2022-08-11T07:25:28-05:00 2021-09-30 010494526 Baker Newman & Noyes LLC 280 Fore Street Portland ME 04101 990 2020-10-01 042864081 Children's Hospital Ophthalmology Foundation Inc CHIL 6173553365 300 Longwood Avenue Fegan 4 Boston MA 02115 David G Hunter MD PhD President 6173553365 2022-08-09 0 David Hunter MD PhD 999009999 Nicholas E Porto P01310283 8002447444 2022-08-09 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z David G Hunter MD PhD 300 Longwood Avenue Fegan 4 Boston MA 02115 30106998 0 X N/A X 2003 MA The Foundation provides ophthalmology services primarily to patients at (see Schedule O) Boston Children's Hospital and at satellite locations. 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 limited in the community. 15 0 22 0 18941 15501 1434091 3329164 21557912 25885231 1241666 522749 91231 94033 24324900 29831177 0 874424 0 0 19700219 21010669 0 0 0 4018379 4045629 23718598 25930722 606302 3900455 61876642 74480259 21410021 22032045 40466621 52448214 X The Foundation's mission is to provide ophthalmology 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 (see Schedule O) ophthalmology. The Foundation also provides care for patients regardless of their ability to pay. 0 0 22803345 874424 25793152 The Foundation provides ophthalmology services primarily to patients at Boston Children's Hospital and at satellite locations. The Foundation may charge for patient care, other medical services, and related products, provided that any net income is used exclusively for the charitable, scientific, and educational purposes for which the Foundation was created. 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. 230337 167300 The 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 ophthalmology by teaching students and other medical and scientific personnel; by providing fellowships, research grants, and stipends; and by giving lectures and publishing information concerning problems and research results in the field of pediatric ophthalmology in order to educate the general public and the medical profession. 23033682 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 1 0 0 1 0 0 1 22 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 15 0 0 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 MA X Rebecca Anderson Controller 6173558112 300 Longwood Avenue Boston MA 02115 David G Hunter MD PhD President 55.00 5.00 X X 1057160 0 118189 Linda R Dagi MD Clerk 60.00 0.00 X X 720275 0 107624 Deborah K VanderVeen MD Treasurer 60.00 0.00 X X 584922 0 115859 Iason Mantagos MD PhD Trustee 60.00 0.00 X 583102 0 114244 Gena Heidary MD PhD Trustee 60.00 0.00 X 581833 0 83845 Carolyn S Wu MD Trustee 60.00 0.00 X 559514 0 117089 Melanie Kazlas MD Trustee 60.00 0.00 X 552373 0 95459 Ankoor S Shah MD PhD Trustee 60.00 0.00 X 529990 0 111300 Lois EH Smith-Porter MD PhD Trustee 60.00 0.00 X 408509 0 104718 Jose Efren Gonzalez-Monroy MD Trustee 60.00 0.00 X 376974 0 110117 Anne B Fulton MD Trustee 60.00 0.00 X 373636 0 86403 Alexandra T Elliott MD Trustee 48.00 0.00 X 311875 0 113217 Bharti Gangwani MD Trustee 39.00 0.00 X 289989 0 108274 Mary Whitman MD PhD Trustee 60.00 0.00 X 282354 0 113960 Suzanne Johnston MD MPH Trustee 22.00 0.00 X 188130 0 92829 Physicians Org at CH Inc Institutional Trustee 2.00 0.00 X 0 0 0 Gordon Massey COO 55.00 5.00 X 0 329767 1580 Maan Alkharashi MD Physician 60.00 0.00 X 387560 0 101804 Joseph F Griffith MD Physician 60.00 0.00 X 325580 0 65977 Eric D Gaier MD PhD Physician 60.00 0.00 X 301035 0 68384 Benjamin G Jastrzembski MD Physician 60.00 0.00 X 282472 0 67800 Carolyn Graeber MD Physician 60.00 0.00 X 240496 0 104248 8937779 329767 2002920 20 0 1 0 MA Eye and Ear Associates 300 Crown Colony Drive Suite 201 Quincy MA 02169 Healthcare services 241854 1 976498 2352666 3329164 Patient service revenue 621300 23916261 23916261 Clinical and other revenue 621990 1801670 1801670 Education and research 611710 167300 167300 25885231 512638 129 512509 10111 0 10111 10111 10111 369854 275821 94033 75221 18812 29831177 25960452 18941 522620 874424 874424 7582423 7226656 355767 10924641 8930431 1994210 329585 323840 5745 1905118 1623585 281533 268902 267882 1020 26447 26447 6750 6750 251933 171112 80821 8764 8764 562988 481865 81123 1143509 1143509 13314 4224 9090 39894 39894 80488 80488 154156 108386 45770 PO Management Services 609169 609169 Billing Expenses 551743 551743 Coordinated Specialty P 287776 287776 Research Expenses 195363 195363 113335 113335 25930722 23033682 2897040 0 6384392 6430427 9289653 6865732 1898322 2400128 20000 0 95000 176000 47605 101871 1465514 511177 460139 954337 26035344 36260303 12970538 16243528 75794 105270 4599855 4942663 61876642 74480259 4398874 4563297 9729319 7460431 100321 18037 7181507 9990280 21410021 22032045 X 40366621 52348214 100000 100000 40466621 52448214 61876642 74480259 3900455 8081138 0 X X 0 1 X 1 0 X 938536 872692 777564 1434091 3329164 7352047 20651131 22122638 24319686 21557912 25960452 114611819 21589667 22995330 25097250 22992003 29289616 121963866 0 0 0 121963866 442969 529091 654863 583096 512509 2722528 11582 6252 6707 -1980 18941 41502 454551 535343 661570 581116 531450 2764030 60867 52450 113317 22044218 23591540 25758820 23625569 29821066 124841213 0.97700 0.97700 0.02210 0.02170 X Schedule A, Part III, Line 12, Explanation of Other Income: Insurance Rebate - 2017 Amount: $ 60,867. 