CHMC SURGICAL FOUNDATION INC: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
CHMC SURGICAL FOUNDATION INC (EIN 04-2767602)
Tax period
2018-10-01 to 2019-09-30
Filed
2020-08-17
IRS object ID
202002309349301215
Schema version
2018v3.2
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)
Return2020-08-17T08:24:11-05:00ReturnTs
Tax Period End2019-09-30TaxPeriodEndDt

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 Begin2018-10-01TaxPeriodBeginDt

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
Signature2020-08-11SignatureDt
Discuss With Paid Preparer0DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonNicholas E PortoPreparerPersonNm
PTINP01310283PTIN
Phone8002447444PhoneNum
Preparation2020-08-11PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address208.105.168.164IPv4AddressTxt
FieldValueIRS element (for citing)
IP2020-08-11IPDt
IP Tm16:09:17IPTm
IP TimezoneEDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id8D27C340D9F2F89D467D155AEFB91C71D643DA43AtSubmissionCreationDeviceId
At Submission Filing Device IdDA1D1F22D002DE74304CAE64996AD19EA354FE22AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2020-09-23 17:36:50ZBuildTS

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$41,550,929GrossReceiptsAmt
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 Employee26TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI-$6,156TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$6,156NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$75,977PYContributionsGrantsAmt
CY Contributions Grants$3,347,679CYContributionsGrantsAmt
PY Program Service Revenue$30,747,467PYProgramServiceRevenueAmt
CY Program Service Revenue$30,861,882CYProgramServiceRevenueAmt
PY Investment Income$657,727PYInvestmentIncomeAmt
CY Investment Income$843,673CYInvestmentIncomeAmt
PY Other Revenue$322,077PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$31,803,248PYTotalRevenueAmt
CY Total Revenue$35,053,234CYTotalRevenueAmt
PY Grants And Similar Paid$1,086,915PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$790,923CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$23,453,104PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$23,234,248CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$3,452,050PYOtherExpensesAmt
CY Other Expenses$3,707,909CYOtherExpensesAmt
PY Total Expenses$27,992,069PYTotalExpensesAmt
CY Total Expenses$27,733,080CYTotalExpensesAmt
PY Revenues Less Expenses$3,811,179PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$7,320,154CYRevenuesLessExpensesAmt
Total Assets BOY$57,108,153TotalAssetsBOYAmt
Total Assets EOY$63,029,765TotalAssetsEOYAmt
Total Liabilities BOY$20,395,537TotalLiabilitiesBOYAmt
Total Liabilities EOY$23,878,685TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$36,712,616NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$39,151,080NetAssetsOrFundBalancesEOYAmt
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$23,109,808ExpenseAmt
Grant$790,923GrantAmt
Revenue$27,226,343RevenueAmt
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 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$519,322ExpenseAmt
Revenue$571,177RevenueAmt
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$2,336,947ExpenseAmt
Revenue$3,064,362RevenueAmt
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$25,966,077TotalProgramServiceExpensesAmt
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
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
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 With Officer Ent0BusinessRlnWithOfficerEntInd
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
Employee26EmployeeCnt
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
Clerk (10/18-6/19)/President (7/19-9/19)45.0015.00Yes (X)Yes (X)$1,266,611$0$130,762
Robert C Shamberger MD
President (10/18-6/19)45.0015.00Yes (X)Yes (X)$975,967$0$131,111
Tom Jaksic MD
Treasurer60.000.00Yes (X)Yes (X)$847,139$0$129,241
Heung Bae Kim MD
Clerk (7/19-9/19)60.000.00Yes (X)Yes (X)$834,073$0$129,467
Craig W Lillehei MD
Director60.000.00Yes (X)$795,660$0$99,610
Biren P Modi MD
Director60.000.00Yes (X)$726,421$0$168,424
Terry L Buchmiller MD
Director60.000.00Yes (X)$930,392$0$103,233
Christopher Weldon MD
Director60.000.00Yes (X)$779,818$0$139,233
Physicians Org at CH Inc
Independent Board Member2.000.00$0$0$0Yes (X)
Russell Jennings MD
Physician60.000.00$885,071$0$128,949Yes (X)
Mark Puder MD
Physician60.000.00$841,236$0$126,966Yes (X)
Thomas Hamilton MD
Physician60.000.00$789,709$0$136,806Yes (X)
Belinda Hsi Dickie MD
Physician60.000.00$776,227$0$180,052Yes (X)
Konstatinos Papadakis MD
Physician60.000.00$758,162$0$141,652Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$11,206,486TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$1,745,506TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K23IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Related Organizations$3,342,679RelatedOrganizationsAmt
All Other Contributions$5,000AllOtherContributionsAmt
Total Contributions$3,347,679TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient service revenue621300$27,226,343$27,226,343
Clinical and other revenue621300$3,064,362$3,064,362
Education and research611710$571,177$571,177
FieldValueIRS element (for citing)
Total Program Service Revenue$30,861,882TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$463,879TotalRevenueColumnAmt
Unrelated Business Revenue-$6,156UnrelatedBusinessRevenueAmt
Exclusion$470,035ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$6,877,489SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$6,497,695SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$379,794SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$379,794TotalRevenueColumnAmt
Exclusion$379,794ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$35,053,234TotalRevenueColumnAmt
Related Or Exempt Func Income$30,861,882RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue-$6,156UnrelatedBusinessRevenueAmt
Exclusion$849,829ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$790,923TotalAmt
Program Services$790,923ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$4,415,138TotalAmt
Program Services$4,415,138ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$15,405,053TotalAmt
Program Services$14,266,326ProgramServicesAmt
Management And General$1,138,727ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$809,160TotalAmt
Program Services$809,160ProgramServicesAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$2,108,833TotalAmt
Program Services$1,746,405ProgramServicesAmt
Management And General$362,428ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$496,064TotalAmt
Program Services$451,418ProgramServicesAmt
Management And General$44,646ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$40,431TotalAmt
Management And General$40,431ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$50,949TotalAmt
Management And General$50,949ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$24,396TotalAmt
Management And General$24,396ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$56,101TotalAmt
Program Services$56,101ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$509TotalAmt
Management And General$509ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$905,494TotalAmt
Program Services$844,499ProgramServicesAmt
Management And General$60,995ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$209,515TotalAmt
Program Services$209,515ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$17,995TotalAmt
Program Services$17,995ProgramServicesAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$164,099TotalAmt
Program Services$164,099ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$5,833TotalAmt
Program Services$5,833ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$562,461TotalAmt
Program Services$518,539ProgramServicesAmt
Management And General$43,922ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmt
PO Dues$661,710$661,710
Billing and collection$537,425$537,425
Coordinated Specialty P$385,712$385,712
Research expenses$85,279$85,279

