CHMC SURGICAL FOUNDATION INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
CHMC SURGICAL FOUNDATION INC (EIN 04-2767602)
Tax period
2020-10-01 to 2021-09-30
Filed
2022-08-02
IRS object ID
202202149349300420
Schema version
2020v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-08-02T13:56:15-05:00ReturnTs
Tax Period End2021-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN010494526PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Baker Newman & Noyes LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1280 Fore StreetAddressLine1Txt
CityPortlandCityNm
State AbbreviationMEStateAbbreviationCd
ZIP04101ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN042767602EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CHMC Surgical Foundation IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCHMCBusinessNameControlTxt
Phone6173554022PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 Longwood Avenue No Fegan3AddressLine1Txt
CityBostonCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02115ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSteven J Fishman MDPersonNm
Person TitlePresidentPersonTitleTxt
Phone6173554022PhoneNum
Signature2022-07-20SignatureDt
Discuss With Paid Preparer0DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstStevenPersonFirstNm
Person LastFishman MDPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonNicholas E PortoPreparerPersonNm
PTINP01310283PTIN
Phone8002447444PhoneNum

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSteven J Fishman MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 Longwood AvenueAddressLine1Txt
CityBostonCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02115ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$44,705,381GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1982FormationYr
Legal Domicile StateMALegalDomicileStateCd
Activity Or MissionThe Foundation provides surgical services and educational services to Boston (see Schedule O) Children's Hospital and Harvard Medical School. The Foundation also provides care for patients regardless of their ability to pay, as well as providing and subsidizing hospital and community based services that are either unavailable or limited elsewhere in the community.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent0VotingMembersIndependentCnt
Total Employee29TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$143TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$714,591PYContributionsGrantsAmt
CY Contributions Grants$3,623,459CYContributionsGrantsAmt
PY Program Service Revenue$29,249,164PYProgramServiceRevenueAmt
CY Program Service Revenue$35,545,476CYProgramServiceRevenueAmt
PY Investment Income$880,141PYInvestmentIncomeAmt
CY Investment Income$863,359CYInvestmentIncomeAmt
PY Other Revenue$1,096,463PYOtherRevenueAmt
CY Other Revenue$1,033,335CYOtherRevenueAmt
PY Total Revenue$31,940,359PYTotalRevenueAmt
CY Total Revenue$41,065,629CYTotalRevenueAmt
PY Grants And Similar Paid$37,613PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$318,643CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$24,099,453PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$30,613,464CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$4,109,603PYOtherExpensesAmt
CY Other Expenses$3,230,193CYOtherExpensesAmt
PY Total Expenses$28,246,669PYTotalExpensesAmt
CY Total Expenses$34,162,300CYTotalExpensesAmt
PY Revenues Less Expenses$3,693,690PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$6,903,329CYRevenuesLessExpensesAmt
Total Assets BOY$73,400,034TotalAssetsBOYAmt
Total Assets EOY$91,440,860TotalAssetsEOYAmt
Total Liabilities BOY$29,609,037TotalLiabilitiesBOYAmt
Total Liabilities EOY$25,535,484TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$43,790,997NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$65,905,376NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionThe Foundation provides surgical services primarily to patients at Boston Children's Hospital and at satellite locations. The Foundation carries on and promotes basic and applied medical research and education in the field of surgery by teaching (see Schedule O) students and other medical and scientific personnel. The Foundation also provides care for patients regardless of their ability to pay.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$28,045,035ExpenseAmt
Grant$318,643GrantAmt
Revenue$31,313,858RevenueAmt
DescThe Foundation was organized to operate for the benefit of Boston Children's Hospital and Harvard Medical School, to provide surgical services to patients, and to conduct and promote research and education in the field of pediatric surgery. The Foundation may charge for patient care and other medical services, provided that any net income be used for the charitable, scientific, and educational purposes for which the Foundation was created. The Foundation also provides care for many patients regardless of their ability to pay, as well as providing and subsidizing hospital and community based services that are either unavailable or limited elsewhere in the community.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$630,226ExpenseAmt
Revenue$692,627RevenueAmt
