2021-08-16T08:51:36-05:00 2020-09-30 010494526 Baker Newman & Noyes LLC 280 Fore Street Portland ME 04101 990 2019-10-01 042943146 Children's Orthopaedic Surgery FoundationInc CHIL 6173558699 300 Longwood Avenue No HU221 Boston MA 02115 Donald S Bae MD Treasurer 6173558699 2021-08-12 1 Nicholas E Porto P01310283 8002447444 2021-08-12 2019 2022-09-23 18:48:47Z Peter M Waters MD 300 Longwood Avenue No HU221 Boston MA 02115 87145633 0 X N/A X 1986 MA The Foundation provides orthopaedic surgery services, medical research, and (see Schedule O) educational services to Boston Children's Hospital and Harvard Medical School. The Foundation also provides care for patients located in Massachusetts in need of orthopaedic services, regardless of their ability to pay, as well as providing and supporting hospital and community based services that are limited in the community. 30 0 47 0 -21520 -21520 442891 1538749 62772605 55548179 822808 1762563 0 485418 64038304 59334909 272980 241482 0 0 46796789 44630135 0 0 0 13270699 12638176 60340468 57509793 3697836 1825116 124047360 133683990 30336751 34795713 93710609 98888277 X The Foundation provides orthopaedic surgery services to patients at Boston Children's Hospital and at satellite locations. The mission strives to provide care for patients with a wide range of developmental, congenital, neuromuscular, and post (see Schedule O) traumatic problems of the musculoskeletal system. The Foundation also provides care for patients in need of orthopaedic services, regardless of their ability to pay. 0 0 53227340 241482 54016005 The Foundation provides orthopaedic surgery 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 exclusively for the charitable, scientific, and educational purposes for which the Foundation was created. The Foundation also provides care for patients in need of orthopaedic services regardless of their ability to pay, as well as providing and supporting hospital and community based services that are limited in the community. 1646206 1532174 The Foundation carries on and promotes basic and applied medical research and education in the field of orthopaedics 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 orthopaedics in order to educate the general public and the medical profession. 54873546 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 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 47 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 30 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Donald S Bae MD 6173558699 300 Longwood Avenue No HU221 Boston MA 02115 Mininder S Kocher MD Director 55.00 5.00 X 2394540 0 103613 Lyle J Micheli MD Director 2.00 0.00 X 1917420 0 67403 Michael P Glotzbecker MD Director 60.00 0.00 X 1587612 0 28357 Benton E Heyworth MD Director 60.00 0.00 X 1481275 0 107170 Benjamin J Shore MD Director 60.00 0.00 X 1363326 0 72462 Eduardo N Novais MD Director 60.00 0.00 X 1326885 0 96199 Young-Jo Kim MD Director 55.00 5.00 X 1226408 0 62672 Peter M Waters MD President 55.00 5.00 X X 1165009 0 79165 Daniel J Hedequist MD Director 60.00 0.00 X 1111983 0 97393 Donald S Bae MD Treasurer 60.00 0.00 X X 1003787 0 110748 Collin May MD Director 60.00 0.00 X 1043878 0 62133 Dennis E Kramer MD Director 60.00 0.00 X 944967 0 112119 William Meehan MD Physician 20.00 0.00 X 945584 0 101779 Carley Vuillermin MD Director 60.00 0.00 X 918854 0 97393 Andrea Bauer MD Director 60.00 0.00 X 914805 0 94303 Matthew D Milewski MD Director 60.00 0.00 X 878277 0 94602 Colyn J Watkins MD Director 60.00 0.00 X 895436 0 60110 Yi-Meng Yen MD Director 60.00 0.00 X 770035 0 123793 James R Kasser MD Director 55.00 5.00 X 815120 0 64099 M Timothy Hresko MD Director 60.00 0.00 X 809079 0 66180 John B Emans MD Director 60.00 0.00 X 813188 0 60183 Samantha A Spencer MD Clerk 60.00 0.00 X X 679774 0 66137 Travis H Matheney MD Director 60.00 0.00 X 650544 0 72561 Megan Hannon MD Director 60.00 0.00 X 598793 0 94962 Andrea Straccolini MD Physician 20.00 0.00 X 620059 0 57000 Lawrence I Karlin MD Director 60.00 0.00 X 587011 0 74299 Thomas J Hart Employee 1.00 60.00 X 502753 0 105815 Pierre d'Hemecourt MD Physician 20.00 0.00 X 492418 0 102710 Michael O'Brien MD Physician 20.00 0.00 X 489915 0 62372 Melissa Christino MD Director 60.00 0.00 X 442351 0 73220 Susan Mahan MD Director 60.00 0.00 X 370418 0 110947 Brian Snyder MD Director 60.00 0.00 X 376628 0 71901 Michael B Millis MD Director 60.00 0.00 X 358444 0 62172 Martha M Murray MD