CHILD HEALTH PATIENT SAFETY ORGANIZATION INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- CHILD HEALTH PATIENT SAFETY ORGANIZATION INC (EIN 27-0386722)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-15
- IRS object ID
- 201613209349308681
- Schema version
- 2015v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-15T13:26:17-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 521855942 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Tate and Tryon | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2021 L Street NW Suite 400 | AddressLine1Txt |
| City | Washington | CityNm |
| State Abbreviation | DC | StateAbbreviationCd |
| ZIP | 20036 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 270386722 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILD HEALTH PATIENT SAFETY ORGANIZATION | BusinessNameLine1Txt |
| Business Name Line2 | INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHIL | BusinessNameControlTxt |
| Phone | 9132621436 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 16011 College Blvd No 250 | AddressLine1Txt |
| City | lenexa | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66219 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Nancy Stahl | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9132621436 | PhoneNum |
| Signature | 2016-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Deborah G Kosnett | PreparerPersonNm |
| PTIN | P00290720 | PTIN |
| Phone | 2022932200 | PhoneNum |
| Preparation | 2016-11-14 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | Yes (X) | AddressChangeInd |
| Principal Officer | Nancy Stahl | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 16011 College Blvd No 250 | AddressLine1Txt |
| City | lenexa | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66219 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $765,000 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | N/A | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2010 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE SAFETY AND QUALITY OF CHILD HEALTH CARE DELIVERY BY CREATING A SECURE ENVIRONMENT TO ANALYZE DATA THAT WILL ENABLE THE REDUCTION OF RISKS AND HAZARDS ASSOCIATED WITH PATIENT CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 14 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $0 | PYContributionsGrantsAmt |
| CY Contributions Grants | $0 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $682,500 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $765,000 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $0 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $682,500 | PYTotalRevenueAmt |
| CY Total Revenue | $765,000 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $613,198 | PYOtherExpensesAmt |
| CY Other Expenses | $817,601 | CYOtherExpensesAmt |
| PY Total Expenses | $613,198 | PYTotalExpensesAmt |
| CY Total Expenses | $817,601 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $69,302 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$52,601 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $76,132 | TotalAssetsBOYAmt |
| Total Assets EOY | $224,715 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,000 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $216,184 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $61,132 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,531 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO IMPROVE THE SAFETY AND QUALITY OF CHILD HEALTH CARE DELIVERY BY CREATING A SECURE ENVIRONMENT WHERE CLINICIANS AND HEALTH CARE ORGANIZATIONS CAN COLLECT, AGGREGATE, AND ANALYZE DATA THAT WILL ENABLE THE IDENTIFICATION AND REDUCTION OF RISKS AND HAZARDS ASSOCIATED WITH PATIENT CARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $694,961 | ExpenseAmt |
| Revenue | $765,000 | RevenueAmt |
| Desc | THE CHILD HEALTH PATIENT SAFETY ORGANIZATION, INC. (PSO) WAS ORGANIZED IN 2010 TO IMPROVE THE SAFETY OF CHILDREN'S HOSPITALS BY SHARING DATA AND EXPERIENCES. MANDATED BY THE PATIENT SAFETY AND QUALITY IMPROVEMENT ACT (PSQIA), THE PSO PROVIDES FEDERAL PROTECTIONS FOR CHILDREN'S HOSPITALS, NOT ONLY TO LEAD IN PATIENT SAFETY, BUT TO ELIMINATE HARM, UTILIZING COLLABORATIVE INITIATIVES AND USE OF NATIONAL EXPERTS. IT IS THE LARGEST PSO IN THE UNITED STATES DEDICATED TO CHILDREN'S HOSPITALS. IT PROVIDES:- A SAFE LEARNING COMMUNITY: CONFIDENTIALITY, MONTHLY USER GROUP CALLS PLUS AN ANNUAL MEETING, REVIEW DATA ANALYSIS, DEVELOPMENT OF NEW STANDARDS FROM BEST PRACTICES, AND SHARD LEARNING AND STANDARDIZED METHODS.- ALERTS TO POTENTIAL SAFETY RISKS: EVIDENCE-BASED RECOMMENDATIONS, SUPPORT FOR SPECIFIC HOSPITAL CULTURES, BENEFITS FOR PEDIATRIC PATIENTS THROUGHOUT THE COMMUNITY.- COMMITMENT TO STATE AND NATIONAL AGENCIES: MEETS STATE MANDATES FOR PSO PARTICIPATION, MEETS LEAPFROG SERIOUS REPORTABLE EVENT POLICY, PROVIDES ALTERNATIVE TO THE JOINT COMMISSION SENTINEL EVENT REPORTING. | Desc |
