2018-08-13T08:01:55-05:00 2017-09-30 010494526 Baker Newman & Noyes LLC 280 Fore Street Portland ME 04101 990 2016-10-01 042764370 CHMC Cardiovascular Surgical Foundation Inc CHMC 6173557008 300 Longwood Avenue Boston MA 02115 Pedro del Nido MD President 6173557008 2018-08-09 0 Nicholas E Porto P01310283 8002447444 2018-08-09 2016 2022-09-23 18:48:47Z Pedro del Nido MD 300 Longwood Avenue Boston MA 02115 17879517 0 X N/A X 1982 MA The Foundation provides cardiovascular services primarily to patients at (see Schedule O) Boston Children's Hospital and at satellite locations. 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. 6 0 8 0 263 0 0 0 16177165 17349315 191238 430202 0 0 16368403 17779517 1721004 4215557 0 0 11529814 12386658 0 0 0 1813786 2638712 15064604 19240927 1303799 -1461410 33259072 37533449 15654463 18300033 17604609 19233416 X The Foundation provides cardiovascular 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 cardiovascular surgery (see Schedule O) by teaching students and other medical and scientific personnel. The Foundation also provides care for patients regardless of their ability to pay. 0 0 16970195 4215557 16872264 The Foundation provides cardiovascular services primarily to patients at Boston Children's Hospital and at satellite locations. The Foundation may charge for patient care and other medical services, provided that any net income is used 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 supporting hospital and community based services that are either unavailable or limited elsewhere in the community. 524851 477051 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 cardiovascular surgery by teaching students and other medical and scientific personnel; by providing research grants; giving lectures; and publishing information concerning problems and research results in the field of pediatric cardiovascular surgery in order to educate the general public and the medical profession. 17495046 1 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 8 1 0 0 0 0 0 0 0 0 0 0 X 6 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X John E Mayer Jr MD 6173557008 300 Longwood Ave Boston MA 02115 Pedro del Nido MD President 55.00 5.00 X X 2022805 0 34764 John E Mayer Jr MD Treasurer/Secretary 60.00 0.00 X X 942878 0 31516 Sitaram M Emani MD Director 60.00 0.00 X 914406 0 31481 Aditya K Kaza MD Director 60.00 0.00 X 808160 0 31099 Christopher W Baird MD Director 60.00 0.00 X 806007 0 32181 Francis Fynn-Thompson MD Director 60.00 0.00 X 802924 0 34156 Physicians Org at CH Inc Institutional Trustee 2.00 0.00 X 0 0 0 Jorge Salazar MD Physician 60.00 0.00 X 365531 0 12565 6662711 0 207762 7 0 1 0 Winslow Wealth Management 175 Federal Street Boston MA 02110 Investment Management 151372 1 Patient Service Revenue 621300 16507246 16507246 Education & Research 611710 477051 477051 Other Revenue 621990 365018 365018 17349315 414544 263 414281 115658 100000 15658 15658 15658 17779517 17349315 263 429939 4215557 4215557 6912172 6912172 3679184 2594396 1084788 623883 623883 978276 683052 295224 193143 193143 78752 78752 62919 62919 151302 151302 23596 23596 316887 280849 36038 80821 80821 2074 2074 19156 19156 382568 369306 13262 PO dues 455407 455407 Bad debt expense 426494 426494 Billing services 318739 318739 Coordinated Specialty P 314270 314270 5727 5727 19240927 17495046 1745881 0 X 1314442 2469062 6467360 4605600 2347161 2665940 2200000 2880000 450952 686387 586888 117769 95231 41694 22538 19102348 23129565 568894 577345 79834 596511 33259072 37533449 15515 80254 3004696 462503 243753 15176445 14971330 15654463 18300033 X 17091313 18985280 513296 248136 17604609 19233416 33259072 37533449 X -1461410 2397374 692843 X X 0 1 X 1 0 X 11943451 12829808 12928195 16177165 17349315 71227934 11943451 12829808 12928195 16177165 17349315 71227934 0 0 0 71227934 142399 242441 258290 295609 414281 1353020 142399 242441 258290 295609 414281 1353020 1331 882 263 2476 -14938 -14938 12070912 13072249 13187816 16473656 17763859 72568492 0.98150 0.98330 0.01860 0.01710 X Schedule A, Part III, Line 12, Explanation of Other Income: Miscellaneous revenue - 2012 Amount: $ -14,938. 513296 265160 248136 765821 252525 513296 1973000 1207179 765821 0 1973000 1973000 1128433 1128433 0.00000 0.00000 1.00000 0 0 117769 95231 22538 22538 Due to Boston Children's Hospital 1367946 Due to Physicians Organization 170241 Due to affiliates 16913 Patient deposits 1684490 Accrued pension obligation 2104288 Accrued professional liability 333994 Accrued profit sharing plan 324000 Accrued severance benefit 8273025 Deferred compensation plan 696433 14971330 X 20869734 2397374 692843 3090217 17779517 0 17779517 19240927 0 19240927 0 19240927 Part V, Line 4: The endowment funds represent assets held in trust that are available for physician recruitment whose use has been restricted by donors to a specific time period or purpose. Part X, Line 2: The Foundation is a tax-exempt corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code), and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. In addition, the Foundation qualifies for the charitable contribution deduction under Section 170(b)(1)(A), and has been classified as an organization that is not a private foundation under Section 509(a)(2). Tax-exempt organization 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, 2017. The Foundation's tax years from 2014 through 2017 are potentially subject to examination. Part XI, Line 2d - Other Adjustments: Pension adjustment 692,843. 