2019 Amount: $ 52,450. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 100000 2352666 2352666 100000 100000 441897 441897 100000 100000 100000 100193 193 100000 100193 100193 0.00000 0.00000 1.00000 0 0 752885 110639 642246 174891 58207 116684 403908 232980 170928 133830 109351 24479 954337 PO Pooled Investment Fund, LLC 16243528 F 16243528 Due from Boston Children's Hospital 315206 Due from Physicians Organization at Children's Hospital, Inc. 622516 Due from MEEI 52228 Investment in LLC 138085 Other receivables 2749009 Right of use asset 1065619 4942663 Due to Boston Children's Hospital 3455451 Due to Physicians Organization at Children's Hospital, Inc. 309438 Deferred compensation 457(b) 4738543 Accrued professional liability 218716 Lease Liability 1081634 FICA Tax Liability 48412 Due to affiliates 138086 9990280 X 38299188 8081138 386873 8468011 29831177 0 29831177 26317595 386873 386873 25930722 0 25930722 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 has been restricted by donors to a specific time period or 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). The Foundation is subject to unrelated business tax on its distributive share of profits from Foundation Optical, LLC and Management Services Organization. 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: Sales of eyewear, net of cost 480,906. Less gain from subsidiary -94,033. Part XII, Line 2d - Other Adjustments: Eyewear sales expenses 309,939. Minority interest 76,934. 1 Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 501(c)(3) 864415 0 N/A N/A Research and general support Massachusetts Eye and Ear Associates 243 Charles Street Boston MA 02114 222658209 501(c)(3) 10000 0 N/A N/A General support 2 0 Part I, Line 2: Monitoring is provided by Children's Hospital Ophthalmology Foundation, Inc. (the Foundation) through oversight of their terms and conditions of a written grant agreement. Multiyear agreements require yearly progress and financial reports for continuation of the funding. During the year ended September 30, 2021, the Foundation only provided grant donations to other 501(c)(3) organizations. X X 0 1 X X X X X 0 1 0 0 0 0 0 1 0 David G Hunter MD PhD President 938110 0 93750 0 25300 0 76750 0 41439 0 1175349 0 0 0 Linda R Dagi MD Clerk 327683 0 352076 0 40516 0 76750 0 30874 0 827899 0 0 0 Deborah K VanderVeen MD Treasurer 327562 0 219466 0 37894 0 76750 0 39109 0 700781 0 0 0 Iason Mantagos MD PhD Trustee 263122 0 293514 0 26466 0 76750 0 37494 0 697346 0 0 0 Carolyn S Wu MD Trustee 258529 0 260288 0 40697 0 76750 0 40339 0 676603 0 0 0 Gena Heidary MD PhD Trustee 265623 0 267474 0 48736 0 76750 0 7095 0 665678 0 0 0 Melanie Kazlas MD Trustee 268217 0 248549 0 35607 0 76750 0 18709 0 647832 0 0 0 Ankoor S Shah MD PhD Trustee 254359 0 250610 0 25021 0 76750 0 34550 0 641290 0 0 0 Lois EH Smith-Porter MD PhD Trustee 281276 0 94107 0 33126 0 76750 0 27968 0 513227 0 0 0 Maan Alkharashi MD Physician 170545 0 213328 0 3687 0 62250 0 39554 0 489364 0 0 0 Jose Efren Gonzalez-Monroy MD Trustee 311065 0 37733 0 28176 0 76750 0 33367 0 487091 0 0 0 Anne B Fulton MD Trustee 266636 0 73529 0 33471 0 76750 0 9653 0 460039 0 0 0 Alexandra T Elliott MD Trustee 203527 0 73565 0 34783 0 75250 0 37967 0 425092 0 0 0 Bharti Gangwani MD Trustee 93330 0 164473 0 32186 0 76750 0 31524 0 398263 0 0 0 Mary Whitman MD PhD Trustee 160908 0 90357 0 31089 0 76250 0 37710 0 396314 0 0 0 Joseph F Griffith MD Physician 172934 0 128991 0 23655 0 34000 0 31977 0 391557 0 0 0 Eric D Gaier MD PhD Physician 161312 0 95729 0 43994 0 33250 0 35134 0 369419 0 0 0 Benjamin G Jastrzembski MD Physician 147180 0 112284 0 23008 0 33500 0 34300 0 350272 0 0 0 Carolyn Graeber MD Physician 210513 0 1500 0 28483 0 70250 0 33998 0 344744 0 0 0 Gordon Massey COO 0 303767 0 0 0 26000 0 0 0 1580 0 331347 0 0 Suzanne Johnston MD MPH Trustee 75373 0 88566 0 24191 0 58250 0 34579 0 280959 0 0 0 Part I, Line 1b For those eligible employees, Children's Hospital Ophthalmology Foundation, Inc. (the Foundation) offers gross-up payments for certain benefits that need to be included as taxable income to the employees. Although a written policy does not exist, these payments are communicated to the employees during the initial employment process by the President and Executive Director. All Boston Children's Hospital employees are eligible (those receiving W-2's). The Foundation hosts an alumni retreat