2015 Report to Our Communities

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Nemours /Alfred I. du Pont Ho spital for C hildren Nemours Biome dical Research Nemours Bri ghtSt art! Nemours Center for C hildre n’s Health Media Nemours Childre n’s Clinic Nemours Childre n’s Hos pital Nemours Children’s Prima ry Care Nemours Children’s Sp ecial ty Care Nemours Children’s Urgent Care Nemours du Pont Pediatrics Nemours E state Nemours Fund f or Childre n’s Health Nemours H ealth & Prevention Servic es Nemours Nat io nal O ffice of Poli cy & Preven tion Nemours Seni orCare Nemours. or g NemoursEdu cation.o rg Shared Guardia ns of KidsHealth.o rg Children’s Health & ReadingBrightSta rt.org JOY 2015 REPORT TO OUR COMMUNITIES

Nemours is not simply a place for care, it’s a way of caring for children. TABLE OF CONTENTS Our promise, “to treat every child as if they were our own,” means we will do

everything within our power to restore and improve the health of children. We are shared guardians of 1 A Message From David Bail ey 26 2015 Commun ity Benef it 4 Meeting Children and Families 29 Recognizing Our Voluntee rs children’s health and, by extension, their JOY. As one of the largest integrated pediatric health systems Where They Are 30 Celebrating the Joy of Giving in the United States we have the power to inﬂuence the places in which we provide care, as well as the 10 Creating a Joyful Environment 32 Stewards of Hea lt h and Joy 14 Finding More Meaning in ways in which we deliver services. To do both most effectively, we examine how we can increase the joy, 35 2015 Governance the Experience inherent and extrinsic, to the environment and experience, and ultimately to the child. It is a philosophy, 36 2015 Awards and Recognition 20 A Future Full of Joyful Possibilities 38 Our Locations a way of caring, that goes far beyond the provision of care. Your child. Our promise. 24 Extending Joy Into the Community NMRS-16-004_CBR_web_spreads_Layout 1 6/3/16 4:37 PM Page 5

A MES SAGE FR OM DAVID BAIL EY VISION Freedom from dis ab ling cond itions.

MISSION

To provide leadership, inst itutions and serv ices to re store and i mprove the he alth TO OUR FAMILIES, FRIENDS AND PART NERS,

of children through care and progra ms There is nothing quite like the joy of a child — hearing their laughter, sharing in the experience of their curiosity not readily ava ilable, with one h igh and wonderment, and witnessing them coming into their own. There is something else that is uniquely universal in standard of qual ity and dis tinction children — their resilience. As Garth Erasmus, our 2015 visiting artist-in-residence at Nemour s/Alfred I. duPont re gardless of the recipient ’s financ ial stat us. Hospital for Children put it, “even in a child’s most fragile state, there is a strength, an aura of positivity expressed in their cheerfulness and laughter.” It is the children who remind us of the joy to be found in the smallest of things and to celebrate the everyday victories — helping us see life through a fresh lens.

At Nemours, we understand parents’ innate drive to do whatever it takes to protect their children — to keep VALUES them safe from harm or to “make it better.” When a child’s ability to experience their natural sense of joy is compromised, there is nothing more urgent than to “ﬁx” it. As a children’s health system, all of us at Nemours Bu ilding and sustaining a cu lture of trust. have accepted a sacred trust … we are shared guardians of children’s hope and joy. We ful fill this trust through a promise to families to treat every child as if they were our own. This means, we will do everything within our EXCEL RESPECT SER VE HON OR LEARN power to help children grow up healthy and reach their full potential, removing barriers — physical, emotional or social — to achieve the best possible outcome for each child.

How health care is delivered continues to change, moving beyond the traditional deﬁnitions of diagnosis and COMMITMENT treatment, outside the walls of medical facilities, and toward keeping people well. Nemours is uniquely positioned to help establish a strong foundation for lifelong health in new and ever-expanding ways — keeping the highest “I will do whatever it takes to make eve ry quality care local for children and families. We are committed to continuing to establish strong networks to co ntact with Nemours a unique ly satis fying exchange knowledge, creating opportunities to inspire the next generation of health professionals, and crafting experience ... for our patients, paren ts, experiences that lighten the load for children and their families. vis itors, colle agues and busine ss pa rtners .” Within the pages of this report are the inspiring stories and highlights from 2 015 that we hope will allow you to share our optimism for the future. On behalf of all of us at Nemours, we are committed to the relentless pursuit of helping children and families preserve their joy by providing exactly the care they need and want, how and when they need and want it.

Your child. Our promise.

David J. Bailey, MD, MBA Nemours President & CEO

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She ca lls the WREX her At 19 months old, Ivy was diagnosed ‘BUTTERF LY A RMS’ with arthrogryposis multiplex congenita and she ca lls Dr. Rahman (AM C), meaning the tendons in her ‘DR. BU TTERF LY .’ wrists, elbows and shoulders are extremely tight. She could not bend or lift her arms, making it impossible for her to do things like brush her hair or feed herself.

Ivy was referred to Tariq Rahman,PhD, at Nemour s/Alfred I. duPont Hospital for Children, who had invented the WREX (Wilmington Robotic EXoskeleto n). The WREX is a device made of lightweight parts that eliminate gravity and allow tension where needed, helping patients use their limbs more freely.

Nemours specialists made Ivy’s WREX by taking a cast mold of her body, to size the plastic shell that goes over her. The rest of the pieces were made with a 3D printer. Ivy doesn’t wear her WREX all the time, but she does use it when doing activities at the table, such as eating.

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“It’s all important. You want to practice on a MEETING CHI LDR EN AND mannequin before real life ... This is what it’s FAMI LIES WHERE THEY ARE going to sound like, this is what it’s going to feel like, this is what it’s going to look like ....” No matter where or when a child is in need of care — at home, at school, in the middle of the night, Nemours is — School nurse attendee, Nemours NICE transforming our system to de liver School Nurse Health Conference at NCH services and support to families where they are, as close to home as possible, even in the palm of their hands. For CONNECTING WITH FAMILIES FOR 20 YEARS health advice, treatment or follo w-up, to ease their worries, and to help In 1995, the Nemours families receive the answers they need Center for Children’s BUILDING SKILLS AND CONFIDENCE TO CARE FOR more quickly, all so kids can get back Health Media launched CHILDREN AT SCHOOL to what they do best — being kids. a new website, KidsHealth.org , and Nemours Institute for Clinical Excellence forever changed the (NICE) remains at the forefront of medical way families access simulation services, an area increasing in CARECONNECT: 2 4/7 ONLINE HOUSE CALL BRINGING CARE INTO MORE COMMUNIT IES trustworthy demand. Using tools from high-tech mannequins to health care theatre, Already an established In our continuing efforts information about health. Industry benchmarking NICE programs enhance participants’ method for community to meet locally the freestanding indicates that KidsHealth provides the highest quality technical, cognitive and behavioral skills. physicians to talk to our demands of families who 0 2 hosp itals information and user experience of all health care pediatric specialists, seek out our care, we are Nemours content providers. What families have experienced has In 2015, NICE hosted the first annual Nemours CareConnect bringing Nemours to 6 0 lo cations now been affirmed by health care systems: about 80 Nemours School Health Conference at has now been expanded to more communities and hosp ital children’s hospitals choose KidsHealth for web content, Nemours Children’s Hospital . Nearly 100 school health Florida families with the neighborhoods through 1 7 affil iations bedside videos and patient instructions. professionals from six Central Florida counties attended 20 15 launch of our direct- expansion, acquisition the conference, which featured the use of mannequins to to-consumer version . The and alliances. In 2 015, we acquired one primary care simulate a number of conditions, including asthma attacks practice in Delaware and four primary care and anaphylactic seizures. service offers families First “My 5-year-old swallowed a ma rble and we 24/7, immediate access # 1 pediatric practices and one specialty care office in were in a panic about it, even though our to a face-to-face online direc t- to-consumer Southeast Pennsylvania ; entered into a care doctor said it would pass naturally . I consultation with a telehe alth se rvice collaboration agreement with the five searched for a picture to show him where Nemours board-certified launch ed in Flori da MedExpress immediate care locations in the marble would travel and found your 2 0 YEARS! pediatrician via mobile Delaware ; and continued to provide website. It calmed him so much to have an device, tablet or computer. hospitalist, neonatal, emergency an d /or understanding of his digesti ve s yst em ... KidsHealth.org has and it was on his level. Now, he ’s so ex cited One low fee applies per visit, and a child does not have surgery services to more than 11 hospitals, grown to be the most- about the other systems and doing a to be a current Nemours patient. Visits are secure and health systems and clinics in Delaware, visited site devoted to connect -th e-dots of the lu ngs. He’s totally children’s health HIPA A-compliant, and prescriptions and follow-up notes Pennsylvania, New Jersey and Maryland . forgotten about the marble.” are available post-visit. In our quest to bring our worl d- In Florida, we established partnerships with Lakeland class care closer to families, it doesn’t get much closer Regional Health to provide highly specialized pediatric than the phone or laptop. care; opened Nemours Children’s Specialty Care, Daytona Beach ; and opened Nemours Children’s — Parent and child visitors to KidsHealth.org Primary Care, Sanford ; all while expanding operations at our existing Florida sites. 4 NEMOURS.ORG REPOR T TO OUR COMMUN ITIES 5 NMRS-16-004_CBR_web_spreads_Layout 1 6/3/16 4:38 PM Page 11

