges that African American woman face in clinical settings and bridge the gaps that can result in negative patient experiences and poor patient outcomes. By engaging providers in practice-based simulated visits, providers are immersed in situations that increase their appreciation for the needs of their patients, while building their skills around how to meaningfully address their patients' needs in a culturally responsive manner. Injury Prevention: In 2021, the car seat program at Children's Colorado distributed 205 harnessed car seats and 42 booster seats. Additionally, car seat installation/inspections were conducted for more than 350 children in conventional car seats and consultations were provided for more than 50 children with special healthcare needs requiring adaptive car seats. Car seat checks were conducted in 14 languages with help from Spanish-speaking Child Passenger Safety Technicians (CPST) along with virtual and in-person translation support. Three Safe Kids CPST certification courses were conducted, certifying 15 hospital employees and 34 community partners as CPSTs to support car seat education in the community. Safe sleep initiatives included distributing 37 pack-n-play cribs to families without safe sleep spaces and 1,380 sleep sacks to patient families through the Child Health Clinic. Forty medication lock boxes and 60 gun trigger locks were donated to community partners who work directly with populations in need of these resources. Educational resources were also provided to families on poison prevention and gun safety. Sixty-three bike helmets were distributed to families and 189 low-cost bike helmets were sold through our hospital-based Safety Store. Mental and Behavioral Health: In 2021, our Government Affairs team coordinated virtual or written testimony from 32 experts on pending legislation at committee hearings, trained 154 new advocates at our 11th Annual Speak Up for Kids Day, and empowered constituents to send almost 646 emails to state lawmakers on pending kids' health legislation. Advocacy and policy change is critical in increasing equable health care access. An example of our statewide advocacy work included advocacy to improve behavioral healthcare services for children."

Schedule H, Part V, Section B, Line 11 Facility A, 2
Facility A, 2 - THE FOLLOWING DESCRIPTION FOR SCHEDULE H, PART V, SECTION B, LINE 11 APPLIES TO ALL FACILITIES INCLUDED IN GROUP (CONT.). In 2021, the Government Affairs team worked with partners to build a better system of care for all children, youth, and families. We supported House Bill 1097 to help implement a key recommendation of the Colorado Behavioral Health Task Force to create a Behavioral Health Administration, a new state agency to lead, promote and coordinate Colorado's behavioral health priorities. We also worked to expand access to behavioral healthcare for children and youth by supporting House Bill 1021 to fund behavioral health services provided by peer support professionals and House Bill 1258, which provided access to up to six telehealth therapy appointments for all school aged children regardless of insurance coverage. professionals and House Bill 1258, which provided access to up to six telehealth therapy appointments for all school aged children regardless of insurance coverage.

Schedule H, Part V, Section B, Line 2
CHCO - NORTH CAMPUS WAS PLACED INTO SERVICE IN MARCH 2020. A CHNA IS SCHEDULED TO BE COMPLETED IN DECEMBER 2022 FOR OUR NORTH CAMPUS HOSPITAL LICENSED IN 2020. THIS MEETS THE IRS REQUIREMENT THAT NONPROFIT HOSPITALS TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WITHIN THE FIRST 2 YEARS OF LICENSING TO BE COMPLETED BY THE LAST DAY OF THE SECOND TAXABLE YEAR.

Schedule H, Part I, Line 6a
CHILDREN'S COLORADO PUBLISHES AN ANNUAL COMMUNITY BENEFIT REPORT. THE 2021 REPORT WILL BE PUBLISHED AFTER THE FINALIZATION OF THE 2021 SCHEDULE H 990 REPORTING. THE 2020 REPORT CAN BE FOUND AT HTTPS://WWW.CHILDRENSCOLORADO.ORG/COMMUNITY/COMMUNITY-HEALTH/. PRIOR TO THE COMPLETION OF THE REPORT A DISTRIBUTION LIST OF COMMUNITY MEMBERS, PARTNERS AND STATE AND LOCAL OFFICIALS IS DEVELOPED, AND THE REPORT IS DISTRIBUTED UPON COMPLETION. COINCIDING WITH THE PHYSICAL DISTRIBUTION THE REPORT IS THEN PUBLISHED ON THE CHCO WEBSITE.

