2015-07-09T16:15:10-05:00 2014-12-31 273605969 CBIZ MHM LLC 13577 FEATHER SOUND DRIVE 400 CLEARWATER FL 33762 990 2014-01-01 362193608 SHRINERS HOSPITALS FOR CHILDREN SHRI 8132810300 POST OFFICE BOX 31356 TAMPA FL 336313356 DOUGLAS MAXWELL PRESIDENT 8132810300 2015-07-09 1 NATHAN SMITH P00543757 7275721400 2014 2016-02-25 16:41:14Z DOUGLAS MAXWELL 2900 ROCKY POINT DRIVE TAMPA FL 33607 4387422740 0 X HTTP://WWW.SHRINERSHQ.ORG/ X 1925 CO WE PROVIDE PEDIATRIC SPECIALTY CARE WITHOUT FINANCIAL OBLIGATION TO PATIENTS OR THEIR FAMILIES. 20 16 5373 5000 0 0 210375005 266294915 133601431 123099846 533553889 527630087 48018396 29419483 925548721 946444331 46000 46000 0 0 351498680 347324927 6549429 4471500 31658253 290528128 310796148 648622237 662638575 276926484 283805756 8971718639 8952599841 855319197 969986179 8116399442 7982613662 X SEE SCHEDULE OSHRINERS HOSPITALS FOR CHILDREN OFFERS "CHARITY CARE" THROUGH AN INTERNATIONAL NETWORK OF PEDIATRIC HOSPITALS DEDICATED TO PROVIDING EXCELLENT PATIENT CARE, RESEARCH, AND EDUCATION FOR ORTHOPAEDIC CONDITIONS, BURNS, SPINAL CORD INJURIES AND CLEFT LIP AND PALATE. OUR SPECIALIZED MEDICAL CARE, BACKED BY THE SKILLS AND KNOWLEDGE OF THE STAFF IN 18 HOSPITALS, DELIVERS EXPERT, FAMILY-FOCUSED CARE REAGRDLESS OF THE FAMILY'S ABILITY TO PAY. ...AS A 501(C)3 NON-PROFIT ORGANIZATION, SHRINERS HOSPITALS RELIES ON THE GENEROUS DONATIONS OF SHRINERS AND THE GENERAL PUBLIC TO CARRY OUT OUR MISSION AND CHANGE THE LIVES OF CHILDREN EVERY DAY. FOR MORE INFORMATION ABOUT SUPPORTING SHRINERS HOSPITALS, PLEASE VISIT WWW.SHRINERSHQ.ORG OR CALL 1-800-241-GIFT. 0 0 91867527 22490466 TREATMENT OF PEDIATRIC BURN VICTIMS ADMISSIONS: 1,128.OUTPATIENT CLINIC VISITS: 23,245 AT 2 BURNS HOSPITALS AND ONE HOSPITAL THAT SPECIALIZES IN BOTH BURNS AND ORTHOPAEDIC SERVICES.OUTPATIENT CLINIC SURGERIES: 2,273.EVERY YEAR THOUSANDS OF CHILDREN HAVE A GREATER CHANCE OF SURVIVING FROM ALL TYPES OF BURN INJURIES, DUE TO SHC'S SPECIALIZED BURN CARE, WHICH PROVIDES CRITICAL, SURGICAL, AND REHABILITATIVE CARE TO CHILDREN WITH VARYING DEGREES OF NEW AND HEALED BURNS. 410962361 46000 100609380 TREATMENT OF ORTHOPAEDIC PATIENTS ADMISSIONS: 5,366. OUTPATIENT CLINIC VISITS: 163,959 AT 16 ORTHOPAEDIC HOSPITALS AND ONE HOSPITAL THAT SPECIALIZES IN BOTH ORTHOPAEDIC AND BURNS SERVICES.OUTPATIENT CLINIC SURGERIES: 9,151.SHC IS DEDICATED TO PROVIDING MEDICAL AND REHABILITATIVE SERVICES TO CHILDREN WITH CONGENITAL DEFORMITIES AND CONDITIONS, PROBLEMS RESULTING FROM ORTHOPEDIC INJURIES AND DISEASES OF THE NEUROMUSCULOSKELETAL SYSTEM. COMMONLY TREATED CONDITIONS INCLUDE CLUBFOOT, HAND DISORDERS, LIMB DEFICIENCIES, HIP DISORDERS, SCOLIOSIS, OSTEOGENESIS PERFECTA, JUVENILE ARTHRITIS AND CEREBRAL PALSY AND SPINA BIFIDA. ALL CARE IS PROVIDED REGARDLESS OF A PATIENT'S OR FAMILY'S ABILITY TO PAY. 23545977 MEDICAL RESEARCH IS CONDUCTED AND PROVIDES A STRONG, POSITIVE IMPACT ON THE CARE AND CURE OF CHILDREN WITH ORTHOPAEDIC PROBLEMS, BURN AND SPINAL CORD INJURIES. 