Nemours is develo ping novel use s RESEAR CH SCREENING IN THE CO MFO RT OF HOME for telehealth beyond medical care, including using Ne mou rs Families applying for inclusion in research studies Ca reConn ect to conduct re sear ch often incur extensive travel costs and a hefty time scree ning s and research studies. commitment to reach the location of i n-person screenings, with no guarantee that their child quali fies under the research protocols. For a recent study, the Neurology Research Team at Nemours Children’s EXTENDING THE OFFICE VISIT I NT O H OMES Hospital (NCH) used telemedicine to pre-screen Nemours researchers are using a two-pronged approach potential participants . Using a readily available app, to study methods to improve the care of adolescents with the NCH team conducted an interview and virtual obesity. First, researchers are equipping primary care evaluation. Families that met de fined criteria were physicians with tools within the electronic health record invited in for more formal in-person screenings. For (EHR) to promote evidence-based practices during ofﬁce families that didn’t meet the criteria, there was a visits. Then, a subset of patients have virtual visits with a much higher level of satisfaction knowing they had telemedicine health done all they could while avoiding unnecessary coach using Nemours expense and disruption to the life of their child. PARENTS HELPING PARENTS PROMOTE HEALTHY CareConnect. During WEIGHT BEHAVIORS the biweekly telehealth Nemours research scientist Tha o- Ly Phan, MD, MPH, meetings, the coach can has received a ﬁve-year National Institutes of Health reiterate the physician’s AN EXTRAORDINA RY PLACE FOR (NIH) award for her study, “Integrating Parenting counseling and patients EXTRAORDINARY KIDS Interventions into Pediatric Obesity Care.” Leveraging can discuss new at-home In 2015, Nemour s/Alfred I. duPont Hospital for Nemours’ strengths in family -centered care, health care exercise regimens, brainstorm food choices together, and Children launched a comprehensive new program for delivery science and multimedia formats, Dr. Phan is even give their coach a tour of their refrigerator. Initial data children with X and Y chromosome variations. Only developing videos featuring families who have received shows weight loss in both groups, with double the loss the third program of its kind in the U.S. , the care in the Weight Management clinic at Nemour s/Alfred among those in the telehealth group . The research explores eXtraordinarY Kids Clinic brings together a team of I. duPont Hospital for Ch ildren . The diverse group of the bene fits of partnering community physicians with experts in medical and therapeutic disciplines to families will share parenting skills that worked best for “ My son was 4 years old and weighed 71 telehealth coaches to reinforce the o ffice visit experience address the unique needs of patients with these common them in changing food and pounds when he entered the Weight in the home. but frequently undiagnosed genetic conditions. In fact, exercise behaviors while Management Program. Now he’s almost 10 there are an estimated 500,000 people in the U.S. with strengthening the paren t/child and weighs 76 pounds. We learned so much an X or Y chromosome variation , but only 25 percent relationship. Families will be through the program. When Dr. Phan asked are actually diagnosed in their lifetime, with most able to access the videos through us to pa rticipate in videos to provide advice # 3 to other families, we were all in. I think diagnoses made through prenatal screening. MyNemours and have Nemours eX traor dinarY listening to someone else who has gone conversations about the most Kids Clinic is o nly the The clinic is led by pediatric endocrinologist through this with their child would be relevant video topics with their third program of its Judith Ross, MD, and supported by a team helpful. My best advice is don’t make a chil d’s health care provider. kind in the U.S. that of pediatric specialists in genetics, child feel di fferent — if yo u’re changi ng addresses the unique developmental pediatrics, psychology, eating or acti vities, do it together and get needs of children with the whole family involved. Our whole f amily X and Y chromosome psychiatry, occupational and speech has become he althier together.” varia tions. therapy, and social work. Denisha A., parent, Wilmington, Del. —

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Did you hear the one Keith, born three months premature, about the GERM? had a variety of health challenges. Most NEVERMIN D, I do n’t significantly, he needed a new bladder and a kidney transplant. want to spread it aroun d. At 18 months old, Keith had his first visit with Nemours pediatric urolo gist Ahmad Bani Hani, MD. Doctors built Keith a new bladder and for t hree years a fter, Keith received dialysis three days per week at Nemour s/Alfred I. duPont Hospital for Children.

Everyone in 3C South knew Keith, or as they called him, “Bubba” or “Mayor.” He was always ready to share his “joke of the day” with his care team.

In 2014, Keith got his kidney transplant and everything is going well — he’s now a healthy 7-yea r-old and is even able to attend public school ful l-time. He still comes to duPont Hospital for Children for appointments and check-ups, and while the visits are less frequent, Keith always has plenty of jokes to go around.