Schedule H, Part I, Line 7
IN 2021, CHILDREN'S HOSPITAL COLORADO PROVIDED $301,516,894 IN BENEFIT TO THE COMMUNITY. MEDICAID AT CHILDREN'S HOSPITAL COLORADO ACCOUNTED FOR $214,738,596 OF NET COMMUNITY BENEFIT EXPENSE WITH $5,798,965 IN FINANCIAL ASSISTANCE. OTHER BENEFITS ACCOUNTED FOR $80,979,333 IN NET COMMUNITY BENEFIT EXPENSE. OF THAT $26,119,546 IN COMMUNITY HEALTH IMPROVEMENT, $25,304,919 IN HEALTH PROFESSION EDUCATION, $7,635,541 IN SUBSIDIZED HEALTH SERVICES, $20,763,062 IN RESEARCH AND $1,156,265 IN CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT. INCLUDED IN SUBSIDIZED HEALTH SERVICES ARE THOSE WHICH CHILDREN'S HOSPITAL COLORADO PROVIDES TO ITS PATIENT POPULATION AT A LOSS. IN 2021, PROGRAMS ASSOCIATED WITH THESE LOSSES ARE REHABILITATION, NEONATOLOGY AND OTHOPEDICS. THE NUMBER REFLECTED IN SUBSIDIZED HEALTH SERVICES EXCLUDES BAD DEBT, MEDICAID AND OTHER MEANS TESTED PROGRAMS SHORTFALLS AND FINANCIAL ASSISTANCE. CHILDREN'S HOSPITAL COLORADO IS COMMITTED TO SERVING ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY.

Schedule H, Part VI, Line 5 Continuation
To address the depth and breadth of community health Children's Colorado continues to build on our long and strong record of collaborating with community-based organizations, K-12, academic institutions, and governmental and non-governmental organizations, with the goal of improving health outcomes and reducing health disparities for children and their families. Additionally, significant resources were allocated in 2021 to support efforts to engage community members advocating for access to healthcare as well as providing educational sessions for both policymakers and advocates on child health issues of importance. Children's Colorado engages in an array of activities addressing community health needs that are not counted in our Schedule H 990 reporting due to IRS guidelines for reporting community benefit. Nonetheless, numerous other investments and activities are designed to benefit the communities we serve. Below, please find details of some of these additional community activities and investments. COVID-19 The COVID-19 pandemic has presented challenges that will have long lasting effects on both the field of pediatric healthcare and the lives of the patients and families we serve. Since March 2020, Children's Colorado has been committed to a systematic response to the COVID-19 pandemic. In addition to maintaining our focus on providing exceptional, quality care for patients and families, Children's Colorado has dedicated financial, people and physical resources to help mitigate the effects of the pandemic on our community. The state has been able to rely on Children's Colorado's dedicated partnership to support the COVID-19 response and to improve the health of Colorado's children and families. At the request of the governor and state public health department, Children's Colorado rapidly instituted a COVID-19 response infrastructure that included mobile testing sites, lab services, public health education resources and webinars for medical professionals as well as community members, mask decontamination for community-based providers, lab services for community-based testing, and shared medical supplies to manage statewide needs. Throughout the pandemic, our system was committed to providing the most up-to date family-friendly information and resources to support kids and families through the pandemic including operating a coronavirus hotline where our clinical teams answered questions about COVID-19 symptoms, vaccines and where to access healthcare. In 2021, there were 12 pages on our website dedicated to sharing the latest information on essential COVID-19 topics with parents and caregivers, with more than 551,000 unique visitors to those pages. COVID-19 vaccine deliberation resources were also created for caregivers and translated into the top eight languages of patient families who utilize our primary care clinics. The 2020-2021 and 2021-2022 school years were particularly challenging for the school and childcare sites we serve. Early in the pandemic, the school health nursing team found that some needs like fielding calls from educators and parents with questions about how to manage a child's diabetes or asthma - could be met virtually, via telehealth. The school health nursing team continued to serve as an advisory partner for school staff and parents throughout the pandemic, delivering trainings and consultations virtually for both individual health needs and systemwide safety guidance. Additionally, after the state issued their public health guidance to schools in September 2020, Children's continued to offer these town halls and participation grew to nearly 700 registered participants from across Colorado. These town halls became an effective venue to share the latest information on the COVID-19 vaccine and equip school leaders with the information they need to encourage