Director 60.00 0.00 X 242053 0 33183 Craig Birch MD Director 60.00 0.00 X 118149 0 12403 Physicians Org at CH Inc Institutional Trustee 2.00 0.00 X 0 0 0 30856778 0 2761558 44 0 1 0 Massachusetts General Physicians Organiz 55 Fruit Street Boston MA 02114 Physiatry services 2101404 Harvard Medical Faculty Physicians 330 Brookline Avenue Boston MA 02215 Physician services 659081 Brigham and Women's Physicians Organizat 75 Francis Street Boston MA 02115 Physician services 130832 Scribe America 1200 East Las Olas Blvd Suite 201 Fort Lauderdale FL 33301 Medical transcription 128531 Brownson Rehmus & Foxworth 399 Knollwood Road Sute 303 White Plains NY 10603 Financial counseling 111438 5 287032 1251717 1538749 Patient service revenue 621300 37803763 37803763 Other service revenue 621300 16212242 16212242 Research, service & other revenue 541700 1105258 1105258 Administrative, teaching & suppor 611710 426916 426916 55548179 798936 -21520 820456 28774351 27810724 963627 963627 963627 Insurance Rebate 900099 485418 485418 485418 59334909 55548179 -21520 2269501 241482 241482 28803792 28803792 13610684 11569082 2041602 1042041 1042041 551713 551713 621905 584644 37261 -563 -563 96012 96012 114517 114517 2194768 2013892 180876 1689541 1610939 78602 1300861 1300861 416789 416789 96735 96735 1390964 1303024 87940 Outside medical service 2562321 2562321 Research and education 1222789 1222789 PO management services 902530 902530 Coordinated Specialty P 650912 650912 57509793 54873546 2636247 0 29089981 33692529 5508305 4504583 759733 393071 24000 100000 418494 133955 1715777 464596 1347915 1251181 53325934 57442026 27087752 29457764 6485246 6708881 124047360 133683990 5654482 8482049 5880278 3959824 6942 6942 18795049 22346898 30336751 34795713 X 91548012 96725680 2162597 2162597 93710609 98888277 124047360 133683990 1825116 3352552 0 X X 0 1 X 1 0 X 416304 107522 104967 442891 1538749 2610433 55596133 13993067 61960825 62772605 55548179 249870809 56012437 14100589 62065792 63215496 57086928 252481242 0 0 0 252481242 569744 183031 782095 814222 820456 3169548 569744 183031 782095 814222 820456 3169548 7075 -3762 -10957 -21520 -29164 502344 485418 987762 56589256 14283620 63346469 64018761 58371282 256609388 0.98390 0.98600 0.01240 0.01060 X Schedule A, Part III, Line 12, Explanation of Other Income: Insurance rebate - 2017 Amount: $ 502,344. 2019 Amount: $ 485,418. Schedule A, Part III: The Foundation changed its year end from June 30 to September 30 starting with the three month period ending September 30, 2017. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2162597 1239217 1239217 2162597 2128995 67000 33398 2162597 2627666 498671 2128995 3020266 392600 2627666 3020266 3020266 0.00000 0.00000 1.00000 0 0 1496614 332225 1164389 104141 51545 52596 115022 80826 34196 1251181 PO Pooled Investment Funds 29457764 F 29457764 Due from Boston Children's Hospital 1684384 Due from Physicians Organization at Children's Hospital, Inc. 1726688 Due from Children's Sports Medicine Foundation, Inc. 2124216 Malpractice Claims Receivable 1135057 Due from Children's Hospital Pediatric Associates, Inc. 29932 Due from Boston Plastic and Oral Surgery Foundation, Inc, 7604 Due from Brigham & Women's Hospital 500 Due from Beth Israel Deaconess Medical Center 500 6708881 Due to Boston Children's Hospital 5416294 Due to Children's Sports Medicine Foundation, Inc 186014 Due to Physicians Organization at Children's Hospital, Inc. 300399 Due to Boston Pediatric Neurosurgical Foundation, Inc. 7115 Due to Boston Plastic and Oral Surgery Foundation, Inc. 5873 Severance plan obligation 4895432 Accrued deferred compensation obligation 8415880 Accrued professional liability 3119891 22346898 X 62687461 3352552 3352552 59334909 0 59334909 57509793 0 57509793 0 57509793 Part V, Line 4: Assets limited as to use represent assets held in trust that are available to pay for future benefits to participants of the deferred compensation plans 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). 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, 2020. The Foundation's tax years from 2018 through 2020 are potentially subject to examination. 