2017-11-06T09:32:18-06:00 2016-12-31 381357951 PLANTE & MORAN PLLC 27400 Northwestern Highway Southfield MI 48034 990 2016-01-01 320087353 CHILDREN'S HOSPITAL OF MICHIGAN FOUNDATION CHIL 3139646994 3011 W GRAND BLVD No 218 DETROIT MI 48202 LAWRENCE BURNS PRESIDENT & CEO 3139646994 2017-10-26 1 LYNNE HUISMANN P00053811 2483522500 2017-10-26 67.59.56.33 2017-10-26 15:25:53 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 235652D9C515385E674F521959CD351FE10D1A0C 2016 2018-03-14 21:41:22Z LAWRENCE BURNS 3011 W GRAND BLVD No 218 DETROIT MI 48202 37995028 0 X WWW.CHMFOUNDATION.ORG X 2003 MI THE MISSION OF CHILDREN'S HOSPITAL OF MICHIGAN FOUNDATION IS TO SUPPORT PEDIATRIC RESEARCH, EDUCATION, COMMUNITY BENEFIT PROGRAMS, AND OTHER INITIATIVES TO IMPROVE THE HEALTH OF CHILDREN IN MICHIGAN. 25 25 22 101 0 19864 4160038 7432956 0 0 2422876 5230424 -189217 -47287 6393697 12616093 6694159 5891563 0 0 1909210 1842788 5900 0 1450839 1460959 1608671 10070228 9343022 -3676531 3273071 104698981 109585818 1739851 2287937 102959130 107297881 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 3612379 3261227 TO SUPPORT RESEARCH PROGRAMS TO IMPROVE THE HEALTH OF CHILDREN IN MICHIGAN. 2016 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 EXPLORE BRAIN NETWORK DYSFUNCTION IN PEDIATRIC BIPOLAR DISORDER USING ADVANCED NEUROIMAGING AND ANALYTIC TECHNIQUESFUNDING TO STUDY THE COAGULOPATHY ASSOCIATED WITH ACUTE PROMYELOCYTIC LEUKEMIA TO IDENTIFY MARKERS ASSOCIATED WITH ADVERSE EVENTSFUNDING TO ESTABLISH A NATIONAL/INTERNATIONAL AND STATEWIDE COLLABORATIVE AT INSTITUTIONS PERFORMING CARDIAC CATHETERIZATION PROCEDURESFUNDING TO EVALUATE CHANGES IN CARDIAC FUNCTION ON ECHOCARDIOGRAMS IN INFANTS WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHYFUNDING TO SUPPORT INNOVATIVE NEUROIMAGING STUDIES IN CHILDHOOD ONSET NEUROPSYCHIATRIC DISORDERS AND CHILDREN AT INCREASED RISK FOR PSYCHIATRIC ILLNESSFUNDING FOR CONTINUING RESEARCH TO UNDERSTAND BIOLOGICAL MECHANISMS BEHIND TOURETTE SYNDROMEFUNDING FOR A NOVEL AND PROMISING NEW APPROACH TO EXAMINE THE IMPACT OF POTENTIAL TOXICANTS ON THE DEVELOPMENT OF CHILDHOOD LEUKEMIA 626740 565816 TO SUPPORT EDUCATION PROGRAMS TO IMPROVE THE HEALTH OF CHILDREN IN MICHIGAN. 2016 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 OPPORTUNITIESFUNDING TO IMPLEMENT TWO CHILD LIFE FELLOWSHIPS, ONE AT CHM, WSU, AND KARMANOS CANCER INSTITUTE AND ONE FOR CHM PATIENTS RECEIVING BONE MARROW TRANSPLANTSFUNDING TO TRAIN BOARD CERTIFIED ANALYSTS IN MOTIVATIONAL INTERVIEWING TO MORE SUCCESSFULLY ENGAGE PARENTS IN THE TREATMENT FOR CHILDREN WITH AUTISM SPECTRUM DISORDERFUNDING FOR PEDIATRIC EDUCATIONAL SESSION FOR PHYSICIANS AND ALLIED HEALTH PROFESSIONALSEDUCATIONAL FUNDING FOR MEDICAL LECTURES FOR COMMUNITY PEDIATRICIANS AND OTHER PHYSICIANS, NURSES, MEDICAL STUDENTS, AND OTHERSFUNDING FOR CONFERENCES FOR CAREGIVERS AND PATIENT FAMILIES 2253990 2064520 TO SUPPORT COMMUNITY BENEFIT PROGRAMS TO IMPROVE THE HEALTH OF CHILDREN IN MICHIGAN. 