2018-11-05T07:09:51-06:00 2017-12-31 381357951 PLANTE & MORAN PLLC 27400 NORTHWESTERN HIGHWAY SOUTHFIELD MI 48034 990 2017-01-01 320087353 CHILDREN'S HOSPITAL OF MICHIGAN FOUNDATION CHIL 3139646994 3011 W GRAND BLVD NO 218 DETROIT MI 48202 LAWRENCE BURNS PRESIDENT & CEO 3139646994 2018-10-31 1 LYNNE HUISMANN P00053811 2483522500 2018-10-31 67.59.56.32 2018-10-31 14:44:49 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 737380BCD7AD51223FD12A91753DF01CE9F34789 2017 2018-06-14 16:35:46Z LAWRENCE BURNS 3011 W GRAND BLVD NO 218 DETROIT MI 48202 44570678 0 X WWW.CHMFOUNDATION.ORG X 2003 MI THE MISSION OF CHILDREN'S HOSPITAL OF MICHIGAN FOUNDATION IS TO SUPPORT PEDIATRIC (SEE SCH O) RESEARCH, EDUCATION, COMMUNITY BENEFIT PROGRAMS, AND OTHER INITIATIVES TO IMPROVE THE HEALTH OF CHILDREN IN MICHIGAN. 29 29 30 318 0 56915 7432956 6563557 0 0 5230424 9530054 -47287 -97625 12616093 15995986 5891563 5624747 0 0 1842788 1941248 0 0 912402 1608671 2315025 9343022 9881020 3273071 6114966 109585818 122202293 2287937 1998076 107297881 120204217 X CHILDREN'S HOSPITAL OF MICHIGAN FOUNDATION SUPPORTS PEDIATRIC RESEARCH, EDUCATION, COMMUNITY BENEFIT PROGRAMS, AND OTHER INITIATIVES TO IMPROVE THE HEALTH OF CHILDREN IN MICHIGAN. 0 0 3098602 2387763 TO SUPPORT RESEARCH PROGRAMS TO IMPROVE THE HEALTH OF CHILDREN IN MICHIGAN. 2017 AWARDS INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: FUNDING FOR THE CHILDREN'S RESEARCH CENTER OF MICHIGANFUNDING FOR WAYNE STATE UNIVERSITY ("WSU") ENDOWED CHAIR AND PROFESSORSHIPSFUNDING VARIOUS STUDIES ON THE TREATMENT OF PEDIATRIC ACUTE MYELOID LEUKEMIAFUNDING TO DEVELOP DUAL-ACTING DRUGS TO WORK SYNERGISTICALLY AGAINST AML AND NEUROBLASTOMA CELLSFUNDING TO STUDY PTSD, ANXIETY, AND DEPRESSION IN REFUGEE CHILDREN FROM SYRIA AND IRAQFUNDING TO STUDY AND IDENTIFY GENETIC AND EPIGENETIC BIOMARKERS FOR EARLY DIAGNOSIS AND NOVEL THERAPEUTIC STRATEGIES FOR THE PREVENTION AND TREATMENT OF PULMONARY HYPERTENSION ASSOCIATED WITH BRONCHOPULMONARY DYSPLASIA.FUNDING VARIOUS STUDIES ON MYELOMONOCYTIC LEUKEMIA RESEARCHFUNDING TO EVALUATE THE BODY WATER STATUS IN CHILDREN WITH HYPERTENSIONFUNDING TO STUDY BONE MARROW CHARACTERISTICS IN BONE MARROW FAILURE SYNDROMESFUNDING TO STUDY THE EFFICACY OF TREATMENTS FOR CHILDHOOD MIGRAINES IN THE EMERGENCY DEPARTMENTSTUDY TO DETERMINE RELATIONSHIP BETWEEN OBESITY AND SECONDARY IMMUNODEFICIENCYFUNDING TO DETERMINE IMPACT OF DOWN SYNDROME ON THE OUTCOME OF FONTAN OPERATION FOR A FUNCTIONALLY UNIVENTRICULAR HEART 761401 690260 TO SUPPORT EDUCATION PROGRAMS TO IMPROVE THE HEALTH OF CHILDREN IN MICHIGAN. 