127 RESEARCH PROJECTS WERE FUNDED, AND 28 RESEARCH FELLOWSHIPS WERE PROVIDED. SHRINERS HOSPITALS FOR CHILDREN IS COMMITTED TO THE SUSTAINED INVESTMENT IN CLINICALLY USEFUL RESEARCH SO THAT FUNDAMENTAL KNOWLEDGE CAN BE ACQUIRED, IMPROVING THE QUALITY OF LIFE FOR CHILDREN WITH ORTHOPAEDIC PROBLEMS, BURN AND SPINAL CORD INJURIES. 526375865 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 0 1 0 0 1 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 933 0 1 5373 1 0 1 AS AU BE BR CA DA FI FR GM HK ID IT JA KS MX NL NO PL SN SF SP SW SZ TH UK PO 0 0 0 1 1 1 2 0 0 0 X 20 16 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY X X SHARON RUSSELL 8132810300 2900 ROCKY POINT DRIVE TAMPA FL 33607 JACK JONES DIRECTOR 5.00 X 0 176655 1440 DOUGLAS MAXWELL PRESIDENT, TRUSTEE 35.00 X X 18000 0 0 JOHN CINOTTO DIRECTOR 5.00 X 0 23750 0 DALE STAUSS CHAIRMAN 5.00 X X 0 47500 0 JERRY GANTT FIRST V.P. 5.00 X X 0 0 0 CHRIS SMITH SECOND V.P. 5.00 X X 0 0 0 GARY BERGENSKE SECRETARY 5.00 X X 0 0 0 JIM CAIN ASSISTANT SECRETARY 5.00 X X 0 0 0 JEFFREY SOWDER DIRECTOR 5.00 X 0 0 0 WAYNE LACHUT DIRECTOR 5.00 X 0 0 0 JAMES SMITH DIRECTOR 5.00 X 0 0 0 RAOUL L FREVAL TRUSTEE 5.00 X 0 0 0 BOBBY SIMMONS TRUSTEE 5.00 X 0 0 0 ANTHONY WEST TRUSTEE 5.00 X 0 0 0 JAMES MCCONNELL TREASURER 5.00 X X 0 0 0 JOSEPH SAVAGLIO DIRECTOR 5.00 X 0 0 0 SKIP STANAWAY DIRECTOR 5.00 X 0 0 0 WILLIAM BAILEY DIRECTOR 5.00 X 0 0 0 KENNETH CRAVEN DIRECTOR 5.00 X 0 0 0 JAMES DOEL TRUSTEE 5.00 X 0 0 0 JOHN MCCABE EXECUTIVE VICE PRESIDENT 40.00 X 374019 0 1843 KEVIN YAKUBOFF GENERAL SURGEON 32.00 X 296911 0 288662 PAUL CASKEY CHIEF OF STAFF 40.00 X 487715 0 1012020 MARGARET RICH ASST COS - ORTHO 28.00 X 333740 0 609779 LAWRENCE JACOBSON CHIEF ANESTHESIOLOGIST 40.00 X 374687 0 381988 STEPHEN SANTORA ORTHOPEDIC SURGEON 40.00 X 296592 0 397150 2181664 247905 2692882 462 0 1 0 S M WILSON AND CO 2185 HAMPTON AVE ST LOUIS MO 63139 CONSTRUCTION SERVICES 21811617 BARTON COTTON HOLDINGS 3030 WATERVIEW AVE BALTIMORE MD 21230 FUNDRAISING AND MARKETING SERVICES 13078624 UTMB AT GALVESTON 301 UNIVERSITY BLVD GALVESTON TX 77550 MEDICAL SERVICES 9194198 EDGE DIRECT LLC PO BOX 35672 TULSA OK 74153 FUNDRAISING AND MARKETING SERVICES 8170749 JJ HEALTHCARE SYSTEMS 425 HOES LANE PISCATAWAY TOWNSHIP NJ 08854 MEDICAL SUPPLIES 6924785 390 1275671 19363318 31403078 214252848 266294915 PATIENT SERVICE 621110 123099846 123099846 123099846 195155160 195155160 82860 82860 15234759 0 15234759 15234759 15234759 3772881775 3437383656 3023192 335498119 -3023192 332474927 332474927 11889939 19363318 571561 11318378 11318378 OTHER INCOME 900099 2783486 2783486 2783486 946444331 123099846 0 557049570 X 46000 46000 393862 338721 55141 270190451 240807788 27657985 1724678 23212548 21321154 1891394 35359097 31345046 4014051 18168969 16202942 1966027 4471500 4471500 14221333 14221333 81514807 59523847 19116458 2874502 14489951 5317140 218652 8954159 19627478 6955650 12602570 69258 6034796 289255 5744006 1535 20059311 16113072 3946239 7138386 4171161 2394796 572429 573919 235875 316954 21090 211380 211380 44766528 37409086 7357442 4037584 3520093 517491 MEDICAL SUPPLIES 74265088 74144181 120131 776 PGA EVENT EXPENSES 10709637 10709637 PATIENT COSTS 2943018 2112081 830937 DUES AND