Community Benefit Insight - Tax-exempt hospital

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The Nemours Foundation

10140 Centurion Parkway North

Jacksonville, FL 32256

EIN: 590634433

The hospital that you have selected is part of a multi-facility organization that reports community benefit expenditures in the aggregate and not by individual hospital. The data shown below are for the multi-facility organization. We encourage you to contact the individual hospital directly if you would like community benefit information on the hospital.Learn more

Individual Facility Details: Alfred I Dupont Hosp For Children

1600 Rockland Road
Wilmington, DE 19899

2 hospitals in organization:
(click a facility name to update Individual Facility Details panel)

Alfred I Dupont Hosp For Children

Nemours Childrens Hospital

Bed count	260	Medicare provider number	083300	Member of the Council of Teaching Hospitals	YES	Children's hospital	YES

The Nemours FoundationDisplay data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

11.4%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 17,973,509 1.21 %
Medicaid as % of operating expenses	$ 97,624,187 6.59 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 2,820,878 0.19 %
Subsidized health services as % of operating expenses	$ 0 0 %
Research as % of operating expenses	$ 29,278,249 1.98 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 19,048,760 1.29 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 2,099,435 0.14 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 0 0 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 1219757230 including grants of $ 1453768) (Revenue $ 1436419070)
See Schedule H, Part VI

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

Schedule H, Part V, Section B, Line 3-Group A
Nemours conducted a Child & Adolescent Community Health Needs Assessment (CHNA) in 2019 for Nemours Children's Hospital, Delaware (NCH-DE), formally known as, Alfred I duPont Hospital for Children (AIDHC) and Nemours Children's Hospital, Florida (NCH-FL). The CHNA reports can be found at https://www.nemours.org/about/community-health-needs.html.

Schedule H, Part V, Section B, Line 5-Group A
As part of the Child & Adolescent Community Health Needs Assessment (CHNA), Nemours solicited information from multiple key informants: physicians, other health professionals, social service providers, business leaders, public health representatives and other community leaders. A list of these key informants can be found in the Nemours CHNA.

Schedule H, Part V, Section B, Line 11-Group A
See the implementation plan and progress reports located at https://www.nemours.org/about/community-health-needs.html

Schedule H, Part V, Section B, Line 16-Group A
http://www.nemours.org/patientfamily/financialassistance.html

Schedule H, Part V, Section B, Line 20a-Group A
No ECAs are permitted.

Supplemental Information

Schedule H (Form 990) Part VI

Schedule H, Part I, Line 6a
"The Nemours 2021 Report to Our Communities entitled, ""Well Beyond Medicine"" can be found at https://www.nemours.org/about/financial-benefit-to-the-community.html."

Schedule H, Part I, Line 7
Nemours calculated the amounts included in Part I, Lines 7a-b utilizing the methodology provided in the various worksheets included in the instructions for Schedule H of Form 990. These worksheets include Worksheet 1, Charity Care at Cost, Worksheet 2, Ratio of Patient Care Cost-to-Charges and Worksheet 3, Unreimbursed Medicaid and Other Means-Tested Government Programs.

Schedule H, Part I, Line 7a
"Financial Assistance at Cost - Nemours' mission is to ""provide leadership, institutions, and services to restore and improve the health of children through care and programs not readily available, with one high standard of quality and distinction regardless of the recipient's financial status."" COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS: During 2021, Nemours continued to focus on leadership and programs dealing with not just health care, but also areas of children's health promotion and disease prevention. Through various program, Nemours subsidized prevention and children's health programs totaling nearly $14.7 million. Nemours provided a variety of community health services for almost 18,000 of Delaware's low-income senior citizens of approximately $4.3 million. These outpatient health care services included dental care, eye examinations and eyeglasses, as well as hearing tests and hearing aids at the Nemours Senior Care. RESEARCH: Nemours continues to improve children's lives through the power of discovery. However, new discoveries are not enough. We are integrating research findings at the bedside and exam room where it has the greatest impact on children. In total, Nemours subsidized health research approximates $29.3 million during 2021 with 529 research projects under the direction of 133 funded researchers and principal investigators. EDUCATION & TRAINING OF HEALTH PROFESSIONALS : Nemours continues to train the next generation of pediatric specialists through affiliations with Thomas Jefferson University, the Mayo Clinic Medical College and others. In 2021, Nemours hosted 1,060 residents and 1,106 medical students and provided fellowship rotations for 112 physicians. Nemours supported education and training programs for health professionals of nearly $2.8 million. UNCOMPENSATED MEDICAL CARE: Nemours' services classified as ""charity care"" or where the recipient could not afford services or lacked adequate health insurance, was nearly $18.0 million in 2021. Nemours also covers the costs in excess of government payments for services provided to Medicaid and other public health beneficiaries of nearly $97.6 million. All totaled, uncompensated care for 2021 approximates $115.6 million."