2017 AWARDS INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: FUNDING FOR WAYNE STATE UNIVERSITY ("WSU") ENDOWED CHAIR AND PROFESSORSHIPSFUNDING TO PROMOTE EXCELLENCE IN NURSING BY PROVIDING ACCESS TO INFORMATION AND NETWORKING OPPORTUNITIESEDUCATIONAL FUNDING FOR CARDIOLOGY FELLOWS, DENTISTRY FELLOWS, THORACIC AND CARDIOVASCULAR SURGERY TEAM, AND POISON CONTROL TEAMFUNDING TO PRODUCE PALLIATIVE CARE PODCASTS FOR USE BY MEDICAL STUDENTS, FELLOWS, AND RESIDENTSFUNDING FOR CONFERENCES FOR VARIOUS POSITIONSFUNDING FOR LECTURE ON HEMATOLOGY-ONCOLOGYFUNDING TO SUPPORT THE PSYCHOLOGY INTERNSHIP PROGRAM AT THE CHILDREN'S HOSPITAL OF MICHIGAN 2809200 2546724 TO SUPPORT COMMUNITY BENEFIT PROGRAMS TO IMPROVE THE HEALTH OF CHILDREN IN MICHIGAN. 2017 AWARDS INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: FUNDING TO TEACH CHILDREN'S HOSPITAL OF MICHIGAN ("CHM") PATIENTS AND FAMILIES ABOUT SAFETY TO REDUCE THE NUMBER OF UNINTENTIONAL INJURIES TO CHILDREN FUNDING TO ASSIST FAMILIES WHO ARE EXPERIENCING FINANCIAL HARDSHIP RELATED TO MEDICAL CARE AND SPECIAL NEEDS OF THEIR CHILDRENFUNDING FOR PSYCHOSOCIAL AND SUPPORTIVE SERVICES FOR CHILDREN AND FAMILIES FACING CHRONIC AND ACUTE LIFE-THREATENING ILLNESSESFUNDING FOR A COMPREHENSIVE CONTINUUM OF CARE, PREVENTION, AND EDUCATION FOR AT-RISK YOUTH AND ESPECIALLY YOUNG WOMEN, WHO ARE AFFECTED BY HIVFUNDING TO REDUCE INFANT MORTALITY DUE TO SLEEP RELATED CAUSES IN DETROIT AND PONTIAC BY PROVIDING INFANT SAFETY AND SLEEP EDUCATION AND THE NECESSARY RESOURCES TO ENSURE A SAFE SLEEP ENVIRONMENTFUNDING TO SUPPORT FITKIDS 360, AN OBESITY INTERVENTION PROGRAM FOR CHILDREN AGES 6-17 AND THEIR FAMILIES 6669203 1 1 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 1 0 0 1 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 18 0 1 30 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 X 29 29 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 MI FL NJ NY OH X KURT MILLER RDM ASSOCIATES 2486207100 7457 M E CAD BLVD SUITE 200 CLARKSTON MI 48348 MATTHEW A FRIEDMAN CHAIRMAN 1.00 1.00 X X 0 0 0 CYNTHIA FORD VICE-CHAIR 1.00 0.00 X X 0 0 0 FRED MINTURN VICE-CHAIR AND TREASURER 1.00 1.00 X X 0 0 0 RITA MARGHERIO SECRETARY 1.00 0.00 X X 0 0 0 JOHN D BAKER MD TRUSTEE 1.00 0.00 X 0 0 0 JAMES F CARR JR TRUSTEE 1.00 0.00 X 0 0 0 DOUGLAS M ETKIN TRUSTEE 1.00 0.00 X 0 0 0 PETER GINOPOLIS TRUSTEE 1.00 0.00 X 0 0 0 JOHNNY GINOPOLIS TRUSTEE 1.00 0.00 X 0 0 0 BRIAN HERMELIN TRUSTEE 1.00 0.00 X 0 0 0 JACK KRASULA TRUSTEE 1.00 0.00 X 0 0 0 STEVEN R LEFKOFSKY TRUSTEE 1.00 0.00 X 0 0 0 EDWARD C LEVY JR TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL J MADISON CFA TRUSTEE 1.00 0.00 X 0 0 0 ANITA MASTERS PENTA TRUSTEE 1.00 0.00 X 0 0 0 DICK PURTAN TRUSTEE 1.00 0.00 X 0 0 0 LYLE M WOLBERG CFP TRUSTEE 1.00 0.00 X 0 0 0 MABLE V JONES PHD TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL BEN TRUSTEE 1.00 1.00 X 0 0 0 TOM CONSTAND TRUSTEE 1.00 0.00 X 0 0 0 GLEN DONOVAN TRUSTEE (PART YEAR) 1.00 0.00 X 0 0 0 ANDREW ZALESKI TRUSTEE 1.00 0.00 X 0 0 0 STEVEN BLAHUNKA TRUSTEE 1.00 0.00 X 0 0 0 AJAY CHAWLA TRUSTEE 1.00 0.00 X 0 0 0 CHARLES BULLOCK TRUSTEE 1.00 0.00 X 0 0 0 LORRON JAMES TRUSTEE 1.00 0.00 X 0 0 0 HON KURTIS WILDER TRUSTEE 1.00 0.00 X 0 0 0 LAURA KOWALCHIK TRUSTEE 1.00 0.00 X 0 0 0 JOSEPH LELLI MD TRUSTEE 1.00 0.00 X 0 0 0 ERIK MORGANROTH TRUSTEE 1.00 0.00 X 0 0 0 LAWRENCE BURNS PRESIDENT AND CEO 40.00 1.00 X 289570 0 14573 JODI L WONG VICE PRESIDENT OF OPERATIONS 40.00 1.00 X 131635 0 5318 421205 0 19891 2 0 1 0 RDM ASSOCIATES INC 7457 M E CAD BLVD SUITE 200 CLARKSTON MI 48348 ACCOUNTING SERVICES 163541 HAMMOND & ASSOCIATES LLC 682 GLENEAGLES HIGHLAND MI 48357 CONSULTING SERVICES 140839 FLOURISH INC 1001 HURON ROAD EAST SUITE 102 CLEVELAND OH 44115 ADVERTISING/MARKETING 123811 3 308505 479793 5775259 284199 6563557 1990131 1990131 35867198 28327275 7539923 7539923 7539923 120810 308505 237181 -116371 -116371 28982 10236 18746 18746 15995986 0 0 9432429 5390306 5390306 234441 234441 428595 111862 214298 102435 1180683 214932 474440 491311 32567 9218 11278 12071 172356 29855 83973 58528 127047 25760 52239 49048 18558 18558 197020 197020 416400 416400 172899 2993 164162 5744 252024 170184 81840 353998 264359 89639 83468 83468 19178 19178 12239 616 8738 2885 40613 25502 11552 3559 34475 34475 32501 249 31545 707 COMMUNITY OUTREACH 567609 567609 DUES & MEMBERSHIP 64742 40654 18415 5673 DONOR RELATIONS 24142 15160 6867 2115 OTHER NONOPERATING EXPE 20159 46 18266 1847 5000 5000 9881020 6669203 2299415 912402 8277511 5043139 788828 714409 351538 504695 73481 99589 248269 80126 132747 168143 83328460 96806884 15953106 18148144 680147 717290 109585818 122202293 254401 331932 2033536 1666144 2287937 1998076 X 24661301 30810564 33954122 40627420 48682458 48766233 107297881 120204217 109585818 122202293 X 6114966 6468112 323258 X X 0 1 X 1 0 X 4652844 6020612 4160038 7432956 6563557 28830007 4652844 6020612 4160038 7432956 6563557 28830007 3787919 25042088 1221597 1376446 1209750 1744705 1990131 7542629 538656 121313 211578 183422 149792 1204761 37577397 0.66640 0.69100 X 3 170747 369948 872650 1 1 68940166 176245 9249354 1733117 565740 76066908 67229865 607276 3406635 1807642 495968 68940166 