CHMC SURGICAL FOUNDATION INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- CHMC SURGICAL FOUNDATION INC (EIN 04-2767602)
- Tax period
- 2017-10-01 to 2018-09-30
- Filed
- 2019-08-13
- IRS object ID
- 201902259349301280
- Schema version
- 2017v2.3
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-08-13T14:31:07-05:00 | ReturnTs |
| Tax Period End | 2018-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 010494526 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Baker Newman & Noyes LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 280 Fore Street | AddressLine1Txt |
| City | Portland | CityNm |
| State Abbreviation | ME | StateAbbreviationCd |
| ZIP | 04101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 042767602 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHMC Surgical Foundation Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHMC | BusinessNameControlTxt |
| Phone | 6173554022 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 Longwood Avenue No Fegan3 | AddressLine1Txt |
| City | Boston | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02115 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Steven J Fishman MD | PersonNm |
| Person Title | Clerk | PersonTitleTxt |
| Phone | 6173554022 | PhoneNum |
| Signature | 2019-08-08 | SignatureDt |
| Discuss With Paid Preparer | 0 | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Nicholas E Porto | PreparerPersonNm |
| PTIN | P01310283 | PTIN |
| Phone | 8002447444 | PhoneNum |
| Preparation | 2019-08-08 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 208.105.168.164 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-08-08 | IPDt |
| IP Tm | 12:49:02 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 8D27C340D9F2F89D467D155AEFB91C71D643DA43 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 86AD5A998A217BD7885303F5109AB5202568ED7D | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Robert C Shamberger MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 Longwood Avenue No Fegan3 | AddressLine1Txt |
| City | Boston | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02115 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $35,694,108 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1982 | FormationYr |
| Legal Domicile State | MA | LegalDomicileStateCd |
| Activity Or Mission | The 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 Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 0 | VotingMembersIndependentCnt |
| Total Employee | 26 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | -$1,990 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $38,520 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $128,125 | PYContributionsGrantsAmt |
| CY Contributions Grants | $75,977 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,156,776 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $30,747,467 | CYProgramServiceRevenueAmt |
| PY Investment Income | $447,324 | PYInvestmentIncomeAmt |
| CY Investment Income | $657,727 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $322,077 | CYOtherRevenueAmt |
| PY Total Revenue | $29,732,225 | PYTotalRevenueAmt |
| CY Total Revenue | $31,803,248 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $7,844,387 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,086,915 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $23,214,631 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $23,453,104 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,485,396 | PYOtherExpensesAmt |
| CY Other Expenses | $3,452,050 | CYOtherExpensesAmt |
| PY Total Expenses | $34,544,414 | PYTotalExpensesAmt |
| CY Total Expenses | $27,992,069 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$4,812,189 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,811,179 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $51,850,709 | TotalAssetsBOYAmt |
| Total Assets EOY | $57,108,153 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $22,228,008 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $20,395,537 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $29,622,701 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $36,712,616 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | The 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 Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $23,129,696 | ExpenseAmt |
| Grant | $1,086,915 | GrantAmt |
| Revenue | $26,374,838 | RevenueAmt |
| Desc | The 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $519,768 | ExpenseAmt |
| Revenue | $577,081 | RevenueAmt |
| Desc | The Foundation receives income from Boston Children's Hospital for providing administration, supervision, and teaching services. The Foundation carries on and promotes basic and applied medical research and education in the field of 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $2,338,958 | ExpenseAmt |
| Revenue | $3,795,548 | RevenueAmt |
| Desc | The Foundation provides clinical services in certain clinics and satellite locations of Boston Children's Hospital (the Hospital) at agreed upon rates for reimbursement. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $25,988,422 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (1) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 1 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 26 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 0 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MA | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tom Jaksic MD | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6173554022 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 Longwood Avenue | AddressLine1Txt |
| City | Boston | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02115 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Institutional TrusteeInstitutionalTrusteeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Robert C Shamberger MD | |||||||||
| President | 55.00 | 5.00 | Yes (X) | Yes (X) | $1,001,302 | $0 | $106,635 | ||
| Steven J Fishman MD | |||||||||
| Clerk | 45.00 | 15.00 | Yes (X) | Yes (X) | $1,081,688 | $0 | $136,841 | ||
| Tom Jaksic MD | |||||||||
