2016-05-11T13:32:07-05:00 2015-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2014-07-01 311459815 CHMC Community Health Services Network CHMC 5138031106 3333 Burnet Avenue Cincinnati OH 452293039 Tom Dewitt Director 5138031106 2016-05-11 1 Alicia Janisch P00741382 5137847100 2014 2016-08-17 19:52:53Z Dee Ellingwood 3333 Burnet Avenue Cincinnati OH 452293039 4099911 0 X N/A X 1995 OH Provide medical services to children in the community 5 0 0 5 0 0 0 0 3356919 4025071 0 0 85519 74840 3442438 4099911 0 0 0 0 2191560 2276403 0 0 0 1214677 1498080 3406237 3774483 36201 325428 1828488 2305629 201689 353402 1626799 1952227 X CHMC Community Health Services Network ("CHSN") is organized and operated exclusively to support Cincinnati Children's Hospital Medical Center ("CCHMC") in CCHMC's efforts to provide medical services to all of the children in the community. 0 0 3774483 4099911 Cincinnati Children's Hospital Medical Center ("CCHMC") is devoted to providing medical services to all of the children in the community. CHMC community health services network ("CHSN") is organized and operated exclusively to support CCHMC in this effort by reaching out to the medically underserved and economically disadvantaged neighborhoods of our community.CHSN serves as the structure for bringing medical professionals who share the vision of providing quality medical care to the underprivileged and underserved. CHSN carries out its charitable purposes by seeking and hiring such "mission oriented physicians. In addition, CHSN will make medical professionals an integral part of these underprivileged neighborhoods by establishing sites within these communities where resident physicians will work. The resident physicians will be able to learn more about the patients they seek to serve and thereby provide better service to them. Furthermore, in order to ensure its goals are met, CHSN will act as a liaison between the neighborhoods and CCHMC and will focus on how to best meet the difficult and unique needs of the underprivileged neighborhoods of our community. 3774483 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 5 0 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 0 0 0 0 0 X Michael Bauer 5138031106 3333 Burnet Avenue Cincinnati OH 452293039 Michael Fisher Director 1.00 49.00 X 0 1041567 214263 Scott J Hamlin Director/Treasurer/Secretary 1.00 49.00 X X 0 1201344 166069 Steve Muething Director (Thru 2014) 1.00 49.00 X 0 370244 74368 Tom Dewitt MD Director 1.00 49.00 X 0 312655 50399 Dee Ellingwood Director/President (Thru 2014) 1.00 49.00 X X 0 563328 31223 Mark Mumford Director 1.00 49.00 X 0 737068 135096 Charlene Mason Director 1.00 49.00 X 0 345465 38719 0 4571671 710137 0 0 1 0 Turner Construction 250 W Court Street Cincinnati OH 45202 Construction 871508 Margaret Mary Community Hospital 321 Mitchell Avenue Batesville IN 47006 Rent 204771 2 Net Patient Revenue 621990 4025071 4025071 4025071 74840 74840 74840 4099911 4099911 0 0 1966579 1966579 309824 309824 30900 30900 601420 601420 244728 244728 28206 28206 82141 82141 Collection fees 406712 406712 Other 103973 103973 3774483 3774483 0 0 301567 991192 314337 373623 0 9508 1127020 195714 148615 931306 1063969 0 1828488 2305629 201689 353402 201689 353402 X 1626799 1952227 1626799 1952227 1828488 2305629 325428 0 X 0 1 X 1 0 X 2871766 2862546 3284561 3356919 4025071 16400863 2871766 2862546 3284561 3356919 4025071 16400863 0 0 0 16400863 63565 227926 34351 85520 74840 486202 2935331 3090472 3318912 3442439 4099911 16887065 0.97120 0.96940 0.00000 X 7500 7500 723729 44669 679060 395791 151045 244746 931306 0 1 0 0 0 0 0 0 0 Michael Fisher Director 0 872843 0 100000 0 68724 0 185013 0 29250 0 1255830 0 0 Scott J Hamlin Director/Treasurer/Secretary 0 646438 0 230907 0 323999 0 139506 0 26563 0 1367413 0 261920 Steve Muething Director (Thru 2014) 0 285952 0 68702 0 15590 0 49476 0 24892 0 444612 0 0 Tom Dewitt MD Director 0 278544 0 975 0 33136 0 26000 0 24399 0 363054 0 0 Dee Ellingwood Director/President (Thru 2014) 0 371659 0 77273 0 114396 0 1616 0 29607 0 594551 0 56540 Mark Mumford Director 0 487395 0 192367 0 57306 0 107686 0 27410 0 872164 0 0 Charlene Mason Director 0 270068 0 55486 0 19911 0 26000 0 12719 0 384184 0 16053 Part I, Line 4b Certain officers and key employees of Cincinnati Children's Hospital Medical Center ("CCHMC"), a related organization to CHSN, have arrangements which provide for supplemental retirement benefits as described in IRC Sec. 457(F). Due to the substantial risk of forfeiture provision, these arrangements are non-vested and there is no guarantee that these officers and faculty members will ever receive these benefits. The following is a listing of officers and key employees that received a deferral, subject to the substantial risk of forfeiture provision, under CCHMC's IRC. Sec. 457(f) plan during the year (these amounts are included in the totals for Schedule J, Part II, Column C, deferred compensation): 1. Mark Mumford - $81,686 2. Michael Fisher - $159,013 3. Scott Hamlin - $113,506 4. Charlene Mason - $16,102 The following is a listing of officers and key employees that received a payment under CCHMC's IRC Sec. 457(f) plan during the year: 1. Scott Hamlin - $261,920 2. Dee Ellingwood - $56,540 3. Charlene Mason - $16,053 Form 990, Schedule J CHMC Community Health Services Network relied on Cincinnati Children's Hospital Medical Center ("CCHMC"), a related organization, to establish the compensation of individuals listed on Form 990, Part VII. CCHMC used one or more of the methods described below to establish an appropriate level of compensation: Compensation Committee Independent Compensation Consultant Form 990 of other organizations Compensation survey or study Approval by the Board or Compensation Committee Explanation of the benefits: All compensation and benefits reported on Form 990, Part VII and Schedule J, Part II are provided by CCHMC, a related entity to CHSN. The employee benefit plan contribution amounts listed on Schedule J, Part II may include one or more of the following benefits: 1. Elective employee deferrals under IRC Sec. 403(b) 2. Discretionary employer contributions under IRC Sec. 403(b) 3. Elective employee deferrals under IRC Sec. 457(b) 4. Elective employee deferrals under IRC Sec. 457(f) In addition to the retirement plan contributions disclosed on Form 990, Part VII and Schedule J, Part II, the following non-taxable employee welfare benefits were made available to the employed, compensated officers and key employees listed on Form 990, Part VII and Schedule J, Part II: 1. Health and dental insurance benefits 2. Group life insurance (portions of which are taxed) 3. Unemployment benefits 4. Disability benefits The officers and key employers listed on Form 990, Part VII and Schedule J, Part II are also eligible for any other available employer benefits. Form 990, Part VI, Section A, line 6 Article III of CHSN's code of regulations provides that Children's Hospital Medical Center, a related organization, possesses the authority to appoint, elect, and remove members of CHSN's board of trustees. Form 990, Part VI, Section A, line 7a Article III of CHSN's code of regulations provide that Children's Hospital Medical Center, a related organization, possesses the authority to appoint, elect, and remove members of CHSN's board of trustees. Form 990, Part VI, Section B, line 11 The CHMC Community Health Services Network ("CHSN") form 990 is prepared by senior management from Cincinnati Children's Hospital Medical Center ("CCHMC"), a related organization. External tax consultants then review the Form 990 for completeness and accuracy. The Form 990 is then made available to all CHSN board members in advance of filing. Form 990, Part VI, Section B, line 12c All of CHSN's board members receive an annual questionnaire requesting information regarding family and business relationships that could potentially result in a conflict of interest under CHSN's conflict of interest policy. Once the questionnaires have been completed by all of CHSN's board members, the questionnaires are reviewed and if CHSN determines that a relationship exists that presents a conflict of interest, CHSN follows the provisions set forth in CHSN's conflict of interest policy to resolve the conflict and determines the appropriate reporting to the board and, if required, Form 990 disclosure. Form 990, Part VI, Section B, line 15 CHSN's board members are employed by Cincinnati Children's Hospital Medical Center ("CCHMC"), a related organization. CCHMC has a compensation committee that annually reviews the recommendations of CCHMC management regarding employee performance evaluation and compensation adjustments for disqualified persons to ensure that CCHMC has complied with the provisions of the rebuttable presumption of reasonableness under IRC Sec. 4958. Form 990, Part VI, Section C, line 19 CHSN's governing documents, conflict of interest policy, and financial statements are maintained on file by CCHMC senior management and are available to the public upon request either in-person, by telephone, or by written request. Form 990, Part VI, Section B, Question 13 CHSN's Board of Trustees has not formally adopted a written whistleblower policy. However, CHSN is a related organization of Cincinnati Children's Hospital Medical Center ("CCHMC"). CCHMC has a written whistleblower policy and CHSN abides by the provisions of this policy. Form 990, Part VI, Section B, Question 14 CHSN's Board of Trustees has not formally adopted a written document retention and destruction policy. However, CHSN is a related organization of Cincinnati Children's Hospital Medical Center ("CCHMC"). CCHMC has a written document retention and destruction policy and CHSN abides by the provisions of this policy. Form 990, Part VIII All individuals listed on Form 990, Part VII are employed by Cincinnati Children's Hospital Medical Center ("CCHMC"), a related organization. Each individual devotes an average of 50 hours/week for their duties to CCHMC and affiliated entities. Form 990, Part XII, Line 2B CHSN's financial statements are included as part of the Cincinnati Children's Hospital Medical Center & affiliates financial statement audit. Children's Hospital Medical Center 3333 Burnet Avenue Cincinnati OH 45229 310833936 Pediatric Medicine OH 501(c)(3) Line 3 The Children's Hospital 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 Children's Hospital Medical Center R 3916195 Cash Children's Hospital Medical Center S 5052130 Cash Form 990, Schedule R During the time period covered by this return, CHMC Community Health Services Network received certain accounting and administrative services from Cincinnati Children's Hospital Medical Center at no cost. The value of these services is an unspecified amount.