71311920 147413 -1551542 2178388 499538 67229865 72226954 158609 1571803 1863605 781841 71311920 67789770 387437 6283076 1860503 372826 72226954 0.00390 0.64110 0.35500 0 0 64295 64295 183974 80126 103848 168143 GLOBAL ASSET ALLOCATION FUNDS 15661262 F PRIVATE EQUITY FUND 2486882 F 18148144 22188155 6468112 158700 501551 7128363 15059792 416400 519794 936194 15995986 9278156 158700 497887 656587 8621569 416400 843051 1259451 9881020 PART V, LINE 4: TO SUPPORT CHILDREN'S PROGRAMS PER THE STIPULATIONS OF THE DONOR. PART XI, LINE 2D - OTHER ADJUSTMENTS: LEGACY CHM REVENUE REPORTED ON LEGACY CHM 990 501,551. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION FROM LEGACY CHM ELIMINATED ON CONSOLIDATED FINANCIALS 479,793. INCREASE IN CASH VALUE OF LIFE INSURANCE -11,357. SPECIAL EVENT EXPENSES PER FS NOT REPORTED AS SUCH ON 990 51,358. PART XII, LINE 2D - OTHER ADJUSTMENTS: LEGACY CHM EXPENSES REPORTED ON LEGACY CHM 990 497,887. PART XII, LINE 4B - OTHER ADJUSTMENTS: REFUNDED GRANT PAYMENTS 311,901. CONTRIBUTION FROM LEGACY CHM ELIMINATED ON CONSOLIDATED FINANCIALS 479,793. SPECIAL EVENT EXPENSES PER FS NOT REPORTED AS SUCH ON 990 51,357. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENTS 3197895 0 0 0 0 0 0 3197895 0 3197895 1 0 1 1 0 0 CHEERS FOR CHILDREN 2016 146157 78045 68112 18271 8295 10546 16980 SUMMMER RECESS 92601 66393 26208 15860 66 8490 9389 13 190557 164067 26490 63758 14550 7874 63102 429315 308505 120810 97889 22911 26910 89471 237181 -116371 28982 3223 6805 208 0 28982 3223 6805 208 10236 18746 MI 1 0 0 0 1.00000 CHILDREN'S HOSPITAL OF MICHIGAN FDN 3011 W GRAND BLVD NO 218 DETROIT MI 48202 0 JODI WONG 1197 SUPERVISES EMPLOYEES WHO KEEP RECORDS, COUNT MONEY, OVERSEE GAMING ACTIVITIES DURING EVENTS, AND PREPARE STATE MANDATED FINANCIAL REPORTS. X 0 FORM 990, SCHEDULE G, PART II THE NET ECONOMIC PROFIT EARNED FROM SPECIAL EVENTS IS $192,134, AS FOLLOWS: SCH. G, PART II, LINE 1 TOTAL GROSS RECEIPTS: $429,315 SCH. G, PART II, LINE 10 - LESS DIRECT EXPENSES ($237,181) NET ECONOMIC PROFIT EARNED FROM SPECIAL EVENTS $192,134 SCH. G, PART II LINE 11 RESULTS IN A NET LOSS DUE TO THE REQUIREMENT TO SEPARATELY STATE THE AMOUNT OF CONTRIBUTIONS, $308,505, REQUIRED BY THE IRS TO BE ACKNOWLEDGED TO DONORS AS CHARITABLE CONTRIBUTIONS. 