| Treasurer | 60.00 | 0.00 | Yes (X) | Yes (X) | $952,759 | $0 | $177,199 | ||
| Heung Bae Kim MD | |||||||||
| Director | 60.00 | 0.00 | Yes (X) | $807,823 | $0 | $152,081 | |||
| Craig W Lillehei MD | |||||||||
| Director | 60.00 | 0.00 | Yes (X) | $736,592 | $0 | $96,000 | |||
| Physicians Org at CH Inc | |||||||||
| Independent Board Member | 2.00 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| Terry L Buchmiller MD | |||||||||
| Physician | 60.00 | 0.00 | $865,115 | $0 | $103,959 | Yes (X) | |||
| Russell Jennings MD | |||||||||
| Physician | 60.00 | 0.00 | $851,621 | $0 | $187,635 | Yes (X) | |||
| David P Mooney MD | |||||||||
| Physician | 60.00 | 0.00 | $797,324 | $0 | $132,451 | Yes (X) | |||
| Mark Puder MD | |||||||||
| Physician | 60.00 | 0.00 | $786,502 | $0 | $130,438 | Yes (X) | |||
| Biren P Modi MD | |||||||||
| Physician | 60.00 | 0.00 | $746,949 | $0 | $162,761 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $8,627,675 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,386,000 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 23 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Boston Medical Center | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | One Boston Medical Center Pl | AddressLine1Txt |
| City | Boston | CityNm |
| State Abbreviation | MA | StateAbbreviationCd |
| ZIP | 02118 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | Medical services | ServicesDesc |
| Compensation | $129,167 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $70,977 | RelatedOrganizationsAmt |
| All Other Contributions | $5,000 | AllOtherContributionsAmt |
| Total Contributions | $75,977 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 621300 | $26,374,838 | $26,374,838 |
| Clinical and other revenue | 621300 | $3,795,548 | $3,795,548 |
| Education and research | 611710 | $577,081 | $577,081 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $30,747,467 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $430,330 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | -$1,990 | UnrelatedBusinessRevenueAmt |
| Exclusion | $432,320 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,118,257 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,890,860 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $227,397 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $227,397 | TotalRevenueColumnAmt |
| Exclusion | $227,397 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Insurance rebate | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $322,077 | TotalRevenueColumnAmt |
| Exclusion | $322,077 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $322,077 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,803,248 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $30,747,467 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$1,990 | UnrelatedBusinessRevenueAmt |
| Exclusion | $981,794 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,086,915 | TotalAmt |
| Program Services | $1,086,915 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,434,410 | TotalAmt |
| Program Services | $4,434,410 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,968,982 | TotalAmt |
| Program Services | $13,569,536 | ProgramServicesAmt |
| Management And General | $1,399,446 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,483,867 | TotalAmt |
| Program Services | $1,483,867 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,013,198 | TotalAmt |
| Program Services | $1,635,602 | ProgramServicesAmt |
| Management And General | $377,596 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $552,647 | TotalAmt |
| Program Services | $502,909 | ProgramServicesAmt |
| Management And General | $49,738 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,853 | TotalAmt |
| Management And General | $7,853 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,551 | TotalAmt |
| Management And General | $32,551 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,610 | TotalAmt |
| Management And General | $23,610 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $95,163 | TotalAmt |
| Program Services | $95,163 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $732,529 | TotalAmt |
| Program Services | $662,681 | ProgramServicesAmt |
| Management And General | $69,848 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $221,719 | TotalAmt |
| Program Services | $221,719 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $411 | TotalAmt |
| Program Services | $411 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,632 | TotalAmt |
| Program Services | $156,632 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,732 | TotalAmt |
| Program Services | $3,732 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $402,854 | TotalAmt |
| Program Services | $359,849 | ProgramServicesAmt |
| Management And General | $43,005 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| PO Dues | $676,144 | $676,144 |
| Billing and collection | $533,998 | $533,998 |
| Coordinated Specialty P | $337,381 | $337,381 |
| Bad debt expense | $204,753 | $204,753 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,720 | TotalAmt |
| Program Services | $22,720 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,992,069 | TotalAmt |
| Program Services | $25,988,422 | ProgramServicesAmt |
| Management And General | $2,003,647 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,452,182 | BOYAmt |
| EOY | $4,804,561 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $859,357 | BOYAmt |
| EOY | $817,728 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,548,865 | BOYAmt |
| EOY | $4,607,808 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,000 | BOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $657,000 | BOYAmt |
| EOY | $568,367 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $193,637 | BOYAmt |
| EOY | $185,129 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $48,540 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $21,942 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,331 | BOYAmt |
| EOY | $26,598 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,371,625 | BOYAmt |
| EOY | $27,982,073 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,420,847 | BOYAmt |