DescThe Foundation receives income from Boston Children's Hospital for providing administration, supervision, and teaching services. The Foundation carries on and promotes basic and applied medical research and education in the field of surgery by teaching students and other medical and scientific personnel; by providing or supplementing income to research personnel through fellowships, research grants, and stipends; and by giving lectures and publishing information concerning problems and research results in the field of pediatric surgery in order to educate the general public and the medical profession.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$2,836,015ExpenseAmt
Revenue$3,538,991RevenueAmt
DescThe Foundation provides clinical services in certain clinics and satellite locations of Boston Children's Hospital (the Hospital) at agreed upon rates for reimbursement.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$31,511,276TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (1)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (1)ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan OutstandingYes (1)LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee29EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member0IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldMAStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Tom Jaksic MDBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6173554022PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 Longwood AvenueAddressLine1Txt
CityBostonCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02115ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtInstitutional TrusteeInstitutionalTrusteeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
Steven J Fishman MD
President55.005.00Yes (X)Yes (X)$1,269,530$0$152,602
Heung Bae Kim MD
Clerk60.000.00Yes (X)Yes (X)$931,934$0$196,534
Terry Buchmiller MD
Director (10/1/20-12/31/20)60.000.00Yes (X)$965,004$0$131,556
Christopher Weldon MD
Director60.000.00Yes (X)$879,193$0$144,847
Biren P Modi MD
Director60.000.00Yes (X)$754,369$0$232,237
Brent Weil MD
Director (1/1/21-9/30/21)60.000.00Yes (X)$718,255$0$209,539
Craig W Lillehei MD
Director60.000.00Yes (X)$659,144$0$97,239
Tom Jaksic MD
Treasurer60.000.00Yes (X)Yes (X)$844,231$0$96,941
Physicians Org at CH Inc
Institutional Trustee2.000.00$0$0$0Yes (X)
Russell Jennings MD
Physician60.000.00$874,080$0$162,418Yes (X)
Belinda Hsi Dickie MD
Physician60.000.00$784,739$0$234,369Yes (X)
Thomas E Hamilton MD
Physician60.000.00$830,189$0$148,090Yes (X)
Catherine Chen MD
Physician60.000.00$761,572$0$152,125Yes (X)
Shawn J Rangel MD
Physician60.000.00$752,294$0$138,179Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$11,024,534TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$2,096,676TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K28IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Brigham and Women's Physician OrganizatiBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 3684AddressLine1Txt
CityBostonCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02241ZIPCd
FieldValueIRS element (for citing)
ServicesPhysician servicesServicesDesc
Compensation$261,149CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Related Organizations$294,712RelatedOrganizationsAmt
Government Grants$1,631,545GovernmentGrantsAmt
All Other Contributions$1,697,202AllOtherContributionsAmt
Total Contributions$3,623,459TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient service revenue621300$31,313,857$31,313,857
Clinical and other revenue621300$3,538,992$3,538,992
Education and research611710$692,627$692,627
FieldValueIRS element (for citing)
Total Program Service Revenue$35,545,476TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$420,445TotalRevenueColumnAmt
Unrelated Business Revenue$143UnrelatedBusinessRevenueAmt
Exclusion$420,302ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$4,082,666SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$3,639,752SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$442,914SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$442,914TotalRevenueColumnAmt
Exclusion$442,914ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescNon-operating pension gainsDesc
Business900099BusinessCd
Total Revenue Column$1,033,335TotalRevenueColumnAmt
Exclusion$1,033,335ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,033,335OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$41,065,629TotalRevenueColumnAmt
Related Or Exempt Func Income$35,545,476RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$143UnrelatedBusinessRevenueAmt
Exclusion$1,896,551ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$318,643TotalAmt
Program Services$318,643ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$6,482,068TotalAmt
Program Services$6,482,068ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$18,193,064TotalAmt
Program Services$16,438,147ProgramServicesAmt
Management And General$1,754,917ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$3,216,737TotalAmt
Program Services$3,216,737ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,131,049TotalAmt
Program Services$1,556,995ProgramServicesAmt
Management And General$574,054ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$590,546TotalAmt
Program Services$537,397ProgramServicesAmt
Management And General$53,149ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$43,097TotalAmt
Management And General$43,097ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$56,824TotalAmt
Management And General$56,824ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$53,040TotalAmt