1 DETROIT SYMPHONY ORCHESTRA 3711 WOODWARD AVE DETROIT MI 48201 381385132 501(C)(3) 30000 TO PROVIDE SUPPORT FOR MUSIC THERAPY FOR SICK CHILDREN HAMTRAMCK PUBLIC SCHOOLS 11410 CHAREST HAMTRAMCK MI 48221 386004194 115 139506 TO SUPPORT THE "NEWCOMER" VACCINATION PROGRAM AT THE HAMTRAMCK SCHOOL BASED HEALTH CENTER KIDS KICKING CANCER 645 GRISWOLD SUITE 444 DETROIT MI 48226 383500655 501(C)(3) 170000 TO PROVIDE PAIN MANAGEMENT, PSYCHOTHERAPEUTIC AND END-OF-LIFE CARE TO CHILDREN AND FAMILIES FACING CHRONIC AND ACUTE LIFE-THREATENING ILLNESS SCDAA MI CHAPTER INC 18516 JAMES COUZENS HIGHWAY DETROIT MI 48235 381963640 501(C)(3) 35000 TO SUPPORT PROJECT ENRICH, AN EDUCATIONAL ENRICHMENT PROGRAM FOR CHILDREN WITH SICKLE CELL CONDITIONS THE CHILDREN'S CENTER OF WAYNE COUNTY 79 W ALEXANDRINE DETROIT MI 48201 381359505 501(C)(3) 20000 TO PROVIDE BEDS TO CHILDREN RECEIVING TCC TREATMENT UNIVERSITY PEDIATRICIANS 3901 BEAUBIEN ROOM 1K40 DETROIT MI 48201 383336414 501(C)(3) 648849 TO SUPPORT PEDIATRIC MEDICAL EDUCATION AND RESEARCH VHS CHILDREN'S HOSPITAL OF MICHIGAN INC 3901 BEAUBIEN DETROIT MI 48201 272845064 1614135 TO SUPPORT PEDIATRIC MEDICAL EDUCATION, RESEARCH, AND OTHER COMMUNITY BENEFIT PROGRAMS WAYNE STATE UNIVERSITY 5401 CASS AVE DETROIT MI 48202 386028429 115 1931828 TO SUPPORT THE CHILDREN'S RESEARCH CENTER OF MICHIGAN AS WELL AS VARIOUS ASPECTS OF PEDIATRIC HEALTH RESEARCH FOR AREAS SUCH AS BRAIN NETWORK DYSFUNCTION, HIV, DIABETES, CANCER, AND OPTHALMOLOGY DETROIT WAYNE COUNTY HEALTH AUTHORITY (SEMHA) 3031 W GRAND BOULEVARD 450 DETROIT MI 48202 381671500 501(C)(3) 108000 TO FUND A PART-TIME PEDIATRICIAN AND MEDICAL SUPPLIES TO PROVIDE SCHOOL PHYS MICHIGAN MEDICINE OFFICE OF DEVELOPMENT 1000 OAKBROOKE DRIVE STE 100 ANN ARBOR MI 48104 386006309 501(C)(3) 90220 TO FUND THE DEVELOPMENT OF A PEDIATRIC CARDIAC PERFUSION PRESERVATION SYSTEM KIDS-TALK CHILD ADVOCACY CENTER 40 EAST FERRY STREET DETROIT MI 48202 381621700 501(C)(3) 60000 TO SUPPORT THE COSTS OF IDENTIFYING, ASSESSING, AND TREATING CHILDREN WHO AR DETROIT EMPLOYMENT SOLUTIONS 440 EAST CONGRESS SUITE 400 DETROIT MI 48226 383353746 509(A)(1) 50000 TO SUPPORT A SUMMER EMPLOYMENT PROGRAM FOR 100 YOUTH IN THE CITY OF DETROIT. HENRY FORD HEALTH SYSTEM 1 FORD PLACE 5A DETROIT MI 48202 321357020 501(C)(3) 50000 TO SUPPORT THE GAME ON CANCER KIDS CLUB PROGRAM IN CONJUNCTION WITH HENRY FO NORTH STAR REACH 1050 HIGHLAND DR SUITE F ANN ARBOR MI 48108 260347065 501(C)(3) 25000 TO PROVIDE 10 CAMPERSHIPS FOR CHM PATIENTS DURING SICKLE CELL WEEK AT THE NO THE JED FOUNDATION 6 EAST 39TH STREET SUITE 1204 NEW YORK NY 10016 134131139 501(C)(3) 15000 TO ENABLE MICHIGAN COLLEGES AND/OR UNIVERSITIES TO ENROLL IN JED CAMPUS, A P SEASONS HOSPICE FOUNDATION 6400 SHAFER COURT SUITE 700 ROSEMONT IL 60018 271825679 501(C)(3) 15000 TO PROVIDE A 3-DAY CAMP FOR CHILDREN STRUGGLING WITH THE LOSS OF A LOVED ONE EPILEPSY FOUNDATION OF MICHIGAN 25200 