REGISTRATIONS 2129924 1866023 249780 14121 8073008 4656750 1171690 2244568 662638575 526375865 104604457 31658253 10708836 6362805 32381302 43175411 18050435 16372801 10361996 9825475 1232185242 618087011 610291578 614098231 6520990621 6428157840 257723656 288897840 1511210215 1545709438 8971718639 8952599841 197332431 285557421 12126811 12798769 36981955 38381142 0 10000000 608878000 623248847 855319197 969986179 X 6726358349 6588673776 309908402 296919343 1080132691 1097020543 8116399442 7982613662 8971718639 8952599841 X 283805756 -266836026 -150755510 X X 0 1 X 1 0 X 0 1 X 7305707433 263100355 323489628 7245318162 6725272450 968695800 388260817 7305707433 6340401648 830356472 445485670 6725272450 6598994424 3569133 262161909 6340401648 6299536273 696982199 397524048 6598994424 0.80760 0.15140 0.04100 0 0 28638234 28638234 800065942 366957160 433108782 10651244 8632901 2018343 314668929 242496950 72171979 78160893 78160893 614098231 BENEFICIAL INTERESTS IN TRUSTS 543919635 ESTATES IN PROCESS 259166846 PATIENT TRANSPORTATION FUNDS 57353253 COLLATERAL CASH AND SECURITIES 623164849 RECEIVABLES FROM INCOME TRUSTS 1946465 RELATED PARTY RECEIVABLES 60158390 1545709438 LIABILITY UNDER SEC. LENDING 623164849 SUSPENSE ACCOUNTS 83998 623248847 663357144 -266836025 -266836025 930193169 16251162 16251162 946444331 646659911 571561 571561 646088350 16550225 16550225 662638575 PART IV, LINE 2B: THE AMOUNT INCLUDED ON FORM 990, PART X, LINE 21 CONSISTS OF ANNUITY LIABILITIES ASSOCIATED WITH CHARITABLE REMAINDER TRUSTS HELD BY SHRINERS HOSPITALS FOR CHILDREN, WHICH ARE DETERMINED BASED ON PRESENT VALUE OF THE ESTIMATED FUTURE PAYMENTS TO BE PAID TO THE DESIGNATED BENEFICIARIES. DEFERRED INCOME IS RECOGNIZED ON GIFTS TO SHRINERS HOSPITALS FOR CHILDREN POOLED INCOME FUNDS WHICH REPRESENT THE DISCOUNTED VALUE OF THE ASSETS FOR THE ESTIMATED TIME PERIOD UNTIL THE DONOR'S DEATH PART V, LINE 4: THE ENDOWMENT FUNDS (INCLUDING UNRESTRICTED FUND BALANCES) ARE THE PRIMARY SOURCE OF SUPPORT FROM WHICH SHRINERS HOSPITALS FOR CHILDREN PERFORMS ITS PROGRAM SERVICES TO ACHIEVE ITS PRIMARY EXEMPT PURPOSE. PART XI, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSES RECLASSIFIED FROM EXPENSES -571,561. OTHER CHANGES 272,498. RECLASSIFIED INVESTMENT EXPENSES 13,830,225. RECLASSIFIED MISCELLANEOUS EXPENSES 2,720,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSES RECLASSIFIED TO NET WITH REVENUES 571,561. PART XII, LINE 4B - OTHER ADJUSTMENTS: RECLASSIFIED INVESTMENT EXPENSES 13,830,225. RECLASSIFIED MISCELLANEOUS EXPENSES 2,720,000. FORM 990, PART XI, LINE 9 CHANGE IN MINIMUM PENSION LIABILITY : (100,698,085) TRANSFERS: SHRINERS HOSPITALS FOR CHILDREN, A MASSACHUSETTS CORPORATION = (25,592,194) SHRINERS HOSPITALS FOR CHILDREN, A CANADIAN CORPORATION = (13,220,664) SHRINERS HOSPITALS FOR CHILDREN, A MEXICAN CORPORATION = (14,337,787) SHRINERS HOSPITALS FOR CHILDREN, A COLORADO CORPORATION = (2,854,065) SUBTOTAL TRANSFERS : (56,004,710) CHANGE IN PATIENT TRANSPORTATION FUNDS HELD BY SHRINE TEMPLES : 2,486,681 PGA NET ASSETS: 5,286,352 OTHER CHANGE IN FUND BALANCE : (1,825,748) TOTAL : (150,755,510) 