Management And General$53,040ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$96,743TotalAmt
Program Services$96,743ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$1,598TotalAmt
Management And General$1,598ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$363,069TotalAmt
Program Services$300,892ProgramServicesAmt
Management And General$62,177ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$308,790TotalAmt
Program Services$308,790ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$125TotalAmt
Program Services$125ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$51,776TotalAmt
Program Services$51,776ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$3,900TotalAmt
Program Services$3,900ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$633,660TotalAmt
Program Services$581,492ProgramServicesAmt
Management And General$52,168ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
PO management services$774,532$774,532
Billing and collection$631,777$631,777
Coordinated Specialty P$131,649$131,649
Research expenses$79,613$79,613

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$34,162,300TotalAmt
Program Services$31,511,276ProgramServicesAmt
Management And General$2,651,024ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$9,131,980BOYAmt
EOY$11,894,228EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$358,636BOYAmt
EOY$149,669EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,777,474BOYAmt
EOY$4,030,996EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$211,000BOYAmt
EOY$231,000EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$360,999BOYAmt
EOY$388,666EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$55,397BOYAmt
EOY$87,687EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$48,540LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$37,741LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$14,699BOYAmt
EOY$10,799EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$31,773,220BOYAmt
EOY$39,429,050EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$19,964,347BOYAmt
EOY$25,108,380EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$7,752,282BOYAmt
EOY$10,110,385EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$73,400,034BOYAmt
EOY$91,440,860EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$33,036BOYAmt
EOY$304,239EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$2,801,095BOYAmt
EOY$2,179,738EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$26,774,906BOYAmt
EOY$23,051,507EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$29,609,037BOYAmt
EOY$25,535,484EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$39,316,721BOYAmt
EOY$59,655,232EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$4,474,276BOYAmt
EOY$6,250,144EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$43,790,997BOYAmt
EOY$65,905,376EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$73,400,034BOYAmt
EOY$91,440,860EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$6,903,329ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$8,353,451NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$6,857,599OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$128,125CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$75,977CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,347,679CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$714,591CurrentTaxYearMinus1YearAmt
Current Tax Year$3,623,459CurrentTaxYearAmt
Total$7,889,831TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$29,156,776CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$30,747,466CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$30,861,882CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$29,249,164CurrentTaxYearMinus1YearAmt
Current Tax Year$35,545,476CurrentTaxYearAmt
Total$155,560,764TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$29,284,901CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$30,823,443CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$34,209,561CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$29,963,755CurrentTaxYearMinus1YearAmt
Current Tax Year$39,168,935CurrentTaxYearAmt
Total$163,450,595TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$163,450,595PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$394,620CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$432,320CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$470,035CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$478,371CurrentTaxYearMinus1YearAmt
Current Tax Year$420,302CurrentTaxYearAmt
Total$2,195,648TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$394,620CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$432,320CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$470,035CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$478,371CurrentTaxYearMinus1YearAmt
Current Tax Year$420,302CurrentTaxYearAmt
Total$2,195,648TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,060CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years-$1,990CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years-$6,156CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year-$10,935CurrentTaxYearMinus1YearAmt
Current Tax Year$143CurrentTaxYearAmt
Total-$15,878TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$322,077CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus1 Year$1,096,463CurrentTaxYearMinus1YearAmt
Current Tax Year$1,033,335CurrentTaxYearAmt