1 Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 501(c)(3) 122046 N/A N/A General Support Orthopaedic Research and Education Foundation 9400 W Higgins Road Suite 215 Rosemont IL 60018 366009467 501(c)(3) 30000 N/A N/A General Support Pediatric Orthopaedic Society of North America 9400 W Higgins Road Suite 500 Rosemont IL 60018 541323281 501(c)(3) 10000 N/A N/A General Support Setting Scoliosis Straight 2535 Camino Del Rio S Suite 325 San Diego CA 92108 262957475 501(c)(3) 15128 N/A N/A General Support Little People of America 617 Broadway 518 Sonoma CA 95476 942965067 501(c)(3) 5000 N/A N/A General Support Children's Spine Foundation PO Box 1072 Layton UT 84041 203169071 501(c)(3) 20500 N/A N/A General Support 6 0 Part I, Line 2: Monitoring is provided by the Children's Orthopaedic 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, 2020, the Foundation only provided grant donations to other 501(c)(3) organizations. X 1 0 X X X X X 1 0 0 0 0 0 0 1 0 Mininder S Kocher MD Director 530616 0 1200000 0 663924 0 57000 0 46613 0 2498153 0 0 0 Lyle J Micheli MD Director 795114 0 1120000 0 2306 0 57000 0 10403 0 1984823 0 0 0 Michael P Glotzbecker MD Director 269174 0 920000 0 398438 0 0 0 28357 0 1615969 0 0 0 Benton E Heyworth MD Director 273926 0 1000000 0 207349 0 57000 0 50170 0 1588445 0 0 0 Benjamin J Shore MD Director 368660 0 800000 0 194666 0 57000 0 15462 0 1435788 0 0 0 Eduardo N Novais MD Director 407969 0 680000 0 238916 0 57000 0 39199 0 1423084 0 0 0 Young-Jo Kim MD Director 448974 0 555000 0 222434 0 57000 0 5672 0 1289080 0 0 0 Peter M Waters MD President 430195 0 470000 0 264814 0 57000 0 22165 0 1244174 0 0 0 Daniel J Hedequist MD Director 472072 0 475000 0 164911 0 57000 0 40393 0 1209376 0 0 0 Donald S Bae MD Treasurer 405204 0 390000 0 208583 0 57000 0 53748 0 1114535 0 0 0 Collin May MD Director 282281 0 495000 0 266597 0 57000 0 5133 0 1106011 0 0 0 Dennis E Kramer MD Director 327311 0 495000 0 122656 0 57000 0 55119 0 1057086 0 0 0 William Meehan MD Physician 301542 0 630000 0 14042 0 57000 0 44779 0 1047363 0 0 0 Carley Vuillermin MD Director 264031 0 460000 0 194823 0 57000 0 40393 0 1016247 0 0 0 Andrea Bauer MD Director 348110 0 485000 0 81695 0 57000 0 37303 0 1009108 0 0 0 Matthew D Milewski MD Director 440696 0 271000 0 166581 0 57000 0 37602 0 972879 0 0 0 Colyn J Watkins MD Director 264636 0 380000 0 250800 0 57000 0 3110 0 955546 0 0 0 Yi-Meng Yen MD Director 373896 0 190000 0 206139 0 57000 0 66793 0 893828 0 0 0 James R Kasser MD Director 449282 0 355950 0 9888 0 57000 0 7099 0 879219 0 0 0 M Timothy Hresko MD Director 467575 0 335000 0 6504 0 57000 0 9180 0 875259 0 0 0 John B Emans MD Director 415584 0 350000 0 47604 0 57000 0 3183 0 873371 0 0 0 Samantha A Spencer MD Clerk 310635 0 365000 0 4139 0 57000 0 9137 0 745911 0 0 0 Travis H Matheney MD Director 444169 0 185000 0 21375 0 57000 0 15561 0 723105 0 0 0 Megan Hannon MD Director 290754 0 268039 0 40000 0 57000 0 37962 0 693755 0 0 0 Andrea Straccolini MD Physician 345059 0 275000 0 0 0 57000 0 0 0 677059 0 0 0 Lawrence I Karlin MD Director 496967 0 85000 0 5044 0 57000 0 17299 0 661310 0 0 0 Thomas J Hart Employee 417824 0 80000 0 4929 0 57000 0 48815 0 608568 0 0 0 Pierre d'Hemecourt MD Physician 445059 0 45000 0 2359 0 57000 0 45710 0 595128 0 0 0 Michael O'Brien MD Physician 374915 0 115000 0 0 0 57000 0 5372 0 552287 0 0 0 Melissa Christino MD Director 440851 0 0 0 1500 0 57000 0 16220 0 515571 0 0 0 Susan Mahan MD Director 213114 0 155000 0 2304 0 57000 0 53947 0 481365 0 0 0 Brian Snyder MD Director 349474 0 20000 0 7154 0 57000 0 14901 0 448529 0 0 0 Michael B Millis MD Director 347504 0 0 0 10940 0 57000 0 5172 0 420616 0 0 0 Martha M Murray MD Director 236804 0 0 0 5249 0 30000 0 3183 0 275236 0 0 0 Part I, Line 1a The Foundation provides gross-up payments for mortgage forgiveness, tuition payments, long-term disability insurance, life insurance, and tax preparation fees. 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 4a The Foundation established a nonqualified severance benefit plan called the Children's Orthopaedic Surgery Foundation, Inc. Severance Benefit Plan, effective as of September 1, 1991, to supplement the severance, death or disability benefits available to certain employees of the Foundation. The Board of Directors designates eligible employees and determines benefits. The Severance Benefit Plan was frozen as of December 31, 2004. Although the assets of the trust have been irrevocably set aside for payment of deferred compensation benefits, they are subject first to the claims of the Foundation's creditors in the event the Foundation is subject to bankruptcy proceedings. Part I, Line 7 The Children's Orthopaedic Surgery Foundation, Inc. (the Foundation) paid bonus