2018-11-14T09:44:50-06:00 2017-12-31 861065772 Deloitte Tax LLP 50 South Sixth Street Ste 2800 Minneapolis MN 55402 990 2017-01-01 411200302 Gillette Children's Hospital Foundation GILL 6512912848 200 University Avenue East St Paul MN 55101 Barbara Joers President 6512912848 2018-11-13 1 Kristina Rasmussen P00143920 6123974000 183.83.198.7 2018-11-13 13:00:52 US P 2BAB4CF4FDA6361F54564B4DE839E61C759617F3 5D9F48D552B520B2386016971BC58EBB7C5BCF28 2017 2019-02-21 02:37:17Z Dennis Jolley 200 University Avenue East St Paul MN 55101 10144901 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 0 116 0 0 7244908 6895732 0 0 248446 827301 -88527 -163565 7404827 7559468 2972306 6071614 0 0 1288060 1360564 0 0 1524785 1106492 1156699 5366858 8588877 2037969 -1029409 22928165 23930628 820841 2008735 22107324 21921893 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 3636067 3636067 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. 1300186 1300186 Capital:The Gillette Children's 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. See Schedule O.During 2017, the Foundation transferred funds to support the renovation of Gillette's Inpatient Rehabilitation Unit. This unit houses patients who have experienced brain or spinal cord injuries, as well as children who are recovering from major surgeries. Patients typically stay on this unit anywhere from six weeks to several months. The renovation created 17 single inpatient rooms, three of which feature high-tech equipment that gives trauma patients the ability to control their environment using their voice, eye gaze or head movements. Gillette is the only pediatric hospital in Minnesota to offer such "smart rooms." Gillette offers the region's largest inpatient rehabilitation program for children and teens, and is among only eight hospitals in the U.S. to hold Commission for Accreditation of Rehabilitation Facilities (CARF) accreditation for both its brain injury program and pediatric specialty program.Foundation funds also supported improvements to Gillette's St. Paul Clinic entrance, check-in and waiting spaces. For instance, the outpatient check-in space is significantly more spacious and designed to meet the needs of children with sensory issues. The hospital's entrance, which is located inside a parking ramp, is brightly-lit and now features a spacious and temperature-controlled space where families can wait while a valet service retrieves their vehicle. These renovations have significantly enhanced the patient experience. The American Institute of Architects-Minnesota Chapter recognized this, naming their tour of Gillette the #1 tour of their 2017 annual conference. 1135361 1135361 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. See Schedule O.During 2017, 106 active studies were underway and 37 studies were published in peer-reviewed journals. Following are several examples of research advancements during 2017: Gillette pioneered a technique for craniosynostosis repair surgery that doesn't require babies to undergo a blood transfusion; a major advancement in patient safety. Data surrounding the transfusion-less technique existed, but hadn't been compiled, formatted and analyzed-a necessity for findings to be publicized. Funding made it possible for a craniofacial resident to analyze the data, allowing findings to be presented as a podium presentation at the Midwestern Association of Plastic Surgeons conference. Gillette will also be submitting the findings to a prestigious journal, Plastic and Reconstructive Surgery. 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-Calv-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. 6071614 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 2 2 1 0 0 0 0 0 0 1 1 0 0 0 0 X 19 17 1 0 0 0 1 1 0 1 1 0 0 0 1 1 1 0 0 1 1 0 MN WI X Kyle Eidem 6512912848 200 University Avenue East St Paul MN 55101 Warren Watson Chair 1.00 1.00 X X 0 0 0 John Foster Vice Chair 1.00 1.00 X X 0 0 0 Mark Kimball Secretary 1.00 1.00 X X 0 0 0 David Bestler Treasurer 1.00 1.00 X X 0 0 0 Barbara Joers Chief Executive Officer 5.00 45.00 X X 0 743371 72674 Phil Becker Director 1.00 1.00 X 0 0 0 Fay DeBellis Director 1.00 1.00 X 0 0 0 John Ellenberger Director 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 Michael Healy MD Prior Chief of Staff (End 01/17) 0.00 50.00 X 0 634537 57229 Linda Ireland Director 1.00 1.00 X 0 0 0 Kevin Klemz Director 1.00 1.00 X 0 0 0 Dan Monson Director 1.00 1.00 X 0 0 0 Tom Novacheck Chief of Staff (Start 01/17) 0.00 50.00 X 0 697150 48561 Scott Robinson Director 