2019-11-15T00:36:42-06:00 2018-12-31 861065772 Deloitte Tax LLP 50 South Sixth Street Ste 2800 Minneapolis MN 55402 990 2018-01-01 411200302 Gillette Children's Hospital Foundation GILL 6512912848 200 University Avenue East St Paul MN 55101 Patrick Nolan Vice President, Finance 6512912848 2019-11-14 1 Kristina Rasmussen P00143920 6123974000 183.83.66.252 2019-11-14 16:50:43 US P D6D028B83EC7BAE48696A0FE418AC7215527A94E AF8CEB370D326163F0BB3B0FE9FA6EE2BD1C282B 2018 2020-03-31 21:24:44Z Dennis Jolley 200 University Avenue East St Paul MN 55101 13373738 0 X www.gillettechildrens.org X 1985 MN The mission of Gillette Children's Hospital Foundation is to support the mission and vision of Gillette Children's Specialty Healthcare. 19 17 0 126 0 0 6895732 11989114 0 0 827301 795336 -163565 -85491 7559468 12698959 6071614 1467978 0 0 1360564 1314372 0 0 1519501 1156699 1374060 8588877 4156410 -1029409 8542549 23930628 29471447 2008735 671791 21921893 28799656 X The mission of Gillette Children's Hospital Foundation (Foundation) is to raise money, build awareness, and develop relationships in support of the patient care, education and research activities of Gillette Children's Specialty Healthcare. 0 0 941949 941949 Patient Care:The Foundation raises money to support activities related to the Gillette mission. This includes offering financial aid to patients based on need, whether or not they have health insurance, and offering charity care to patients who are financially unable to pay all or part of their medical bills. Gillette evaluates each situation based on a patient's income, assets and other resources, and the hospital assists with establishing manageable payment plans (including co-pays and co-insurance). For people without insurance, Gillette charges for care in accordance with the 501(r) guidelines.See Schedule O.If patients inform Gillette that they will have a difficult time meeting their financial obligations, Gillette helps patients in their efforts to qualify for public assistance or the Gillette charity care program. Income eligibility for the program is based on national poverty guidelines. Gillette will never turn away a family due to an inability to pay for treatment. Additionally, funds raised by the Foundation support areas of Gillette operations that are unreimbursed or under-reimbursed. For example, Gillette operates Outreach Clinics in communities in greater (largely rural) Minnesota. However, in providing these services, Gillette incurs losses. Gillette Outreach Clinics offer appointments with doctors, nurse practitioners, and seating and adaptive equipment specialists. Outreach clinics also help with care coordination and education for community providers in the specialized needs of Gillette patients living in their communities. Similarly, Gillette provides a variety of services to patients through our Child and Family Services area that are unreimbursed or under-reimbursed. Child life specialists, for example, help children and families prepare for and cope with hospital stays and medical procedures. Social workers provide emotional support and help with practical concerns for families of children who have disabilities, such as ordering medical equipment and finding transportation or other resources. 70235 70235 Capital: The Foundation raises funds to support Gillette Children's Specialty Healthcare's mission of providing specialized health care for children and adults who have complex and rare medical conditions. The Foundation's support allows Gillette to further its vision of helping patients realize their full potential. This includes raising contributions for improvements to capital assets of Gillette Children's Specialty Healthcare, which ensures modern, efficient and effective technology and resources are available to serve our patients.See Schedule O.During 2018, Gillette transferred funds for capital projects related to various projects including capital improvements at Greater Minnesota clinics and child life technology. Additionally, funds were raised for projects including Mobile CT imaging and supporting Gillette's Pediatric Spine Institute, including capital investments in technology such as EOS and LessRay imaging systems, 3-D printers, and a 3-D robot carver. 