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CREATING AJOYFUL “I was diagnosed with leukemia, and spent “After a stressful preoperative phys ical ther apy a lot of time in the hospital and receiving appointment, we walked through the Atrium as the ENVIRO NM ENT treatments. The Nemours IT team connected OperaDelaware pe rformer be gan. My daughter froze, my Xbox 360 so I could game with my spellbound ... for a brief time a fter a hard day, Hospitals and doctors’ offices are not friends and brothers, including one brother no words were necessa ry ... ” places that most people look forward to stationed at Camp Lejeune. I made my gamer tag about leukemia and educated visiting. Nemours has worked to create — Nemours patient mom environments that minimize stress and other pla yers about the di sease if they asked, and became friends with another anxiety for fam ilies who must be in our gamer with leukemia. Gaming was a way to THE HEALING POWER OF MUSIC fac ilities for trea tment or fo llow -up. We take my mind off of ever ything going on and have also worked to create places that a way for my online commun ity to suppo rt The world-class design are more natural settings for hea ling me through my treatment.” of the Anthony N. and support. Hosp itals among ga rdens, Fusco, Sr., Atrium at and ac tiv it ies within loca tions create a Nemour s/Alfred I. sense of normal cy and promote duPont Hospital for — Brady C., Nemours patient, Chester Springs, Pa. comfort and, at times, even fun. Children is now showcasing world- A HOSPITAL AMONG GARDENS PROMOTES class musicians for the THERAPEUTIC BENEFITS OF NATURE beneﬁt of patients, CAMP WEBELONG, AN IN PATIENT CAMP EXPERIENCE SMOOTHING THE VISIT FOR CH ILDREN WITH AUTISM Nemours Associates In the words of our founder, Alfred I. duPont, “Old and the public. A chance meeting between Nemours’ It’s bad enough to be in the Nemours continues its enterprisewide approach to Dame Nature” is the best medicine. Heeding these Paul Rosen, MD, and Brendan Cooke, general manager hospital, but it’s even worse welcoming and better accommodating children with autism, words and calling back to the original therapeutic role of OperaDelaware , brought about a question: With when it’s summer vacation who may be hypersensitive to a physical space’s sights and it once played, the majestic mansion and gardens of the performers coming in for OperaDelaware’s Sunday shows and your friends are all at sounds. Working together, the newly created Autism Family Nemours Estate , which neighbors Nemour s/Alfred I. needing rehearsal time on Fridays, why not use a beautiful camp. Enter the Child Life Advisory Coun ci l and Associates at Nemour s/Alfred I. duPont Hospital for Children, will look to integrate setting with an appreciative live audience — the Atrium? Department at Nemour s/ duPont Hospital for Children are developing an autism- operations more closely with the hospital. Activities in Alfred I. duPont Hospital friendly environment at the hospital and other clinical sites . 2015 included hosting the Night At Nemours Gala , the Nemours Children’s Clinic, Pensacola also stresses the for Children, creators of At Nemours Children’s Hospital (NCH) Emergency Hear We Go 5K Ru n/ Walk , the Kids with Conﬁdence 5K healing power of music. A partnership formed in 2 015 2015’s first annual Camp WeBelong . Held Department (ED) , the Wal k/Run , 4.5-star-rated Trip Advisor tours , and more with The Pensacola Symphony provides professional for hospital inpatients during the first week than 800 Nemours Associates and their family members at demonstrations in the lobbies along with outdoor “Trips to the hospital come with a lot of recently enacted of August, Camp WeBelong ensured the a holiday season open house . Going forward, the Nemours concerts and instrument petting zoos for special events. anxi ety, espe cially for families of children REACH (Respecting entertainment of children of all abilities Estate is planning a slate of health, wellness, healing with special needs. The REACH program Each Awesome Child through food and games, face-painting, gives the ED team the tools and resources Here) program identi fies and play experiences for mak e-your -own pizza, ponies, to provide the best care possible to eve ry children who have children, their families “beach” volleyball, exotic cars, child and f ami ly in a way that is autism when they enter and the entire Nemours 6 0 0 safari night, science displays, comfo rtable to them.” the ED. The family is community, including runner s/walkers a dance-a -thon and a huge, then offered the option hosting the Annual pa rticipated in the walk -in Earth balloon . th of a more soothing, Remembrance event for 7 Annual Hear We — Cara Harwell, ARN P, CPN P, PMHS, ED Nurse quieter waiting area children who have Go 5K Ru n/Walk held Practitioner, Nemours Childre n’s Hosp ital passed and had been on the grounds of stocked with sensory the Nemours Estate toys, headphones and iPads. NCH is evaluating the under our care. expansion of REACH to other areas of the hospital.

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Shortly after birth, doctors discovered that Josh had a very rare disorder called atelosteogenesis type 3 (AO3), which means his bones don’t develop properly. His doctor referred him to William Mackenzie, MD, at Nemour s/Alfred I. duPont Hospital for Children. They discovered Josh’s spine was severely curved and he was at risk for severing his spinal cord.

At 20 months, Josh had the 12-hour life- saving surgery. He went home with a halo that he had to wear for three months until his spine fused and healed. At 24 months he got a walker and took his first steps — he took off with pure joy and exhilaration on his face.

Today, Josh is followed by Stephen Frick, MD, at Nemours Children’s Hospital in Florida, as well as Dr. Mackenzie. He’s had multiple surgeries to align his limbs and fix his Achilles tendons. He wears a back brace for scoliosis, which will eventually require surgery. But for now, he goes to school, rides his tricycle and is about to start equine therapy and baseball.

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SPIRITUAL SUPPORT FOR EVERY SPIRIT “Faith is in Nemours Children’s Hospital’s DNA. ” FIN DING MORE MEANING Nemours Children’s Hospital (NCH) opened with, and IN THE EXPERIENCE continues to enjoy, support from the entire faith community. NCH’s nondenominational chapel , stocked — Jim Degrado, manager, Spiritual Care, NCH Being open to learning about experiences with religious materials that are different than our own enables for all faiths and ages, has Nemours to institute programs, services become a place of “Nemours has again shown its commitment to famil y- and processes that more accurately reflection and worship for centered care by fulling supporting Parent to Parent reflect and address the physical, our patient families and training here at the hospital. ” emotional, social and spiritual needs of Associates, as well as our those we serve. For children and communities . Tuesdays — Lori Brady, Co-chair, Family Advisory Council families, these holistic experiences are and Thursdays bring Nemour s/Alred I. duPont Hospital for Children intended to minimize adversity during a music and meditation , a Catholic mass on Wednesday and serious or difficult situation and to an Islamic service on Friday. Chaplains are ever-present in maximize the ability for a child to express our surgical waiting rooms, and pastoral care is available FAMILIES SHARING THEIR EXPERIENCES TO HELP OTHER FAMILIES freedom and jo y. 24/7 for everyone — patients, families and Associates alike, including an annual “blessing of the hands” for our About seven years ago, Nemour s/Alfred I. duPont medical staff and “blessing of the paws” for our pet Hospital for Children created its first Family Advisory therapy team. Our annual Day of Remembrance , for Council (FAC), firmly establishing families as a resource THE ART OF TRANSFORMING EXPERIENCES children who have passed, is also led by our spiritual care to improve the family experience at Nemours. Now, team. The 2015 event featured an orchestra, speakers, Highlighting the positive effect of music and art on “We made musical instruments out of tongue councils include a youth council, a virtual council, and activities and food. the healing process, 2 015 saw a partnership between depressors and tubing, and art out of items more than 20 diseas e- or issue -specific councils . Looking Nemour s/Alfred I. duPont Hospital for Children and the from the stock room. The children tapped to assist Nemours parents as well as the hospital, Lori into their full powers of imagination and University of Delaware to host its inaugural international ENSURING EXPERIENCES MATCH UNIQUE NEEDS Brady, duPont Hospital for fantasy. I was inspired by their presence. visiting artis t-in-residence , South African Garth Erasmus. Children FAC co-chair, connected Even in their most fragile state, there was a The Nemours O ff ice of Health Equity & Inclusion was When at duPont Hospital for Children, Erasmus with Delaware Family Voices and strength, an aura of positivity. They were created to help us be respectful, mindful and sensitive to collaborated with the the related Parent to Parent USA full of cheerfulness, laughter – fun! The the cultural and spiritual needs and differences of children hospita l’s art and music programs. Parent to Parent offers reaction of the children was life-changing and families we encounter. In 2 015, Nemours created the therapists and offered So uth for me. I’m still reflecting on the experience. trained and situatio n- matched “Support # 1 Health Equity Consortium , a new advisory body consisting performances and African It’s a feeling I don’t want to lose and I will Parents” as a resource for families with artist Ga rth Erasmus of community members representing underserved workshops for patients, find a way to work it into my future art.” children who have special needs . was the f irst populations or those experiencing health disparities . families and Nemours international vis iting Associates. Drawing from artist-in-residence By developing these partnerships among Nemours his own influences of at Nemour s/du Pont Associates, our families and our communities, we are able — Garth E., 2015 University of D elaware indigenous peoples’ art Hospital for Children to develop a deeper understanding of different cultures, years ago, Nemours formed its first Vis iting A rtist-i n-Residence, and nontraditional languages, genders, sexual orientations, gender identities 0 7 Fami ly Advisory Council ... Today, Cape Town, South Africa materials, Erasmus helped and expressions, religions, abilities, socioeconomic statuses diseas e- or issue-speci fic adviso ry children create art and music using a variety of items. and more . These factors, along with the community input, 2 0 councils meet regularly along with ... This included medical materials, showing children will have a significant and positive impact on our ability vi rtual adviso ry coun cil and several 0 1 youth adviso ry councils how items associated with hospitals and illness can to deliver even more ef ficient and effective diagnoses, care be transformed , both literally and symbolically, into plans, education and support. something beyond their medical use.