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$27,733,080TotalAmt
Program Services$25,966,077ProgramServicesAmt
Management And General$1,767,003ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$4,804,570BOYAmt
EOY$5,148,228EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$817,728BOYAmt
EOY$245,324EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,607,808BOYAmt
EOY$4,439,495EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

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

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$568,367BOYAmt
EOY$400,000EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$185,129BOYAmt
EOY$193,188EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$48,540LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$27,775LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$26,598BOYAmt
EOY$20,765EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$27,982,073BOYAmt
EOY$29,309,848EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$14,276,290BOYAmt
EOY$15,709,890EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$3,839,590BOYAmt
EOY$7,332,027EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$57,108,153BOYAmt
EOY$63,029,765EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$102,803BOYAmt
EOY$417,002EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$4,324,464BOYAmt
EOY$2,763,732EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$15,968,270BOYAmt
EOY$20,697,951EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$20,395,537BOYAmt
EOY$23,878,685EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$34,828,707BOYAmt
EOY$34,688,137EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,883,909BOYAmt
EOY$4,462,943EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$36,712,616BOYAmt
EOY$39,151,080EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$57,108,153BOYAmt
EOY$63,029,765EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$7,320,154ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$577,808NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets-$5,459,498OtherChangesInNetAssetsAmt
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$60,000CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus2 Years$128,125CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$75,977CurrentTaxYearMinus1YearAmt
Current Tax Year$3,347,679CurrentTaxYearAmt
Total$3,611,781TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$24,972,218CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$27,167,996CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$29,156,776CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$30,747,466CurrentTaxYearMinus1YearAmt
Current Tax Year$30,861,882CurrentTaxYearAmt
Total$142,906,338TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$25,032,218CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$27,167,996CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$29,284,901CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$30,823,443CurrentTaxYearMinus1YearAmt
Current Tax Year$34,209,561CurrentTaxYearAmt
Total$146,518,119TotalAmt