2016 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 FOR PSYCHOSOCIAL AND SUPPORTIVE SERVICES FOR CHILDREN AND FAMILIES FACING CHRONIC AND ACUTE LIFE-THREATENING ILLNESSESEMERGENCY ASSISTANCE FOR NON-MEDICAL NEEDS FOR FAMILIES OF CHILDREN WITH ACUTE MEDICAL NEEDSFUNDING TO SUPPORT A COMPREHENSIVE CONTINUUM OF CARE PROGRAM FOR AT-RISK YOUTH AND YOUTH LIVING WITH HIVFUNDING TO SUPPORT VACCINATION PROGRAMSFUNDING TO SUPPORT IMPLEMENTATION OF FITKIDS 360, AN OBESITY INTERVENTION PROGRAM FOR CHILDREN AGES 6-17 AND THEIR FAMILIESFUNDING TO INTEGRATE MENTAL HEALTH SERVICES FOR CHM GENERAL PEDIATRIC AND ADOLESCENT MEDICINE CLINIC PATIENTSFUNDING FOR A "CELEBRATION OF LIFE" TO RECOGNIZE AND SUPPORT CANCER SURVIVORS 6493109 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 1 0 0 0 1 1 1 0 0 1 22 0 1 22 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 0 X 25 25 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 CHAIR 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 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 LUANNE EWALD TRUSTEE (PART YEAR) 1.00 0.00 X 0 0 0 LARRY GOLD TRUSTEE (PART YEAR) 1.00 0.00 X 0 0 0 DR JOSEPH LELLI TRUSTEE (PART YEAR) 1.00 0.00 X 0 0 0 HON KURTIS WILDER TRUSTEE 1.00 0.00 X 0 0 0 DR STEVEN LIPSCHULTZ TRUSTEE (PART YEAR) 1.00 0.00 X 0 0 0 ANTHONY A WERNER PRESIDENT AND CEO (PART YEAR) 40.00 1.00 X 190564 0 12975 JODI L WONG VICE PRESIDENT OF OPERATIONS 40.00 1.00 X 155248 0 10588 345812 0 23563 2 0 1 0 PHOENIX INNOVATE 1775 BELLINGHAM TROY MI 48083 ADVERTISING/MARKETING 211521 HURON CONSULTING GROUP PO BOX 71223 CHICAGO IL 60694 CONSULTING SERVICES 194108 RDM ASSOCIATES INC 7457 M E CAD BLVD SUITE 200 CLARKSTON MI 48348 ACCOUNTING SERVICES 163568 3 376521 599840 6456595 233571 7432956 1744705 1744705 28633945 25148226 3485719 3485719 3485719 153577 376521 220149 -66572 -66572 29845 10560 19285 19285 12616093 0 0 5183137 5654426 5654426 237137 237137 211244 52811 105622 52811 1300165 267270 368007 664888 33836 8867 7252 17717 181842 25474 44396 111972 115701 23614 34948 57139 34640 34640 190570 190570 349296 349296 398971 156563 182058 60350 277580 27087 500 249993 181391 11779 169612 7855 5319 1329 1207 30228 30228 27333 27189 144 DONOR RELATIONS 37779 25580 6393 5806 OTHER NONOPERATING EXPE 37219 2628 34591 PLEDGE WRITE OFF 22575 22575 DUES & MEMBERSHIP 13234 8961 2239 2034 9343022 6493109 1399074 1450839 5301050 8277511 551781 788828 121766 351538 71076 73481 178398 45651 89199 132747 62136020 83328460 35754667 15953106 673422 680147 104698981 109585818 217888 254401 1521963 2033536 1739851 2287937 X 22251000 24661301 32582848 33954122 48125282 48682458 102959130 107297881 104698981 109585818 X 3273071 779748 285932 X X 0 1 X 1 0 X 5928408 4652844 6020612 4160038 7432956 28194858 5928408 4652844 6020612 4160038 7432956 28194858 3120706 25074152 1356300 1221597 1376446 1209750 1744705 6908798 127555 538656 121313 211578 183422 1182524 36286180 0.69100 0.94320 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2 175000 646977 1 1 67229865 607276 3406635 1807642 495968 68940166 71311920 147413 -1551542 2178388 499538 67229865 72226954 158609 1571803 1863605 781841 71311920 67789770 387437 6283076 1860503 372826 72226954 63347448 92660 6095870 1692041 54167 67789770 0.00380 0.70620 0.29000 0 0 178398 45651 132747 132747 GLOBAL ASSET ALLOCATION FUNDS 13840268 F PRIVATE EQUITY FUND 2024978 F MONEY MARKET