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A WEBSITE BY AND FOR FAMILIES TO ADDRESS TYPE 1 DIABETES IN VERY YOUNG CHILDREN “ My daughter Caitlyn was diagnosed with an airway defect at age 1. Her voicebox covers While a diagnosis of Type 1 diabetes is serious at any age, her airway, so she uses a tracheostomy when a child younger than age 6 is involved the care device to get air in and out instead of concerns are magnified and more difficult. Parents find through her mouth. It was very scary finding that, for this age range, there are few places to have their out about the trach, knowing all of my speci fic issues addressed. Seeing a critical need, researchers responsibilities as her parent and at the Nemours Center for Healthcare Delivery Science caregiver. Knowing that I would have to secured a National Institutes of Health ( NI H) grant for take a cras h-course in nursing and their project, “A Crowdsourced Social Media Portal for respiratory therapy just to be able to be le ft Parents of Very Young Children with Type I Diabetes.” alone with my child. Without the simulation, I do n’t think we would have been able to The researchers are collaborating with nearly 200 families bring her home... I would n’t be a ble to c are (including 15 from foreign countries) to develop a patient- for her the way I do.” centered, “family-sourced” website for expert content and guidance, social support and other resources. Once up and running, the researchers will analyze the efficacy of the site — Amber M., parent, Orlando, Fla. with controlled trials. CONFIDENT LY TAKING THE EXPERIENCE HOME

Nemours Institute for C linical Excellence CARE EVERYWHERE MEANS BETTER CARE HERE (NICE) uses medical simulation to train physicians, nurses and other health care CONTROLLING ASTHMA ONE STEP AT A TIME Within Nemours’ electronic health record (EHR) providers across a broad spectrum. software is a button called “Care Everywhere” — and Developed for a recent grant project seeking to optimize Nemours KidsHealth’s Asthma Sequenced Perhaps even more important is Learning Tools include a fi ve-week while the button is small, the benefits are big. Care health outcomes for children with asthma in Delaware, the training given parents of e-newsle tter that addresses a new topic Everywhere allows physicians to identify and access the Nemours KidsHealth is extending and scaling the successful children with complex issues each week, and includes a weekly video and EHR of their patients who have seen other health care intervention and education resource known as and medical devices that must follow-up questions; and a 12 -week texting providers that use the Epic EHR platform . This provides “Asthma Sequenced be cared for at home . In many cases, program with two age-specific educational instant access to the records including medications and Learning Tools.” discharge instructions or a medical device manual texts per week, daily medication reminders, dosages , lab results (to avoid ordering duplicates) and any These learning tools, will not give them the con fidence they need. Friday check-ins for medication adherence, changes in the patients’ care , as noted by the other available in English and links to more content. physician(s). Care Through simulation, Nemours creates a safe and Spanish, and Everywhere is crucial for learning environment where parents and approved by the U.S. Nemours exchanged Nemours patients, many caregivers work on speci fic skills without Department of Health of whom have complex 3 2 7 0 0 0 worrying they are going to make a mistake. and Human Services , conditions and may see The simulation mannequins can blink, speak (HHS) and the electronic medical records with multiple providers. In one and simulate breathing noises ; they can change Centers for Medicare situation, a child with a 1 8 3 IN 4 7 colors and have seizures . The mannequins also & Medicaid Services congenital lung issue was states respond positively or negatively to the treatment (CMS), help children organizations part of a military family — truly providing a life-like experience to help build confidence in managing their asthma through that had been stationed in parents master nuances of care. supportive messaging that promotes ste p-by- step mastery various cities across the U.S. By accessing the child’s without being overwhelming, and motivates with regular records and “connecting the dots,” the Nemours encouragement. physician was able to recognize and institute a more effective course of treatment.

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He loves to ta lk about

Brennan was born with a congen ital his LITTLE EAR condition called microtia which resulted to anyone close enough in the defo rmi ty of his right ear, or his “litt le ear,” as he likes to ca ll it. A fter to LISTE N. failing his hearing test at b irth, Brennan’s parents brought him to the Nemours ENT (Ear, Nose & Throa t) Division and into the care of Robert O’Reilly, MD. Brennan needed three ear tube surgeries as well as a fourth surgery to remove auricular pi ts (a p it -l ike dimpl e) above both his ears.

At age 5, Brennan had reconstructive surgery to reb uil d his ri ght o uter ear. Throughout this journey, he has been working with audiology, most recently getting his new ear mold to fit his reconstructed ear. He says he loves that he “can hear every thing so much louder!”

While he awaits inner ear recons truc tion, he and his family are very involved with raising funds and awareness for hearing loss programs at Nemours, including active involvement with Nemours’ annual “Hear We Go” 5K held on the grounds of the Nemours Estate.

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ENGAGING STUDENTS IN HEALTH CAREERS “Rare Disease Day went so well you’d have A FUTUR E FULL OF In the fall of 2 015, Nemours Children’s Hospital (NCH) never guessed it was the first year of the event. JOYFUL POSSIBILITIES The students had to complete multiple layers hosted 200 high school students from Orange, Seminole, of work — prepping for and conducting Brevard, Osceola and Volusia counties for an interactive As the health care industry accelerates interviews with researchers and families, career exploration day at the hospital. Participating its evolution, discovery and innovation developing a display and honing their students were all part of a health scienc e/medical academy are moving faster than ever before. presentation skills, but it was worth the program and had the opportunity to hear from a variety of New and better ways to diagnose, tremendous opportunity to have exposure to the Nemours health care professionals. Presenters shared what treat, research and improve health are many engaged Nemours Associates, clinicians they do, the educational and career path that led them to and researchers of a first -class pediatric health emerging through pathways that were their current position, and what they love about their role. system, and to gain such confidence from their once only imaginary. This current state Students heard about careers in medicine, respiratory achievements.” is not only inspiring new opportunities therapy, pharmacy, child life, nursing, social work, health for improving health, it is also inspiring a informatics, and more .

new generation of health professionals During lunch, Nemours — Peggy Enslen, RN, EdD, Education Associate - who will find their passion through the Health Sciences, Delaware Department of Associates visited the joy of serving others. Education, HOSA State Advisor students’ tables in a speed networking environment to provide PEDSNET LAUNCHES THE FUTURE OF RESEARCH INSPIRING FUTURE HEALTH PROFESSIONALS A NEW CENTER FOCUSES ON AU TISM, an opportunity for NOW AND FOR THE FUTURE In 2013, we reported how questions about A “rare disease” affects fewer than 200,000 individuals in Nemours was one of just different careers at the U.S., so for families of children with rare diseases the At Nemour s/Alfred I. duPont Hospital for Children, a 4 5 eight children’s health Nemours. It was a great journey may seem lonely. In February 2015, Nemour s/ generous donation from Dan and Susan Katzin and the . opportunity to expose Alfred I. duPont Hospital for Children teamed with the addition of Diane Chugani, PhD, as director of MILLION systems selected to participate young people to the wide variety of professions within the Delaware HOSA-Future Health Professionals for Nemours’ neuroscience research have come together to create the de-identi fied patient in a Patien t- Centered health care field as they prepare to enter college and begin first annual Rare and Chronic Disease Research Event . Katzin Diagnostic and Research Center . The Center records ava ilable Outcomes Research Institute to Nemours to think about their career paths. Leading up to the event, high school students interacted will house the area’s first PE T/MRI imaging system — (PCORI) grant to create a researchers secure electronic network, with Nemours rar e-disease researchers, clinicians and bringing both immediate and long-term bene fits to through PEDSnet patient families. At the event, these students presented Delaware children. dubbed PEDSnet . In 2 015, disease information that heightened awareness; recognized the group successfully “PEDSnet allows Nemours to conduct studies For children currently the first families that deal with rare diseases; raised $5,000 for established the PEDSnet technical infrastructure and that could only be imagined a few years under our care, the # 1 PE T/MRI research; and offered innovative ideas for improving a dataset, giving researchers at Nemours access to 4.5 ago. No one health system could ever new PE T/MRI system imaging system in the gather a sample size this large.” child’s quality of life. million de-identi fied patient records to answer medical generates more Delaware area will bring immediate and questions that have challenged families and providers for information in less time long -term benefits to generations. “The two students who visited with our family are part of a (meaning fewer visits), Delaware children and — Terri H. Finkel, MD, PhD, dental assisting program through Howard High School of requires less sedation aid in leading -edge Nemours has received an $850,000 PCORI grant to chief scientific officer and chair of pediatrics, Technology. They were surprised to learn that going to the and no blood draws. autism research conduct its first clinical research studies using the dentist can be one of the most traumatic appointments for Nemours Children’s Hospital For Dr. Chugani’s launched PEDSnet . One study will explore why children a child with cerebral palsy. They were wonderful with my leadin g-edge autism with asthma, who are also obese, report more severe son Nicholas, and did a great job with their presentation.” research , the imaging system maps physiologic asthma symptoms; the other study will analyze the risk of processes that could result in earlier diagnosis and new, infection in children who take over-the -counter — Senator Nicole Poore (D-District 12, medications used to block stomach acid. New Castle), Nicholas’ mom innovative treatments .