| Total Program Service Expenses | $694,961 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 2 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Nancy Stahl | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9132621436 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 16011 College Blvd No 250 | AddressLine1Txt |
| City | lenexa | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66219 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Patricia DePompeiMSN | ||||||||
| CHAIR/PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Tom Shufflebarger | ||||||||
| Vice Chair/Vice President | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Tom Kmetz | ||||||||
| Secretary/treasurer | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| James Shmerling DHA FACHE | ||||||||
| Director | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Christopher A Gessner | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Mark Wietecha | ||||||||
| CEO | 1.00 | 39.00 | Yes (X) | $22,623 | $882,269 | $188,197 | ||
| Amy Knight | ||||||||
| COO | 5.00 | 35.00 | Yes (X) | $69,068 | $483,472 | $102,267 | ||
| D Brian Humphreys | ||||||||
| VP of Finance | 1.00 | 39.00 | Yes (X) | $6,501 | $253,548 | $48,959 | ||
| Nancy Stahl | ||||||||
| Chief Financial Officer | 1.00 | 39.00 | Yes (X) | $2,108 | $82,230 | $12,789 | ||
| Katherine Conrad | ||||||||
| VP, Delivery System Transformation | 20.00 | 20.00 | $115,459 | $115,459 | $29,808 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $215,759 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,816,978 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $382,020 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp
Contractor Name ContractorName
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ECRI Institute Inc | BusinessNameLine1Txt |
Contractor Address ContractorAddress
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5200 Butler Pike | AddressLine1Txt |
| City | Plymouth Meeting | CityNm |
| State Abbreviation | PA | StateAbbreviationCd |
| ZIP | 19462 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Services | IT and Analytics Services | ServicesDesc |
| Compensation | $360,500 | CompensationAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 1 | CntrctRcvdGreaterThan100KCnt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PARTICIPATION FEES | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $765,000 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $765,000 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $765,000 | TotalProgramServiceRevenueAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $765,000 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $765,000 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,187 | TotalAmt |
| Program Services | $123,409 | ProgramServicesAmt |
| Management And General | $21,778 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,836 | TotalAmt |
| Program Services | $13,461 | ProgramServicesAmt |
| Management And General | $2,375 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,040 | TotalAmt |
| Program Services | $1,734 | ProgramServicesAmt |
| Management And General | $306 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $411,200 | TotalAmt |
| Program Services | $349,520 | ProgramServicesAmt |
| Management And General | $61,680 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,759 | TotalAmt |
| Program Services | $1,495 | ProgramServicesAmt |
| Management And General | $264 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,071 | TotalAmt |
| Program Services | $2,610 | ProgramServicesAmt |
| Management And General | $461 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,400 | TotalAmt |
| Program Services | $6,290 | ProgramServicesAmt |
| Management And General | $1,110 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,798 | TotalAmt |
| Program Services | $47,428 | ProgramServicesAmt |
| Management And General | $8,370 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Overhead Allocation | Desc |
| Total | $175,310 | TotalAmt |
