2016-11-01T06:30:11-05:00 2015-12-31 861065772 Deloitte Tax LLP 50 South Sixth Street Ste 2800 Minneapolis MN 55402 990 2015-01-01 411200302 Gillette Children's Hospital Foundation GILL 6512912848 200 University Avenue East St Paul MN 55101 James Haddican VP Finance 6512912848 2016-11-01 1 Kristina Rasmussen P00143920 6123974000 2015 2017-02-10 21:41:12Z James Haddican 200 University Avenue East St Paul MN 55101 41621214 0 X www.gillettechildrens.org X 1985 MN The Foundation raises money for and otherwise supports Gillette Children's Specialty Healthcare. 20 15 0 164 0 0 10132519 6406365 0 0 240881 223299 -424493 -378955 9948907 6250709 3039678 6522610 0 0 1476542 1261306 152468 0 1246308 1140424 651386 5809112 8435302 4139795 -2184593 23481935 20774912 1174237 1148302 22307698 19626610 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 5730631 5730631 Capital: The Foundation raises money to support 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 2015, the Foundation transferred donated funds to support the construction of a new St. Paul therapy pool. The pool, which opened in December 2015, increases Gillette's capacity to offer aquatic therapy to patients. Aquatic therapy provides an ideal environment for patients to receive therapy and practice skills.See Schedule O.Gillette offers aquatic therapy in Burnsville and Maple Grove in addition to St. Paul. Each pool is designed for patients who have disabilities. The St. Paul therapy pool features an adjustable floor that lowers into the water, eliminating the need for patients to use a ramp or lift to enter the water. The pool also features underwater cameras to help therapists evaluate patients' movements, and water jets that adjust based on the water resistance level each patient needs.Foundation transfers to the Hospital in 2015 also supported renovation of Gillette's facilities in St. Paul, including the renovation of existing inpatient rooms from semi-private to private, expansion of the hospital's surgical suites, and the addition of a new playroom in the surgery waiting area. 629932 629932 Patient Care:The Foundation raises money to support activities related to Gillette's 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 assists patients in efforts to qualify for public assistance or Gillette's charity care program. Income eligibility for Gillette's program is based on national poverty guidelines. Gillette will never turn a family away due to an inability to pay for treatment.Additionally, funds raised by the Foundation support areas of Gillette's operations that are unreimbursed or under-reimbursed. For example, Gillette operates Outreach Clinics in 11 communities in greater (largely rural) Minnesota. However, in providing these services, Gillette incurs losses. Gillette's Outreach Clinics offer appointments with doctors, nurse practitioners, seating and adaptive equipment specialists, and rehabilitation engineering technologists. Outreach clinics also assist 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. 162047 162047 Research:Research that advances the knowledge base and improves care and outcomes is an important part of Gillette's mission and is key to developing effective medical interventions for disabling conditions and their related effects.In 2015, grants from the Foundation supported research across Gillette's five designated research areas. One example is the Gait and Motion Outcomes Fund.See Schedule O.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 plans treatments and surgeries, the motion laboratory is also used for research. Due to its more than 25 years of data collection, Gillette is in a unique position to investigate the long-term outcomes of patients who received gait analysis services as children. 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 makes this groundbreaking research possible. 2015 Foundation grants also supported research with the Medical Education and Research Association (MERA) Fund. MERA funds research aimed at improving the care of patients served at Gillette. 2015 MERA-funded projects focused on pain management in patients with Rett syndrome, a rare neurodevelopmental disorder that primarily affects females, and on improved methods for diagnosing hip damage in patients who have Legg-Calve-Perthes disease, a rare orthopedic condition. Gillette has unique expertise in treating both conditions due to its specialty care focus. 