2018-08-15T08:00:39-05:00 2017-09-30 010494526 Baker Newman & Noyes LLC 280 Fore Street Portland ME 04101 990 2016-10-01 042864081 Children's Hospital Ophthalmology Foundation Inc CHIL 6173553365 300 Longwood Avenue No Fegan4 Boston MA 02115 David G Hunter MD PhD President 6173553365 2018-08-13 0 Nicholas E Porto P01310283 8002447444 2018-08-13 2016 2022-09-23 18:48:47Z David G Hunter MD PhD 300 Longwood Avenue No Fegan4 Boston MA 02115 22677336 0 X N/A X 2003 MA The Foundation provides ophthalmology 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 limited in the community. 13 0 15 0 11582 8833 561052 938536 20502397 20624360 280763 447487 92682 35173 21436894 22045556 172189 12414688 0 0 13548294 15734315 0 0 0 3890782 4234017 17611265 32383020 3825629 -10337464 47122726 54242744 7019815 20995013 40102911 33247731 X The Foundation's mission is to provide ophthalmology 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 (see Schedule O) ophthalmology. The Foundation also provides care for patients regardless of their ability to pay. 0 0 29308239 12414688 20482687 The Foundation provides ophthalmology services primarily to patients at Boston Children's Hospital and at satellite locations. The Foundation may charge for patient care, other medical services, and related products, provided that any net income is used exclusively 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. 1542539 168444 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 ophthalmology by teaching students and other medical and scientific personnel; by providing fellowships, research grants, and stipends; and by giving lectures and publishing information concerning problems and research results in the field of pediatric ophthalmology in order to educate the general public and the medical profession. 30850778 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 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 1 1 1 1 0 0 1 0 0 1 15 1 1 1 0 0 0 0 0 0 0 0 0 X 13 0 0 1 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 MA X Deborah K VanderVeen MD 6173555766 300 Longwood Avenue Boston MA 02115 David G Hunter MD PhD President 55.00 5.00 X X 991793 0 107472 Linda R Dagi MD Clerk 60.00 0.00 X X 664226 0 105095 Deborah K VanderVeen MD Treasurer 60.00 0.00 X X 588546 0 109147 Iason Mantagos MD Trustee 60.00 0.00 X 561317 0 96762 Ankoor S Shah MD Trustee 60.00 0.00 X 539976 0 101722 Gena Heidary MD Trustee 60.00 0.00 X 523965 0 76872 Carolyn S Wu MD Trustee 60.00 0.00 X 486256 0 110529 Melanie Kazlas MD Trustee 60.00 0.00 X 484226 0 90684 Lois E H Smith-Porter MD Trustee 60.00 0.00 X 360076 0 96732 Robert A Petersen MD Trustee 60.00 0.00 X 325050 0 82144 Anne B Fulton MD Trustee 60.00 0.00 X 331433 0 90572 Alexandra T Elliott MD Trustee 60.00 0.00 X 307951 0 107551 Suzanne Johnston MD Trustee 60.00 0.00 X 179052 0 106224 Physicians Org at CH Inc Institutional Trustee 2.00 0.00 X 0 0 0 Mary Whitman Physician 60.00 0.00 X 195539 0 39058 Bharti Gangwani Physician 60.00 0.00 X 182375 0 26781 6721781 0 1347345 15 0 1 0 Massachusetts Eye and Ear Infirmary 243 Charles Street Boston MA 02114 Healthcare services 147173 1 938536 938536 Patient service revenue 621300 19826624 19826624 Clinical and other revenue 621990 629292 629292 Education and research 611710 168444 168444 20624360 446149 3180 442969 401338 400000 1338 1338 1338 266953 231780 35173 26771 8402 22045556 20651131 11582 444307 12414688 12414688 5602563 5602563 8397782 7283528 1114254 223409 204627 18782 1320814 1195653 125161 189747 188969 778 93092 93092 390 390 70960 33258 37702 15617 15617 703908 611161 92747 990407 990407 77357 72063 5294 79452 77581 1871 18826 18826 114909 88355 26554 Bad Debt Expense 525211 525211 PO Dues 524886 524886 Billing Expenses 432367 432367 Coordinated Specialty P 249798 249798 336837 336837 32383020 30850778 1532242 0 6343629 6889485 7736518 10335272 2033448 1980116 100000 80000 32175 41266 572660 284434 307052 288226 17403987 20209342 12152800 13590805 73359 66420 939758 761812 47122726 54242744 3557937 4326712 12141181 73446 32852 3388432 4494268 7019815 20995013 X 40002718 33147538 100193 100193 40102911 33247731 47122726 54242744 X -10337464 3282284 200000 X X 0 1 X 1 0 X 436525 479504 589259 561052 938536 3004876 18452101 20827083 19323008 20537567 20651131 99790890 18888626 21306587 19912267 21098619 21589667 102795766 0 0 0 102795766 5700 86745 157408 277756 442969 970578 9550 8695 15915 11497 11582 57239 15250 95440 173323 289253 454551 1027817 47853 47853 18903876 21402027 20085590 21435725 22044218 103871436 0.98960 0.99360 0.00990 0.00590 X Schedule A, Part III, Line 12, Explanation of Other Income: Insurance Rebate - 2015 Amount: $ 47,853. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 100193 100193 545862 445669 100193 545862 545862 545862 545862 604998 59136 545862 0.00000 0.00000 1.00000 0 0 362091 73865 288226 12047 12047 0 54840 54840 0 143682 143682 0 288226 PO Pooled Investment Fund, LLC 13590805 F 13590805 Due to Boston Children's Hospital 1497515 Due to Physicians Organization 529632 Deferred compensation 457(b) 2143189 Accrued professional liability 323932 4494268 X 25613484 3282284 3282284 22331200 -285644 -285644 22045556 32668664 285644 285644 32383020 0 32383020 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 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). The Foundation is subject to unrelated business tax on its distributive share of profits from Foundation Optical, LLC and Management Services Organization. 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, 2017. The Foundation's tax years from 2014 through 2017 are potentially subject to examination. Part XI, Line 4b - Other Adjustments: Sales of eyewear, net of cost -320,817. Gain from subsidiary 35,173. Part XII, Line 2d - Other Adjustments: Eyewear sales expenses 256,866. Minority interest 28,778. 1 Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 501(c)(3) 12404688 N/A N/A Research and general support Massachusetts Eye and Ear Associates 243 Charles Street Boston MA 02114 222658209 501(c)(3) 10000 N/A N/A General support 2 0 Part I, Line 2: Monitoring is provided by Children's Hospital Ophthalmology 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, 2017, the Foundation only provided grant donations to other 501(c)(3) organizations. X X 0 1 X X X X 0 1 0 0 0 0 0 1 0 David G Hunter MD PhD President 839602 0 134956 0 17235 0 71250 0 36222 0 1099265 0 0 0 Linda R Dagi MD Clerk 289708 0 340287 0 34231 0 71250 0 33845 0 769321 0 0 0 Deborah K VanderVeen MD Treasurer 282196 0 270649 0 35701 0 71250 0 37897 0 697693 0 0 0 Iason Mantagos MD Trustee 235420 0 303488 0 22409 0 71250 0 25512 0 658079 0 0 0 Ankoor S Shah MD Trustee 221798 0 295824 0 22354 0 71250 0 30472 0 641698 0 0 0 Gena Heidary MD Trustee 234962 0 264482 0 24521 0 71250 0 5622 0 600837 0 0 0 Carolyn S Wu MD Trustee 242063 0 218068 0 26125 0 71250 0 39279 0 596785 0 0 0 Melanie Kazlas MD Trustee 237141 0 216721 0 30364 0 71250 0 19434 0 574910 0 0 0 Lois E H Smith-Porter MD Trustee 248768 0 81406 0 29902 0 71250 0 25482 0 456808 0 0 0 Robert A Petersen MD Trustee 237141 0 60167 0 27742 0 71250 0 10894 0 407194 0 0 0 Anne B Fulton MD Trustee 248987 0 52544 0 29902 0 71250 0 19322 0 422005 0 0 0 Alexandra T Elliott MD Trustee 191289 0 91961 0 24701 0 71250 0 36301 0 415502 0 0 0 Suzanne Johnston MD Trustee 63103 0 93918 0 22031 0 69928 0 36296 0 285276 0 0 0 Mary Whitman Physician 90488 0 84742 0 20309 0 20500 0 18558 0 234597 0 0 0 Bharti Gangwani Physician 53013 0 109227 0 20135 0 8500 0 18281 0 209156 0 0 0 Part I, Line 1b For those eligible employees, Children's Hospital Ophthalmology Foundation, Inc. (the Foundation) offers gross-up payments for certain benefits that need to be included as taxable income to the employees. Although a written policy does not exist, these payments are communicated to the employees during the initial employment process by the President and Executive Director. All Boston Children's Hospital employees are eligible (those receiving W-2's). The Foundation hosts an alumni retreat biennially, in which it reimburses travel costs for employees and their respective guests. Reimbursements are included as taxable income on the employees' W-2. Part I, Line 4b Effective