biennially, in which it reimburses travel costs for employees and their respective guests. Reimbursements are included as taxable income on the employees' W-2. Part I, Line 4b Effective December 15, 2015, the Foundation established a 457(f) plan to provide benefits to certain eligible employees whose ability to make elective deferrals under Code Section 403(b) is eliminated or impaired as determined by the Administrator. Non-elective contributions are made by the employer for the participant. Investments are held in trust. During the year ended September 30, 2021, there were no contributions made to the plan. Part I, Line 7 The total bonus pool for each fiscal year is built into the yearly budgets and approved by the Board of Directors. This approved bonus pool is distributed to both the leased staff and the physicians. All bonuses are discretionary. The bonus is not a division of earnings of Children's Hospital Ophthalmology Foundation, Inc. (the Foundation). The Ophthalmologist-in-Chief determines a bonus pool based on available funds and then allocates the bonus pool based on the contributions of each professional employee taking into account a variety of factors, including clinical and research contributions, academic performance, and quality services. The Foundation ensures that the total compensation does not exceed the fair market value (FMV) and Reasonableness Maximum compensation upper limits as defined in the Guidelines for Employed Physician and Affiliated Physician Foundation Compensation and Oversight Requirements as set by Boston Children's Hospital. Children's Ophthalmology PC Dr. Hunter is the 100% owner of COPC 514875 Investment 0 Schedule L, Part IV: In December 2016, the Foundation Board approved an investment in a new Management Services Organization (MSO), Children's Ophthalmology Management Services, LLC, which is intended to provide a full level of non-clinical services support in New York. The Foundation is the sole owner of the MSO. The entity will provide services to Children's Ophthalmology, PC (COPC) whose owner is the Foundation President. COPC will be located in the region of New York where Boston Children's Health Physicians has its 60+ locations and approximately 300 pediatric primary care and specialty physicians. COPC began providing ophthalmology services to patients during the Foundation's fiscal year 2018. Form 990, Part VI, Section A, line 1 A majority of Children's Hospital Ophthalmology Foundation, Inc.'s (the Foundation's) board members are physicians who are not independent from the Foundation because they are compensated by the Foundation. However, the Foundation participates in an integrated delivery system with Boston Children's Hospital (the Hospital) which does have a community board. The Foundation was organized in 2003. 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 on the PO's rights. Form 990, Part VI, Section A, line 3 The Physicians Organization at Children's Hospital, Inc. (the PO) is a Class "C" member of Children's Hospital Ophthalmology Foundation, Inc. (the Foundation). The PO is responsible for providing certain 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 approve, the annual operating budget. The PO Board has the right to approve 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 modifications to the physician compensation and benefit plans for all physician employees of the Foundation. Form 990, Part VI, Section A, line 6 Children's Hospital Ophthalmology Foundation, Inc. (the Foundation) has 4 classes of members. The Ophthalmologist-in-Chief shall be the sole Class "A" member. Any other member of the Foundation who has, for at least three years, been a physician-employee of the Foundation with an active medical staff appointment from Boston Children's Hospital (the Hospital) and has a faculty appointment at the rank of instructor or above in the Department of Ophthalmology at Harvard Medical School (Harvard) shall be a Class "B" member. Any other physician-employee of the Foundation with an active medical staff appointment from the Hospital and a faculty appointment at the rank of instructor or above in the Department of Ophthalmology at Harvard shall be a Class "D" member. Each Class "A", "B", and "D" member shall hold membership as long as he/she remains qualified for membership. The Physicians Organization at Children's Hospital, Inc. shall be the sole Class "C" member. The qualifications and rights of members, including voting rights, shall be as set forth from time to time in the by-laws of the Foundation. Form 990, Part VI, Section A, line 7a According to the by-laws, the initial Trustees shall be those individuals named in the Children's Hospital Ophthalmology Foundation, Inc.'s (the Foundation's) Articles of Organization who shall serve until the first annual meeting of the members. Thereafter, the Board of Trustees shall