it among their staff and school community. This school leader town hall series conducted 34 virtual meetings between April 2020 and December 2021. Children's Colorado opened a COVID-19 vaccine clinic in December 2020, initially serving frontline healthcare workers and community providers, then school staff and eventually opened our clinic to patients and the public throughout 2021. We administered more than 140,000 COVID-19 vaccines in 2021. Additionally, we hosted the Colorado Department of Public Health and Environment's mobile vaccine busses on each of our hospital campuses during the pediatric vaccine rollouts in late 2021 and plan to again beginning in June 2022 when the youngest age group (6 months+) is authorized. The provided summary does not fully capture the investment of financial resources and staff time to rapidly build and implement new infrastructure, clinic operations, public health education initiatives, research programs and cross-system activities that continued to be necessary in the second year of the COVID-19 pandemic. Social Determinants of Health The immediate impact of the pandemic imposed complex social and economic challenges for many families. The complexity of needs continued to be paramount throughout 2021. Critical needs included baby formula, diapers, food, utility assistance, housing and eviction prevention, and public benefits. Prior to the pandemic, Children's Colorado had systems in place to address social determinants of health within our walls and in the community and we were able to rapidly adjust to address the most pressing needs of our families and the community. Health Navigation is a patient-centric evidence-based model focused on addressing the social determinants of health. Navigators reduce barriers that keep patients from getting timely treatment by identifying patient needs and supporting them in accessing clinical, financial, or social supports. More than 20 navigators work in multiple clinical and primary care settings across our health care system. In 2021, resource support was provided to 13,855 unique patients and their families. In 2019, Children's Colorado opened Resource Connect in our Health Pavilion facility. Resource Connect anchors the Children's Colorado's strategy for population health-delivering healthcare that lasts beyond a clinic visit and enhances care for patient and families by creating a centralized place to access their most common social needs. The services provided through Resource Connect promote equitable access to the resources that all families. This is all accomplished through robust partnerships between Children's Hospital Colorado and community-based organizations. In 2021, Children's Colorado providers and other team members referred nearly 1,700 families to Resource Connect. More than 85% of Children's Colorado's Health Pavilion patients are insured by Medicaid/publicly funded insurance or underinsured/not insured. Families seen at the Health Pavilion are ethnically and racially diverse; many identify as Latino and there is a growing population of immigrant families from Africa, Nepal, and southeast Asia. Approximately 60% of children seen are age 3 and under. As a not-for-profit hospital, Children's Colorado is proud to provide investments that respond to community needs and serve our community. This summary is a snapshot of our responsiveness to community need. Another component of addressing community need is ensuring equitable access to health care for all children. Children's Colorado provides more health care services to children covered by Colorado Medicaid than any other provider in the State. In 2021, the health insurance coverage mix among our patient population included 48% of patients covered by Medicaid, 43.6% managed/commercial care, 6.5% other government programs, and 1.8% self-pay, indigent, or uninsured. Oral Health Promotion and Community Outreach Although, oral health has not been identified as a priority through the Community Health Needs Assessment process the community has expressed concern about the cost and lack of providers in their communities. In response, the Child Health Advocacy Institute provides various oral health services to increase access to dental care, help address barriers, and improve the oral health of children in our community. The strategies include oral health promotion through community outreach, increasing access to care by providing preventive oral health services at the School-Based Dental Clinic (SBDC) and increasing preventive dental services at primary medical visits. There were approximately 440 patient encounters in the SBDC with 444 referrals from the SBHCs. The majority of referrals (44%) qualified for the Aurora Public Schools Dental Program Fund, followed by Medicaid (24%).

Schedule H, Part VI, Line 7
IN 2019, COLORADO LAWMAKERS PASSED HB19-1320 REQUIRING NONPROFIT HOSPITALS TO SUBMIT AN ANNUAL COMMUNITY BENEFIT REPORT.