December 15, 2015, the Foundation established a 457(f) plan to provide benefits to certain eligible employees whose ability to make elective deferrals under Code Section 403(b) is eliminated or impaired as determined by the Administrator. Non-elective contributions are made by the employer for the participant. Investments are held in trust. During the year ended September 30, 2017, there were no contributions made to the plan. Part I, Line 7 The total bonus pool for each fiscal year is built into the yearly budgets and approved by the Board of Directors. This approved bonus pool is distributed to both the leased staff and the physicians. All bonuses are discretionary. The bonus is not a division of earnings of Children's Hospital Ophthalmology Foundation, Inc. (the Foundation). The Ophthalmologist-in-Chief determines a bonus pool based on available funds and then allocates the bonus pool based on the contributions of each professional employee taking into account a variety of factors, including clinical and research contributions, academic performance, and quality services. The Foundation ensures that the total compensation for the physicians (base and bonus) does not exceed the Harvard Medical School guidelines. Gena Heidary MD Trustee Retention X 100000 80000 0 1 1 80000 0 Schedule L, Part II: Children's Hospital Ophthalmology Foundation, Inc. (the Foundation) has provided a noninterest bearing loan to a physician employee. The Foundation is allowed to forgive an amount of the loan balance for each year of continued employment of the physician. The amount of the loan forgiveness will be included as compensation on the employee's W-2 in the year forgiven. The estimated future forgiveness for the above loan is $20,000 for 2018; $20,000 for 2019; $20,000 for 2020; and $20,000 for 2021. Schedule L, Part IV: In December 2016, the Foundation Board approved an investment in a new Management Services Organization (MSO), Children's Ophthalmololgy Management Services, LLC, which is intended to provide a full level of non-clinical services support in New York. The Foundation is the sole owner of the MSO. The entity will provide services to Children's Ophthalmology, PC (COPC) whose owner is the Foundation President. COPC will be located in the region of New York where Boston Children's Health Physicians has its 60+ locations and approximately 300 pediatric primary care and specialty physicians. COPC is exptected to begin providing opthalmology services to patients during the Foundation's fiscal year 2018. Form 990, Part VI, Section A, line 1 A majority of Children's Hospital Ophthalmology Foundation, Inc.'s (the Foundation's) board members are physicians who are not independent from the Foundation because they are compensated by the Foundation. However, the Foundation participates in an integrated delivery system with Boston Children's Hospital (the Hospital) which does have a community board. The Foundation was organized in 2003. 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 on 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 Children's Hospital Ophthalmology Foundation, Inc. (the Foundation). The PO is responsible for providing certain 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 approve, the annual operating budget 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 modifications to the physician compensation and benefit plans for all physician employees of the Foundation. Form 990, Part VI, Section A, line 6 Children's Hospital Ophthalmology Foundation, Inc. (the Foundation) has 4 classes of members. The Ophthalmologist-in-Chief shall be the sole Class "A" member. Any other member of the Foundation who has, for at least three years, been a physician-employee of the Foundation with an active medical staff appointment from Boston Children's Hospital (the Hospital) and has a faculty appointment at the rank of instructor or above in the Department of Ophthalmology at Harvard Medical School (Harvard) shall be a Class "B" member. Any other physician-employee of the Foundation with an active medical staff appointment from the Hospital and a faculty appointment