TELEGRAPH ROAD SUITE 110 SOUTHFIELD MI 48033 381508581 501(C)(3) 6000 TO PROVIDE PARTIAL CAMPERSHIPS TO 10 CHILDREN REFERRED TO CAMP DISCOVERY BY SPHINX ORGANIZATION 400 RENAISSANCE CTR STE 2550 DETROIT MI 48243 383283759 501(C)(3) 5000 TO PROVIDE 11 MUSICAL PERFORMERS BY SPHINX ARTISTS AT CHM IN 2017. THE GUIDANCE CENTER 13101 ALLEN ROAD SOUTHGATE MI 48195 381621700 501(C)(3) 151139 TO SUPPORT THE COSTS OF IDENTIFYING, ASSESSING AND TREATING CHILDREN WHO ARE STARFISH FAMILY SERVICES 3000 HIVELEY ROAD INKSTER MI 48141 382230416 501(C)(3) 49850 TO SCREEN, ASSESS AND PROVIDE INTERVENTION TO CHILDREN WHO EXHIBIT DEVELOPME DETROIT EDUCATION & RESEARCH 4201 ST ANTOINE ROOM 9C-25 UHC DETROIT MI 48201 455124360 501(C)(4) 36380 TO PAY FOR EDUCATION CONFERENCES FOR RESIDENTS AND FELLOWS PEDIATRIC RETINAL RESEARCH FOUNDATION 39650 ORCHARD HILL PLACE STE 200 NOVI MI 48375 204229924 501(C)(3) 33500 TO FUND THE SALARY AND EDUCATION COSTS OF AN OPHTHALMOLOGY RESEARCH COORDINA LIONS HEARING CENTER OF MICHIGAN 4201 ST ANTOINE 5E UHC DETROIT MI 48201 201311803 501(C)(3) 30040 TO EXPAND THE CHILDREN AND YOUTH PROGRAM OF THE LIONS HEARING CENTER TO IDEN DETROIT INSTITUTE FOR CHILDREN 2075 EAST MAPLE ROAD SUITE B-203 WALLED LAKE MI 48390 381359511 501(C)(3) 5000 TO PURCHASE THERAPY EQUIPMENT AND CONDUCT ASSESSMENTS TO HELP CHILDREN WITH FESTIVAL OF TREES 2734 WEST ELEVEN MILE ROAD BERKLEY MI 48072 382785495 501(C)(3) 10000 HOLIDAY FESTIVAL OF TREES EVENT SPONSORSHIP GREENLIGHT FUND 200 CLARENDON 44TH FLOOR BOSTON MA 02116 200407083 501(C)(3) 10000 SPONSORSHIP 24 1 GIFTS TO PEDIATRIC PATIENTS 219120 234441 DONOR VALUES BOOKS, GAMES, TOYS, ETC. PART I, LINE 2: AT THE END OF THE GRANT PERIOD, THE ORGANIZATION REQUIRES A FINAL REPORT OF GRANT ACTIVITIES AND A FINAL FINANCIAL ACCOUNTING REPORT. ADDITIONALLY, ANY GRANTS THAT ARE ON A REIMBURSEMENT BASIS MUST BE ACCOMPANIED BY A DETAILED INVOICE FOR REIMBURSEMENT. SCHEDULE I, PART III, COLUMN B: THE NUMBER OF RECIPIENTS IS AN ESTIMATE, WHICH IS BASED ON THE NUMBER OF PEDIATRIC PATIENTS SEEN DURING THE YEAR FOR INPATIENT, OUTPATIENT, AND EMERGENCY ROOM SERVICES. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 LAWRENCE BURNS PRESIDENT AND CEO 278190 0 0 0 11380 0 4455 0 10118 0 304143 0 0 0 PART I, LINE 1A DURING THE YEAR, HEALTH AND SOCIAL CLUB DUES WERE PROVIDED TO LARRY BURNS. THE DUES WERE TREATED AS TAXABLE COMPENSATION. X 8321 COST X 40705 THRIFT SHOP VALUE X 5 57354 FAIR MARKET VALUE X TOYS & CRAFTS 269 150076 COST X MISCELLANEOUS 33 20241 COST X ENTERTAINMENT 15 5032 MARKET RATE X ELECTRONICS 3 1820 COST X GIFT CARDS 6 650 