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When V icky was 20 weeks pre gna nt with Isaiah, her doctors discovered so mething was not right. The u ltraso und s howed her bab y’s legs were s igni fican tly bowed, his arms sho rter than norm al, and his rib cage broken. They diagnosed her baby with osteogenesis impe rfecta, also known as brittle bone disease. Three days after his birth, Isaiah was transferred to Nemours and has been in our care ever since.

He required a lot of treatment as a young baby; Isaiah has broken several bones just doing what nor mal babies do, like pushing against his mom or sneezing. Vicky had to learn quickly how to splint him in instances of a “bre ak.”

Isaiah receives tr eatments to stren gthen his bones, along with physical ther apy — and it’s working. His mom used to have to carry him around on a p illow to provide cushioning to his bones, but now she can hold him in her arms.

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ADVANCING DIVERSITY IN THE STUDY OF HEALTH “The skills and confidence I acquired throughout EXTENDING JOY The Nemours Office of Health Equity & Inclusion hosts my Health Disparities Practicum at Nemours, in INTO THE COMMUNI TY students at three education levels, promoting the next addition to being published, have set me apart generation of health professionals. In the Health Equity as a Master’s of Public Health graduate for the Reaching out into the places where our Summer Scholar Program , 10 high school students and four positions I’ve held since. Being involved in every aspect of research, coupled with the communities’ members live, work, learn to six college students study epidemiology , the cause and opportunity to mentor and to be mentored was pattern analysis of population health and disease. The and play is a way for Nemours to share unique and extremely beneficial. While I had an health knowledge, as well as gain Health Disparities Epidemiology Practicum is a six-month, interest in public health as an undergrad, my greater understanding of the needs of intensive program in which two graduate-level public time at Nemours sparked a further passion as it those we serve. Our outreach activities health students undertake advanced research, analysis and gave me a glimpse at what my future could be include education, research, prevention scientific writing that can result in peer-reviewed looking at the bigger picture of a community publication, a rarity at the master’s level. Setting Nemours and its health.” and advocacy on local, regional and apart is that both the program and practicum are designed national levels. We also invite to improve the pipeline of diverse candidates who are communities “in,” where we deliver otherwise underrepresented in health care professions. — Lavisha McClarin, MPH, Research Data Manager, workshops, programs and events to Department of Epidemiology, Bloomberg School enrich both health and joy. of Public Health, Johns Hopkins University COALITION DRIVES PASSAGE OF SAFETY LAW

For children, all terrain vehicle (ATV) accidents don’t A COMMUNITY EXCHANGE HIGHLIGHTS RESEARCH A LAND DONATION FOR ALL TO ENJOY account for the highest number of injuries, but they do ENSURING ACCESS TO EMERGENCY CARE FOR KIDS account for the most severe injuries. Alarmed by the People often think medical research is only done in In 2015, The Nemours Nemours Children’s Hospital hosted the second annual statistics, in 2013 the Nemour s/Alfred I. duPont Hospital laboratories. While Nemours does have world-class labs, Foundation donated 46 ABC’s of Pediatric EMS , a program designed to educate for Children Trauma Program joined forces with our research also takes acres of forestland from EMS professionals on how to assess a pediatric patient in Nemours Health & Prevention Services and Nemours place in hospitals, the Nemours Estate to the the field. EMTs and paramedics from Orlando to Tampa the first Delaware Valley Government Relations to recruit a # 1 clinics, primary care Delaware Department of and Ft. Lauderdale, Fla. attended the one-day program annual offices and broad-based coalition that included health systems, injury Nemours Research Natural Resources and that included topics such as environmental allergies, prevention organizations, state officials and agencies, Exchange enabled neighborhoods, led by Environmental Control’s pediatric sepsis and pediatric shock. A special skills session law enforcement and the ATV industry . Taking a Associates, families and our scientists, doctors, Alapocas Run State Park . took place in the afternoon that included critical thinking nurses, therapists and balanced approach, by 2015 the coalition had successfully community members to The donation completed stations based on the morning lectures followed by case- community partners. advocated for the introduction and passage of legislation learn how to make the last stretch of the Northern Delaware Greenway Trail , based scenarios using pediatric patient simulators. Nemours research more Each year, Nemours requiring helmets a 10-mile hiking and biking path. meaningul and effective hosts “Research and limiting Access to optimal emergency care for children is affected Days,” with events for passengers for by the knowledge and skill level of the responding EMS fellow researchers and community leaders. A new part of recreational ATV personnel; the Florida Emergency Research Days 2015 at Nemour s/Alfred I. duPont “ Alfred I. duPont understood the healing and therapeutic drivers under age Medicine Foundation and the Florida benefits of nature, for both children and their families. Hospital for Children was the first annual Nemours 18. Delaware College of Emergency Physicians, As stewards of Mr. duPont’s legacy, it is fitting that Research Exchange . Open to the community, the day Governor Jack who created the program, recognize these lands be transferred to the State of Delaware featured presentations, question and answer sessions, that children who require emergency and improved for the enjoyment of the community.” Markell signed the and a closing forum . Attendees learned about our legislation into law in July . care have unique needs, especially when research in health disparities, asthma, obesity, cancer, emergencies are serious or life threatening. sickle cell disease, orthopedic conditions and other Nemours continues outreach efforts in the community diseases; in turn they offered their thoughts for making — Roy Proujansky, MD, chief executive of to educate about the new law and provide other tips on Delaware Valley Operations and EV our work more meaningful. P, Nemours safety so families can safely enjoy this popular recreational activity. 24 NEMOURS.ORG REPOR T TO OUR COMMUN ITIES 25 NMRS-16-004_CBR_web_spreads_Layout 1 6/3/16 4:39 PM Page 31

2015 COMMUNI TY BENE FIT

Since opening our doors, Nemours has 2015 TO TAL COMMUNI TY invested more than $ 2.7 billion to enable BENEFI T: $193.8 MILLION a higher standard of care for children’s health. Our investment in children, families, research, prevention and UNCOMPENSATED MEDICAL CA RE $147.7 education is a response to evolving SUBSIDIZED HEA LTH SERVICES $5.0 community health needs as Nemours aims to fulfill its mission to provide RESEARCH $18.4 leadership, institutions and services EDUCATION & TR AINI NG OF to restore and improve the health of HEA LTH P ROFESSIONA LS $4.0 ch ildren with one high standard of quality and distinction regardless of PREVENTION & INFLUENCING the recipient ’s financial status. CHILDREN’S HEALTH $18.7