| Program Services | $149,014 | ProgramServicesAmt |
| Management And General | $26,296 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $817,601 | TotalAmt |
| Program Services | $694,961 | ProgramServicesAmt |
| Management And General | $122,640 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $224,715 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,132 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,132 | BOYAmt |
| EOY | $224,715 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $882 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,000 | BOYAmt |
| EOY | $52,500 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $162,802 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,000 | BOYAmt |
| EOY | $216,184 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,132 | BOYAmt |
| EOY | $8,531 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,132 | BOYAmt |
| EOY | $8,531 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $76,132 | BOYAmt |
| EOY | $224,715 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$52,601 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $250,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $290,521 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $570,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $682,500 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $765,000 | CurrentTaxYearAmt |
| Total | $2,558,021 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $250,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $290,521 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $570,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $682,500 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $765,000 | CurrentTaxYearAmt |
| Total | $2,558,021 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $200,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $235,521 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $342,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $338,550 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $367,500 | CurrentTaxYearAmt |
| Total | $1,483,571 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $200,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $235,521 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $342,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $338,550 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $367,500 | CurrentTaxYearAmt |
| Total | $1,483,571 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $1,074,450 | PublicSupportTotal509Amt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $250,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $290,521 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $570,000 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $682,500 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $765,000 | CurrentTaxYearAmt |
| Total | $2,558,021 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.42000 | PublicSupportCY509Pct |
| Public Support PY509 | 0.36380 | PublicSupportPY509Pct |
| Investment Income CY | 0.00000 | InvestmentIncomeCYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to CHCA | $33 |
| Due to NACHRI | $162,769 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $162,802 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $765,000 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $765,000 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $765,000 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $817,601 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $817,601 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $817,601 | TotalExpensesPerForm990Amt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Mark Wietecha | ||||||||||||||
| CEO | $17,334 | $676,010 | $5,250 | $204,750 | $39 | $1,509 | $4,096 | $159,754 | $683 | $26,637 | $27,402 | $1,068,660 | $0 | $0 |
| Amy Knight | ||||||||||||||
| COO | $51,499 | $360,491 | $15,000 | $105,000 | $2,569 | $17,981 | $9,740 | $68,180 | $3,415 | $23,905 | $82,223 | $575,557 | $0 | $0 |
| D Brian Humphreys | ||||||||||||||
| VP of Finance | $5,366 | $209,292 | $1,100 | $42,900 | $35 | $1,356 | $594 | $23,166 | $631 | $24,601 | $7,726 | $301,315 | $0 | $0 |
| Katherine Conrad | ||||||||||||||
| VP, Delivery System Transformation | $97,393 | $97,393 | $17,750 | $17,750 | $316 | $316 | $6,655 | $6,655 | $8,265 | $8,265 | $130,379 | $130,379 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 4b | FormAndLineReferenceDesc |