Total$2,451,875TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$29,682,581CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$31,575,850CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$34,673,440CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$31,527,654CurrentTaxYearMinus1YearAmt
Current Tax Year$40,622,715CurrentTaxYearAmt
Total$168,082,240TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.97240PublicSupportCY509Pct
Public Support PY5090.97540PublicSupportPY509Pct
Investment Income CY0.01310InvestmentIncomeCYPct
Investment Income PY0.01380InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule A, Part III, Line 12, Explanation of Other Income:FormAndLineReferenceDesc
ExplanationInsurance rebate - 2017 Amount: $ 322,077. 2019 Amount: $ 284,139. Non-operating pension gains - 2019 Amount: $ 812,324. 2020 Amount: $ 1,033,335.ExplanationTxt

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,474,276BeginningYearBalanceAmt
Contributions$3,552,652ContributionsAmt
Other Expenditures$1,776,784OtherExpendituresAmt
End Year Balance$6,250,144EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,462,943BeginningYearBalanceAmt
Contributions$681,949ContributionsAmt
Other Expenditures$670,617OtherExpendituresAmt
End Year Balance$4,474,276EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,883,909BeginningYearBalanceAmt
Contributions$3,167,000ContributionsAmt
Other Expenditures$587,966OtherExpendituresAmt
End Year Balance$4,462,943EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,883,962BeginningYearBalanceAmt
Other Expenditures$53OtherExpendituresAmt
End Year Balance$1,883,909EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,051,785BeginningYearBalanceAmt
Other Expenditures$1,167,823OtherExpendituresAmt
End Year Balance$1,883,962EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.00000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY1.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$48,540OtherCostOrOtherBasisAmt
Depreciation$37,741DepreciationAmt
Book Value$10,799BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$10,799TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescInterest in the P.O. Pooled Investment FundDesc
Book Value$25,108,380BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$25,108,380TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (14 entries)

DescDescBook ValueBookValueAmt
Due from Boston Children's Hospital$420,378
Due from Physicians Org. at CH, Inc.$919,339
Due from Dana Farber Cancer Institute$36,736
Due from Harvard Medical School$330,731
Due from Boston Medical Center$381,218
Due from New England Organ Bank$33,250
Due from Children's Hospital Pediatric Associates, Inc.$37,500
Malpractice Claims receivable$3,025,215
Due from BCH - Egan Family Charitable Fund$600,000
Due from Brigham & Women's$174,297
Due from Children's Orthopedic Surgery Foundation, Inc.$203
Due from Children's Urological Foundation, Inc.$772
Due from CHMC Anesthesia Foundation, Inc.$917
Prepaid defined benefit pension plan$4,149,829
FieldValueIRS element (for citing)
Total Book Value Other Assets$10,110,385TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (14 entries)

DescDescAmtAmt
Due to Boston Children's Hospital$2,754,444
Due to Physicians Org. at CH, Inc$182,682
Due to Boston Medical Center$12,833
Accrued salaries and benefits$5,278,972
Accrued deferred compensation$10,619,058
Accrued professional liability$4,062,574
Due to Brigham & Women's$33,934
Due to CHMC Otolaryngologic Foundation, Inc.$8,447
Due to Boston Children's Hospital - Vascular Biology$100,000
Due to Boston Pediatric Neurosurgical Foundation, Inc.$18
Due to Children's Orthopedic Surgery Foundation, Inc.$2,214
Due to Children's Hospital Pathology Foundation, Inc.-$3,299
Due to Children's Urological Foundation, Inc.$934
Due to Beth Israel-$1,304
FieldValueIRS element (for citing)
Total Liability$23,051,507TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$56,276,679TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$8,353,451NetUnrealizedGainsInvstAmt
Other Revenue$6,857,599OtherRevenueAmt
Revenue Not Reported$15,211,050RevenueNotReportedAmt
Revenue Subtotal$41,065,629RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$41,065,629TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$34,162,300TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$34,162,300ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$34,162,300TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part V, Line 4:The endowment funds represent assets held in trust that are available to pay for future benefits to participants for a deferred compensation benefit plan and investments whose use have been restricted by donors to a specific time period and purpose.
Part X, Line 2:The Foundation is a tax-exempt corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code), and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. In addition, the Foundation qualifies for the charitable contribution deduction under Section 170(b)(1)(A), and has been classified as an organization that is not a private foundation under Section 509(a)(2). Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items, including unrelated business income or tax status. Management of the Foundation has evaluated the positions taken on the Foundation's filed tax returns and has concluded that no uncertain income tax positions exist at September 30, 2021.