1 Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 501(c)(3) 4204007 N/A N/A General Support 1 0 Part I, Line 2: Monitoring is provided by CHMC Cardiovascular Surgical Foundation, Inc. (the Foundation) through oversight of the terms and conditions of a written grant agreement. Multi-year agreements require yearly progress and financial reports for continuation of funding. During the year ended September 30, 2017, the Foundation only provided grant donations to other 501(c)(3) organizations. X 1 1 X X X X X 1 1 0 0 0 0 0 1 0 Pedro del Nido MD President 1528050 0 25000 0 469755 0 0 0 34764 0 2057569 0 0 0 John E Mayer Jr MD Treasurer/Secretary 802202 0 0 0 140676 0 0 0 31516 0 974394 0 0 0 Sitaram M Emani MD Director 651912 0 0 0 262494 0 0 0 31481 0 945887 0 0 0 Aditya K Kaza MD Director 572750 0 0 0 235410 0 0 0 31099 0 839259 0 0 0 Christopher W Baird MD Director 589662 0 0 0 216345 0 0 0 32181 0 838188 0 0 0 Francis Fynn-Thompson MD Director 589662 0 0 0 213262 0 0 0 34156 0 837080 0 0 0 Jorge Salazar MD Physician 333333 0 0 0 32198 0 0 0 12565 0 378096 0 0 0 Part I, Line 1a The Foundation provides gross-up payments for mortgage forgiveness, tuition payments, 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, Lines 4a-b The Foundation established the CHMC Cardiovascular Surgical 2005 Supplemental Executive Retirement Plan (the SERP), effective as of January 1, 2005, to reward licensed physician employees with a benefit based on service. The SERP's sources of contributions are from employer discretionary amounts (if any), severance benefit, and elective deferrals. The amounts are vested after five years, attainment of age 63, death, disability, or change in control. The Foundation made SERP payments to the following individual during the year ended September 30, 2017: Christopher W. Baird, MD $288,000. Part I, Line 4b: The Foundation has a deferred compensation arrangement under a nonqualified defined contribution plan to provide supplemental retirement benefits to certain employees. The Foundation made defined compensation payments to the following individuals during the year ended September 30, 2017: Pedro del Nido, MD $18,000; John E. Mayer, Jr., MD $18,000; Sitaram Emani, MD $18,000; Aditya K. Kaza, MD $18,000; Christopher W. Baird, MD $18,000; and Francis Fynn-Thompson, MD $18,000. Part I, Line 7 Bonus compensation amounts are determined by the Chief of CHMC Cardiovascular Surgical Foundation, Inc. (the Foundation). The amounts are discretionary based on job performance and on the financial performance of the Foundation. Pedro del Nido MD President Retention X 2000000 400000 0 1 1 Sitaram M Emani MD Director Retention X 500000 100000 0 1 1 Francis Fynn-Thompson MD Director Retention X 500000 100000 0 1 1 Francis Fynn-Thompson MD Director Retention X 780000 780000 0 1 1 John E Mayer Jr MD Treasurer/Secretary Retention X 500000 100000 0 1 1 Aditya K Kaza MD Director Housing X 400000 280000 0 1 1 Aditya K Kaza MD Director Retention X 780000 780000 0 1 1 Christopher W Baird MD Director Housing X 600000 320000 0 1 1 Jorge Salazar MD Physician Housing X 450952 20000 0 1 1 2880000 Schedule L, Part II: The Foundation has provided secured forgivable loans to employees. The loans bear carrying interest rates up to 1.94%. In most cases, the Foundation forgives an amount equal to 20% of the principal value for each year of continued employment. The amount forgiven is included in the employee's W-2 during the year of forgiveness. At September 30, 2017, the balance of the loans outstanding is $1,658,400. Future principal balances due are $1,232,000 in 2018; $492,000 in 2019; $472,000 in 2020; $372,000 in 2021; and $312,000 in 2022. Form 990, Part VI, Section A, line 1 A majority of CHMC Cardiovascular 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 the 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 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 on the PO's rights. Form 990, Part VI, Section A, line 3 The Physicians Organization at Children's Hospital, Inc. (the PO) is the Class "C" member of CHMC Cardiovascular 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 Cardiovascular Surgical Foundation, Inc. (the Foundation) has three classes of members. The Chief of the Department of Cardiac Surgery (the Department) of Boston Children's Hospital (the Hospital) is the sole Class "A" member. Any member of the Department (other than the Chief) who holds a professional staff appointment from Harvard Medical School, and who is geographically full-time at the Hospital shall be a Class "B" member. Other physicians' upon recommendation from the Chief and approval from the President of the Hospital may be permitted to be Class "B" members. The Physicians Organization at Children's Hospital, Inc. is the Class "C" member of the Foundation. Form 990, Part VI, Section A, line 7a According to the Articles of Organization, the Class "A" member is the Chief of the Department of Cardiac Surgery (the Department) of Boston Children's Hospital (the Hospital). Any other member of the Department who holds a professional staff appointment in cardiovascular surgery at the Hospital, has a full-time faculty appointment from Harvard Medical School, and who is geographically full-time at the Hospital shall be a Class "B" member. A Class "A or "B" member shall hold membership as long as he/she remains qualified for membership. Only Class "A and "B" members may vote in annual meetings or other elections, serve on the Hospital's Board of Trustees, or nominate candidates for election to the Board. Form 990, Part VI, Section A, line 7b The Physicians Organization at Children's Hospital, Inc. (the PO) is the Class "C" member of CHMC Cardiovascular 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 any modification to the 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, Pedro J. del Nido, MD and the Administrator, Janet Horgan. 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 In conjunction with Boston Children's Hospital, the Physicians Organization at Children's Hospital, Inc. (the PO) administers an annual conflict of interest disclosure process to all of its member Foundations which asks physicians (officers, top management, and highly compensated employees) and selected Foundation staff to disclose potential conflicts. A disclosure statement will be circulated annually to members of the PO. The audit committee shall determine those individuals (including medical staff members) who shall be required to complete the disclosure statement. The audit committee, at its discretion, may either: 1) refer any or all 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 personally or through a desingnee(s). Any person not receiving a disclosure statement has an affirmative obligation to disclose to the PO President, PO General Counsel, or his/her supervisor whenever he/she believes he/she has or may have a conflict of interest. Similarly, each person completing a disclosure statement has an affirmative obligation to update the statement any time circumstances change and/or he/she believes that a conflict of interest may exist. In the event a conflict of interest is found to exist, the Foundation prohibits the member from voting on any matter to which that conflict relates or otherwise influences the voting on such matter. Form 990, Part VI, Section B, line 15 All the physicians (top management, officers, and highly compensated individuals) fall under compensation guidelines determined by Harvard University (Harvard) with limitations established for certain positions/ranks within the medical school. Annually, compensation is reviewed and reported to Boston Children's Hospital's (the Hospital's) Board of Trustees to ensure that total direct and indirect compensation does not exceed the pre-determined guidelines of Harvard. Any new indirect benefit plan requires approval by CHMC Cardiovascular Surgical Foundation, Inc.'s (the Foundation's) Board of Directors, which then must be reviewed and permitted by the Hospital. Major procedures of the approval process involve: comparing compensation data of physicians within the comparable field of medicine; indirect compensation currently being offered; and the financial stability of the Foundation. 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 X, Column A: The prior year column of the balance sheet on Form 990 was updated to agree to the audited financial statements. The lines that were updated are: Line 1 was updated from $3,296,102 to $1,314,442; Line 2 was updated from $2,514,000 to $6,467,360; Line 5 was updated from $0 to $2,200,000; Line 7 was updated from $2,650,952 to $450,952; Line 11 was updated from $14,120,214 to $19,102,348; Line 12 was updated from $7,522,728 to $568,894; line 17 was updated from $1,223,728 to $15,515; and Line 25 was updated from $13,968,232 to $15,176,445. Form 990, Part XI, line 9: Pension adjustment 692,843. Form 990, Part XII, Line 2c: The audit process and scope has not changed from the prior year. Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 Hospital MA 501(c)(3) Line 3 N/A 0 Physicians Organization at Children's Hospital Inc 300 Longwood Avenue Boston MA 02115 043266103 Physician Organization MA 501(c)(3) Line 12c, III-FI N/A 0 0 1 0 0 1 0 0 0 0 0 0 0 1 1 1 1 1 0 0