| Explanation | THE FOLLOWING LISTED EMPLOYEE PARTICIPATED IN A 457(F) PLAN DURING THE YEAR: -MARK WIETECHA (NO DISTRIBUTION IN 2015, $140,000 WAS CONTRIBUTED TO THE PLAN) -NANCY STAHL (NO DISTRIBUTION IN 2015, $10,108 WAS CONTRIBUTED TO THE PLAN) -AMY KNIGHT ($20,009 DIStribution 2015, $36,071 WAS CONTRIBUTED TO THE PLAN) | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 3 | THERE IS AN "OFFICE SHARING AND ADMINISTRATIVE SERVICES AGREEMENT" WITH CHILD HEALTH CORPORATION OF AMERICA, A RELATED FOR-PROFIT DELAWARE CORPORATION. |
| Form 990, Part VI, Section A, line 6 | THE NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS, INC., A SECTION 501(c)(6) ORGANIZATION, IS THE PSO'S SOLE MEMBER. |
| Form 990, Part VI, Section A, line 7a | AS SOLE MEMBER, THE NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS, INC. MAY APPOINT MEMBERS OF THE GOVERNING BOARD. |
| Form 990, Part VI, Section B, line 11 | An outside firm prepares the tax return. It is then reviewed by staff. One week before filing, the entire return is provided to the full Board of Trustees. The CFO receives comments back and clears these up prior to filing a final return. |
| Form 990, Part VI, Section B, line 12c | PERIODICALLY, THE BOARD OF TRUSTEES MUST FILL OUT A CONFLICT OF INTEREST QUESTIONNAIRE AND ALSO SUBMIT TO BACKGROUND CHECKS OF VARYING DEGREES. THE RESULTS ARE REVIEWED BY THE CEO AND ALSO THE EXTERNAL AUDITORS. AT THE START OF ALL BOARD AND COMMITTEE MEETINGS, THE PARTICIPATING MEMBERS ARE ASKED TO DECLARE ANY CONFLICT OF INTEREST ACCORDINGLY. PERIODICALLY, ALL STAFF MUST FILL OUT A CONFLICT OF INTEREST FORM AND MUST ADHERE TO THE ASSOCIATION'S CONFLICT OF INTEREST POLICY. ANY CONFLICTS OF INTEREST ARE RESOLVED AS APPROPRIATE. THE HUMAN RESOURCE DEPARTMENT ENCOURAGES STAFF TO BRING ANY SITUATIONS TO THEIR ATTENTION AND MAKE PROMPT AND FULL DISCLOSURE OF ANY POTENTIAL SITUATIONS THAT MAY INVOLVE A CONFLICT OF INTEREST. THE POLICY IS INCLUDED IN OUR EMPLOYEE MANUAL AND WHISTLEBLOWER POLICY. |
| Form 990, Part VI, Section B, line 15 | THE CURRENT PRESIDENT AND CEO WAS HIRED IN SEPTEMBER 2011 AND The Current COO WAS HIRED IN DECEMBER 2011. THIS PROCESS INVOLVED A NATIONAL SEARCH FIRM THAT WAS CLOSELY MONITORED BY A TASK FORCE AND THE BOARD OF TRUSTEES. IN ADDITION, THE GOVERNANCE COMMITTEE ALSO ACTS AS THE COMPENSATION COMMITTEE AND REVIEWS, and approves, ALL COMPENSATION RELATED MATTERS. THE CEO AND COO's COMPENSATION WAS BASED ON MARKET COMPARABLES OF SIMILAR SIZED ORGANIZATIONS AND RESPONSIBILITIES. THE COMPENSATION IS ALSO INCLUDED IN A WRITTEN EMPLOYMENT AGREEMENT. A COMPLETE REVIEW OF ALL SALARIES occurred during 2014. Salary INCREASES are RECOMMENDED BY THE GOVERNANCE COMMITTEE TO THE FULL BOARD FOR APPROVAL IN EXECUTIVE SESSION WITHOUT THE CEO PRESENT. FOR ALL OTHER STAFF, THE ASSOCIATION PERIODICALLY ENGAGES AN OUTSIDE CONSULTANT FOR COMPENSATION STUDIES TO REVIEW ALL JOB DESCRIPTIONS AND SALARIES. THIS CONSULTANT HAS EXPERTISE IN THE NON-PROFIT AND HEALTH FIELDS AND IS VERY FAMILIAR WITH THE COMPENSATION PRACTICES. THE CONSULTANT REVIEWS THE COMPENSATION OF OTHER NATIONAL ASSOCIATIONS AND PEER GROUPS. SELECTED SENIOR STAFF WERE GIVEN RAISES AS A RESULT OF A CONSOLIDATION OF POSITIONS AND THESE WERE REVIEWED BY THE GOVERNANCE COMMITTEE. A FORMAL EVALUATION OF ALL CURRENT SALARIES occured during 2015. ALL OTHER STAFF RECEIVED MINIMAL INCREASES IN LINE WITH THE MOST RECENT COMPENSATION STUDIES COMPLETED. |
| Form 990, Part VI, Section C, line 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| Form 990, Part IX, line 11g | Consulting fees: Program service expenses 349,520. Management and general expenses 61,680. Fundraising expenses 0. Total expenses 411,200. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS INC (NACH) | |||||||||||
| 600 13TH STREET NW SUITE 500 | WASHINGTON | DC | 20005 | 582176067 | ASSIST CHILDREN'S HOSPITALS IN COMMON BUSINESS INTERESTS AND ECON. WELFARE | GA | 501(C)(6) | N/A | N/A | 0 | |
| NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS INC | |||||||||||
| 600 13TH STREET NW SUITE 500 | wASHINGTON | DC | 20005 | 510120256 | TO PROMOTE SUPPORT OF CHILDREN'S HOSPITALS | GA | 501(C)(3) | 509(A)(2) | 0 | NACH | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt |
|---|---|
| NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS INC | |
| N | $145,187 |
| NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS INC | |
| O | $175,311 |
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