FUNDS 87860 F 15953106 13194973 779748 216639 630460 1626847 11568126 349296 698671 1047967 12616093 8846047 216639 620285 836924 8009123 349296 984603 1333899 9343022 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 990 630,460. Part XI, Line 4b - Other Adjustments: CONTRIBUTION FROM LEGACY CHM ELIMINATED ON CONSOLIDATED FINANCIALS 599,840. INCREASE IN CASH VALUE OF LIFE INSURANCE 36,863. SPECIAL EVENT EXPENSES PER FS NOT REPORTED AS SUCH ON 990 61,968. Part XII, Line 2d - Other Adjustments: LEGACY CHM EXPENSES REPORTED ON LEGACY CHM 990 620,285. Part XII, Line 4b - Other Adjustments: REFUNDED GRANT PAYMENTS 322,795. CONTRIBUTION FROM LEGACY CHM ELIMINATED ON CONSOLIDATED FINANCIALS 599,840. SPECIAL EVENT EXPENSES PER FS NOT REPORTED AS SUCH ON 990 61,968. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 INVESTMENTS 10218272 0 0 0 0 0 0 10218272 0 10218272 1 0 1 1 0 0 CHEERS FOR CHILDREN 2016 115542 75885 39657 16924 14066 8331 7500 SUMMMER RECESS 67725 47200 20525 3546 5350 14906 15612 13 346831 253436 93395 70543 9330 54041 530098 376521 153577 91013 19416 32567 77153 220149 -66572 29845 10445 115 0 29845 10445 115 10560 19285 MI 1 0 0 0 1.00000 CHILDREN'S HOSPITAL OF MICHIGAN FDN 3901 BEAUBIEN CARLS BLDG 1ST FLOOR DETROIT MI 48201 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 $309,949, AS FOLLOWS: SCH. G, PART II, LINE 1 TOTAL GROSS RECEIPTS: $530,098 SCH. G, PART II, LINE 10 - LESS DIRECT EXPENSES ($220,149) NET ECONOMIC PROFIT EARNED FROM SPECIAL EVENTS $309,949 SCH. G, PART II LINE 11 RESULTS IN A NET LOSS DUE TO THE REQUIREMENT TO SEPARATELY STATE THE AMOUNT OF CONTRIBUTIONS, $376,521, REQUIRED BY THE IRS TO BE ACKNOWLEDGED TO DONORS AS CHARITABLE CONTRIBUTIONS. 1 WAYNE STATE UNIVERSITY 5401 CASS AVE DETROIT MI 48202 386028429 115 1933475 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 WAYNE CHILDREN'S HEALTHCARE ACCESS PROGRAM INC 37567 HUBBELL DETROIT MI 48235 454949783 501(C)(3) 69000 TO SUPPORT THE FITKIDS 360 AND FITKIDS ON THE MOVE PROGRAMS VHS CHILDREN'S HOSPITAL OF MICHIGAN INC 3901 BEAUBIEN DETROIT MI 48201 272845064 1189766 TO SUPPORT PEDIATRIC MEDICAL EDUCATION, RESEARCH, AND OTHER COMMUNITY BENEFIT PROGRAMS UNIVERSITY PEDIATRICIANS 3901 BEAUBIEN ROOM 1K40 DETROIT MI 48201 383336414 501(C)(3) 1354380 TO SUPPORT PEDIATRIC MEDICAL EDUCATION AND RESEARCH THE GUIDANCE CENTER 13101 ALLEN ROAD SOUTHGATE MI 48195 381621700 501(C)(3) 125000 TO SUPPORT THE COSTS OF IDENTIFYING, ASSESSING AND TREATING CHILDREN WHO ARE THE SUSPECTED VICTIMS OF CHILD MALTREATMENT OR OTHER FORMS OF TRAUMA THE CHILDREN'S CENTER OF WAYNE COUNTY 79 W ALEXANDRINE DETROIT MI 48201 381359505 501(C)(3) 10000 TO PROVIDE BEDS TO CHILDREN RECEIVING TCC TREATMENT THE BOTTOMLESS TOY CHEST PO BOX 623 BLOOMFIELD HILLS MI 483030623 263315140 501(C)(3) 10000 TO PROVIDE ENGAGING, EMPOWERING AND INTERACTIVE TOYS TO PEDIATRIC CANCER PATIENTS SPHINX ORGANIZATION 400 RENAISSANCE CTR STE 2550 DETROIT MI 48243 383283759 501(C)(3) 9200 TO PROVIDE SIX MUSICAL PERFORMANACES BY SPHINX ARTISTS AT CHM FROM JANUARY-JUNE 2017 SOUTHEASTERN MICHIGAN HEALTH ASSOCIATION 3011 WEST GRANT BOULEVARD SUITE 200 200 DETROIT MI 48202 381671500 501(C)(3) 135000 TO PROVIDE