Schedule H, Part III, Section A, Line 2
Implicit Price Concessions are calculated according to Generally Accepted Accounting Principles (GAAP).

Schedule H, Part III, Section A, Line 4
In the Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida audited financial statements, see footnote 2 located on pages 13 and 37 respectively, for a description of implicit price concession.

Schedule H, Part III, Section B, Line 8
The entire shortfall related to Medicare reported on line 7 should be considered a community benefit. Nemours is bearing the burden of providing care in excess of our costs to those Medicare patients. The source of the Medicare allowable costs comes from the 2021 Medicare Cost Reports.

Schedule H, Part III, Section C, Line 9b
The Nemours financial assistance policy applies to all of the facilities that it operates. Debt collection is not pursued against patients who qualify for the financial assistance program.

Schedule H, Part VI, Line 2
"Nemours assesses the healthcare needs of these communities using various methods. For example, Nemours community relations team is active at all sites to identify specific community needs for children. At Nemours, we seek to understand the health needs of the families who live in the communities we serve. Nemours has clinical operations in communities in Delaware, southeastern Pennsylvania and southern New Jersey (referred to as the Delaware Valley), Maryland and Florida. Nemours is committed to improving the health of children, even those who never enter our doors. To do this effectively, Nemours conducts community health needs assessments (CHNAs) then explores potential strategies to influence them. The CHNA can be found at https://www.nemours.org/about/why/coummunity-health-needs.html . The ""areas of opportunity"" listed below represent the significant health needs of children and adolescents in the communities our hospitals serve. Areas of opportunity in the Delaware Valley: substance use and abuse, access to mental health care, mental health and trauma, social determinants of health, housing and transportation, nutrition, physical activity and weight, youth activities and community safety. Areas of opportunity in Central Florida: access to health services, allergies, asthma, bone, joint and muscle conditions, cognitive and behavioral conditions, diabetes and infant health. Nemours seeks to educate families about children's health and parenting through its website (KidsHealth.org). KidsHealth helps families by enabling parents, kids and teens to better understand and take mastery of their own health. Nemours creates integrated suites of physician-reviewed, family-friendly, engaging media that provide families with knowledge, perspective, advice and comfort."

Schedule H, Part VI, Line 5
The Nemours Children's Hospital, Delaware and the Nemours Children's Hospital, Florida have open model medical staffs. Criteria for membership and clinical privileges are outlined in the Medical Staff Bylaws. Certain areas of practice are only open to practitioners employed by or under contract with Nemours and are eligible for privileges in their respective areas.

Schedule H, Part VI, Line 6
Nemours is not a part of an affiliated health care system. However, Nemours works in tandem with numerous community resources in the communities it serves.

Schedule H, Part VI, Line 7
Nemours is not required to file its Community Benefit report with the state of Delaware or Florida. However, Nemours is happy to provide access to its community report on the internet at https://www.nemours.org/about/financial-benefit-to-the-community.html.

