2017-11-14T08:29:18-06:00 2016-12-31 861065772 Deloitte Tax LLP 50 South Sixth Street Ste 2800 Minneapolis MN 55402 990 2016-01-01 411200302 Gillette Children's Hospital Foundation GILL 6512912848 200 University Avenue East St Paul MN 55101 Barbara Joers President & CEO 6512912848 2017-11-14 1 Kristina Rasmussen P00143920 6123974000 167.219.48.53 2017-11-14 08:08:13 US P 95D488DDDB93F28E11BA57F71D1579C969396077 4A8E829812D54CAB6C2275BE50CB0148062D08BB 2016 2017-02-10 21:41:12Z Barbara Joers 200 University Avenue East St Paul MN 55101 7888115 0 X www.gillettechildrens.org X 1985 MN The Foundation raises money for and otherwise supports Gillette Children's Specialty Healthcare. 18 16 0 126 0 0 6406365 7244908 0 0 223299 248446 -378955 -88527 6250709 7404827 6522610 2972306 0 0 1261306 1288060 0 0 1566260 651386 1106492 8435302 5366858 -2184593 2037969 20774912 22928165 1148302 820841 19626610 22107324 X The mission of Gillette Children's Hospital Foundation (Foundation) is to raise money, build awareness, and develop relationships so the mission of Gillette Children's Specialty Healthcare (Gillette) can be fulfilled. 0 0 1208149 1208149 Capital: The Foundation raises money to support the Gillette mission to provide specialized health care for children and adults who have complex and rare medical conditions affecting the musculoskeletal and neurological systems. In 2016, the Foundation transferred donated funds to support the purchase and installation of an EOS X-ray Imaging System in its facility in St. Paul. EOS offers a significantly lower dose of radiation than that of traditional X-rays, making it ideal for use in the treatment of patients who have a limb issues or spine deformities like scoliosis.See Schedule O.EOS captures the body area in a single scan, and this accuracy of the imaging allows staff to tailor treatments to the unique circumstances of each patient, all with less radiation. Gillette is the only hospital in the Twin Cities to offer EOS imaging, and the only hospital in the state of Minnesota to offer it specifically for children.Foundation transfers to the hospital in 2016 also supported development of the hospital's neurosciences programs through the purchase of MRI software and hardware. The technology allows Gillette to perform functional MRI (fMRI), a neuroimaging procedure that measures brain activity by detecting changes associated with blood flow. The equipment helps specialists explore where seizures begin and how they spread throughout the brain in patients who have epilepsy. 1144871 1144871 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. 619286 619286 Research:Research that advances the knowledge base and improves care and outcomes is an important part of the Gillette mission and is key to developing effective medical interventions for disabling conditions and their related effects.See Schedule O.In 2016, grants from the Foundation supported research across 14 research emphasis areas. These 14 research emphasis areas are bone health, cerebral palsy, craniofacial, epilepsy, gait and motion analysis, Legg-Calve-Perthes Disease, musculoskeletal, neuromuscular disease, pain and comfort, Rett syndrome, spina bifida, spine, upper extremity and nursing. One example is the Gait and Motion Outcomes Fund. The James R. Gage Center for Gait and Motion Analysis at Gillette Children's Specialty Healthcare is the busiest clinical motion laboratory in the U.S. and among the busiest in the world.In addition to providing vital information on patients' movement to help physicians plan treatments and surgeries, the motion laboratory is also used for research. In 2016, researchers completed a study of the long-term outcomes of patients who had received Distal Femoral Extension Osteotomy with Patellar Tendon Advancement surgery at Gillette. The surgery was pioneered at Gillette many years ago. The study was designed to determine how patients treated as children are doing as adults. Funds were used to bring back two groups of patients: 1) those who had the surgery >8 years prior and 2) those who didn't have the surgery but looked "similar" (based on gait data, age, etc.) to the other group before they had surgery. These studies are for research purposes only, and therefore are not paid for by insurance or reimbursed by Medicare. Findings will become the cornerstone of future work and will be shared with motion analysis centers throughout the world. Support from the Foundation made this groundbreaking research possible.2016 Foundation grants also supported other research aimed at improving the care of patients served at Gillette, including to improve methods for diagnosing hip damage in patients who have Legg-Calve-Perthes disease, a rare orthopedic condition. Because of its specialty care focus, Gillette has unique expertise in treating this condition. 