6522610 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 3 3 1 0 0 0 0 0 0 1 1 0 0 0 0 X 20 15 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 Brad Keil Chairman 1.00 1.00 X X 0 0 0 Warren Watson Vice Chairman 1.00 1.00 X X 0 0 0 Yvonne Cheek Secretary 1.00 1.00 X X 0 0 0 Scott Robinson Treasurer 1.00 1.00 X X 0 0 0 Barbara Joers President, CEO 15.00 40.00 X X 0 644806 68495 Phil Becker Director 1.00 1.00 X 0 0 0 David Bestler Director 1.00 1.00 X 0 0 0 Fay DeBellis Director 1.00 1.00 X 0 0 0 John Ellenberger Director 1.00 1.00 X 0 0 0 David Fettig Director 1.00 1.00 X 0 0 0 John Foster Director 1.00 1.00 X 0 0 0 Diane Harper Director 1.00 1.00 X 0 0 0 Michael Healy MD Chief of Staff 1.00 40.00 X 0 609145 54007 Mark Kimball Director 1.00 1.00 X 0 0 0 Dan Monson Director 1.00 1.00 X 0 0 0 Phillip Trier Director 1.00 1.00 X 0 0 0 Robert Wagner MD Prior Chief of Staff 1.00 40.00 X 0 262739 47011 Marcie Ward Director 1.00 1.00 X 0 266884 46091 Martin Winges Director 1.00 1.00 X 0 0 0 Dennis Jolley FND President 18.00 27.00 X 97137 145705 37498 James Haddican VP of Finance 5.00 40.00 X 0 371199 46921 Darlis Clausen CMN Manager 40.00 0.00 X 140673 0 8167 Blaine Thrasher Supervisor Senior Gifts 40.00 0.00 X 138235 0 32016 376045 2300478 340206 2 0 1 0 0 1057904 5348461 23817 6406365 276382 276382 34711157 34764240 -53083 -53083 -53083 191663 1057904 601706 -410043 -410043 35647 4559 31088 31088 6250709 0 0 -155656 6478570 6478570 44040 44040 112137 112137 1149169 255413 893756 430 48 382 38495 23097 15398 47691 22924 24767 138115 67852 70263 35780 20876 14904 16559 4791 11768 29507 12538 16969 36995 22197 14798 Dues and Memberships 297948 83107 214841 Meals 25016 8382 16634 Minor Equipment 4084 2428 1656 Bad Debt Expense -92303 -92303 73069 30594 42475 8435302 6522610 666384 1246308 X 4223606 4467007 8845450 6349624 1298063 728899 53113 72919 209273 210112 255132 149646 142481 105486 8709949 8840865 23481935 20774912 52092 865 1122145 1147437 1174237 1148302 X 13307685 12356024 6760992 5031565 2239021 2239021 22307698 19626610 23481935 20774912 -2184593 -500915 4420 0 X 0 1 X 1 0 X X 1 Gillette Children's Specialty Healthcare 363379150 3 1 6459340 0 1 6459340 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 3880733 145615 -15453 99923 111266 3799706 3282691 839883 28253 170053 100041 3880733 3365618 105570 303267 362928 128836 3282691 3365786 79278 480113 446878 112681 3365618 3791838 8432 56433 369299 121618 3365786 0.00000 0.59000 0.41000 0 0 255132 149646 105486 105486 Gift Annuity Liability - Wisc 59288 Gift Annuity Liability 39075 Due to Medical Center 1049074 1147437 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: The Internal Revenue Service has determined that the Foundation is tax-exempt organization under Section 501(c)(3) of the Internal Revenue Code ("IRC") and is not a private institution as defined by Section 509(a) of the IRC. There was no unrecognized tax liabilities or uncertain tax positions for the years ended December 31, 2015 and 2014. Event 1 - Come Fly with Me 574175 511550 62625 419254 Event 2 - Friends of Gillette Benef 284419 239819 44600 82803 6 390973 306535 84438 99649 1249567 1057904 191663 601706 601706 -410043 35647 4559 0 35647 4559 4559 31088 MN 1 A license is not required in the State of Minnesota for 5 or fewer raffles. The Foundation held 5 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 Gillette Children's Specialty Healthcare 200 University Avenue East St Paul MN 55101 363379150 501(c)(3) 6459340 FMV General Support Apple Inc 1 Infinite Loop Cupertino CA 95014 942404110 6094 FMV Adaptive Equipment Strauss Skates 1751 E Cope Avenue Maplewood MN 411446679 411446679 13136 FMV Adaptive Equipment 1 2 Patient Care Grants 22 44040 0 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 499224 0 78578 0 67004 0 29397 0 39098 0 713301 0 0 Michael Healy MD Chief of Staff 0 550969 0 11119 0 47057 0 14045 0 39962 0 663152 0 0 Robert Wagner MD Prior Chief of Staff 0 237249 0 1000 0 24490 0 12847 0 34164 0 309750 0 0 Marcie Ward Director 0 228518 0 825 0 37541 0 12056 0 34035 0 312975 0 0 Dennis Jolley FND President 75761 113641 10800 16200 10576 15864 4062 6092 10938 16406 112137 168203 0 0 James Haddican VP of Finance 0 288796 0 34992 0 47411 0 16174 0 30747 0 418120 0 0 Blaine Thrasher Supervisor Senior Gifts 134104 0 1761 0 2370 0 7647 0 24369 0 170251 0 0 0 Part I, Line 3 The chair of Gillette's personnel committee requests information from the external consultant. The personnel 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 personnel 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 personnel committee meetings. Meeting minutes are recorded. Part I, Line 4b Certain employees of Gillette are provided the opportunity to participate in various non-qualifed 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 Personnel Committee of the Board of Directors. Form 990, Part VI, Section A, 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. The following individuals have a business relationship: Phil Becker David Bestler Yvonne Cheek Fay DeBellis John Ellenberger David Fettig John Foster James Haddican Diane Harper Michael Healy, MD Barbara Joers Dennis Jolley Brad Keil Mark Kimball Dan Monson Scott Robinson Phillip Trier Robert Wagner, MD Marcie Ward, MD Warren Watson Martin Winges 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 11 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 our Administrative Council. 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 personnel 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 personnel 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 personnel 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