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$146,518,119PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$367,136CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$368,706CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$394,620CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$432,320CurrentTaxYearMinus1YearAmt
Current Tax Year$470,035CurrentTaxYearAmt
Total$2,032,817TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$367,136CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$368,706CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$394,620CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$432,320CurrentTaxYearMinus1YearAmt
Current Tax Year$470,035CurrentTaxYearAmt
Total$2,032,817TotalAmt

Net Income From Other UBI NetIncomeFromOtherUBIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,555CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,946CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$3,060CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year-$1,990CurrentTaxYearMinus1YearAmt
Current Tax Year-$6,156CurrentTaxYearAmt
Total$415TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$273,327CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus1 Year$322,077CurrentTaxYearMinus1YearAmt
Total$595,404TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$25,402,909CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$27,811,975CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$29,682,581CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$31,575,850CurrentTaxYearMinus1YearAmt
Current Tax Year$34,673,440CurrentTaxYearAmt
Total$149,146,755TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.98240PublicSupportCY509Pct
Public Support PY5090.98220PublicSupportPY509Pct
Investment Income CY0.01360InvestmentIncomeCYPct
Investment Income PY0.01350InvestmentIncomePYPct
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 - 2015 Amount: $ 273,327. 2017 Amount: $ 322,077.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$1,883,909BeginningYearBalanceAmt
Contributions$3,167,000ContributionsAmt
Other Expenditures$587,966OtherExpendituresAmt
End Year Balance$4,462,943EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,051,785BeginningYearBalanceAmt
Other Expenditures$1,167,823OtherExpendituresAmt
End Year Balance$1,883,962EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,641,282BeginningYearBalanceAmt
Other Expenditures$1,589,497OtherExpendituresAmt
End Year Balance$3,051,785EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$4,659,481BeginningYearBalanceAmt
Contributions$60,000ContributionsAmt
Other Expenditures$78,199OtherExpendituresAmt
End Year Balance$4,641,282EndYearBalanceAmt
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$27,775DepreciationAmt
Book Value$20,765BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$20,765TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp

FieldValueIRS element (for citing)
DescInterest in the P.O. Pooled Investment FundDesc
Book Value$15,709,890BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Securities$15,709,890TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (13 entries)

DescDescBook ValueBookValueAmt
Due from Boston Children's Hospital$3,376,794
Due from Physicians Org. at CH, Inc.$816,350
Due from Dana Farber Cancer Institute$38,210
Due from Harvard Medical School$327,042
Due from Boston Medical Center$78,559
Due from New England Organ Bank$2,500
Due from CHPA, Inc.$71,778
Malpractice Claims receivable$1,362,598
Due from BCH - Egan Family Charitable Fund$1,200,000
Due from Brigham & Women's$36,343
Due from CV Surgery$19,817
Due from Urology$586
Due from Anesthesia$1,450
FieldValueIRS element (for citing)
Total Book Value Other Assets$7,332,027TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (10 entries)

DescDescAmtAmt
Due to Boston Children's Hospital$1,776,713
Due to Physicians Org. at CH, Inc$293,100
Due to Boston Medical Center$4,417
Accrued salaries and benefits$3,967,605
Accrued deferred compensation$7,663,544
Accrued professional liability$1,807,137
Due to Harvard$300,000
Due to CHMC Anesthesia Foundation, Inc.$18,750
Due to Brigham & Women's$19,872
Accrued defined benefit plan$4,846,813
FieldValueIRS element (for citing)
Total Liability$20,697,951TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$30,171,544TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$577,808NetUnrealizedGainsInvstAmt
Other Revenue-$5,459,498OtherRevenueAmt
Revenue Not Reported-$4,881,690RevenueNotReportedAmt
Revenue Subtotal$35,053,234RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$35,053,234TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$27,733,080TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$27,733,080ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$27,733,080TotalExpensesPerForm990Amt

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, 2019. The Foundation's tax years from 2016 through 2019 are potentially subject to examination.
Part XI, Line 2d - Other Adjustments:Pension adjustment -5,459,498.