1 MEXICO 1 327 FUNDING TO HOSPITAL SHRINERS PARA NINOS, A RELATED NONPROFIT ORGANIZATION.;LISTTOTAL 15499000 16169000 CANADA 1 259 FUNDING TO SHRINERS HOSPITALS FOR CHILDREN, A RELATED NONPROFIT ORGANIZATION.;LISTTOTAL 23961000 21876000 2 586 0 0 2 586 38045000 0 38045000 0 0 0 0 0 0 PART I, LINE 2: THE FOREIGN ORGANIZATIONS RECEIVING FUNDING ARE ENTIRELY CONTROLLED BY THIS ORGANIZATION'S OFFICERS. THE SAME PROTOCOLS FOR THIS ORGANIZATION'S PROGRAM SERVICE INITIATIVES APPLY TO THE FOREIGN ORGANIZATIONS. X X X X X X 1 EDGE DIRECT 3030 WATERVIEW AVE BALTIMORE MD 21230 DIRECT MAIL SOLICITATION 0 14609642 3755500 10854142 EDGE DIRECT 3030 WATERVIEW AVE BALTIMORE MD 21230 TELEVISION ADVERTISEMENT 0 2747170 716000 2452327 17356812 4471500 13306469 AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY PAPER CRUSADE 9846231 6100347 3745884 180068 FOOTBALL GAME 5703106 3533426 2169680 104299 31 15703920 9729545 5974375 287194 31253257 19363318 11889939 571561 571561 11318378 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 502829888 123099846 379730042 0.57310 502829888 123099846 379730042 0.57310 23545977 23545977 0.03550 23545977 23545977 0.03550 526375865 123099846 403276019 0.60860 0 0 18 1 SHRINERS HOSPITAL FOR CHILDREN-CHICAGO 2211 NORTH OAK PARK AVENUE CHICAGO IL 607073392 X X X X A 2 SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT 3229 BURNET AVENUE CINCINNATI OH 452293095 X X X X A 3 SHRINERS HOSPITAL FOR CHILDREN-ERIE 1645 WEST 8TH STREET ERIE PA 16505 X OUTPATIENT AMBULATORY SURGICAL CENTER & CLINIC A 4 SHRINERS HOSPITAL FOR CHILDREN-GALVESTON 815 MARKET STREET GALVESTON TX 77550 X X X X A 5 SHRINERS HOSPITAL FOR CHILDREN-GREENV 950 WEST FARIS ROAD GREENVILLE SC 29605 X X X X A 6 SHRINERS HOSPITAL FOR CHILDREN-HONOLULU 1310 PUNAHOU STREET HONOLULU HI 968261099 X X X X A 7 SHRINERS HOSPITAL FOR CHILDREN-HOUSTON 6977 MAIN STREET HOUSTON TX 770303701 X X X X A 8 SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON 1900 RICHMOND ROAD LEXINGTON KY 40502 X X X X A 9 SHRINERS HOSPITAL FOR CHILDREN-LA 3160 GENEVA STREET LOS ANGELES CA 90020 X X X X A 10 SHRINERS HOSPITAL FOR CHILDREN-PHILADELP 3551 NORTH BROAD STREET PHILADELPHIA PA 191404131 X X X X A 11 SHRINERS HOSPITAL FOR CHILDREN-PORTLAND 3101 SW SAM JACKSON PARK RD PORTLAND OR 972393095 X X X X A 12 SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE FAIRFAX ROAD AT VIRGINIA STREET SALT LAKE CITY UT 84103 X X X X A 13 SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR 3100 SAMFORD AVENUE SHREVEPORT LA 71103 X X X X A 14 SHRINERS HOSPITAL FOR CHILDREN-SPOKANE 911 WEST 5TH AVENUE SPOKANE WA 99204 X X X X A 15 SHRINERS HOSPITAL FOR CHILDREN-ST LOUIS 2001 S LINDBERGH BOULEVARD ST LOUIS MO 631313597 X X X X A 16 SHRINERS HOSPITAL FOR CHILDREN-TAMPA 12502 USF PINE DRIVE TAMPA FL 336129499 X X X X A 17 SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY 2025 EAST RIVER PARKWAY MINNEAPOLIS MN 55414 X X X X A 18 SHRINERS HOSPITAL FOR CHILDREN-N CALI 2425 STOCKTON BOULEVARD SACRAMENTO CA 95817 X X X X A SHRINERS HOSPITAL FOR CHILDREN-GROUP A 0 0 1 X X X X X X X X 12 1 1 0 1 X