1.00 1.00 X 0 0 0 Marshall Stanton Director (Start 01/17) 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 14733 279924 27056 James Haddican VP of Finance 5.00 45.00 X 0 420849 52429 Erin Bailey Foundation Manager (Start 10/17) 10.00 0.00 X 21459 87278 26029 Elizabeth Utter Manager Foundation (End 10/17) 50.00 0.00 X 124062 0 7182 Rachel Wobschall Senior Major Gifts Officer 50.00 0.00 X 118223 0 18929 278477 2863109 310089 2 0 1 0 0 1372027 5523705 121805 6895732 515537 515537 2523943 2212179 311764 311764 311764 151360 1372027 352159 -200799 -200799 58329 21095 37234 37234 7559468 0 0 663736 6010135 6010135 29070 29070 32409 32409 16085 16085 1344479 428488 915991 73838 46887 26951 139372 49717 89655 1320 397 923 72858 46265 26593 20091 5130 14961 7504 2893 4611 36995 23492 13503 Intercompany Expenses 500000 317500 182500 Dues & Memberships 343934 48462 295472 Meals 11346 3203 8143 Minor Equipment 4035 2505 1530 -54594 1454 -56048 8588877 6071614 992478 1524785 5317851 5161137 6343059 6361580 1103232 740473 325166 137843 196063 210000 255132 223636 68491 31496 9574303 11288099 22928165 23930628 23574 7500 14321 26919 782946 1974316 820841 2008735 X 14231016 14652399 5637287 5030473 2239021 2239021 22107324 21921893 22928165 23930628 -1029409 843978 0 X 0 1 X 1 0 X X 1 Gillette Children's Specialty Healthcare 363379150 3 1 5939265 0 1 5939265 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 3508732 225153 63058 328980 88015 3379948 3799706 183272 27865 406953 95158 3508732 3880733 145615 -15453 99923 111266 3799706 3282691 839883 28253 170053 100041 3880733 3365618 105570 303267 362928 128836 3282691 0.00000 0.61000 0.39000 0 0 255132 223636 31496 31496 Due to Gillette Children's Specialty Healthcare 1889126 Gift Annuity Liability 85190 1974316 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, 2017 and 2016. 1 0 0 0 0 0 0 0 0 0 North America Adaptive Equipment 32409 Check Adaptive Equipment FMV 0 1 0 0 0 0 0 0 120 Gala 412137 385737 26400 118820 Mauer & Friends Kids Classic 332346 322746 9600 29254 5 778904 663544 115360 204085 1523387 1372027 151360 352159 352159 -200799 58329 21095 0 58329 21095 21095 37234 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 0 1 Strauss Skates & Bicycles 1751 East Cope Ave Maplewood MN 55109 411446679 11529 FMV Adaptive Equipment Reliable Medical Supply 9401 Winnetka Av n Brooklyn Park MN 55445 411631370 5000 FMV Adaptive Equipment Handi Medical Supply Inc 2505 University Avenue W St Paul MN 55114 411668164 5315 FMV Adaptive Equipment Daveport Group Inc 4166 Lexington Avenue N St Paul MN 55126 562361678 7160 FMV Adaptive Equipment Gillette Children's Specialty Healthcare 200 University Avenue East St Paul MN 55101 363379150 501(c)(3) 5939265 FMV General Support 1 4 Adaptive Equipment 1 5000 FMV Adaptive Equipment 1 5000 FMV Patient Care Grant 11 19070 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 0 1 0 0 0 0 0 1 0 Barbara Joers Chief Executive Officer 0 552886 0 104976 0 85509 0 34224 0 38450 0 816045 0 0 Michael Healy MD Prior Chief of Staff (End 01/17) 0 586158 0 10419 0 37960 0 14310 0 42919 0 691766 0 0 Tom Novacheck Chief of Staff (Start 01/17) 0 620578 0 7639 0 68933 0 14310 0 34251 0 745711 0 0 Dennis Jolley Foundation President 11320 215061 1444 27451 1969 37412 530 10061 822 15643 16085 305628 0 0 James Haddican VP of Finance 0 327734 0 43356 0 49759 0 18720 0 33709 0 473278 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 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. Barbara Joers: $18,000 James Haddican: $18,000 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 8 82789 Cost or selling price X Event 1 34100 X Food 1 2916 X Printing 1 2000 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: Warren Watson John Foster Mark Kimball David Bestler Barbara Joers Phil Becker Fay DeBellis John Ellenberger David Fettig Jeffrey Freyer Diane Harper Michael Healy Linda Ireland Kevin Klemz Dan Monson Tom Novacheck Scott Robinson 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 the executive leadership team. 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 the annual 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. Form 990, Part VI, Section B, Line 14: Foundation employees are expected to follow all hospital policies. The code-of-conduct, document-retention, and document-destruction policies authored by the hospital hence are followed by the Foundation staff. Gillette Children's Specialty Healthcare 200 University Avenue E 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