2017-07-14T18:11:20-05:00 2016-08-31 420714325 RSM US LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2015-09-01 363283051 CHILDREN'S SURGICAL FOUNDATION CHIL 3122276420 737 N Michigan Ave No 2050 CHICAGO IL 60611 Kathleen R Billings MD Treasurer 3122276420 2017-06-26 1 Wayne Harder P00294296 3126343400 2015 2021-01-29 14:40:06Z Erik King MD 737 N Michigan Ave No 2050 CHICAGO IL 60611 48095690 0 X N/A X 1984 IL Dedicated to providing outstanding pediatric surgical services to our patients. 8 1 58 0 0 0 7589365 5517148 37445476 42032940 202677 175191 250750 276263 45488268 48001542 284685 326330 0 0 28004846 30613050 0 0 0 15772928 16094290 44062459 47033670 1425809 967872 10405357 11683850 1566725 1736449 8838632 9947401 X The Children's Surgical Foundation ("the Foundation or "CSF") is dedicated to providing outstanding pediatric surgical services to our patients incorporating family-centered care, comprehensive research, and the highest quality specialized education. 0 0 43859197 326330 42309203 The Foundation is at the forefront of pediatric surgical care, specializing in nine surgical disciplines and a number of multidisciplinary programs. The Foundation has a reputation for the finest quality care, superb teaching, and ground-breaking research. The latest advances in surgical treatments and state-of-the-art technology, coupled with a spirit of compassion and more years of experience than any other pediatric surgical group in the Midwest creates the vital difference to our patients and their families: Cardiovascular-Thoracic Surgery; Neurosurgery; Ophthalmology; Orthopedic Surgery; Otolaryngology; Pediatric Surgery; Plastic Surgery; Transplant Surgery; Urology.In addition, 35-45% of the patients served by the Foundation are covered by Medicaid. The shortfall of the reimbursement versus the actual surgical costs are absorbed by the Foundation as a benefit to the community. 43859197 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 139 0 1 58 0 0 0 0 0 0 0 0 0 0 0 X 8 1 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X Regina Allard 3122276420 737 N Michigan Ave No 2050 CHICAGO IL 60611 Erik King MD President 40.00 X X 611250 0 38227 Earl Y Cheng MD Vice President 40.00 X X 664342 0 64470 Kathleen R Billings MD Treasurer 40.00 X X 553837 0 56311 John Maddalozzo MD Secretary 40.00 X X 366707 0 64470 John J Grayhack MD Director 40.00 X 561533 0 66808 Marilyn B Mets MD Director 40.00 X 426383 0 47247 Andrew Arkin Director 1.00 X 0 0 0 Bruce Lindgren Director 40.00 X 579183 0 64470 Dana Thompson MD Director 40.00 X 687300 0 47992 Carl L Backer MD Physician 40.00 X 992833 0 66808 Marleta Reynolds MD Physician 40.00 X 898500 0 66808 Tadanori Tomita MD Physician 40.00 X 635533 0 58488 James F Sarwark MD Physician 40.00 X 659488 0 47247 7636889 0 689346 57 0 1 0 Children's Faculty Practice Plan 737 N Michigan Ave Ste 2040 Chicago IL 60611 Credentiality Services/Benefit Packages 3074434 Pediatric Faculty Foundation 225 E Chicago Ave Chicago IL 60611 Physician Services 955418 Quatrro FPO Solutions 8401 102nd St Ste 500 Pleasant Praire WI 53158 Accounting Services 336000 Nixon Peabody 70 W Madison Ave Ste 3500 Chicago IL 60602 Legal 173416 The Advisory Board PO Box 79461 Baltimore MD 21279 Consulting 123480 7 5517148 5517148 Program Service Revenue 900099 29736865 29736865 Physician Services 900099 6851872 6851872 Medicaid 900099 5444203 5444203 42032940 269339 269339 94148 -94148 -94148 -94148 Meaningful Use 900099 276263 276263 276263 48001542 42309203 0 175191 326330 326330 5084785 5046379 38406 21507385 21344939 162446 1960699 1930197 30502 1241946 1232113 9833 818235 807558 10677 134973 134973 385503 385503 26426 26426 1387638 1380080 7558 233689 175909 57780 665206 571434 93772 6526 6526 27987 27987 407 407 31560 31560 369606 98985 270621 Hospital Fees 9400057 8686517 713540 Assessment Fees 1615347 1615347 Billing and Collection 1113848 1113848 Education and Research 546827 546827 148690 36628 112062 47033670 43859197 3174473 0 3697150 5129056 543402 410417 439274 286058 180392 153216 5968473 5987753 15940 3408 10405357 11683850 271644 112178 1295081 1624271 1566725 1736449 X 8838632 9947401 8838632 9947401 10405357 11683850 967872 140897 0 X 0 1 X 1 0 X 792112 2748633 2345159 7589365 5517148 18992417 35151808 37174397 38877639 37445476 42032940 190682260 35943920 39923030 41222798 45034841 47550088 209674677 0 0 0 209674677 211141 256214 266295 253617 269339 1256606 211141 256214 266295 253617 269339 1256606 82141 425003 429250 250750 276263 1463407 36237202 40604247 41918343 45539208 48095690 212394690 0.98720 0.98660 0.00590 0.00580 X Schedule A, Part III, Line 12, Explanation of Other Income: Forgiveness of Debt - 2011 Amount: $ 82,141. Meaningful Use - 2012 Amount: $ 425,003. 2013 Amount: $ 429,250. 2014 Amount: $ 250,750. 2015 Amount: $ 276,263. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 41285 2677 38608 397989 283381 114608 153216 Due To Ann & Robert H. Lurie Children's Hospital of Chicago 1624271 1624271 X 48142439 140897 140897 48001542 0 48001542 47033670 0 47033670 0 47033670 Part X, Line 2: The Foundation adopted the accounting standard on accounting for uncertainty in income taxes, which addresses the determination of whether tax benefits claimed or expected to be claimed on a tax return should be recorded in the financial statements. Under this guidance, the Foundation may recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merits of the position. Examples of tax positions include the tax-exempt status of the Foundation and various positions related to the potential sources of unrelated business taxable income. The tax benefits recognized in the financial statements from such a position are measured based on the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement. The guidance on accounting for uncertainty in income taxes also addresses de-recognition, classification, interest and penalties on income taxes, and accounting in interim periods. At August 31, 2016 and 2015, there were no unrecognized tax benefits identified or recorded as liabilities. The Foundation files Forms 990 in the U.S. federal jurisdiction and the State of Illinois. With few exceptions, the Foundation is no longer subject to examination by the Internal Revenue Service for years before August 31, 2013. 1 Ann & Robert H Lurie Children's Hospital of Chicago 225 E Chicago Avenue Chicago IL 60611 362170833 501(c)(3) 265200 General support YMCA of Metropolitan Chicago 801 N Dearborn Street Chicago IL 60610 362179782 501(c)(3) 20000 General Support Northwestern University 303 E Chicago Avenue Chicago IL 60611 362167817 501(c)(3) 16000 General support 3 0 Part I, Line 2: The Foundation has an active and close working relationship with the grantees who are well-respected Chicagoland 501(c)(3) organizations. X X X 0 0 0 0 0 0 0 1 0 Erik King MD President 611250 0 0 0 0 0 35000 0 3227 0 649477 0 0 0 Earl Y Cheng MD Vice President 664342 0 0 0 0 0 35000 0 29470 0 728812 0 0 0 Kathleen R Billings MD Treasurer 553837 0 0 0 0 0 35000 0 21311 0 610148 0 0 0 John Maddalozzo MD Secretary 366707 0 0 0 0 0 35000 0 29470 0 431177 0 0 0 John J Grayhack MD Director 561533 0 0 0 0 0 35000 0 31808 0 628341 0 0 0 Marilyn B Mets MD Director 421383 0 5000 0 0 0 35000 0 12247 0 473630 0 0 0 Bruce Lindgren Director 579183 0 0 0 0 0 35000 0 29470 0 643653 0 0 0 Dana Thompson MD Director 687300 0 0 0 0 0 35000 0 12992 0 735292 0 0 0 Carl L Backer MD Physician 892833 0 100000 0 0 0 35000 0 31808 0 1059641 0 0 0 Marleta Reynolds MD Physician 898500 0 0 0 0 0 35000 0 31808 0 965308 0 0 0 Tadanori Tomita MD Physician 635533 0 0 0 0 0 35000 0 23488 0 694021 0 0 0 James F Sarwark MD Physician 659488 0 0 0 0 0 35000 0 12247 0 706735 0 0 0 Part I, Line 7 The Board of Directors has the ultimate discretion regarding whether bonuses are paid. Suggested bonuses are provided to the Board of Directors by the Finance Committee who reviews recommendations received from the Compensation Committee. All bonuses are based on overall financial performance of the organization as well as individual performance of the physician. Ann & Robert H Lurie Children's Hospital of Chicago Substantial Contributor 8666599 Space rental, insurance, and other program services 0 Central DuPage Hospital Substantial Contributor 560719 Clinical Space Rent 0 Children's Hospital of Chicago Faculty Practice Plan Inc Substantial Contributor 3074434 Credentiality and Benefit Package 0 Form 990, Part III, Line 1 The latest advances in surgical treatments and state-of-the-art technology, coupled with a spirit of compassion and more years of experience than any other pediatric surgical group in the Midwest creates the vital difference to our patients and their families. More specifically, CSF is organized exclusively to: (1) Engage in the professional enterprise of furnishing information, research, clinical studies associated within all specialties of pediatric surgery; (2) Provide information and instruction to graduate physicians and other health care personnel in medical specialty education related to pediatrics and all subspecialties of pediatric surgery; (3) Conduct research in all branches of clinical medicine, with specialties in pediatrics and pediatric surgery; (4) Provide medical information to patients in connection with the foregoing, without regard to the patient's ability to pay; (5) Propose, encourage and stimulate research, experiments and studies related to diseases affecting pediatric patients and foster the education of the medical community and the dissemination of information relating to maladies and illnesses affecting pediatric patients and the alleviation thereof; (6) Participate in such other activities of a charitable and/or medical and educational nature as may be permitted under the provisions of the Illinois Not-for-Profit Corporation Act. Form 990, Part VI, Section A, line 6 All physicians employed by the Foundation who have been employed by the Foundation for 24 