Schedule H, Part II, Line 10
IN 2021, CHILDREN'S HOSPITAL COLORADO PROVIDED $ 902,047 IN COMMUNITY BUILDING ACTIVITIES. THESE ACTIVITIES ARE DESIGNED TO PROMOTE THE HEALTH OF THE BROADER COMMUNITY. WE CONTINUE TO BUILD ON OUR LONG AND STRONG RECORD OF COLLABORATION WITH COMMUNITY GROUPS, BUSINESSES, ACADEMIC INSTITUTIONS AND GOVERNMENTAL AND NON-GOVERNMENTAL ORGANIZATIONS, WITH THE GOAL OF IMPROVING HEALTH OUTCOMES AND REDUCING HEALTH DISPARITIES FOR CHILDREN AND THEIR FAMILIES.

Schedule H, Part VI, Line 6
AFFILIATIATED HC SYSTEM - N/A

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
THE ORGANIZATION RECOGNIZES NET PATIENT SERVICE REVENUE IN ACCORDANCE WITH ACCOUNTING STANDARDS CODIFICATION (ASC) 606, REVENUE FROM CONTRACTS WITH CUSTOMERS. THE ADOPTION OF ASC 606 RESULTED IN CHANGES TO THE PRESENTATION FOR NET PATIENT SERVICES REVENUE RELATED TO UNINSURED OR UNDERINSURED PATIENTS. UNDER ASC 606, THE ESTIMATED UNCOLLECTABLE AMOUNTS DUE FROM THESE PATIENTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO NET PATIENT SERVICE REVENUE, RATHER THAN AS A PROVISION FOR BAD DEBTS, AND ARE BASED PRIMARILY ON HISTORICAL COLLECTION EXPERIENCE. OTHER THAN THESE CHANGES IN PRESENTATION, THE ADOPTION OF ASC 606 DID NOT HAVE A MATERIAL IMPACT ON THE OVERALL FINANCIAL STATEMENTS OF THE ORGANIZATION. EXPANDED DISCLOSURES REQUIRED BY ASC 606 ARE INCLUDED WITHIN NOTE 4, NET PATIENT SERVICES REVENUE.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
CHILDREN'S HOSPITAL INACTIVATES AR BALANCES BETWEEN 150-175 DAYS AFTER THE FIRST BILLING CYCLE. ACCOUNTS ARE REFERRED TO COLLECTION AGENCIES FOR RECOVERY. THE HOSPITAL DOES NOT REPORT ANY BAD DEBT AMOUNT IN COMMUNITY BENEFIT.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
THE ORGANIZATION RECOGNIZES NET PATIENT SERVICE REVENUE IN ACCORDANCE WITH ACCOUNTING STANDARDS CODIFICATION (ASC) 606, REVENUE FROM CONTRACTS WITH CUSTOMERS. THE ADOPTION OF ASC 606 RESULTED IN CHANGES TO THE PRESENTATION FOR NET PATIENT SER VICES REVENUE RELATED TO UNINSURED OR UNDERINSURED PATIENTS. UNDER ASC 606, THE ESTIMATED UNCOLLECTABLE AMOUNTS DUE FROM THESE PATIENTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO NET PATIENT SERVICE REVENUE, RATHER THAN AS A PROVISION FOR BAD DEBTS, AND ARE BASED PRIMARILY ON HISTORICAL COLLECTION EXPERIENCE. OTHER THAN THESE CHANGES IN PRESENTATION, THE ADOPTION OF ASC 606 DID NOT HAVE A MATERIAL IMPACT ON THE OVERALL FINANCIAL STATEMENTS OF THE ORGANIZATION. EXPANDEDDISCLOSURES REQUIRED BY ASC 606 ARE INCLUDED WITHIN NOTE 4, NET PATIENT SERVICES REVENUE.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
THE SHORTFALL REPORTED IN LINE 7 REPRESENTS MEDICARE SHORTFALLS FOR HIGH NEED PEDIATRIC PATIENTS SERVED BY CHILDREN'S HOSPITAL COLORADO. IF CHILDREN'S HOSPITAL COLORADO DID NOT SUBSIDIZE THE HIGHLY SPECIALIZED CARE, ACCESS FOR THIS POPULATION WOULD BE LIMITED, THUS WE VIEW THIS CARE AS COMMUNITY BENEFIT. THE HOSPITAL UTILIZED COST TO CHARGE RATIO METHODOLOGY TO ARRIVE AT THIS NUMBER. THE AMOUNT INCLUDES ALL COSTS LESS ALL PAYMENTS RECEIVED.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
YES, THE ORGANIZATION DOES HAVE A WRITTEN DEBT COLLECTION POLICY. PRIOR TO DEBT REFERRALS, ACCOUNTS ARE REVIEWED FOR ALL THIRD-PARTY PAYER ELIGBILITY PRIOR TO QUALIFYING FOR ANY CHARITY CARE OR FINANCIAL ASSISTANCE. ONCE THE PATIENT'S RESPONSIBILITY IS VALIDATED, THE HOSPITAL PROVIDES SLIDING SCALE DISCOUNTS BASED ON INCOME AND/OR EXPENSES. PARENTS WHOSE CHILDREN DO NOT QUALIFY FOR MEDICAID CAN ALSO APPLY FOR THIS DISCOUNT PLAN. THE HOSPITAL HAS A DEDICATED FINANCIAL COUNSELING/SERVICES DEPARTMENT WHO WORK CLOSELY WITH PARENTS TO ESTABLISH PAYMENT PLANS.

Schedule H, Part V, Section B, Line 16a FAP website