455794 455794 Research:Gillette research activities concentrate on clinical applications devoted to finding effective medical interventions for disabling conditions and their related effects. Research at Gillette consists of fourteen emphasis areas, all of which seek to improve the lives of children who have disabilities and complex conditions. These areas include bone health, cerebral palsy, craniofacial, epilepsy, gait and motion analysis, Legg-Calve-Perthes Disease, musculoskeletal, neuromuscular disease, pain and comfort, Rett syndrome, spina bifida, spine, upper extremities and nursing research.See Schedule O.During 2018, over 100 active studies were underway and 50 studies were published in peer-reviewed journals and manuscripts. Following are several examples of research studies and advancements:Gillette's Center for Gait and Motion Analysis actively measures and publishes short-term treatment outcomes. There is, however, limited data from any gait and motion center documenting long-term outcomes of treatments. The Long-Term Selective Dorsal Rhizotomy (SDR) Outcomes study examines the long-term effects of treatments for cerebral palsy-a comparison of SDR surgery to standard cerebral palsy treatments without SDR. This study examines matched cohorts of patients in early adulthood and assesses important factors such as pain, function and quality of life.Research continues on long-term outcomes associated with distal femoral extension osteotomy and patellar tendon advancement. Distal femoral extension osteotomy and patellar tendon advancement (DFEO-PTA) is a promising, relatively new treatment for persistent crouch gait in children and adolescents who have cerebral palsy. As pioneers in this treatment, Gillette's Center for Gait and Motion Analysis studies short-term outcomes and technique optimization for this surgery. We are now examining long-term outcomes to assess important issues such as maintaining the surgical correction and addressing later complications from the procedure.Research into pain assessment in nonverbal patients has also continued to move forward. Findings from a study on spasticity-related pain, experienced by patients before and after an intrathecal bump (ITB) pump placement, has been presented nationally and internationally, and research into assessing pain experienced by patients who have Rett syndrome (a rare disorder that primarily affects females) was published in the journal Paediatric Anaesthesia.Gillette is a leader in the treatment of, and research into, a rare orthopedic condition called Legg-Calve-Perthes (LCP). We participate in an international LCP study group and have the world's third-highest number of participants in this study group. Ongoing clinical and pre-clinical studies have prognostic, diagnostic and therapeutic implications for treatment of LCP. 1467978 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 1 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 3 3 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 19 17 1 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 MN WI X Kyle Eidem 6512912848 200 University Avenue East St Paul MN 55101 John Foster Chair 1.00 1.00 X X 0 0 0 John Ellenberger Vice Chair 1.00 1.00 X X 0 0 0 Dan Monson Secretary 1.00 1.00 X X 0 0 0 David Bestler Treasurer 1.00 1.00 X X 0 0 0 Warren Watson Past Chair 1.00 1.00 X X 0 0 0 Barbara Joers Chief Executive Officer 50.00 5.00 X X 0 780630 75990 Phil Becker Director 1.00 1.00 X 0 0 0 Fay DeBellis Director (End 1/23/18) 1.00 1.00 X 0 0 0 David Fettig Director 1.00 1.00 X 0 0 0 Jeffrey Freyer Director 1.00 1.00 X 0 0 0 Diane Harper Director 1.00 1.00 X 0 0 0 Linda Ireland Director 1.00 1.00 X 0 0 0 Mark Kimball Director 1.00 1.00 X 0 0 0 Kevin Klemz Director 1.00 1.00 X 0 0 0 Thomas Novacheck MD Chief of Staff 50.00 0.00 X 0 774294 76173 Scott Robinson Director 1.00 1.00 X 0 0 0 Rulon Stacey Director (Start 1/18) 1.00 1.00 X 0 0 0 Marshall Stanton MD Director 1.00 1.00 X 0 0 0 Phillip Trier Director 1.00 1.00 X 0 0 0 Martin Brad Winges Director 1.00 1.00 X 0 0 0 Dennis Jolley Foundation President 5.00 45.00 X 31529 283764 32415 James Haddican VP of Finance (End 1/18) 5.00 45.00 X 0 517295 6938 Erin Bailey Foundation Manager 10.00 0.00 X 25367 101468 33269 Rachel Wobschall Senior Major Gifts Officer 50.00 0.00 X 128511 0 19976 185407 2457451 244761 1 0 1 0 Bentz Whaley Flessner 7251 Ohms Lane Minneapolis MN 55439 Consulting Services 151779 1 855934 11133180 85291 11989114 789970 789970 422857 417491 5366 5366 5366 130266 855934 223561 -93295 -93295 41531 33727 7804 7804 12698959 0 0 709845 1421749 1421749 6421 6421 39808 39808 34770 34770 1279602 435113 844489 180712 125240 55472 122283 52519 69764 1772 784 988 100574 70402 30172 13632 3700 9932 7602 3889 3713 31496 22047 9449 Intercompany Expenses 510000 357000 153000 Dues & Memberships 465134 58908 406226 Meals 4826 2022 2804 Misc. 2263 1006 1257 -66234 1531 -67765 4156410 1467978 1168931 1519501 5161137 12031584 6361580 6460437 740473 327431 137843 16744 210000 288323 184975 184975 31496 0 11288099 10346928 23930628 29471447 7500 84011 26919 50257 1974316 537523 2008735 671791 X 14652399 14981365 5030473 11474948 2239021 2343343 21921893 28799656 23930628 29471447 8542549 -1698601 33815 0 X 0 1 X 1 0 X X 1 Gillette Children's