HTTP://WWW.SHRINERSHOSPITALFORCHILDREN.ORG X 0 0 1 X 300.000000000000 400.000000000000 X X 1 1 X 0 0 0 0 X X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: SHRINERS HOSPITAL FOR CHILDREN-CHICAGO, - FACILITY 2: SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT, - FACILITY 3: SHRINERS HOSPITAL FOR CHILDREN-ERIE, - FACILITY 4: SHRINERS HOSPITAL FOR CHILDREN-GALVESTON, - FACILITY 5: SHRINERS HOSPITAL FOR CHILDREN-GREENV, - FACILITY 6: SHRINERS HOSPITAL FOR CHILDREN-HONOLULU, - FACILITY 7: SHRINERS HOSPITAL FOR CHILDREN-HOUSTON, - FACILITY 8: SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON, - FACILITY 9: SHRINERS HOSPITAL FOR CHILDREN-L.A., - FACILITY 10: SHRINERS HOSPITAL FOR CHILDREN-PHILADELP, - FACILITY 11: SHRINERS HOSPITAL FOR CHILDREN-PORTLAND, - FACILITY 12: SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE, - FACILITY 13: SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR, - FACILITY 14: SHRINERS HOSPITAL FOR CHILDREN-SPOKANE, - FACILITY 15: SHRINERS HOSPITAL FOR CHILDREN-ST. LOUIS, - FACILITY 16: SHRINERS HOSPITAL FOR CHILDREN-TAMPA, - FACILITY 17: SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY, - FACILITY 18: SHRINERS HOSPITAL FOR CHILDREN-N. CALI GROUP A-FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN - CHICAGO PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN - CHICAGO PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 3 -- SHRINERS HOSPITAL FOR CHILDREN-ERIE PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 3 -- SHRINERS HOSPITAL FOR CHILDREN-ERIE PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 4 -- SHRINERS HOSPITAL FOR CHILDREN-GALVESTON PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 4 -- SHRINERS HOSPITAL FOR CHILDREN-GALVESTON PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 5 -- SHRINERS HOSPITAL FOR CHILDREN-GREENV PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 5 -- SHRINERS HOSPITAL FOR CHILDREN-GREENV PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 6 -- SHRINERS HOSPITAL FOR CHILDREN-HONOLULU PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 6 -- SHRINERS HOSPITAL FOR CHILDREN-HONOLULU PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 7 -- SHRINERS HOSPITAL FOR CHILDREN-HOUSTON PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 7 -- SHRINERS HOSPITAL FOR CHILDREN-HOUSTON PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 8 -- SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 8 -- SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 9 -- SHRINERS HOSPITAL FOR CHILDREN-L.A. PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 9 -- SHRINERS HOSPITAL FOR CHILDREN-L.A. PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 10 -- SHRINERS HOSPITAL FOR CHILDREN-PHILADELP PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 10 -- SHRINERS HOSPITAL FOR CHILDREN-PHILADELP PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 11 -- SHRINERS HOSPITAL FOR CHILDREN-PORTLAND PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 11 -- SHRINERS HOSPITAL FOR CHILDREN-PORTLAND PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 12 -- SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 12 -- SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 13 -- SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 13 -- SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 14 -- SHRINERS HOSPITAL FOR CHILDREN-SPOKANE PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 14 -- SHRINERS HOSPITAL FOR CHILDREN-SPOKANE PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 15 -- SHRINERS HOSPITAL FOR CHILDREN-ST. LOUIS PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 15 -- SHRINERS HOSPITAL FOR CHILDREN-ST. LOUIS PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 16 -- SHRINERS HOSPITAL FOR CHILDREN-TAMPA PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 16 -- SHRINERS HOSPITAL FOR CHILDREN-TAMPA PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 17 -- SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 17 -- SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. GROUP A-FACILITY 18 -- SHRINERS HOSPITAL FOR CHILDREN-N. CALI PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 18 -- SHRINERS HOSPITAL FOR CHILDREN-N. CALI PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. PART I, LINE 3C: SHRINERS HOSPITALS FOR CHILDREN OFFERS SPECIALIZED MEDICAL SERVICES PERTAINING TO ORTHOPAEDIC CONDITIONS, BURNS, SPINAL CORD INJURIES AND CLEFT LIP AND PALATE. UPON PATIENT ADMITTANCE FOR ONE OF THESE CONDITIONS, SHRINERS HOSPITALS FOR CHILDREN REVIEWS THE PATIENT'S "ABILITY TO PAY" USING THE FEDERAL POVERTY GUIDELINES SPECIFIED IN SCHEDULE H, PART I, LINES 3A AND 3B, AND PROVIDES FREE OR DISCOUNTED CARE PURSUANT TO THESE GUIDELINES. NEVERTHELESS, SHRINERS HOSPITALS FOR CHILDREN WILL ALWAYS SERVE THESE SPECIALIZED NEEDS FOR ALL OF ITS PATIENTS, REGARDLESS OF THEIR "ABILITY TO PAY". AS SUCH, SHRINERS HOSPITALS FOR CHILDREN DID NOT APPLY ANY INCOME-BASED CRITERIA, ASSET TEST, OR OTHER MEANS TEST OR THRESHOLD FOR PROVIDING FREE CARE TO PATIENTS IN 2014. PART I, LINE 7: A GENERAL LEDGER ACCOUNTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7. THE SYSTEM ADDRESSES ALL PATIENT SEGMENTS (INPATIENT AND OUTPATIENT). A COST-TO-CHARGE RATIO IS NOT PART OF THE SYSTEM. PART III, LINE 4: BAD DEBT EXPENSE IS NOT APPLICABLE TO SHRINERS HOSPITALS FOR CHILDREN, AND AS SUCH, IS NOT PART OF THE FOOTNOTES IN ITS FINANCIAL STATEMENTS. SHRINERS HOSPITALS FOR CHILDREN PROVIDES PATIENT CARE REGARDLESS OF THEIR ABILITY TO PAY. AS SUCH, THERE ARE NO REVENUES AGAINST WHICH A BAD DEBT COULD ARISE. PART III, LINE 9B: SHRINERS HOSPITALS FOR CHILDREN PROVIDES PATIENT CARE REGARDLESS OF THEIR ABILITY TO PAY. AS SUCH, THERE IS NO DEBT COLLECTION POLICY. PART VI, LINE 2: SHRINERS HOSPITALS FOR CHILDREN PROVIDES PEDIATRIC, ORTHOPAEDIC, AND BURN CARE REGARDLESS OF THEIR ABILITY TO PAY. PART VI, LINE 3: SHRINERS HOSPITALS FOR CHILDREN POSTS ITS CHARITY CARE POLICY IN ADMISSION AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT, AND PROVIDES A COPY OF ITS POLICY TO PATIENTS AS PART OF THE INTAKE PROCESS AND WITH DISCHARGE MATERIALS. PART VI, LINE 4: SHRINERS HOSPITALS FOR CHILDREN (THROUGH THIS ENTITY AND ITS RELATED ENTITY) SERVE