A - CHILDREN'S HOSPITAL COLORADO (CHCO) - ANSCHUTZ MEDICAL CAMPUS: Line 16a URL: www.childrenscolorado.org/your-visit/insurance-financial-resources/financial-assistance-programs/; - CHCO - NORTH CAMPUS: Line 16a URL: www.childrenscolorado.org/your-visit/insurance-financial-resources/financial-assistance-programs/;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - CHILDREN'S HOSPITAL COLORADO (CHCO) - ANSCHUTZ MEDICAL CAMPUS: Line 16b URL: www.childrenscolorado.org/your-visit/insurance-financial-resources/financial-assistance-programs/; - CHCO - NORTH CAMPUS: Line 16b URL: www.childrenscolorado.org/your-visit/insurance-financial-resources/financial-assistance-programs/;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - CHILDREN'S HOSPITAL COLORADO (CHCO) - ANSCHUTZ MEDICAL CAMPUS: Line 16c URL: www.childrenscolorado.org/your-visit/insurance-financial-resources/financial-assistance-programs/; - CHCO - NORTH CAMPUS: Line 16c URL: www.childrenscolorado.org/your-visit/insurance-financial-resources/financial-assistance-programs/;

Schedule H, Part VI, Line 7 State filing of community benefit report
CO

Schedule H, Part VI, Line 5 CONTINUATION 2
Over 3,000 oral health promotion items have been distributed within the community including toothbrushes, toothpaste, oral health education, toothbrushing charts, and books. Four virtual parent coffees and school events, three Back-to-School events, and a city-wide community event were attended. Screening events happened at three schools. A total of over 300 students received oral health education and 134 students received screenings. Planning for an additional 5 school screening events for the remaining 2021- 2022 school year also occurred. Pediatric Mental Health Institute At Children's Colorado, our commitment to mental health has been longstanding and unwavering. Child and youth mental health is a top priority for us across the entire organization. But the mental health crisis in Colorado is still growing and continues to challenge children and families, as well as Children's Colorado's care teams and our system's capacity. Children's Colorado is one of the most comprehensive providers of youth mental health services in Colorado, treating kids from all 64 counties. Across four hospitals, we treat the most children in crisis through our emergency departments, are one of the largest providers of outpatient care and provide inpatient care to the most complex pediatric patients. Children's Colorado is stepping up as a trusted community resource to help fill the gaps in Colorado's public systems. * We hosted 53 virtual lunch-and-learn sessions reaching more than 520 providers. * More than 60 community mental health education events were hosted, directed toward parents, schools, coaches, and other adults. * More than 70,000 kids are reached by our school nurse consultation program, which provides mental health consultations across hundreds of schools and childcare centers. * We crafted more than 20 state policy initiatives aimed at prevention and comprehensive, community-based youth mental health treatment options. Other Health Profession Education As part of our mission to improve the health of children, Children's Colorado offers a broad spectrum of training, education, and certification programs for healthcare professionals, aimed at developing and sustaining pediatric expertise. In addition to providing training opportunities in clinical settings we provide a wide range of professional development opportunities to support community-based health care professionals As a Level One Trauma Center, we also connect with first responders, hospital providers and other medical facilities via our Outreach and Education team. Many of these providers live and work in rural communities across Colorado and the surrounding six states. Our team leverages