This report is an update to a 2009 study done by Georgia Tech to assess the economic and fiscal impact, as well as the economic and fiscal presence, of Children’s Healthcare of Atlanta on the State of Georgia. The economic presence of Children’s refers to the total interaction of Children’s with the Georgia economy. It simply estimates how much economic activity is being supported by the flow of resources through Children’s and how those resources then interact with the economy. It does NOT attempt to discern what resources are new to the economy because of Children’s, nor does it address the issue of how the Georgia economy would be hurt if Children’s did not exist. The economic impact of Children’s represents the difference in the Georgia economy between having and not having Children’s. The focus here is on resources that would likely not exist in the state were it not for Children’s. This includes 1) resources that Children’s brings in from outside the state, and 2) resources that are already in Georgia, but would leave the state if Children’s did not exist.