TESTING FOR LEAD IN 200 SCHOOLS IN THE CITY OF DETROIT, FOLLOW UP TESTING WHERE INDICATED, AND AN EMERGENCY WATER SUPPLY IF NEEDED SEASONS HOSPICE FOUNDATION 6400 SHAFER COURT SUITE 700 DES PLAINES IL 60018 271825679 501(C)(3) 15000 TO SUPPORT A BEREAVEMENT CAMP FOR CHILDREN 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 RYAN'S CASE FOR SMILES 295 E SWEDESFORD ROAD 396 WAYNE MI 19087 861173750 501(C)(3) 10000 TO PROVIDE PILLOWCASES TO CHM PATIENTS RECEIVING TREATMENT THROUGH INTERACTIVE HOSPITAL SEWING DAYS RONALD MCDONALD HOUSE OF DETROIT 3911 BEAUBIEN ST DETROIT MI 48201 382182406 501(C)(3) 25000 TO PROVIDE TRANSPORTATION TO AND FROM CHM FOR THE FAMILIES OF SICK CHILDREN MICHIGAN STATE UNIVERSITY 3408 WOODWARD AVE DETROIT MI 48201 386005984 501(C)(3) 32000 TO PROVIDE PAIN MANAGEMENT, RELAXATION, EMOTIONAL EXPRESSION, NORMALIZATION, SOCIALIZATION, AND DISTRACTION TO CHM PATIENTS THROUGH MUSIC THERAPY KIDS KICKING CANCER 645 GRISWOLD SUITE 444 DETROIT MI 48226 383500655 501(C)(3) 175000 TO PROVIDE PAIN MANAGEMENT, PSYCHOTHERAPEUTIC AND END-OF-LIFE CARE TO CHILDREN AND FAMILIES FACING CHRONIC AND ACUTE LIFE-THREATENING ILLNESS HAMTRAMCK PUBLIC SCHOOLS 11410 CHAREST HAMTRAMCK MI 48221 386004194 115 116366 TO SUPPORT THE "NEWCOMER" VACCINATION PROGRAM AT THE HAMTRAMCK SCHOOL BASED HEALTH CENTER GREENLIGHT FUND 200 CLARENDON STREET 44TH FLOOR BOSTON MA 02116 200407083 501(C)(3) 10000 TO ADDRESS CRITICAL NEEDS FACING LOW-INCOME CHILDREN, YOUTH AND FAMILIES IN DETROIT BY SUPPORTING THE EXPANSION OF PROVEN, INNO0VATIVE, RESULTS-ORIENTED PROGRAMS INTO THE COMMUNITY. PAYMENT FOR YEAR 1 OF $50,000 PLEDGE FESTIVAL OF TREES 2734 WEST ELEVEN MILE RD BERKLEY MI 48072 382785495 501(C)(3) 8000 HOLIDAY FESTIVAL OF TREES EVENT SPONSORSHIP 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 CHM PEDIATRIC NEUROLOGISTS DETROIT SYMPHONY ORCHESTRA 3711 WOODWARD AVE DETROIT MI 48201 381385132 501(C)(3) 30000 TO PROVIDE SUPPORT FOR MUSIC THERAPY FOR SICK CHILDREN CATCH 223 FISHER BUILDING 3011 WGRAND BLVD DETROIT MI 48202 382746810 501(C)(3) 10000 OUTSTANDING HIGH SCHOOL GRADS EVENT SPONSORSHIP 20 1 GIFTS TO PEDIATRIC PATIENTS 306120 237137 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 1 0 0 0 0 0 0 0 0 ANTHONY A WERNER PRESIDENT AND CEO (PART YEAR) 146207 0 0 0 44357 0 3344 0 9631 0 203539 0 0 0 JODI L WONG VICE PRESIDENT OF OPERATIONS 130248 0 25000 0 0 0 4349 0 6239 0 165836 0 0 0 Part I, Line 1a DURING THE YEAR, HEALTH AND SOCIAL CLUB DUES WERE PROVIDED TO ANTHONY WERNER. THE DUES WERE TREATED AS TAXABLE COMPENSATION. Part I, Line 4a ANTHONY WERNER $44,357 X 1 100 COMPARABLE SALES X 12195 COST X 68059 THRIFT SHOP VALUE X 5 10538 FAIR MARKET VALUE X TOYS & CRAFTS 622 113604 COST X MISCELLANEOUS 332 15861 COST X ENTERTAINMENT 17 8163 MARKET RATE X GIFT CARDS 17 3635 COST X ELECTRONICS 4 1416 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 322,795. CHANGE IN CASH VALUE OF LIFE INSURANCE -36,863. FORM 990, PART XII, LINE 2C: THE PROCESS FOR SELECTION AND OVERSIGHT HAS NOT CHANGED FROM THE PROCESS USED IN PRIOR YEARS. LEGACY CHM 3901 BEAUBIEN CARLS BLDG 1ST FLOOR DETROIT MI 48201 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 599840 CASH