months and worked at least 50% of a full-time surgeon for the prerequisite 24-month period and are anticipated to continue to work at least 50% of a full-time surgeon for the foreseeable future. However, the Board of Directors does have the authority to waive the requirement for 24 months of the Foundation employment for a specific physician as long as that physician commits to work at least 50% of a full-time surgeon. Form 990, Part VI, Section A, line 7a At the Annual Meeting of Members, or at another designated meeting set by the Board of Directors, the Members elect the Member physicians to serve on the Board of Directors. Form 990, Part VI, Section A, line 7b The approval of the Members is needed for the following actions: - approval of the standard form of employment agreement for the Foundation physicians; - approval of a merger, consolidation, sale of all or substantially all the assets of CSF or partial or total dissolution; - approval of all amendments to the Foundation's corporate Articles of Incorporation and bylaws; - approval of the Board's selection of its Chair/President from among the physicians serving on the Board of the Foundation; - approval of the creation of any tax exempt or taxable corporations or control subsidiary, or the acquisition of any entity; - approval of all salaries and salary increases paid to the executive director, corporate officers and Board Directors for their services as executive director, officers and directors; and - approval of any obligations which require personal guarantees of the Members provided; however, for any such personal guarantees to be deemed approved there must be an affirmative vote of two-thirds (2/3) of all Members of the Foundation without regard to the number of Members attending the meeting and further provided that the Foundation shall not be authorized to require Members to sign personal guarantees joint and several liability. Form 990, Part VI, Section B, line 11 Form 990 is sent to all members of the Finance Committee. The review of Form 990 takes place at the next Finance Committee Meeting which takes place after the delivery of Form 990 by the CPA firm who prepares Form 990. The CSF Administrator provides a detailed written review of Form 990 and highlights any changes from the prior year. This review is completed and the information is sent to the Finance Committee and the Board of Directors along with a copy of Form 990. The Board of Directors provides the Administrator with documentation that they have reviewed the form. This documentation is maintained in corporate records. Form 990, Part VI, Section B, line 12c Annually, individuals are asked to disclose or update a conflict of interest form provided by the Foundation regarding any interests that could give rise to conflicts, such as a list of family members, substantial business or investment holdings, and other transactions or affiliations with businesses and other organizations or those of a family member that may benefit them financially from a decision he or she makes in a capacity of authority within the Foundation. For each interest disclosed to the Board of Directors, the Board will determine whether to: (a) take no action; (b) assure full disclosure to the Board of Directors and other individuals covered by this policy; (c) ask the person to recuse from participation in related discussions or decisions within the Organization; or (d) ask the person to resign from his or her position in the Organization or, if the person refuses to resign, become subject to possible removal in accordance with the Organization's removal procedures. The Organization's Administrator and Executive Director will monitor proposed or ongoing transactions for conflicts of interest and disclose them to the Board of Directors in order to deal with potential or actual conflicts, whether discovered before or after the transaction has occurred. Form 990, Part VI, Section B, line 15 CSF's Compensation Committee is made up of the doctors of the Foundation. Each year the Compensation Committee meets to review salaries of all employees of the organization, which includes the organization's directors and key employees. The Committee strives to develop a compensation plan that encourages and recognizes physician productivity and quality; to further CSF's mission, goals and objectives and to compensate physicians fairly in comparison to internal and external benchmarks. MGMA, AMGA and Sullivan Cotter surveys are used by the Compensation Committee. All compensation related decisions and deliberations are contemporaneously documented in the Compensation Committee and Board of Director minutes. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statements are available upon request for the same period of disclosure as set forth in IRC Section 6104(d). Revenue Integrity Management Services LLC 737 N Michigan Ave Suite 1650 Chicago IL 60611 300550350 Medical Billing Services IL 153676 85058 Children's Surgical Foundation Inc