| EOY | $14,276,290 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,297,865 | BOYAmt |
| EOY | $3,839,599 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,850,709 | BOYAmt |
| EOY | $57,108,153 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $96,884 | BOYAmt |
| EOY | $102,803 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,943,964 | BOYAmt |
| EOY | $4,324,464 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,187,160 | BOYAmt |
| EOY | $15,968,270 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,228,008 | BOYAmt |
| EOY | $20,395,537 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,738,739 | BOYAmt |
| EOY | $34,828,707 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,883,962 | BOYAmt |
| EOY | $1,883,909 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,622,701 | BOYAmt |
| EOY | $36,712,616 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,850,709 | BOYAmt |
| EOY | $57,108,153 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,811,179 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,820,965 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $1,457,771 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $267,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $60,000 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus1 Year | $128,125 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $75,977 | CurrentTaxYearAmt |
| Total | $531,102 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $24,164,215 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $24,972,218 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,167,996 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $29,156,776 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $30,747,466 | CurrentTaxYearAmt |
| Total | $136,208,671 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $24,431,215 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $25,032,218 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,167,996 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $29,284,901 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $30,823,443 | CurrentTaxYearAmt |
| Total | $136,739,773 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $136,739,773 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $315,432 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $367,136 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $368,706 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $394,620 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $432,320 | CurrentTaxYearAmt |
| Total | $1,878,214 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $315,432 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $367,136 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $368,706 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $394,620 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $432,320 | CurrentTaxYearAmt |
| Total | $1,878,214 | TotalAmt |
Net Income From Other UBI NetIncomeFromOtherUBIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,254 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,555 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $1,946 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $3,060 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | -$1,990 | CurrentTaxYearAmt |
| Total | $8,825 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus2 Years | $273,327 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year | $322,077 | CurrentTaxYearAmt |
| Total | $595,404 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $24,748,901 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $25,402,909 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $27,811,975 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $29,682,581 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $31,575,850 | CurrentTaxYearAmt |
| Total | $139,222,216 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.98220 | PublicSupportCY509Pct |
| Public Support PY509 | 0.98410 | PublicSupportPY509Pct |
| Investment Income CY | 0.01350 | InvestmentIncomeCYPct |
| Investment Income PY | 0.01370 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part III, Line 12, Explanation of Other Income: | FormAndLineReferenceDesc |
| Explanation | Insurance rebate - 2015 Amount: $ 273,327. 2017 Amount: $ 322,077. | ExplanationTxt |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,883,962 | BeginningYearBalanceAmt |
| Other Expenditures | $53 | OtherExpendituresAmt |
| End Year Balance | $1,883,909 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,051,785 | BeginningYearBalanceAmt |
| Other Expenditures | $1,167,823 | OtherExpendituresAmt |
| End Year Balance | $1,883,962 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,641,282 | BeginningYearBalanceAmt |
| Other Expenditures | $1,589,497 | OtherExpendituresAmt |
| End Year Balance | $3,051,785 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,659,481 | BeginningYearBalanceAmt |
| Contributions | $60,000 | ContributionsAmt |
| Other Expenditures | $78,199 | OtherExpendituresAmt |
| End Year Balance | $4,641,282 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,399,981 | BeginningYearBalanceAmt |
| Contributions | $267,000 | ContributionsAmt |
| Other Expenditures | $7,500 | OtherExpendituresAmt |
| End Year Balance | $4,659,481 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $48,540 | OtherCostOrOtherBasisAmt |
| Depreciation | $21,942 | DepreciationAmt |
| Book Value | $26,598 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $26,598 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Interest in the P.O. Pooled Investment Fund | Desc |
| Book Value | $14,276,290 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $14,276,290 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (10 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due from Boston Children's Hospital | $407,957 |
| Due from Physicians Org. at CH, Inc. | $602,699 |
| Due from Dana Farber Cancer Institute | $55,554 |
| Due from Harvard Medical School | $321,313 |
| Due from Boston Medical Center | $240,155 |
| Due from New England Organ Bank | $13,861 |