Part XI, Line 2d - Other Adjustments:Pension adjustment 6,857,599.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Boston Children's HospitalBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 Longwood AvenueAddressLine1Txt
CityBostonCityNm
State AbbreviationMAStateAbbreviationCd
ZIP02115ZIPCd
FieldValueIRS element (for citing)
Recipient EIN042774441RecipientEIN
IRC Section501(c)(3)IRCSectionDesc
Cash Grant$318,643CashGrantAmt
Valuation Method UsedN/AValuationMethodUsedDesc
Non Cash AssistanceN/ANonCashAssistanceDesc
Purpose Of GrantGeneral SupportPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 2:FormAndLineReferenceDesc
ExplanationMonitoring is provided by CHMC Surgical Foundation, Inc. (the Foundation) through oversight of the terms and conditions of a written grant agreement. Multiyear agreements require yearly progress and financial reports for continuation of funding. During the year ended September 30, 2021, the Foundation only provided grant donations to other 501(c)(3) organizations.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PmtsYes (X)IdemnificationGrossUpPmtsInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsYes (1)AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Steven J Fishman MD
President$1,008,242$0$204,737$0$56,551$0$113,460$0$39,142$0$1,422,132$0$0$0
Heung Bae Kim MD
Clerk$638,336$0$246,479$0$47,119$0$150,204$0$46,330$0$1,128,468$0$0$0
Terry Buchmiller MD
Director (10/1/20-12/31/20)$619,652$0$300,570$0$44,782$0$111,684$0$19,872$0$1,096,560$0$0$0
Russell Jennings MD
Physician$635,868$0$180,531$0$57,681$0$121,236$0$41,182$0$1,036,498$0$0$0
Christopher Weldon MD
Director$504,020$0$328,193$0$46,980$0$100,714$0$44,133$0$1,024,040$0$0$0
Belinda Hsi Dickie MD
Physician$410,984$0$308,785$0$64,970$0$179,876$0$54,493$0$1,019,108$0$0$0
Biren P Modi MD
Director$419,124$0$294,222$0$41,023$0$178,363$0$53,874$0$986,606$0$0$0
Thomas E Hamilton MD
Physician$476,776$0$303,060$0$50,353$0$108,295$0$39,795$0$978,279$0$0$0
Tom Jaksic MD
Treasurer$702,108$0$85,555$0$56,568$0$57,000$0$39,941$0$941,172$0$0$0
Brent Weil MD
Director (1/1/21-9/30/21)$377,188$0$291,320$0$49,747$0$170,548$0$38,991$0$927,794$0$0$0
Catherine Chen MD
Physician$446,124$0$265,205$0$50,243$0$109,963$0$42,162$0$913,697$0$0$0
Shawn J Rangel MD
Physician$442,744$0$264,091$0$45,459$0$99,339$0$38,840$0$890,473$0$0$0
Craig W Lillehei MD
Director$551,336$0$67,279$0$40,529$0$57,000$0$40,239$0$756,383$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 1aThe Foundation provides gross-up payments for mortgage forgiveness, long-term disability insurance, and life insurance. These payments are included as taxable wages during the year. All permanent full-time employees of the Foundation are eligible for the gross-up payments.
Part I, Line 4bCHMC Surgical Foundation, Inc. (the Foundation) established a Defined Benefit Pension Plan, effective October 1, 2006, to provide its employees with fair and adequate retirement benefits. The plan calls for benefits to be paid to eligible employees at retirement based upon years of service with the Foundation and compensation rates near retirement. Contributions to the plan reflect benefits attributed to employees' services to date, as well as services expected to be earned in the future. During the year ended September 30, 2021, the Foundation made the following contributions to the plan: Steven J. Fishman, MD, $56,460; Heung Bae Kim, MD, $93,204; Russell Jennings, MD, $64,236; Terry L. Buchmiller, MD, $54,684; Biren P. Modi, MD, $121,363; Christopher Weldon, MD, $43,714; Thomas E. Hamilton, MD, $51,295; Belinda Hsi Dickie, MD, $122,876; Brent Weil, MD $113,548, Catherine Chen, MD $52,963, and Shawn J. Rangel, MD, $42,339.