CHILDREN IN NEED OF SPECIALIZED ORTHOPAEDIC AND BURN CARE ACROSS THE UNITED STATES AND WORLD-WIDE. 1 AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS 6300 NORTH RIVER ROAD ROSEMONT IL 60018 362110592 501(C)(3) 46000 SPONSORSHIP GRANT 1 PART I, LINE 2: SHRINERS HOSPITALS FOR CHILDREN IS ACTIVELY INVOLVED WITH ALL GRANT RECIPIENTS. THROUGH THIS ACTIVE INVOLVEMENT, THE ORGANIZATIONS ARE MONITORED TO ENSURE THEIR GRANT PROCEEDS ARE BEING USED APPROPRIATELY. X X 1 1 X X X 0 1 0 0 0 0 0 0 0 JACK JONES DIRECTOR 0 159155 0 0 0 17500 0 1440 0 0 0 178095 0 0 JOHN MCCABE EXECUTIVE VICE PRESIDENT 356519 0 0 0 17500 0 1843 0 0 0 375862 0 0 0 KEVIN YAKUBOFF GENERAL SURGEON 282103 0 0 0 14808 0 288662 0 0 0 585573 0 0 0 PAUL CASKEY CHIEF OF STAFF 470215 0 0 0 17500 0 1012020 0 0 0 1499735 0 0 0 MARGARET RICH ASST COS - ORTHO 333740 0 0 0 0 0 609779 0 0 0 943519 0 0 0 LAWRENCE JACOBSON CHIEF ANESTHESIOLOGIST 357187 0 0 0 17500 0 381988 0 0 0 756675 0 0 0 STEPHEN SANTORA ORTHOPEDIC SURGEON 279092 0 0 0 17500 0 397150 0 0 0 693742 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS ORGANIZED AS A NONPROFIT CORPORATION WITH MEMBERS. MEMBERS HAVE THE RIGHT TO ELECT PERSONS BELONGING TO THE GOVERNING BODY, AND TO APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY. COMPENSATION IS NOT PROVIDED FOR BEING A MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS APPROXIMATELY 1,400 MEMBERS WHOM ARE APPOINTED FROM THE TOTAL MEMBERSHIP OF SHRINERS INTERNATIONAL (A RELATED ORGANIZATION). MEMBERS MAY ELECT PERSONS ON THE ORGANIZATION'S GOVERNING BODY, AND MAY APPOVE SIGNIFICANT DECISIONS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B UNDER THE BYLAWS OF THE ORGANIZATION, SIGNIFICANT DECISIONS OF THE GOVERNING BODY REQUIRE APPROVAL BY THE ORGANIZATION'S 1,400 MEMBERS (SUCH AS CHANGES TO THE BYLAWS, OR SIGNIFICANT RESTRUCTURING OR EXTRAORDINARY EVENTS). THE ORGANIZATION'S MEMBERS ALSO MAY ELECT PERSONS TO SERVE ON THE ORGANIZATION'S GOVERNING BODY. THE ORGANIZATION'S MEMBERS DO NOT HAVE CONTROL OVER THE GENERAL OPERATIONS OR FINANCIAL MATTERS OF THE ORGANIZATION. ELECTIONS ARE HELD ANNUALLY BY THE MEMBERS AT VARYING LOCATIONS IN THE U.S.. VOTING IS DECIDED WITH SIMPLE MAJORITY, WHERE EACH MEMBER'S VOTE IS EQUAL WEIGHTED. ELECTED PERSONS SERVE A THREE-YEAR TERM ON THE BOARD OF TRUSTEES, A ONE-YEAR TERM ON THE BOARD OF DIRECTORS, A ONE-YEAR TERM FOR THE ORGANIZATION'S PRESIDENT, AND A ONE-YEAR TERM FOR THE ORGANIZATION'S TREASURER. THE ORGANIZATION'S OFFICERS ARE NOT ELECTED, AND INSTEAD ARE HIRED BY COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11 A FULL VERSION OF FORM 990 AS FILED WITH THE IRS IS MADE AVAILABLE TO EACH VOTING MEMBER OF THE GOVERNING BODY AND/OR DESIGNATED COMMITTEE RESPONSIBLE FOR PERFORMING A REVIEW PROCESS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND ALL MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTING INTERESTS OR STATE "NONE" ON THE ANNUAL CONFLICT OF INTEREST FORM. POTENTIAL CONFLICTS ARE DETERMINED BY THE BOARD OF DIRECTORS. THE PERSON(S) HAVING A POTENTIAL CONFLICT OF INTEREST ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS/DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 A SALARY & PERSONNEL COMMITTEE IS INVOLVED WITH ALL COMPENSATION AND APPROVES WAGES FOR MANAGEMENT AND COMPARES THESE SALARIES TO VARIOUS MARKET INDICATORS. FORM 990, PART VI, SECTION C, LINE 19 THESE DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART IX, LINE 11G PUBLIC RELATIONS & OTHER: PROGRAM SERVICE EXPENSES 6,833,068. MANAGEMENT AND GENERAL EXPENSES 10,594,641. FUNDRAISING EXPENSES 2,874,502. TOTAL EXPENSES 20,302,211. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 51,262,804. MANAGEMENT AND GENERAL EXPENSES 8,521,817. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 59,784,621. AGENCY PERSONNEL SERVICES: PROGRAM SERVICE EXPENSES 1,427,975. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,427,975. FORM 990, PART XI, LINE 9: CHANGE IN PENSION FUNDING OBLIGATION -100,698,085. TRANSFERS TO RELATED ENTITIES -56,004,710. CHANGE IN PATIENT TRANSPORTATION FUNDS HELD BY SHRINE TEMPLES 2,486,681. OTHER CHANGES IN FUND BALANCE -1,825,748. PGA NET ASSETS 5,286,352. FORM 990, PART XI, LINE 2C, AUDIT COMMITTEE OVERSIGHT PROCESS: THE ORGANIZATION HAS NOT CHANGED (DURING THE CURRENT YEAR) ITS OVERSIGHT PROCESS OR ITS SELECTION PROCESS REGARDING THE COMMITTEE RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. PEDIATRIC ORTHOPEDIC & PROSTHETIC SERVICES - NORTH CALIFORNIA LLC 2425 STOCKTON BLVD SACRAMENTO CA 95817 272210763 ORTHOPEDICS & PROSTHETICS DE 634851 326545 NO PEDIATRIC ORTHOPEDIC & PROSTHETIC SERVICES - TAMPA LLC 12502 USF PINE DRIVE TAMPA FL 336129499 452723185 ORTHOPEDICS & PROSTHETICS DE 812977 170971 NO PEDIATRIC ORTHOPEDIC & PROSTHETIC SERVICES - GREENVILLE LLC 950 W FARIS RD GREENVILLE SC 29605 453940485 ORTHOPEDICS & PROSTHETICS DE 287801 156716 NO THE SHRINERS' HOSPITAL FOR CHILDREN POST OFFICE BOX 31356 TAMPA FL 336313356 042121377 HOSPITAL SYSTEM MA 501(C)(3) LINE 3 NO 0 SHRINERS INTERNATIONAL POST OFFICE BOX 31356 TAMPA FL 336313356 362158164 FOUNDED SHRINERS HOSPITALS FOR CHILDREN IA 501(C)(10) N/A NO 0 SHRINERS HOSPITALS FOR CHILDREN EMPLOYEE DISASTER RELIEF FUND 2900 ROCKY POINT DRIVE TAMPA FL 33607 263733381 DISASTER RELIEF DC 501(C)(3) LINE 9 NO 0 SHRINERS HOSPITALS FOR CHILDREN (QUEBEC) INC 1529 CEDAR AVE MONTREAL CA H36 1A6 HOSPITAL SYSTEM CA 501(C)(3) EQUIVALENT LINE 3 NO 0 SHRINERS HOSPITALS FOR CHILDREN A CANADIAN CORPORATION 1529 CEDAR AVE MONTREAL CA H36 1A6 HOSPITAL SYSTEM CA 501(C)(3) EQUIVALENT LINE 3 NO 0 SHRINERS HOSPITALS FOR CHILDREN A MEXICAN ASSOCIATION MX AV DEL IMAN NO 257 MEXICO CITY MX 04600 HOSPITAL SYSTEM MX 501(C)(3) EQUIVALENT LINE 3 NO 0 0 1 0 1 1 0 0 0 0 1 0 0 0 0 1 1 1 0 0 THE SHRINERS' HOSPITAL FOR CHILDREN E 51846504 CASH THE SHRINERS' HOSPITAL FOR CHILDREN B 25592194 CASH SHRINERS INTERNATIONAL D 106670 CASH THE SHRINERS' HOSPITAL FOR CHILDREN O 0 AMOUNT UNDETERMINABLE THE SHRINERS' HOSPITAL FOR CHILDREN D 61174942 CASH SHRINERS INTERNATIONAL J 487607 CASH SHRINERS INTERNATIONAL Q 232720 CASH SHRINERS INTERNATIONAL P 5605163 CASH SHRINERS HOSPITALS FOR CHILDREN CAN B 13220664 CASH SHRINERS HOSPITALS FOR CHILDREN MEX B 14337787 CASH