UNCOMPENSATED MEDICAL CARE : SUBSIDIZED HEALTH SERVICES : RESEARCH : $18.4 MILLION EDUCATION & TRAINING OF HEALTH $147.7 MILLION $5.0 MILLION By increasing the amount of research activity and creating PROFESSIONALS : $4.0 MILLION Uncompensated medical care includes health care In his will, our founder, Alfred I. duPont called for his ever-increasing integration between our clinical and Nemours continues to train the next generation of services without a direct source of payment . In 2 015, estate to also benefit the elderly in Delaware. Nemours research enterprises, Nemours aims to decrease the time pediatric specialists through its affiliations with Sydney total uncompensated medical care provided by Nemours Health Clinic, now known as Nemours SeniorCare , was between discovery and practice . Beyond treatments, we Kimmel Medical College at Thomas Jefferson University, included: established in 1981 and has provided vision, hearing and also seek to investigate and understand processes that Mayo Clinic School of Medicine, Florida State University, dental care services to hundreds of thousands of affect the de livery, safety, outcomes, cost, quality and University of Central Florida College of Medicine and the • $6.7 m illion in services classified as “char ity ca re” where Delaware’s low-income seniors at little to no cost. In 2015, value of pediatric care. Currently, Nemours boasts: University of Florida College of Medicine. In 2015, the recipient could not afford services or lacked adequate these outpatient services at Nemours SeniorCare included: Nemours hosted: health insurance • 382 active research projects and clinical trials • 10,930 dental care visits • 3,242 hearing care visits • 100 + Nemours physicia n-scien tists • 743 residents • 115 physician fellows • $112.0 million in un reimbursed cost , or shortfalls that occur when providers are reimbursed below the cost of providing • 15,728 vision care visits • 25 PhD center directors and l aboratory h eads • 633 medical students services for Medicaid and other public health program • 200 research s uppo rt sta ff The online presence of Nemours Continuing Medical beneficiaries Education continues to grow through • $29.0 million in uncoll ected pa tient care charges , NemoursEducation.org , with more than 81,000 registered unde rwritten by Nemours, where patients were presumed able users . In 2015, PedsUniversity.org launched a new iPad to pay, but from whom Nemours was unable to collect app to improve access to its online offerings, including more than 100 units of study.

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CELEBRATING A DECADE OF BRIGHT STARTS In 2005, Nemours BrightStart! began with a simple, but RECOGNIZING OUR VOLUNTEERS powerful, premise: literacy is the single strongest predictor of adult health status and a major contributor to child health In 2015, nearly 1,400 volunteers pro vided issues . Through an integrated clinical, neuroscience and public more than 108,000 hours of service to more health mindset, it was the ﬁrst organization to identify and than 1 50 departments throughout Nemours. intervene with at-risk preschoolers , implementing a method of Many work direc tly with patients and their instruction that led to an average 114 percent gain in reading families, others choose to work behind the readiness scores . Nemours BrightStart! then developed a scenes supporting staff. Some work with pre-school curriculum and teacher training program to help their hands, while others work with their reach more struggling students. Most recently, to directly reach paws. All of them are vital members of our parents, Nemours BrightStart! launched ReadingBrightStart.org , health care team. We are grateful for the which includes a preschool reading screener and family activities. support and skills they bring to our With opportunities to scale with partners and further digitize their organization and to the children, families assets, Nemours BrightStart! is poised to experience major and communities we serve. new growth and impact for decades to come.

PREVENTION & INFLUENCING • Nemours Health & Prevention Ser vices NEMOUR S/ALFRED I. DUPONT HOSPITAL FOR CHILDREN Since 2004, Nemours Health & Prevention Services (NHPS) CHILDREN’S HEALTH : $18.7 MILLION “The experience of being a volunteer chaplain has implemented and researched hundreds of evidenc e-based 694 volunteers provided 56,437 hours of service to Nemours continues to focus leadership and programs in for families and Associates at NCH since 2012 practices throughout the state of Delaware, wo rked closely with 101 department s/divisions, valued at $1,329,656 the areas of health promotion and disease prevention . has been life-changing in every way. I have hundreds of key strategic pa rtners that have policy and pr actice These efforts positively impact population health within NEMOURS CHILDREN’S HOSPITAL learned so much about myself through serving ch ange in fluence over organizations that serve children, and led our service area as well as millions of children who may others in this capaci ty — to slow down and be strategies to link the prevention and health promotion work of 477 volunteers provided 39 ,737 hours of service to still, to be a better listener, to be mindful ... to never know our name. The following divisions work to NHPS with the clinical services of Nemours, focusing on be more vulnerable. I see my job as being able connect our child health experts to community partners, 45 department s/divisions, valued at $922,800 primary care. to let others unburden themselves of what they policymakers, educators, health providers and families: NEMOURS CHILDREN’S SPECIALTY CARE, are feeling or experiencing, so that they can • Nemours National Of fice of Policy & Preve ntion • Nemou rs BrightStart! JACKSONVILLE reclaim their joy. We need all of our emotions Nemours National Office of Policy & Prevention works alongside Ten years ago, Nemours launched Nemours BrightStart!, the to be complete.” divisions throughout the Nemours enterprise, as well as e xternal 182 volunteers provided 11,354 hours of service to first program of its kind in the nation to develop evidenc e- organizations, to promote Nemours as a trusted resource to 17 department s/divisions, valued at $2 61,9 37 based tools to reach young children at risk of reading failure. influence and inform policies and practices that make a To date, Nemours has reached more than 117,400 children difference for children, with the ultimate goal of spreading what NEMOURS CHILDREN’S CLINIC, PENSACOLA — Sharon Z., volunteer chaplain, across the U.S. through early literacy screening and targeted works nationally and connecting innovation back to Nemours in Nemours Children’s Hospital, Orlando, FL educational activities, including Nemours’ own evidenc e-based 22 volunteers provided 1,102 hours of service our journey to be a value-based health system. (See p. 37) curriculum. With the launch of ReadingBrightStart.org in 2014, valued at $25,423 Nemours BrightStart! has made early literacy tools and • Nemours Center for Child ren ’s Hea lth M edia 7 4 resources available to families everywhere. For 20 years, the Nemours Center for Children ’s Health Media has developed and distributed products that provide doctor- Animal-Assisted approved advice and comfort to children and families across Activities teams volunteer across the U.S. This includes Nemours’ KidsHealth.org — the #1 most - Nemours visited website for children’s health information and a suite of

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CELEBRATING THE JOY OF GIV ING $ 5 5 7,0 0 0 Fundraising continues to play a cr itical role supporting Nemours in building a Toni Jennings and Rick Walsh (pictured at healthier f uture for children. We are left) served as co-chairs of the 20 15 Le Vie grateful for the more than 6,500 en Couleur gala committee, he lping to raise generous donors and partners who $557,000 for the Transport Program at Nemours Children ’s Ho spital in Orlando, Fla. supported us in 2015. Last year, the Thanks to their hard work, critically ill Nemours Fund for Ch ildren’s Health children in a much larger radius will have received gifts totaling more than $ 12 access to expert care when minutes mi llion to support our mission, bringing matter most. the gifts of hea lth and joy to more ch ildren than ever before. Your gift helps us grow! Visit Nemours.or g/give.

FUN FOR CHILDREN OF ALL ABILITIES CORPORATE PARTNERS DRIVE GIFTS TO NEMOURS FUNDED BY PHILANTHROPY

Philanthropic donations allowed Nemours to construct Mercedes-Benz of Wilmington, Del. is a generous partner CAPITAL PROJECTS & EQUIPMENT an All Abilities Playground on the campus of Nemour s/ to Nemours. For every car leased or sold during the month - Purchased a cryoablation unit to destroy childhood tumors WHO CONTRIBUTE S Alfred I. duPont Hospital for Children in Wilmington, of August 2015, the dealership donated $150 to (Orlando, Fla.) CORPORATIONS, FOUNDATIONS & COMMUNITY ORGANIZATIONS Del., adding to the existing playground equipment that was Nemour s/Alfred I. duPont Hospital for Children. In 31 - Acquired a transport Isolette ® to provide intensive care to originally donated by the Auxillary of the Alfred I. duPont days, they raised a total of $18,450 , which was counted infants while on the move (Wilmington, Del .) COMMUNITY MEMBERS Hospital for Children. The new pieces are accessible to toward our total funds raised during the Help Our Kids NEMOURS ASSOCIATES PATIENT CARE & SERVICES children who use wheelchairs or other assistive equipment Radiothon , a partnership with Delmarva Broadcasting . BOARD MEMBERS - Funded the cochlear implant summer camp, which educates and encourage integrated play by children of differing In 2015, we celebrated the ﬁfth year of the radiothon and a and connects children with hearing loss (Jacksonville, Fla .) abilities. In large part, the funds were raised through the record-breaking total of nearly $1 million raised since the - Provided “comfo rt kits” to newly diagnosed oncology patients efforts of Kate and Ed Leong , who did so in memory of inception of this annual event beneﬁting duPont Hospital (Pensacola, Fla.) their son Gavin, who would have enjoyed playing alongside for Children. HOW CONTRIBUTIONS ARE SPENT his brother on the new equipment. BIOMEDICAL & CLINICAL RESEARCH CAPITAL PROJECTS & - Researched leukemia to develop treatments more appropriate EQUIPMENT for children PATIENT CARE & SERVICES $ 5 0 - Learned to identify which children with sickle cell disease are at risk for chronic kidney disease BIOMEDICAL & CLINICAL MILLION RESEARCH 2 2,689 PATIENT AND raised since PATIENT & PROFESSIONAL EDUCATION PROFESSIONAL EDUCATION 2004 when generous donors have made - Conducted obesity prevention workshops targeted toward Nemours Fund for contributions to Nemours young adults (Jacksonville, Fla.) Children’s Health Fund for Children’s Health was established since 2004 - Continued the trauma injury prevention program to educate parents about child safety equipment (Wilmington, Del .)