| Due from CHPA, Inc. | $12,500 |
| Malpractice Claims receivable | $1,895,255 |
| Due from COSF, Inc. | $1,056 |
| Prepaid Defined Benefit Pension Plan | $289,249 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,839,599 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (8 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to Boston Children's Hospital | $1,824,847 |
| Due to Physicians Org. at CH, Inc | $518,793 |
| Due to Boston Medical Center | $16,833 |
| Accrued salaries and benefits | $3,772,852 |
| Accrued deferred compensation | $7,191,232 |
| Accrued professional liability | $2,318,583 |
| Due to Harvard | $300,000 |
| Due to CHMC Anesthesia Foundation, Inc. | $25,130 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $15,968,270 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $35,081,984 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $1,820,965 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $1,457,771 | OtherRevenueAmt |
| Revenue Not Reported | $3,278,736 | RevenueNotReportedAmt |
| Revenue Subtotal | $31,803,248 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $31,803,248 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $27,992,069 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $27,992,069 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $27,992,069 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2018. The Foundation's tax years from 2015 through 2018 are potentially subject to examination. |
| Part XI, Line 2d - Other Adjustments: | Pension adjustment 1,457,771. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|---|
| Boston Children's Hospital | |||||||||
| 300 Longwood Avenue | Boston | MA | 02115 | 042774441 | 501(c)(3) | $776,054 | N/A | N/A | Research |
| Harvard Medical School | |||||||||
| 1033 Massachusetts Avenue Ste 3 | Cambridge | MA | 02138 | 042103580 | 501(c)(3) | $300,000 | N/A | N/A | General Support |
| American Pediatric Surgery Association | |||||||||
| One Parkview Plaza Ste 5800 | Oakbrook Terrace | IL | 60181 | 237097289 | 501(c)(3) | $10,000 | N/A | N/A | General Support |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | Monitoring 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, 2018, the Foundation only provided grant donations to other 501(c)(3) organizations. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Robert C Shamberger MD | ||||||||||||||
| President | $773,539 | $0 | $195,117 | $0 | $32,646 | $0 | $66,806 | $0 | $39,829 | $0 | $1,107,937 | $0 | $0 | $0 |
| Steven J Fishman MD | ||||||||||||||
| Clerk | $711,280 | $0 | $334,600 | $0 | $35,808 | $0 | $95,323 | $0 | $41,518 | $0 | $1,218,529 | $0 | $0 | $0 |
| Tom Jaksic MD | ||||||||||||||
| Treasurer | $673,574 | $0 | $246,793 | $0 | $32,392 | $0 | $135,024 | $0 | $42,175 | $0 | $1,129,958 | $0 | $0 | $0 |
| Heung Bae Kim MD | ||||||||||||||
| Director | $536,208 | $0 | $240,710 | $0 | $30,905 | $0 | $107,003 | $0 | $45,078 | $0 | $959,904 | $0 | $0 | $0 |
| Craig W Lillehei MD | ||||||||||||||
| Director | $520,529 | $0 | $175,249 | $0 | $40,814 | $0 | $54,000 | $0 | $42,000 | $0 | $832,592 | $0 | $0 | $0 |
| Terry L Buchmiller MD | ||||||||||||||
| Physician | $560,731 | $0 | $272,876 | $0 | $31,508 | $0 | $85,627 | $0 | $18,332 | $0 | $969,074 | $0 | $0 | $0 |
| Russell Jennings MD | ||||||||||||||
| Physician | $591,010 | $0 | $228,456 | $0 | $32,155 | $0 | $142,133 | $0 | $45,502 | $0 | $1,039,256 | $0 | $0 | $0 |
| David P Mooney MD | ||||||||||||||
| Physician | $541,744 | $0 | $223,547 | $0 | $32,033 | $0 | $89,168 | $0 | $43,283 | $0 | $929,775 | $0 | $0 | $0 |
| Mark Puder MD | ||||||||||||||
| Physician | $492,524 | $0 | $262,069 | $0 | $31,909 | $0 | $89,168 | $0 | $41,270 | $0 | $916,940 | $0 | $0 | $0 |
| Biren P Modi MD | ||||||||||||||
| Physician | $417,895 | $0 | $298,768 | $0 | $30,286 | $0 | $120,125 | $0 | $42,636 | $0 | $909,710 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 1a | The 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 4b | CHMC 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, 2018, 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; David P. Mooney, MD, $30,000; and Biren P. Modi, $72,000. |
| Part I, Line 7 | Bonus 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 O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The 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 3 | The 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 6 | CHMC 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 7a | According 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 7b | The 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 11b | The detailed review will be conducted by the President of the Foundation, Robert C. Shamberger, 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 12c | The 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 15 | Faculty compensation must comply with the Boston Children's Hospital (the Hospital) Physician Compensation Guidelines. These guidelines are developed in consultation with an independent external compensation consulting firm and are approved by the independent Compensation Committee of the Board of Children's Medical Center Corporation and the Hospital. The guidelines set the maximum compensation limits based on a peer group analysis for 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 19 | The Foundation maintains all financial records, conflict of interest policies, and governing documents at its main office at 300 Longwood Avenue, Boston, MA 02115. The documents are available upon request. |
| Form 990, Part XI, line 9: | Pension adjustment 1,457,771. |
| 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/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Boston Children's Hospital | ||||||||||
| 300 Longwood Avenue | Boston | MA | 02115 | 042774441 | Hospital | MA | 501(c)(3) | Line 3 | N/A | 0 |
| Physicians Organization at Children's Hospital Inc | ||||||||||
| 300 Longwood Avenue | Boston | MA | 02115 | 043266103 | Management services | MA | 501(c)(3) | Line 12c, III-FI | N/A | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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