Specialty Healthcare 363379150 3 1 1345440 0 1 1345440 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3379948 305455 -44439 22083 97420 3521461 3508732 225153 63058 328980 88015 3379948 3799706 183272 27865 406953 95158 3508732 3880733 145615 -15453 99923 111266 3799706 3282691 839883 28253 170053 100041 3880733 0.00000 0.67000 0.33000 0 0 184975 184975 0 0 Due to Gillette Children's Specialty Healthcare 456576 Gift Annuity Liability 80947 537523 X Part V, Line 4: The Foundation has endowment funds for capital, charity care, patient care, research and education, and unrestricted needs. These funds are used to improve and provide health care and related services to patients of Gillette. Part X, Line 2: As a result of the implementation of authoritative guidance on the accounting for uncertainty in income taxes, the organization was not required to recognize a liability. There were no unrecognized tax liabilities for the years ended December 31, 2018 and 2017. 1 0 0 0 0 0 0 0 0 0 North America Adaptive Equipment 39808 Check Adaptive Equipment FMV 0 1 0 0 0 0 0 0 Mauer & Friends Kids Classic 363258 353928 9330 33767 Friends of Gillette 300612 242412 58200 79904 4 322330 259594 62736 109890 986200 855934 130266 223561 223561 -93295 63529 21998 33727 0 63529 21998 33727 55725 7804 MN 1 A license is not required in the State of Minnesota for five or fewer raffles. The Foundation held four raffles this year. A State exempt permit was obtained on each of them. 0 1 0 0.00000 1.00000 Kyle Eidem 200 University Avenue E St Paul MN 55101 0 Dennis Jolley 0 Mr. Jolley oversees gaming activities conducted during the year. X 1 7804 1 GB Kids Inc 1470 Kingsview Lane N Plymouth MN 55447 411947042 7551 FMV Adaptive Equipment Prentke Romich Company 1022 Heyl Road Wooster OH 44691 341174227 5995 FMV Adaptive Equipment Strauss Skates & Bicycles 1751 East Cope Ave Maplewood MN 55109 411446679 38681 FMV Adaptive Equipment Gillette Children's Specialty Healthcare 200 University Avenue East St Paul MN 55101 363379150 501(c)(3) 1345440 FMV General Support 1 3 Adaptive Equipment 5 6421 FMV Part I, Line 2: Members of Gillette's hospital board are also members of the Foundation board, resulting in common control of both entities and the sharing of community oversight, strategic planning, financial oversight, and fundraising responsibilities equally among all board members. As a Type II support organization pursuant to IRC section 509(a)(3), Reg. 1.509(a)-4(f)(2)(ii), the Foundation grants monies to Gillette and maintains endowment funds, restricted and unrestricted assets, and contributions received to benefit Gillette. These funds held by the Foundation are granted to Gillette pursuant to the restrictions of the particular fund. Periodically, the Foundation receives financial reports from Gillette documenting the use of monies, including endowment funds, restricted funds, and unrestricted funds, received by Gillette. X X X X 1 1 0 0 0 0 0 1 0 Barbara Joers Chief Executive Officer 0 569284 0 120577 0 90769 0 37450 0 38540 0 856620 0 0 Thomas Novacheck MD Chief of Staff 0 645576 0 60245 0 68473 0 14575 0 61598 0 850467 0 0 Dennis Jolley Foundation President 23768 213917 3421 30789 4340 39058 1561 14050 1680 15124 34770 312938 0 0 James Haddican VP of Finance (End 1/18) 0 68610 0 49088 0 399597 0 4016 0 2922 0 524233 0 0 Erin Bailey Foundation Manager 23600 94402 1746 6984 21 82 1458 5832 5196 20783 32021 128083 0 0 Part I, Line 3 The chair of Gillette's Compensation Committee requests information from the external consultant. The Compensation Committee is empowered to evaluate the reasonableness of compensation. It does so in all cases by referencing recognized, objective resources on the reasonableness of and market value for the types of personnel and services being considered. That data is prepared for and distributed to the Compensation Committee members. Compensation policy is approved by the board of directors. Actions related to CEO/president and other executive compensation are discussed and voted upon at Compensation Committee meetings. Meeting minutes are recorded. Part I, Line 4a: James Haddican received severance payments of $376,980. Part I, Line 4b: Certain Gillette employees (executives and physicians) are eligible to participate in non-qualified deferred compensation plans. These plans comply with Section 457(f) of the Internal Revenue Code. These plans require employees to be executives or physicians to participate. Payments from the Plan occur annually by July 1 of the year following the end of the Plan year. The Plan is a "gap" plan, which provides participants with a deposit that closes the gap between the limits of IRC 403(b) and the actual cash compensation of the participant. None of the individuals