COST 0 1 0 PART I, COLUMN (B): THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART VI, SECTION A, LINE 2 TRUSTEES JOHNNY GINOPOLIS AND PETER GINOPOLIS HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B AFTER CHMF'S MANAGEMENT HAS REVIEWED THE FORM 990, THE RETURN IS PROVIDED TO THE BOARD CHAIR, TREASURER, AND PRESIDENT AND CEO. THESE INDIVIDUALS REVIEW THE FORM 990 WITH THE AUDIT COMMITTEE. ANY NECESSARY CHANGES WILL THEN BE UPDATED ON THE FORM. ONCE ALL NECESSARY CHANGES ARE MADE AND THE CHMF BOARD CHAIR IS IN AGREEMENT WITH THE AUDIT COMMITTEE ABOUT THE FINISHED FORM 990, IT WILL BE SIGNED BY THE CHMF PRESIDENT AND CEO, DATED AND SUBMITTED BY THE FILING DEADLINE. PRIOR TO FILING, A COPY OF THE APPROVED FORM 990 WILL BE MADE AVAILABLE TO ALL OF THE CHMF BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO THE ORGANIZATION'S BOARD TRUSTEES, OFFICERS, KEY EMPLOYEES AND STAFF MEMBERS. THE COVERED PARTIES DISCLOSE INTERESTS THROUGH A QUESTIONNAIRE. EACH COVERED PERSON IS REQUIRED TO ACKNOWLEDGE, NOT LESS THAN ANNUALLY, THAT HE OR SHE HAS READ AND IS IN COMPLIANCE WITH THE POLICY AND MUST RE-ATTEST IN WRITING THAT THERE ARE NO CONFLICTS OR DISCLOSE ANY CONFLICTS THAT DO EXIST. AN ANNUAL REVIEW IS DONE BY THE EXECUTIVE COMMITTEE. IF A CONFLICT ARISES, THE INVOLVED PERSON(S) RECUSE THEMSELVES FROM VOTING ON THE MATTER. COVERED MEMBERS ALSO MUST DECLARE ANY CONFLICT(S) OF INTEREST THAT ARISE BETWEEN ANNUAL DECLARATIONS AS THEY EMERGE. FAILURE TO DISCLOSE, DEPENDING ON GRAVITY, CAN LEAD TO BEING REMOVED FROM THEIR POSITION. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION HAS A COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT PERSONS CURRENTLY SERVING ON THE BOARD OF TRUSTEES. PERSONS WITH A CONFLICT OF INTEREST REGARDING THE PRESIDENT AND CEO'S COMPENSATION ARRANGEMENT ARE NOT INVOLVED IN THIS PROCESS. COMPARABILITY DATA SHOWING COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS IS REVIEWED WHEN DETERMINING THE PRESIDENT AND CEO'S COMPENSATION. CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION WAS MAINTAINED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: REFUND OF GRANT PAYMENTS 311,901. CHANGE IN CASH VALUE OF LIFE INSURANCE 11,357. FORM 990, PART XII, LINE 2C: THE PROCESS FOR SELECTION AND OVERSIGHT HAS NOT CHANGED FROM THE PROCESS USED IN PRIOR YEARS. LEGACY CHM 3011 W GRAND BLVD NO 218 DETROIT MI 48202 381357994 PEDIATRIC HEALTH CARE - IMPROVING HEALTH/WELLBEING OF CHILDREN MI 501(C)(3) LINE 12A, I CHILDREN'S HOSPITAL OF MI FOUNDATION 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 LEGACY CHM C 479793 CASH