at the rank of instructor or above in the Department of Ophthalmology at Harvard shall be a Class "D" member. Each Class "A", "B", and "D" member shall hold membership as long as he/she remains qualified for membership. The Physicians Organization at Children's Hospital, Inc. shall be the sole Class "C" member. The qualifications and rights of members, including voting rights, shall be as set forth from time to time in the by-laws of the Foundation. Form 990, Part VI, Section A, line 7a According to the by-laws, the initial Trustees shall be those individuals named in the Children's Hospital Ophthalmology Foundation, Inc.'s (the Foundation's) Articles of Organization who shall serve until the first annual meeting of the members. Thereafter, the Board of Trustees shall consist of the Class "A and "B" members, each of whom shall serve ex-officio with vote. The Class "A" member is the President of the Foundation. All other officers shall be elected by the Trustees for two-year terms at the Foundation's annual meeting. All officers shall be Trustees. Form 990, Part VI, Section A, line 7b The Physicians Organization at Children's Hospital, Inc. (the PO) is a Class "C" member of Children's Hospital Ophthalmology Foundation, Inc. (the Foundation). The PO is responsible for providing certain 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 upon by the PO and the Foundation. The PO has the right to review, but not to approve, the annual operating budget 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 modifications 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, David G. Hunter, MD, PhD; the administrator, Gordon Massey; and the accountant, Rebecca Anderson. The Foundation ensures the tax documents are thoroughly reviewed by a governing group which includes the President (as a Class "A" member) and the Physicians Organization at Children's Hospital, Inc. (as a Class "C" member and as an audit committee member). All reviews 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 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 to 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 influence 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 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 B, Line 16a: In January 2007, Children's Hospital Ophthalmology Foundation, Inc. (the Foundation) formed a for-profit limited liability company, Foundation Optical, LLC, to establish a retail optical shop located within a Boston Children's Hospital satellite location. The primary purpose of Foundation Optical, LLC is to offer eyewear needs to patients of the Foundation. The Foundation is the majority owner of Foundation Optical, LLC with a 55% ownership interest. Form 990, Part VI, Section B, Line 16b: It is the policy of Children's Hospital Ophthalmology Foundation, Inc. (the Foundation) to retain an ownership stake in any entity that is consistent with its charitable mission. Further, if the Foundation does retain an ownership stake in any appropriate entity, it will secure legal advice and language in any such operating agreements to ensure it has full authority to prevent and override any action of such entity that the Foundation may determine is inconsistent with its charitable purposes or that may jeopardize the Foundation's tax-exempt status. Form 990, Part VI, Section C, line 19 The Foundation maintains or has access to all financial statements, 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: Investment in Ophthalmology Management Services, LLC 200,000. Form 990; Part XII, Line 2c: The audit process and scope have not changed from the prior year. Children's Ophthalmology Management Services LLC 40 Saw Mill River Road Upper Level Hawthorne NY 10532 820621893 Management Service Organization NY 347056 Children's Hospital Ophthalmology Foundation Inc 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 Foundation Optical LLC 9 Hope Avenue Waltham MA 02453 208236402 Eyeglass Sales MA Children's Hospital Ophthalmology Foundation Inc Related 35173 66418 0 8402 1 0.55000 0 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 1 Foundation Optical LLC S 42112