consist of the Class "A and "B" members, each of whom shall serve ex-officio with vote. The Class "A" member is the President of the Foundation. All other officers shall be elected by the Trustees for two-year terms at the Foundation's annual meeting. All officers shall be Trustees. Form 990, Part VI, Section A, line 7b The Physicians Organization at Children's Hospital, Inc. (the PO) is a Class "C" member of Children's Hospital Ophthalmology Foundation, Inc. (the Foundation). The PO is responsible for providing certain 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 upon by the PO and the Foundation. The PO has the right to review, but not to approve, the annual operating budget. The PO Board has the right to approve 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 modifications 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 11b The tax return is prepared with information, data, and detail provided by the President of the Foundation, the Executive Director, and the Controller and is reviewed by a representative from the tax preparation firm. The full Form 990 filing is reviewed by the President of the Foundation, the Executive Director, and the Controller prior to filing. It is reviewed by an officer of the corporation and/or the officer who will sign the Form 990. A representative from a tax preparation firm will present a summary of the Form 990 filing to a quorum of the Finance Committee, with Class C member or staff representative from the Physicians Organization at Children's Hospital, Inc. invited for that summary. The Form 990 that was presented to and approved by a quorum of the Finance Committee will be provided to the Foundation's Board of Directors in a subsequent Board meeting packet along with a copy of the Form 990 (with salaries redacted). Form 990, Part VI, Section B, line 12c The Physicians Organization at Children's Hospital, Inc. (the PO) and Boston Children's 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 to 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 influence the voting on such matter. Form 990, Part VI, Section B, line 15 Faculty compensation must comply with the Boston Children's Hospital Physician Compensation Guidelines. These guidelines are developed in consultation with an independent external compensation consulting firm and are approved by independent Compensation Committee of Board of Children's Medical Center Corporation and Boston Children's Hospital. The guidelines set the maximum compensation limits based on a peer group analysis for the Foundations. The maximum compensation limits are based on pediatric specialty, sub-specialty, academic rank and include a productivity adjustment. Any proposed compensation that exceeds the limit 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 each 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 B, Line 16a: In January 2007, Children's Hospital Ophthalmology Foundation, Inc. (the Foundation) formed a for-profit limited liability company, Foundation Optical, LLC, to establish a retail optical shop located within a Boston Children's Hospital satellite location. The primary purpose of Foundation Optical, LLC is to offer eyewear needs to patients of the Foundation. The Foundation is the majority owner of Foundation Optical, LLC with a 55% ownership interest. Form 990, Part VI, Section B, Line 16b: It is the policy of Children's Hospital Ophthalmology Foundation, Inc. (the Foundation) to retain an ownership stake in any entity that is consistent with its charitable mission. Further, if the Foundation does retain an ownership stake in any appropriate entity, it will secure legal advice and language in any such operating agreements to ensure it has full authority to prevent and override any action of such entity that the Foundation may determine is inconsistent with its charitable purposes or that may jeopardize the Foundation's tax-exempt status. Form 990, Part VI, Section C, line 19 The Foundation maintains or has access to all financial statements, 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 XII, Line 2c: The audit process and scope have not changed from the prior year. Children's Ophthalmology Management Services LLC 40 Saw Mill River Road Upper Level Hawthorne NY 10532 820621893 Management Service Organization NY -136857 1620651 Children's Hospital Ophthalmology Foundation Inc Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 Hospital MA 501(c)(3) Line 3 N/A 0 Physicians Organization at Children's Hospital Inc 300 Longwood Avenue Boston MA 02115 043266103 Management services MA 501(c)(3) Line 12c, III-FI N/A 0 Foundation Optical LLC 9 Hope Avenue Waltham MA 02453 208236402 Eyeglass Sales MA Children's Hospital Ophthalmology Foundation Inc Related 94033 80469 0 18812 1 0.55000 0 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1 Foundation Optical LLC S 89356 Actual per books