evidence-based research and guidelines developed by Children's Colorado to provide training opportunities that often change the way Emergency Medical Services teams respond to pediatric emergencies, helping them achieve improved outcomes. Workforce Development Founded at Children's in 1998, the Medical Career Collaborative program (MC2), is a hands-on learning program that serves low-income minority youth interested in pursuing a career in the health care field. MC2 serves as an educational and supportive outlet for high achieving and driven students who often lack necessary supports in their communities. The program's mission of helping high school students from diverse backgrounds explore the world of healthcare and discover the opportunities available to them in the medical industry, is a strategic program as part of HR's workforce development efforts. As the program invests in these students it is essentially increasing the diversity and cultural awareness of the healthcare workforce as it builds the next generation of professionals here at Children's Colorado and in the community. Medical Faculty Profile Our open medical staff arrangement allows community practitioners to hold privileges at our hospitals, and more than half of our approximately 1,700 medical staff of providers and advanced practice nurses are community-based. Among the thousands of referring providers throughout our seven-state region, these community staff members are frontline partners not only in establishing a seamless continuum of care for our young patients, but in providing training opportunities in primary care for the medical students and residents who will become tomorrow's pediatric professionals. Through our affiliation with family medicine residency programs in Colorado and Wyoming, we're able to provide pediatric rotation at our hospitals, which offers significant benefit to a region with a large rural population and a shortage of rural care providers. These affiliations also ensure that a primary care perspective is central to our strategies for providing the region's children with the broadest spectrum of care. Research Research is woven into Children's Colorado's mission to improve the health of children through the provision of high-quality, coordinated programs of patient care, education, research, and advocacy. We offer our patients the most innovative treatments available, and in affiliation with the University of Colorado School of Medicine, Children's Colorado has been a national center for pediatric research for more than 50 years. Our Pediatric Clinical Translational Research Center accelerates the translation of innovative science to get advanced treatments to patients more quickly. Our physician-scientists have pioneered seminal research in the treatment of pediatric liver disease, infectious disease and vaccines, pediatric and adolescent HIV and AIDS, cystic fibrosis, pulmonary hypertension, pediatric cardiology, and neonatology. Board of Directors At the time of filing this form 990, Children's Hospital Colorado's Board of Directors is made up of twenty-six volunteers and the associated executive leaders from the hospital and affiliated institutions. Board service is a commitment to help further the hospital's mission of improving the health of children through the provision of high quality, coordinated programs of patient care, education, research, and advocacy. Kids are Our Bottom Line As a non-profit organization, surplus funds are invested back into providing health care services and resources to the community, including but not limited to new patient care locations and equipment, expanded programs and services, community health promotion, research, and training of physicians, nurses, and other allied health professionals.