compensation based on revenues of the Foundation. Bonuses are normally paid in June and December. There is an income statement maintained for each physician. The bonuses are based on the excess balance accumulated in each physician's income statements, the performance of the physician during the six month period, the necessary reserve requirement of the three month's salary plus any other reserve deemed appropriate by the Chief of the Department. Bonus compensation is determined by the Chief of the Foundation. The amounts are discretionary based on various factors, including but not limited to the financial performance of the Foundation. Part II: Various individuals listed in Form 990, Part VII are compensated for services rendered to an unrelated organization, Children's Sports Medicine Foundation, Inc. Salary and benefit information reported in Form 990 Part VII and Schedule J, Part II represents compensation for services the individuals provided to both organizations. As an allocation of compensation specific to the Foundations cannot be readily performed, the respective individuals' total salary and benefits have been reported on the Foundation's Form 990 in accordance with Internal Revenue Service instructions. Andrea Bauer MD Director Recruitment X 200000 40000 0 1 1 Eduardo N Novais MD Director Recruitment X 600000 240000 0 1 1 Megan Hannon MD Director Recruitment X 26400 26400 0 1 1 Matthew D Milewski MD Director Recruitment X 260000 86671 0 1 1 393071 Schedule L, Part II: The Foundation has provided secured forgivable loans to employees. The loans bear carrying interest rates up to 4.89%. 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 $493,071. Future principal balances due are $295,845 in 2021; $158,613 in 2022; and $38,613 in 2023. 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 Internal Revenue Service instructions. Form 990, Part VI, Section A, line 1 A majority of the Children's Orthopaedic Surgery Foundation, Inc.'s (the Foundation's) board members are physicians who are not independent from 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 1986. 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 the Class "C" member of Children's Orthopaedic Surgery 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 6 The Children's Orthopaedic Surgery Foundation, Inc. (the Foundation) has four classes of members. The Chief of the Department of Orthopaedic Surgery (the Department) of Boston Children's Hospital (the Hospital) is the Class "A" member. Each person who is a member of the Foundation, other than the Chief of the Department, may become a Class "B" member of the Foundation upon recommendation by the Class "A" member and approval of the Class "B" members. The Physicians Organization at Children's Hospital, Inc. is the Class "C" member of the Foundation. All full-time physicians with Harvard Medical School appointments in the Department of Orthopaedics at the Hospital (excluding the Class A member and the Class B members) shall be Class D members. Form 990, Part VI, Section A, line 7a According to the Articles of Organization, the Chief of the Department of Orthopaedic Surgery of Boston Children's Hospital is the Class "A" member of Children's Orthopaedic Surgery 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 7b The Physicians Organization at Children's Hospital, Inc. (the PO) is the Class "C" member of Children's Orthopaedic Surgery 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. As the 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, Peter M. Waters, MD and the Finance Manager, Marc Conroy. A copy of Form 990 will be provided to the Board prior to filing. The Physicians Organization at Children's Hospital, Inc. will review the Form 990 with the board members. 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 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 designee(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 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 (the 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 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 individuals faculty members is set by the President of Children's Orthopaedic Surgery 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 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 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 Org 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 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 0 0