2021-08-13T07:48:45-05:00 2020-09-30 010494526 Baker Newman & Noyes LLC 280 Fore Street Portland ME 04101 990 2019-10-01 042764370 CHMC Cardiovascular Surgical Foundation Inc CHMC 6173557008 300 Longwood Avenue Boston MA 02115 Pedro del Nido MD President 6173557008 2021-08-05 0 Nicholas E Porto P01310283 8002447444 2021-08-05 2019 2022-09-23 18:48:47Z Pedro del Nido MD 300 Longwood Avenue Boston MA 02115 23002780 0 X N/A X 1982 MA The Foundation provides cardiovascular 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 either unavailable or limited elsewhere in the community. 6 0 6 0 0 0 0 402930 20745203 19947379 -51180 193462 0 142037 20694023 20685808 826748 1042490 0 0 14117442 16615364 0 0 0 2815571 2642609 17759761 20300463 2934262 385345 37139855 38696663 12357075 9820757 24782780 28875906 X The Foundation provides cardiovascular 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 cardiovascular surgery (see Schedule O) by teaching students and other medical and scientific personnel. The Foundation also provides care for patients regardless of their ability to pay. 0 0 17231595 1042490 19446345 The Foundation provides cardiovascular services primarily to patients at Boston Children's Hospital and at satellite locations. The Foundation may charge for patient care and other medical services, provided that any net income is used 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 supporting hospital and community based services that are either unavailable or limited elsewhere in the community. The Foundation provided $477,350 in free care services for the year ended September 30, 2020. 532936 501034 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 cardiovascular surgery by teaching students and other medical and scientific personnel; by providing research grants; giving lectures; and publishing information concerning problems and research results in the field of pediatric cardiovascular surgery in order to educate the general public and the medical profession. 17764531 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 6 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 6 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Janet Horgan 6173557008 300 Longwood Avenue Boston MA 02115 Sitaram M Emani MD Director 60.00 0.00 X 3631802 0 69317 Christopher W Baird MD Director 60.00 0.00 X 3525941 0 69978 Francis Fynn-Thompson MD Director 60.00 0.00 X 3020779 0 68060 Pedro del Nido MD President 55.00 5.00 X X 2731670 0 65501 Aditya K Kaza MD Clerk 60.00 0.00 X X 1054218 0 68478 John Mayer MD Director 60.00 0.00 X 870522 0 69317 Janet Horgan Treasurer (non-voting) 2.00 38.00 X 0 213698 24722 Physicians Org at CH Inc Institutional Trustee 2.00 0.00 X 0 0 0 14834932 213698 435373 6 0 1 0 Lighthouse Medical Technology Group PO Box 842086 Boston MA 02284 Medical Consultants 212346 Duane Morris LLP 30 South 17th Street Philadelphia PA 19103 Legal Services 189791 Charles Schwab 600 Atlantic Avenue Floor 18 Boston MA 02210 Investment Management 143877 3 402930 402930 Patient Service Revenue 621300 18360026 18360026 Other Revenue 621990 1086319 1086319 Education & Research 611710 501034 501034 19947379 244835 244835 2265599 2316972 -51373 -51373 -51373 Insurance rebate 900099 170301 170301 Non-operating pension losses 900099 -28264 -28264 142037 20685808 19947379 0 335499 1042490 1042490 17684124 17445704 238420 4941132 3495539 1445593 -7882738 -7882738 1586738 1145594 441144 286108 286108 154160 154160 39512 39512 140207 140207 9195 9195 515581 464482 51099 68912 68912 3574 3574 5678 5678 532368 515766 16602 PO dues 479093 479093 Coordinated Specialty P 391395 391395 Billing service 296504 296504 Research expense 6430 6430 20300463 17764531 2535932 0 4328340 2088021 3866090 6160693 3039393 3061116 2290000 1494000 663158 719993 1002316 40613 3179 961703 21830206 22652053 598266 604477 521223 954607 37139855 38696663 212716 147498 1839269 1238578 43751 0 10261339 8434681 12357075 9820757 X 24782780 28472976 0 402930 24782780 28875906 37139855 38696663 X 385345 2549576 1158205 X X 0 1 X 1 0 X 402930 402930 16177165 17349315 20201867 20827530 19947379 94503256 16177165 17349315 20201867 20827530 20350309 94906186 0 0 0 94906186 295609 414281 460733 268583 244835 1684041 295609 414281 460733 268583 244835 1684041 882 263 485 -241 0 1389 215642 142037 357679 16473656 17763859 20878727 21095872 20737181 96949295 0.97890 0.97860 0.01740 0.01900 X Schedule A, Part III, Line 12, Explanation of Other Income: Insurance rebate - 2017 Amount: $ 215,642. 2019 Amount: $ 170,301. Non-operating pension losses - 2019 Amount: $ -28,264. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 402930 402930 248136 248136 513296 265160 248136 765821 252525 513296 0.00000 0.00000 1.00000 0 0 933026 2827 930199 69290 37786 31504 961703 Due to Boston Children's Hospital 2170075 Due to Physicians Organization 27493 Due to affiliates 139 Patient deposits 3097211 Accrued pension obligation 896966 Accrued professional liability 661196 Accrued profit sharing plan 342000 Deferred compensation plan 1239601 8434681 X 24393589 2549576 1158205 3707781 20685808 0 20685808 20300463 0 20300463 0 20300463 Part V, Line 4: The endowment funds represent donations that were given for operations. The uses of these funds were restricted by the donor. 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 organization 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, 2020. The Foundation's tax years from 2018 through 2020 are potentially subject to examination. Part XI, Line 2d - Other Adjustments: Pension adjustment 1,158,205. 1 Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 501(c)(3) 963530 N/A N/A General support Hospitality Homes PO Box 15265 Boston MA 02115 043204112 501(c)(3) 75000 N/A N/A General support 2 0 Part I, Line 2: Monitoring is provided by CHMC Cardiovascular Surgical Foundation, Inc. (the Foundation) through oversight of the terms and conditions of a written grant agreement. Multi-year agreements require yearly progress and financial reports for continuation of funding. During the year ended September 30, 2020, the Foundation only provided grant donations to other 501(c)(3) organizations. X 1 1 X X X X X 1 1 0 0 0 0 0 1 0 Sitaram M Emani MD Director 825450 0 0 0 2806352 0 19000 0 50317 0 3701119 0 2363051 0 Christopher W Baird MD Director 825450 0 0 0 2700491 0 19000 0 50978 0 3595919 0 2309229 0 Francis Fynn-Thompson MD Director 673359 0 0 0 2347420 0 19000 0 49060 0 3088839 0 2001927 0 Pedro del Nido MD President 2569432 0 46125 0 116113 0 19000 0 46501 0 2797171 0 0 0 Aditya K Kaza MD Clerk 673359 0 0 0 380859 0 19000 0 49478 0 1122696 0 0 0 John Mayer MD Director 842814 0 0 0 27708 0 19000 0 50317 0 939839 0 0 0 Janet Horgan Treasurer (non-voting) 0 190971 0 0 0 22727 0 0 0 24722 0 238420 0 0 Part I, Line 1a The Foundation provides gross-up payments for mortgage forgiveness, tuition payments, 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, Lines 4a-b The Foundation established the CHMC Cardiovascular Surgical 2005 Supplemental Executive Retirement Plan (the SERP), effective as of January 1, 2005, to reward licensed physician employees with a benefit based on service. The SERP's sources of contributions are from employer discretionary amounts (if any), severance benefit, and elective deferrals. The amounts are vested after five years, attainment of age 63, death, disability, or change in control. The Foundation did not make any SERP payments during the calendar year ended December 31, 2019. During the year ended September 30, 2020 payments were made to the physicians who had vested in the plan based on the criteria. The Foundation made SERP payments to the following individuals during the year ended September 30, 2020: Sitaram M. Emani, MD $2,363,051; Christopher W. Baird, MD $2,309,229; and Francis Fynn-Thompson, MD $2,001,927. Part I, Line 4b: The Foundation has a deferred compensation arrangement under a nonqualified defined contribution plan to provide supplemental retirement benefits to certain employees. The Foundation made defined compensation payments to the following individuals during the year ended September 30, 2020: Pedro del Nido, MD $19,000; John E. Mayer, Jr., MD $19,000; Sitaram M. Emani, MD $19,000; Aditya K. Kaza, MD $19,000; Christopher W. Baird, MD $19,000; and Francis Fynn-Thompson, MD $19,000. Part I, Line 7 Bonus compensation amounts are determined by the Compensation Committee of the Board of Children's Medical Center Corporation and Boston Children's Hospital (the Hospital). The amounts are discretionary based on job performance. Sitaram M Emani MD Director Retention X 810000 324000 0 1 1 Francis Fynn-Thompson MD Director Retention X 780000 312000 0 1 1 Aditya K Kaza MD Director Retention X 780000 312000 0 1 1 Christopher W Baird MD Director Retention X 500000 0 0 1 1 Christopher W Baird MD Director Retention X 810000 486000 0 1 1 Aditya K Kaza MD Director Retention X 300000 60000 0 1 1 1494000 Schedule L, Part II: The Foundation has provided secured forgivable loans to employees. The loans bear carrying interest rates up to 2.87%. In most cases, the Foundation forgives an amount equal to 20% of the principal value for each year of continued employment. The amount forgiven is included in the employee's W-2 during the year of forgiveness. At September 30, 2020, the