Part I, Line 7Bonus compensation amounts are determined by the Chief of CHMC Surgical Foundation, Inc. (the Foundation). The amounts are discretionary based on job performance and the financial performance of the Foundation.

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp (2 entries)

Relationship With OrgRelationshipWithOrgTxtLoan PurposeLoanPurposeTxtLoan From OrganizationLoanFromOrganizationIndOriginal PrincipalOriginalPrincipalAmtBalance DueBalanceDueAmtDefaultDefaultIndBoard Or Committee ApprovalBoardOrCommitteeApprovalIndWritten AgreementWrittenAgreementInd
Belinda Hsi Dickie MD
PhysicianHousing loanYes (X)$300,000$191,0000Yes (1)Yes (1)
Brent Weil MD
PhysicianHousing loanYes (X)$100,000$40,0000Yes (1)Yes (1)
FieldValueIRS element (for citing)
Total Balance Due$231,000TotalBalanceDueAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule L, Part II, Loans to and from Interested Persons:FormAndLineReferenceDesc
ExplanationCHMC Surgical Foundation, Inc. (the Foundation) has provided several secured and unsecured loans to employees. The loans were made for recruitment and retention purposes, to assist physician employees in the purchase of their primary residence. The amounts for the recruitment loans were determined by restricted donations provided by Boston Children's Hospital for use in recruitment. The loans will be forgiven over the terms of the notes if the recipients remain employed at the Foundation or its affiliates. The amount of the loan forgiveness will be included with accrued interest, if applicable, as compensation in the year forgiven. The balance of the loans outstanding are $619,666 at September 30, 2021. Future principal amounts due are as follows $207,889 in 2022; $123,604 in 2023; $90,271 in 2024; $51,381 in 2025; and $146,521 in 2026. Loan amounts to individuals reported in Part VII have been disclosed in Schedule L, Part II, the balance of the notes receivable are with individuals who are not required to be disclosed in Schedule L per the IRS instructions.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 1The majority of CHMC Surgical Foundation, Inc.'s (the Foundation's) board members are physicians who are not independent from the Foundation. However, the Foundation is part of an integrated delivery system with Boston Children's Hospital (the Hospital) which does have a community board. The Foundation was organized in 1982. At that time, the board was composed entirely of physicians, a board structure that was approved by the Internal Revenue Service. The Foundation has since adjusted the board structure to make it more responsive to the hospital by adding the Physicians Organization at Children's Hospital, Inc. (the PO) as a member. See Schedule O, Part VI, Questions 3, 6, 7b, and 12 for more details of the PO's rights.
Form 990, Part VI, Section A, line 3The Physicians Organization at Children's Hospital, Inc. (the PO) is a Class "C" member of CHMC Surgical Foundation, Inc. (the Foundation). The PO is responsible for providing management services to the Foundation. The PO has the power to approve the independent auditor and legal counsel of the Foundation from a list of firms mutually agreed to by the PO and the Foundation. The PO also has the right to review, but not to approve, the annual budgets and by-law changes of the Foundation. Lastly, Boston Children's Hospital has the right to review for compliance with applicable law, the general terms of and any modification to physician compensation and benefit plans for all physician employees of the Foundation.
Form 990, Part VI, Section A, line 6CHMC Surgical Foundation, Inc. (the Foundation) has three classes of members. The Chief of the Department of Surgery (the Department) of Boston Children's Hospital (the Hospital) is a Class "A" member. Each person who is a member of the Foundation, other than the Chief of the Foundation, who holds a medical staff appointment under the auspices of the Chief Surgeon from Harvard University Medical School, and who is a full time employee at the Hospital, shall be a Class "B" member. In addition, upon the recommendation of the Chief Surgeon and with the approval of the President of the Hospital or his designee, exceptions may be made to permit other physicians who are members of the Department to be Class "B" members. The Physicians Organization at Children's Hospital, Inc. is a Class "C" member of the Foundation.