2972306 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 18 16 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 Chairman 1.00 0.00 X X 0 0 0 John Foster Vice Chairman 1.00 0.00 X X 0 0 0 Mark Kimball Secretary 1.00 0.00 X X 0 0 0 David Bestler Treasurer 1.00 0.00 X X 0 0 0 Barbara Joers President/CEO 15.00 40.00 X X 0 797891 72481 Phil Becker Director 1.00 0.00 X 0 0 0 Fay DeBellis Director 1.00 0.00 X 0 0 0 John Ellenberger Director 1.00 0.00 X 0 0 0 David Fettig Director 1.00 0.00 X 0 0 0 Jeffrey Freyer Director 1.00 0.00 X 0 0 0 Diane Harper Director 1.00 0.00 X 0 0 0 Michael Healy MD Chief of Staff 1.00 0.00 X 0 715336 53243 Linda Ireland Director 1.00 0.00 X 0 0 0 Kevin Klemz Director 1.00 0.00 X 0 0 0 Dan Monson Director 1.00 0.00 X 0 0 0 Scott Robinson Director 1.00 0.00 X 0 0 0 Phillip Trier Director 1.00 0.00 X 0 0 0 Martin Brad Winges Director 1.00 0.00 X 0 0 0 Dennis Jolley FND President 4.00 36.00 X 29300 263701 25935 James Haddican VP of Finance 5.00 45.00 X 0 434317 54916 Rachel Wobschall Senior Major Gifts Officer 40.00 0.00 X 114813 0 18012 Elizabeth Utter Manager - Foundation 40.00 0.00 X 142540 0 8303 286653 2211245 232890 2 0 1 0 0 986182 6258726 58757 7244908 243654 243654 241655 236863 4792 4792 4792 130248 986182 243232 -112984 -112984 27650 3193 24457 24457 7404827 0 0 159919 2927591 2927591 37759 37759 6956 6956 31889 31889 1256171 413322 842849 38913 20165 18748 115433 46552 68881 30292 15370 14922 70133 42080 28053 19233 4800 14433 7117 3297 3820 36995 22197 14798 Dues and Memberships 370500 49747 320753 Intercompany Expense 263477 158086 105391 Bad Debt Expense 82904 82904 Meals 23620 6113 17507 47875 14674 33201 5366858 2972306 828292 1566260 4467007 5317851 6349624 6343059 728899 1103232 72919 325166 210112 196063 255132 186641 105486 68491 8840865 9574303 20774912 22928165 865 23574 0 14321 1147437 782946 1148302 820841 X 12356024 14231013 5031565 5637290 2239021 2239021 19626610 22107324 20774912 22928165 2037969 428903 13842 0 X 0 1 X 1 0 X X 1 Gillette Children's Specialty Healthcare 363379150 3 1 2917318 0 1 2917318 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3799706 183272 27865 406953 95158 3508732 3880733 145615 -15453 99923 111266 3799706 3282691 839883 28253 170053 100041 3880733 3365618 105570 303267 362928 128836 3282691 3365786 79278 480113 446878 112681 3365618 0.00000 0.64000 0.36000 0 0 255132 186641 68491 68491 Due to Hospital 689283 Gift Annuity Liablity 93663 782946 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, 2016 and 2015. 1 0 0 0 0 0 0 0 0 0 North America Adaptive Equipment 6956 Check Adaptive Equipment FMV 1 0 0 0 0 0 0 Mauer & Friends Kids Classic 421633 402541 19092 65947 FOG Benefit Event 269326 226026 43300 88029 5 425471 357615 67856 89256 1116430 986182 130248 243232 243232 -112984 27650 3193 0 27650 3193 3193 24457 MN 1 A license is not required in the State of Minnesota for five or fewer raffles. The Foundation held five 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 Libby Utter 0 Ms. Utter oversees gaming activities conducted during the year. X 0 1 Strauss Skates & Bicycles 1751 E cope Ave Maplewood MN 55109 411446679 10273 FMV Adaptive Equipment Gillette Children's Specialty Healthcare 200 University Avenue East St Paul MN 55101 363379150 501(c)(3) 2917318 FMV General Support 1 1 Patient Care Grants 29 37759 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 President/CEO 0 512860 0 208739 0 76292 0 39723 0 32758 0 870372 0 0 Michael Healy MD Chief of Staff 0 641258 0 36118 0 37960 0 14045 0 39198 0 768579 0 0 Dennis Jolley FND President 21848 196635 5386 48470 2066 18596 1022 9242 1567 14104 31889 287047 0 0 James Haddican VP of Finance 0 305679 0 84466 0 44172 0 21223 0 33693 0 489233 0 0 Elizabeth Utter Manager - Foundation 140916 0 250 0 1374 0 7523 0 780 0 150843 0 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 employees of Gillette are provided the opportunity to participate in various non-qualified compensation plans organized under code section 457(f). The exact purpose of each plan varies but they include: compensation limitation make-up plans, supplemental retirement benefits and capital accumulation. All plans are administered by Gillette. Part I, Line 7 Certain employees are eligible for an annual one-time award to recognize employees. The amount and payment of the award is made at the discretion of the compensation Committee of the Board of Directors. X 8 44916 Cost or selling price X Printing 1 13842 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, MD Linda Ireland Kevin Klemz Dan Monson Scott Robinson 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 an abbreviated 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