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ST EWARDS OF HEALTH AND JOY

Thoughtf ul stewardship and s trategic planning have enabled Nemours to grow while continuously de livering exce ll ent care throughout our hea lth system. During 2015, Nemours provided direct care and services for more than 35 0,000 ch ildren as well as outrea ch, educa tion, advocacy and suppo rt for thousands more.

THE N EMOURS FOUND ATION CON DENSED C OMBINED BALANCE SHEETS: DECE MBER 31, 2015, AND 2014 (Doll ars in t ho usan ds) (Unaudited)

In all that we do, increasing access to care and services, improving satisfaction with eve ry experience, ASSETS 2015 2014 and generating the best outcomes for our patie nts and families remains our great est commitments. Current assets $ 385,479 $ 246,490 The remarkable success Nemours has had in outcomes, service and stewardship has been predicated on the ever-increasing integration of people, processes and technology throughout our he alth system. Non-cu rrent assets 1,239,325 1,261,165 Total unres tricted assets 1,624,804 1,507,655 The health care industry continues to undergo significant transformation that is impacting the way we operate. In response, Nemours remains focused on an operational strategy that creates an environment Res tricted assets 215,424 242,122 with sufficient flexibility to rapidly address the external pressures and changes facing our organization. Total assets $ 1,840,228 $ 1,749,777 During 2015, we continued to advance continuous improvement initiatives across the organization to Rodney A. McKen dree, CPA LIA BILITIES AND NET A SSETS Sr. Vice Pre sident and CFO optimize efficiency and productivity, and implemented cost control measures — all of which have had Current liabilities $ 161,437 $ 137,547 a positive impact on our bottom line. Non -current liabili ties 604,835 644,565 In 2015, Nemours experienced continued success in meeting strategic initiatives critical to achieving our organizational Total l iabilities 766,272 782,112 goals. We continue to expand our presence throughout Delaware, Southeast Pennsylvania, and Central Florida to bring Nemours-quality pediatric specialty services, urgent care and primary care to the least acute settings possible. We also Net assets broke ground on a new ambulatory surgery center and specialty clinic in Deptford, New Jersey, slated to open in 2016. Unrest ri cted $ 858,532 $ 725,543 Our Nemours CareConnect is bringing primary and urgent care direct to families and we will continue to explore novel Tempo rar ily re stri ct ed 207,169 236,022 ways to bring our services to those in need. Nemours is poised to navigate the changing environment through further Permanen tly re stri ct ed 8,255 6,100 integration and alignment, ensuring we stay true to our mission and vision so that we provide our patients and families Total net a sse ts 1,073,956 967,665 the exact care they need and want, how and when they need and want it. $ 1,840,228 $ 1,749,777

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2015 GO VER NANCE

Governance for The Nemours Foundat ion THE NEMOURS FOUNDATION BOARD OF DIR ECTOR S is comprised of a group of people whose (pic tu red at left) skills complement the talented profess ional, Brian P. Anderson Richard T. Christopher executive and medical staff employed by Chair Vice C hair Nemours. The Bo ard of Directors and Leonard L. Be rry, PhD* John S. Lord Boards of Managers collectively possess Hugh M. Durden J. Michael McGinnis, MD breadth and depth of expe rt ise in a wide Rosa B. Hakala John F. Porter, III array of discip lines inclu ding finance, Toni Jenni ngs Robert G. Riney marketing, distr ibu tion, opera tions, health Terri L. K el ly Geoffrey M. Rogers care management and more. Through *not pic tu red these lenses, they contr ibute to the con tinued growth of our organiza tion and our focus on improving the lives of ch ildren.

THE N EMOURS FOUND ATION CON DENSED C OMBINED STATEMENTS OF OPERATIONS YEARS ENDED DECE MBER 31, 2015, AND 2014 (Doll ars in t ho usan ds) (Unaudited) 2015 201 4

Net pa tient se rvice reve nue $ 886,571 $ 809,802 Contribu tions from the Alfred I. du Pont Tes tame ntary Trust 157,381 150,223

Other in come 96,204 99,455 Total reve nue and other suppo rt 1,140,156 1,059,480 BOARD OF MANA GE RS, DELAWARE BOARD OF MANA GE RS, FLORID A Total o pera ting expenses 1,093,050 1,011,239 Richard T. Christopher Leonard H. Habas Opera ting income 47,106 48,241 Chair Chair Catherine M. Bonuccelli, MD Hugh M. Brown Andrea Massey-Farrell

Net assets r eleased from res tric tions u sed William Dugdale Catherine Brow n-Bu tler Dora Casanova Toro Hinton J. Lucas, Jr. Matthew Certo Judy Wall, MD for ca pital purc ha ses 1,933 3,269 Gina F. Ward Carol Craig* Richar d J. W alsh Pension li abil ity adjus tment 83,950 (162,250) David A. Dizney Nina M. Waters Increase (de cre ase) in unres tric ted J. M alc olm Jones, Jr.* Ro be rt K. Wilson, Jr., MD net assets $ 132,989 $ (110,740) *not pic tu red

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2015 AW ARDS AND R ECOGNI TION