Schedule H, Part VI, Line 2 Needs assessment
IN ADDITION TO THE CHNA, CHILDREN'S HOSPITAL COLORADO REGULARLY ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY WE SERVE. ACROSS THE HOSPITAL, NUMEROUS INTERNAL AND EXTERNAL DATA SOURCES ARE REGULARLY MONITORED AND UTILIZED TO IDENTIFY TRENDS AND OPPORTUNITIES TO IMPACT CHILD HEALTH. ADDITIONALLY, HOSPITAL STAFF DEDICATES SIGNIFICANT TIME TO SERVING ON COMMUNITY BOARDS AND OTHER COMMUNITY GROUPS THAT ASSESS HEALTH NEEDS OF THE COMMUNITY AND PROACTIVELY PARTICIPATES IN THE HEALTH IMPROVEMENT EFFORTS LED BY THESE PARTNERS. IN 2018, CHCO FORMALIZED A POPULATION HEALTH STRATEGY. THE GOAL IS THE CREATION AND OPERATION OF A COMMUNITY BASEDPARTNER DRIVEN NETWORK OF CARE. THIS NETWORK BOTH EXPANDS ACCESS TO TRADITIONAL PEDIATRIC HEALTHCARE AND EXPANDS ACCESS TO NON-TRADITIONAL CARE THAT ADDRESSES A CHILD'S TOTAL PICTURE OF HEALTH. A COMMUNITY BASED, PARTNER DRIVEN NETWORK OF CARE REQUIRES IDENTIFYING PARTNERS THAT WILL ENGAGE IN A TRANSFORMATIVE SYSTEM OF CARE, ONE THAT ALLOWS A PEDIATRIC SPECIALTY HOSPITAL TO WORK WITH COMMUNITY BASED PARTNERS TO GENERATE IMPROVED HEALTH FOR ALL KIDS IN A TARGETED REGION, DESPITE NEVER BEING PATIENTS OR HAVING LIMITED INTERACTIONS WITH THAT HOSPITAL. THE NETWORK SUPPORTS IMPROVEMENTS IN THE DELIVERY OF TRADITIONAL HEALTHCARE SERVICES, LIKE THE NUMBER OF IMMUNIZATIONS, WELL-CHILD VISITS, ORAL HEALTH SCREENINGS AND BEHAVIORAL HEALTH INTERVENTIONS. IN ADDITION, SUPPORTING IMPROVEMENTS IN SOCIAL CONDITIONS IMPACTING HEALTH SUCH AS INCREASED ATTENDANCE AT SCHOOL, INCREASED ACCESS TO NUTRITIONAL FOOD AND SUSTAINED ACCESS TO STABLE HOUSING. THIS WORK WILL INFORM HOW WE ESTABLISH EFFECTIVE HEALTH SYSTEM-COMMUNITY BASED ORGANIZATION COLLABORATIONS WHILE WORKING TOWARD LONG-TERM SUSTAINABILITY IN HOW HEALTH CARE IS DELIVERED TO THE CHILDREN AND FAMILIES WE SERVE.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
CHILDREN'S HOSPITAL COLORADO HAS A PROCESS FOR INFORMING AND EDUCATING FAMILIES ABOUT HOW THEY MAY BE BILLED FOR PATIENT CARE AND THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. CHILDREN'S HOSPITAL COLORADO'S FULL TIME PATIENT FINANCIAL COUNSELORS ARE DEDICATED TO WORKING WITH FAMILIES TO PROVIDE GUIDANCE REGARDING AVAILABLE FINANCIAL ASSISTANCE WHICH ENSURES THAT ITS PATIENT POPULATION RECEIVES THE CRITICAL CARE IT NEEDS. ADDITIONALLY, CHILDREN'S HOSPITAL COLORADO PROVIDES PATIENT ASSISTANCE TO HELP IDENTIFY COMMUNITY-BASED RESOURCES, FACILITATE SERVICES AND PROVIDE APPROPRIATE REFERRAL ASSISTANCE TO HELP WITH CONTINUITY OF CARE. INPATIENT PROCESS: THIS PROCESS APPLIES TO PATIENTS WHO ARE BEING ADMITTED FOR OBSERVATION, SURGERY OR OTHER INPATIENT SERVICES. IF THE PATIENT IS PRE-SCHEDULED, CHILDREN'S HOSPITAL COLORADO PATIENT ACCESS WORKS TO CONTACT THE FAMILY PRIOR TO ADMISSION TO ARRANGE FOR A FINANCIAL SCREENING APPOINTMENT. REGARDLESS OF WHETHER AN APPOINTMENT IS SET PRIOR TO ADMISSION, THE PATIENT FINANCIAL COUNSELING TEAM WORKS WITH THE FAMILY TO DETERMINE THEIR SELF-PAY STATUS (EITHER NON-COMMERCIAL OR GOVERNMENT INSURANCE) AND SUBSEQUENTLY WORKS WITH THEM TO SCREEN FOR FINANCIAL ASSISTANCE OPTIONS. OUTPATIENT PROCESS: WHEN A PATIENT SCHEDULES A NON-EMERGENT OR URGENT OUTPATIENT CLINIC VISIT, THEY WILL IDENTIFY