balance of the loans outstanding is $1,494,000. Future principal balances due are $696,000 in 2021; $636,000 in 2022; and $162,000 in 2023. Form 990, Part VI, Section A, line 1 A majority of CHMC Cardiovascular 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 the 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 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 on the PO's rights. Form 990, Part VI, Section A, line 3 The Physicians Organization at Children's Hospital, Inc. (the PO) is the Class "C" member of CHMC Cardiovascular 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 which approval shall not be withheld if selected from an approved list of firms mutually agreed to by the Board and the Members (provided, further, that neither the Board nor the Members shall unreasonably withhold their approval to the addition of the new firms to the list from time to time).. 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. As a class "C" member of the Foundation, the PO attends the Foundation's annual meeting. Form 990, Part VI, Section A, line 6 CHMC Cardiovascular Surgical Foundation, Inc. (the Foundation) has three classes of members. The Chief of the Department of Cardiac Surgery (the Department) of Boston Children's Hospital (the Hospital) is the sole Class "A" member. Any member of the Department (other than the Chief) who holds a professional staff appointment from Harvard Medical School, and who is geographically full-time at the Hospital shall be a Class "B" member. Other physicians upon recommendation from the Chief and approval from the President of the Hospital may be permitted to be Class "B" members. The Physicians Organization at Children's Hospital, Inc. is the Class "C" member of the Foundation. Form 990, Part VI, Section A, line 7a According to the Articles of Organization, the Class "A" member is the Chief of the Department of Cardiac Surgery (the Department) of Boston Children's Hospital (the Hospital). Any other member of the Department who holds a professional staff appointment in cardiovascular surgery at the Hospital, has a full-time faculty appointment from Harvard Medical School, and who is geographically full-time at the Hospital shall be a Class "B" member. A Class "A or "B" member shall hold membership as long as he/she remains qualified for membership. Only Class "A and "B" members may vote in annual meetings or other elections, serve on the Hospital's Board of Trustees, or nominate candidates for election to the Board. Form 990, Part VI, Section A, line 7b The Physicians Organization at Children's Hospital, Inc. (the PO) is the Class "C" member of CHMC Cardiovascular 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 which approval shall not be withheld if selected from an approved list of firms mutually agreed to by the Board and the Members (provided, further, that neither the Board nor the Members shall unreasonably withhold their approval to the addition of the new firms to the list from time to time). 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 any modification to the 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 detailed review will be conducted by the President of the Foundation, Pedro J. del Nido, MD and the Treasurer, Janet Horgan. The Physicians Organization at Children's Hospital, Inc. will present the Form 990 to board members. 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 12c In conjunction with Boston Children's Hospital, the Physicians Organization at Children's Hospital, Inc. (the PO) administers an annual conflict of interest disclosure process to all of its 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 personally or through a desingnee(s). Any person not receiving a disclosure statement 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 that conflict relates or otherwise influences the voting on such matter. Form 990, Part VI, Section B, line 15 Faculty 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 CHMC Cardiovascular Foundation, Inc. (the Foundation). The maximum compensation limits are based on pediatric specialty, sub-specialty, academic rank and 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 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 Hospital's Chief Executive Officer and President/Chief Operating Officer. Form 990, Part VI, Section C, line 19 The 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 1,158,205. Form 990, Part XII, Line 2c: The audit process and scope has not changed from the prior year. 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 Physician Organization MA 501(c)(3) Line 12c, III-FI N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0