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$784,431CashGrantAmt
Valuation Method UsedN/AValuationMethodUsedDesc
Non Cash AssistanceN/ANonCashAssistanceDesc
Purpose Of GrantResearchPurposeOfGrantTxt
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, 2019, 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
Clerk (10/18-6/19)/President (7/19-9$714,877$0$500,526$0$51,208$0$85,000$0$45,762$0$1,397,373$0$0$0
Robert C Shamberger MD
President (10/18-6/19)$792,860$0$155,000$0$28,107$0$85,000$0$46,111$0$1,107,078$0$0$0
Tom Jaksic MD
Treasurer$679,399$0$115,819$0$51,921$0$85,000$0$44,241$0$976,380$0$0$0
Heung Bae Kim MD
Clerk (7/19-9/19)$544,989$0$246,452$0$42,632$0$85,000$0$44,467$0$963,540$0$0$0
Craig W Lillehei MD
Director$533,525$0$223,911$0$38,224$0$55,000$0$44,610$0$895,270$0$0$0
Biren P Modi MD
Director$393,717$0$295,638$0$37,066$0$127,000$0$41,424$0$894,845$0$0$0
Terry L Buchmiller MD
Director$596,682$0$293,769$0$39,941$0$85,000$0$18,233$0$1,033,625$0$0$0
Christopher Weldon MD
Director$428,353$0$311,112$0$40,353$0$95,000$0$44,233$0$919,051$0$0$0
Russell Jennings MD
Physician$618,079$0$214,408$0$52,584$0$85,000$0$43,949$0$1,014,020$0$0$0
Mark Puder MD
Physician$500,897$0$292,192$0$48,147$0$85,000$0$41,966$0$968,202$0$0$0
Thomas Hamilton MD
Physician$454,593$0$292,934$0$42,182$0$95,000$0$41,806$0$926,515$0$0$0
Belinda Hsi Dickie MD
Physician$360,201$0$354,898$0$61,128$0$138,000$0$42,052$0$956,279$0$0$0
Konstatinos Papadakis MD
Physician$466,953$0$252,375$0$38,834$0$95,000$0$46,652$0$899,814$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, 2019, the Foundation made the following contributions to the plan: Robert C. Shamberger, MD, $30,000; Tom Jaksic, MD, $30,000; Steven J. Fishman, MD, $30,000; Heung Bae Kim, MD, $30,000; Russell Jennings, MD, $30,000; Terry L. Buchmiller, MD, $30,000; Mark Puder, MD, $30,000; Biren P. Modi, MD, $72,000; Christopher Weldon, MD, $40,000; Thomas E. Hamilton, MD, $40,000; Belinda Hsi Dickie, MD, $83,000; and Konstatinos Papadakis, MD, $40,000.
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

FieldValueIRS element (for citing)
PersonBelinda Hsi Dickie MDPersonNm
Relationship With OrgPhysicianRelationshipWithOrgTxt
Loan PurposeHousing loanLoanPurposeTxt
Loan From OrganizationYes (X)LoanFromOrganizationInd
Original Principal$300,000OriginalPrincipalAmt
Balance Due$231,000BalanceDueAmt
Default0DefaultInd
Board Or Committee ApprovalYes (1)BoardOrCommitteeApprovalInd
Written AgreementYes (1)WrittenAgreementInd
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 $613,000 at September 30, 2019. Future principal amounts due are as follows: $107,068 in 2020; $107,066 in 2021; $107,066 in 2022; $54,430 in 2023; $44,430 in 2024; and $210,940 thereafter. 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 Chief Executive Officer and President/Chief Operating 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 -5,459,498.
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

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.