Schedule H, Part VI, Line 3
"All of Nemours hospital and clinic locations share the same practice of educating patients and their families in the eligibility process. Information regarding financial assistance can be found on our website at https://www.nemours.org/patientfamily/financialassistance.html. Nemours employs Financial Advocates, as well as engages independent firms (collectively referred to as Financial Advocates) to assist in determining Medicaid eligibility. The Financial Advocates, some of whom are multi-lingual, work with families to educate and assist them with form completion regarding any program for which they might be eligible, including programs in the state of residence. Patients that arrive for an appointment at one of our practices, or are admitted to or present to the emergency room at NCH-DE or NCH-FL as ""self-pay"" are screened for Medicaid eligibility. The Financial Advocates follow up directly with the respective State regarding their decision/determination. In certain situations, qualified personnel may go to the family's home. In some instances, Financial Advocates will ask for and receive written or verbal consent, in an effort to assist the family with the Medicaid eligibility process. To benefit from Nemours' Financial Assistance Program, a family must participate in the Medicaid eligibility process described above first. Through that process, Nemours assesses eligibility for our charity care program, which is based on Federal Poverty Guidelines as indicated in Schedule H, Part I, lines 3a and b. Eligibility for the Nemours Financial Assistance Program is completed by the Financial Advocates. Personnel at NCH-DE have also established the Family Advisory Council (FAC), a group of parents whose children have had services at NCH-DE. The purpose of the FAC is to obtain feedback from families about additional ways Nemours can assist with financial eligibility issues. In an effort to perform proactive outreach in the Delaware Valley, Nemours' Financial Advocates go to our various locations, as well as local Community Health Center facilities. Both types of places represent a source from which families come to Nemours. Such visits focus on educating staff about the various funding sources for which patients may be eligible. Nemours is Community Partners with Delaware and Pennsylvania State Medicaids."

Schedule H, Part VI, Line 4
Nemours' clinical operations include two children's hospitals and multiple outpatient clinics. In Wilmington, Delaware, Nemours operates specialty and primary care children's clinics and a health clinic for the elderly. Nemours' service area includes 23 counties throughout Delaware, southeastern Pennsylvania, and southern New Jersey . Based on the April 2020 Population Census results, an estimated 206,900 children and youth under the age of 18 lived in Delaware (https://www.census.gov/quickfacts/DE) compromising approximately 20.9% of the area's total population (US Census Bureau, 2020). In 2020, Delaware's under-18 population was comprised primarily of 47% Non-Hispanic White, 25% Non-Hispanic Black and 17% Hispanic/Latino (datacenter.KidsCount.org, 2020) compared to 50% Non-Hispanic White, 14% Non-Hispanic Black and 26% Hispanic/Latino nationally (KidsCount, 2020). Household income level can have a significant impact on the health status of children living in the household. Overall, the percentage of children and youth in Delaware (16%) living below 100% of the Federal Poverty Level (FPL) (KidsCount, 2019) is relatively the same as the national rate of children in poverty (17%) (KidsCount, 2019). Approximately 43% of the area's children and youth live in households with incomes below 250 percent of the poverty level (KidsCount, 2019). The vast majority of children and youth in Delaware (95%) have health insurance coverage, but approximately 34% are covered by public health insurance programs such as Medicaid/CHIP (KidsCount, 2019). Nemours' clinical operations in Florida include a children's hospital in Orlando, and North and Central Florida physician practices with campuses primarily in Jacksonville, Pensacola and Orlando service areas. The majority of children and youth in Florida are Non-Hispanic White (42%) while Hispanic/Latino children make up 31% and Non-Hispanic Black children make up 20% of the population (KidsCount, 2020). A slightly larger number of children and youth in Florida (18%) live below 100% of the FPL when compared to the national rate of children in poverty (17%) (KidsCount, 2019). Approximately 53% of the State's children and youth live in households with incomes below 250 percent of the poverty level compared to the national rate of 47% (KidsCount, 2019). The vast majority of children and youth in Florida (92%) have health insurance coverage, but approximately 37% are covered by public health insurance programs such as Medicaid/CHIP which is slightly higher than the national average of 34% (KidsCount, 2019). For more information about the communities Nemours serves, please see our CHNA at https://www.nemours.org/about/why/coummunity-health-needs.html