TOP 25 PERCENT FOR SAFETY IN THE U.S. NEMOURS PHYSICIANS AMONG THE VERY BEST CANCER CENTER RECEIVES ELITE ACCREDITATION IMPROVING THE HEALTH OF CHILDREN NATIONWIDE Nemours Children’s Hospital and Nemour s/Alfred I. A total of 142 Nemours physicians The Nemours Center Nemours continuously aims to impact national policies duPont Hospital for Children rank within the top 25 were named to the “Best Doctors for Cancer and Blood and practices by leveraging our innovations and expertise. percent of all hospitals nationwide for safety as evaluated in America” list for 2015-2016, Disorders at In this way, we can reach millions of children nationwide by the Leapfrog Group, a not-for-profit, independent compiled by Best Doctors, Inc. Nemour s/Alfred I. who will never “walk through our doors.” In 2015, our organization that ranks hospitals for safety. Both through a validated peer review of duPont Hospital for Children has received a full work included: Nemours hospitals have been recognized by Leapfrog physicians, by physicians. Only five percent of doctors in three-year accreditation with commendation from the in their Top Tier safety rankings of all hospitals in the America earn this prestigious honor. American College of Surgeons (ACOS) Commission on • HELPING CHILDREN GROW UP HEALTHY country in the last five years. Cancer . This designation represents the nation’s highest Reaching 200,000 children in 2,200 child care centers in 10 NEMOURS RECOGNIZED FOR PATIENT EXPERIENCE standard of excellence in cancer care. Only about 25 states with healthy eating and physical activity. The Nemours RANKED IN NINE U SN&WR SPEC IA LTIES Press Ganey , a provider of percent of U.S. hospitals have earned the Commission on National Office of Policy & Prevention was also awarded a Nemour s/Alfred I. duPont Hospital patient experience measurement Cancer accreditation and duPont Hospital for Children is planning grant from the Robert Woods Johnson Foundation th for Children placed prominently in and performance analytics for only the 11 children’s cancer program to be accredited. to ensure every child enters kindergarten at a healthy U.S. News & World Report 2015-16 health care organizations, weight through state-level policy and practice change using NEW PROGRAM HONORED FOR INNOVATION edition of “Best Children’s formally recognized Nemours a multi-sectorial approach . Hospitals,” ranking in eight Children’s Hospital with its The Boo Boo Care Team , Further establishing Nemours leadership, the National Office th specialties : Cancer (38 ), Cardiology prestigious “Guardian of Excellence Award,” recognizing comprised of skilled convened the Healthy Kids, Healthy Future Summit , bringing nd th & Heart Surgery (32 ), Gastroenterology (35 ), the hospital’s performance in the 95 th percentile or above paramedics who can treat together more than 170 federal, state, and local experts in th th th Neonatology (39 ), Nephrology (39 ), Orthopedics (5 ), for patient experience. kids with less serious injuries research, practice, and policy to focus on the intersection of Pulmonology (42 nd ) and Urology (27 th ). In Jacksonville, such as cuts, bites and stings in the Nemours Children’s child health and early care and education around obesity our partner Wolfson Children’s Hospital ranked in two ONE OF “100 GREATEST HOSPITALS IN AMERICA” Hospital Emergency Department (ED) , was honored by prevention . specialties : Gastroenterology (47 th ) and Neurology & the Florida Hospital Association with its Innovation in Nemours Children’s Finally, Moving Health Care Upstream , funded by the Kresge Neurosurgery (50 th ). Patient Care award , which recognizes new approaches to Hospital was named to Foundation , tests, spreads, and accelerates population care delivery. The program shortens waiting times for the 2015 list of “100 health innovations in 33 communities , enhancing our A “MO ST WIRED” HEALTH SYSTEM families and saves hundreds of hours in ED physician time. Great Hospitals in America,” published by Becker's national reputation and enabling strategic partnerships. The Nemours Children’s Health System Hospital Review , a monthly publication offering news PARALYMPIC SPORTS CLUB (including both Nemour s/Alfred I. and analysis relating to hospitals and health systems. DESIGNATION • ADVOCATING FOR SUCCESSFUL MODELS OF CARE duPont Hospital for Children and Releasing a policy brief covering our Health Care Innovation The United States Paralympics Nemours Children’s Hospital) was LEADING THE WAY FOR LGBT HEALTHCARE EQUALITY Award from the Center for Medicare & Medicaid Innovation th Committee , a division named to the 17 annual Hospitals and Health Networks For the second year in a row, (CMMI) – “Optimizing Health Outcomes for Children with of the U.S. Olympic Committee, magazine 2015 “Most Wired” list. This is the fifth Nemour s/Alfred I. duPont Asthma in Delaware.” The brief describes Nemours’ model of has designated Nemour s/Alfred consecutive year duPont Hospital for Children made the Hospital for Children has care to improve health for children with asthma and provides I. duPont Hospital for Children as a Paralympic Sports list , while Nemours Children’s Hospital is being been identified as one of a recommendations for Congress and the Administration to Club . With this designation, duPont Hospital for Children recognized for the third time since opening in 2012. With select group of health care advance innovation in pediatric populations . Nemours is joins a community-based club network in 48 states and health data security and patient engagement as top facilities nationwide to be named a Leader in LGBT distributing the brief at CMMI, the Office of Management Washington, D.C., offering competitive opportunities priorities, “Most Wired” acknowledges excellence in the Healthcare Equality by the Human Rights Campaign and Budget (OMB) and on Capitol Hill. for athletes with visual and physical disabilities . The use of information technology in four key areas: (HRC) Foundation , the educational arm of the country’s designation supports Nemours’ commitment to helping infrastructure, business and administrative management, largest lesbian, gay, bisexual and transgender (LGBT) civil children of all ability levels grow up healthy. clinical quality and safety, and clinical integration. rights organization.

36 NEMOURS.ORG REPOR T TO OUR COMMUN ITIES 37 NMRS-16-004_CBR_web_spreads_Layout 1 6/3/16 4:39 PM Page 43

OUR LOCA TIONS

CELE BRATING 75 YE ARS

Nemours celebrated several important milestones in 2015, chief among them the 75 th anniversary of Nemour s/Alfred I. duPont Hospital for Children, the 20 th anniversary of Nemours KidsHea lth and the 10 th anniversary of Nemours BrightStart!. Our integrated children’s health system continues to consistently deliver on our mission and promise to do what is within our power to restore and improve the health of children throughout the communities we serve.

MARY LAND NEW JERSEY PENNSYLVANIA

COLLABORATING SPECIALTY CARE COLLABORATING SPECIALTY CARE COLLABORATING A SYSTEM DESIGNED TO HELP BRING JOY HOSPITALS • Vineland HOSPITALS • Bryn Mawr HOSPITALS • Union Hospital, Elkton • Voorhees • Inspira Medical Center • Collegeville • Bryn Mawr Ho sp ital, TO CHILDREN AND FAMILIES EVER YWHERE Vineland, Vineland • Lancaster Bryn M awr • Inspira Medical Center • Newtown Square • Lankena u Me dical Center, Clinical integration and collaboration across Nemours’ regional ne tworks increasingly enables all of our resources to suppo rt the GEORGIA Woodbury, Woodbury • Philadelphia Wynnewo od • Paoli Hospital, Paoli highest level of patient care at the location of our families’ choosing. Leveraging our childre n’s health media, education and • Upland SPECIALTY CARE • Phoenixville Hospital, prevention resources continues to add value for families, providers and commun ities — even in areas where Nemours does not PRIMARY CARE • Brunswick Phoenixville have a physical presence. • Ph ila de lp hia • Thomas Jefferson Univer sity • Villanova Ho spital, Philadelphia DELAWARE FLORIDA

HOSPITAL PRIMARY CARE COLLABORATING NEMOURS HOME OFFICE SPECIALTY CARE PRIMARY CARE URGENT CARE • Indian River Medical • Ne mour s/Alfred I. d uPont • Bear • Se aford HOSPITALS BRIGHTSTART! • Jacks onvil le • Bonifay • Clermont • Altamonte Springs Center, Vero Beach Ho spital for Children, • Collegeville • Wayne • Beebe Hospital, Lewes • Seaford • Daytona Beach • Horizon West • Dr. Phillips • Lakeland Regional NEMOURS Wilmington • Concordville • Wilmington • Christiana Hospital, Newark NEMOURS HEALTH BRIGHTSTART! • Destin • Kissi mmee • Hunter’s Creek Health, Lakeland • Dover - Foulk Road • Nanticoke Memorial • Fleming Island • Lake Nona • Melbourne • The Children’s Hospital at SPECIALTY CARE & PREVENTION • Jacks onvil le • Exton - Jessup Street Hospital, Seaford • Jacks onvil le • Lo ngwood • Sanford Sacred He art, Pensacola • Bear SERVICES • Orlando • Middletown - Pike Creek • Saint Francis Hospital, • Jacks onvil le South • Ma itland • Waterford Lakes • Wolfson Children’s • Dover • Wilmington • Mi lford - Rockland Road Wilmington HOSPITAL • Lakeland • Ormond Beach Hospital, Jacks onvil le • Mi lford NEMOURS ESTATE COLLABORATING • Newark - St. Francis • Nemours Children’s • Lake Mary • Oviedo • Wuesthoff Regional • Se aford NEMOURS • Wilmington HOSPITALS • Paoli Ho spital, Orlando • Melbourne • Palm Bay Medical Center, Rockledge • Wilmington SENIORCARE • He art of Florida • Milford • Orlando Downtown • Sanford Regional Medical • Wilmington • Pensacola • Vero Beach Center, Haines City • Tallahassee • Waterford Lakes • Windermere • Winter Haven 38 NEMOURS.ORG REPOR T TO OUR COMMUN ITIES 39 NMRS-16-004_CBR_web_spreads_Layout 1 6/3/16 3:47 PM Page 1