Form 990, Part VI, Section A, line 7aAccording to the Articles of Organization, the Chief of the Department of Surgery (the Department) of Boston Children's Hospital is the Class "A" member of CHMC Surgical Foundation, Inc. (the Foundation). Each person who is a member of the Foundation, other than the Chief of the Department, is a Class "B" member of the Foundation. The Class "A and "B" members of the Foundation elect the Board of Directors from nominees presented by the Executive Committee at their annual meeting. Each member is entitled to one vote upon any question at any meeting of the members.
Form 990, Part VI, Section A, line 7bThe Physicians Organization at Children's Hospital, Inc. (the PO) is a Class "C" member of CHMC Surgical Foundation, Inc. (the Foundation). The PO is responsible for providing management services to the Foundation. The PO has the power to approve the independent auditor and legal counsel of the Foundation from a list of firms mutually agreed to by the PO and the Foundation. The PO also has the right to review, but not to approve, the annual budgets and by-law changes of the Foundation. Lastly, Boston Children's Hospital has the right to review for compliance with applicable laws, the general terms of and any modification to physician compensation and benefit plans for all physician employees of the Foundation. As a Class "C" member of the Foundation, the PO attends the Foundation's annual meeting.
Form 990, Part VI, Section B, line 11bThe detailed review will be conducted by the President of the Foundation, Steven J. Fishman, MD, and the administrator, Todd Katzman. A copy of the Form 990 will be provided to the board prior to filing. The detailed review will be conducted before filing the return with the Internal Revenue Service.
Form 990, Part VI, Section B, line 12cThe Physicians Organization at Children's Hospital, Inc. (the PO) and Boston Children's Hospital (the Hospital) administer an annual conflict of interest disclosure process to all of their member Foundations, which asks physicians (officers, top management, and highly compensated employees) and selected Foundation staff to disclose potential conflicts. A disclosure statement will be circulated annually to members of the PO. The audit committee shall determine those individuals (including medical staff members) who shall be required to complete the disclosure statement. The audit committee, at its discretion, may either: 1) refer any or all disclosure statements to the Board of Directors; 2) appoint an ad hoc committee to review and resolve any conflict of interest issues; or 3) review and resolve any conflict of interest issues personally or through a designee(s). Any person not receiving a disclosure statement nevertheless has an affirmative obligation to disclose to the PO President, PO General Counsel, or his/her supervisor whenever he/she believes he/she has or may have a conflict of interest. Similarly, each person completing a disclosure statement has an affirmative obligation to update the statement any time circumstances change and/or he/she believes that a conflict of interest may exist. In the event a conflict of interest is found to exist, the Foundation prohibits the member from voting on any matter to which the conflict relates or otherwise influencing the voting on such matter.
Form 990, Part VI, Section B, line 15Faculty compensation must comply with the Boston Children's Hospital (the Hospital) Physician Compensation Guidelines. These guidelines are developed in consultation with an independent external compensation consulting firm and are approved by the independent Compensation Committee of the Board of Children's Medical Center Corporation and the Hospital. The guidelines set the maximum compensation limits based on a peer group analysis for the Foundation. The maximum compensation limits are based on pediatric specialty, sub-specialty, academic rank and include productivity adjustments. Any proposed compensation that exceeds the limits must be prospectively approved by the independent compensation committee of the Board of the Hospital. Annual compensation for individual faculty members is set by the President of the CHMC Surgical Foundation, Inc. (the Foundation), reviewed and approved by the Foundation in accordance with the Foundation's compensation policies and procedures. The Foundation's President's compensation is reviewed and approved annually on a prospective basis by the Boston Children's Hospital President/Chief Executive Officer.
Form 990, Part VI, Section C, line 19The Foundation maintains all financial records, conflict of interest policies, and governing documents at its main office at 300 Longwood Avenue, Boston, MA 02115. The documents are available upon request.
Form 990, Part XI, line 9:Pension adjustment 6,857,599.
Form 990, Part XII, Line 2c:The audit process and scope has not changed from the prior year.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
Boston Children's Hospital
300 Longwood AvenueBostonMA02115042774441HospitalMA501(c)(3)Line 3N/A0
Physicians Organization at Children's Hospital Inc
300 Longwood AvenueBostonMA02115043266103Management servicesMA501(c)(3)Line 12c, III-FIN/A0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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