received payments from the Plan. Part I, Line 7: Certain employees are eligible for an annual one-time award to recognize accomplishments. The amount and payment of the award is made at the discretion of the Compensation Committee of the Board of Directors. X 10 63293 Cost or Selling Price X Indian Motorcycle 2 21998 0 0 1 0 Part I, Column (b): The organization used the number of contributions recieved. Form 990, Part VI, Section A, line 2 Members of the Gillette hospital board are also members of the Foundation board, resulting in common control of both entities and the sharing of community oversight, strategic planning, financial oversight, and fundraising responsibilities equally among all board members. The following individuals have a business relationship: John Foster John Ellenberger Dan Monson David Bestler Warren Watson Barbara Joers Phil Becker Fay DeBellis David Fettig Jeffrey Freyer Diane Harper Linda Ireland Mark Kimball Kevin Klemz Thomas Novacheck, MD Scott Robinson Rulon Stacey Marshall Stanton Phillip Trier Martin (Brad) Winges Dennis Jolley James Haddican Form 990, Part VI, Section A, line 6 The Foundation has a sole member, Gillette Children's Specialty Healthcare, a Minnesota nonprofit corporation. Form 990, Part VI, Section A, line 7a The Foundation has a sole member, Gillette Children's Specialty Healthcare, a Minnesota nonprofit corporation which elects all members of the Foundation board. Form 990, Part VI, Section B, line 11b A copy of the form 990, including all supplemental schedules except schedule B, was provided to every member of the governing body before it was filed. Schedule B was redacted in order to protect donor confidentiality. The form was completed by a committee that included representatives from finance, human resources and communications. This committee prepared all the documentation necessary; the forms were compiled by Gillette's accounting firm. The draft documents were then reviewed by representatives from our Administrative Council. After all internal reviews were complete, the final version was presented to the finance committee and the board of directors for approval. Form 990, Part VI, Section B, line 12c Gillette enforces policies on external professional activities. Gillette employees, officers, volunteers, board members, and medical staff members are expected to disclose outside activities that involve potential conflicts of interests. In fact, directors must sign a conflict of interest statement acknowledging any potential conflicts related to Gillette. Gillette requires staff members to discuss potential conflicts with their immediate manager and with the compliance officer. The disclosure includes a written description of the activity, the extent of the staff member's participation, and the possible duration of the relationship. If a conflict exists, the employee must not engage in the activity. Form 990, Part VI, Section B, line 15 Foundation staff members are employed by Gillette. Gillette is the organization that actually pays the compensation and has the process for determining compensation as stated below. At the request of the Compensation Committee of the Gillette board, an independent consultant provides the committee with survey data and recommendations for chief executive officer (CEO)/president and other executive salary ranges based on Gillette's compensation philosophy, which was developed by the Compensation Committee and is reviewed regularly. The members of this committee determine the CEO/president's salary and the salary ranges for other executives. The committee oversees the executive incentive plan, approves any incentive plan payouts, and regularly evaluates the benefits provided to executives. The external consultant has provided total compensation data for all executives, and the committee has diligently followed the process for establishing a presumption of reasonableness. In addition to the oversight function of executive total compensation, the Compensation Committee oversees any payments under any incentive compensation plans and evaluates all transactions with "disqualified persons." Form 990, Part VI, Section C, line 19 Gillette posts an abbreviated audited financial statement to its website, www.gillettechildrens.org. Gillette's 990 form is available from the states of Minnesota and Wisconsin and at Guidestar.org. Gillette discloses financial statements to bondholders, the MHA and the Minnesota attorney general's office. The governing documents and conflict of interest policy are made available to the public upon request. Gillette Children's Specialty Healthcare 200 University Avenue East St Paul MN 55101 363379150 Hospital MN 501(c)(3) Line 3: 170(b)(1)(a) N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1