THEMSELVES AS SELF-PAY IF THEY DO NOT HAVE EITHER COMMERCIAL OR GOVERNMENT INSURANCE. AT THIS POINT, THEY ARE GIVEN TWO OPTIONS: (1) PAY A $200 DEPOSIT AT THE TIME OF APPOINTMENT AND BE BILLED ANY REMAINING BALANCE OR (2) SCHEDULE TIME WITH PATIENT FINANCIAL COUNSELING FOR ASSISTANCE. IF THE PATIENT WAS SEEN IN THE EMERGENCY DEPARTMENT OR URGENT CARE WITHOUT THE PRE-SCREEN, THEY STILL CAN APPLY FOR FINANCIAL ASSISTANCE WITH THE PATIENT FINANCIAL COUNSELING OFFICE. ALL SELF-PAY FAMILIES ARE AUTOMATICALLY GIVEN A 35 PERCENT DISCOUNT. CHILDREN'S HOSPITAL COLORADO HAS A FORMAL POLICY REGARDING ELIGIBILITY CRITERIA FOR CHARITY CARE. THE DECISION TO PROVIDE CHARITY CARE WILL BE, IN ALL CASES, BASED ON A REVIEW OF THE INCOME, ASSETS AND LIABILITIES OF THE FAMILY AT THE TIME OF ADMISSION TO THE HOSPITAL OR CLINIC. THE LEVELS OF CHARITY CARE AND FINANCIAL ASSISTANCE PROVIDED BY CHILDREN'S HOSPITAL COLORADO WILL BE DETERMINED BASED ON FEDERAL POVERTY GUIDELINES WHICH MAY BE ADJUSTED UP TO 200 PERCENT AND REVISED FROM TIME TO TIME. FAMILIES WITH ADJUSTED GROSS INCOME BETWEEN 200 PERCENT AND 400 PERCENT OF FEDERAL POVERTY GUIDELINES MAY ALSO BE CONSIDERED FOR CHARITY CARE WITH A CAP FOR OUT-OF-POCKET RESPONSIBILITY. DETERMINATION OF ELIGIBILITY WILL BE EFFECTIVE FOR SIX MONTHS AND APPLY TO ALL PATIENTS REGARDLESS OF IMMIGRATION STATUS. CHILDREN'S COLORADO WORKS TO PROVIDE NECESSARY HOSPITAL-RELATED SERVICES CONSISTENT WITH ITS MISSION, ITS STATUS AS A NONPROFIT HOSPITAL AND ITS STEWARDSHIP RESPONSIBILITY TO ITS DONORS. CHILDREN'S HOSPITAL COLORADO'S FINANCIAL ASSISTANCE PUBLIC POLICY AND PLAIN LANGUAGE SUMMARY ARE available at www.childrenscolorado.org/your-visit/insurance-financial-resources/financial-assistance-programs/.

Schedule H, Part VI, Line 4 Community information
Across Colorado, approximately 1.3 million children under the age of 18 represent 22% of the population. It is estimate that three in ten households in Colorado have children. Our Anschutz Medical Campus, South Campus, and location at Parker Adventist all sit within the Denver Metro area. Most of our admissions and outpatient visits come from children living in four Metro Denver counties: Arapahoe, Adams, Denver, and Douglas. Aurora, Colorado, the location of our Anschutz Medical Campus, is the third most populous city in Colorado and spans three counties: Adams, Arapahoe, and Douglas. With 20% of residents born outside the country and 33% who speak a language other than English at home, Aurora is one of the most diverse municipalities in the state. Children's Colorado, Colorado Springs, opened May 28, 2019. The facility is southern Colorado's first pediatric-only hospital, providing more than 175,000 children with pediatric care closer to home. Colorado Springs is the second-most populated city in Colorado. The city is located in El Paso County, which surpassed the City and County of Denver as the state's most populous county as of the 2020 Census. Census Bureau data from 2019 shows that 10% of children under the age of 18 in El Paso County live below the poverty line. United States Army, Air Force and Space Force bases are situated in the county, which leads to a significant presence of military families and adds to the diversity of population.