2014-07-15T10:31:40-05:00 2013-12-31 273605969 CBIZ MHM LLC 13577 FEATHER SOUND DRIVE 400 CLEARWATER FL 33762 990 2013-01-01 042121377 THE SHRINERS' HOSPITAL FOR CHILDREN SHRI 8132810300 POST OFFICE BOX 31356 TAMPA FL 336313356 DOUGLAS MAXWELL PRESIDENT 8132810300 2014-07-15 1 NATHAN SMITH P00543757 7275721400 2013 2015-11-30 17:44:51Z DOUGLAS MAXWELL 2900 ROCKY POINT DRIVE TAMPA FL 33607 521832960 0 X HTTP://WWW.SHRINERSHQ.ORG/ X 1925 MA WE PROVIDE PEDIATRIC SPECIALTY CARE WITHOUT FINANCIAL OBLIGATION TO PATIENTS OR THEIR FAMILIES. 20 17 503 1000 0 0 41166474 24165195 5925184 11380353 45834475 79180991 1598055 1408523 94524188 116135062 0 0 0 0 34553667 32009321 0 0 0 28079499 38524195 62633166 70533516 31891022 45601546 941556297 1043158680 13675966 17449535 927880331 1025709145 X SEE SCHEDULE OSHRINERS HOSPITALS FOR CHILDREN IN BOSTON AND SPRINGFIELD OFFER "CHARITY CARE" AS PART OF AN INTERNATIONAL NETWORK OF PEDIATRIC HOSPITALS DEDICATED TO PROVIDING EXCELLENT PATIENT CARE, RESEARCH, AND EDUCATION FOR ORTHOPAEDIC CONDITIONS AND BURNS.SHRINERS HOSPITALS FOR CHILDREN-BOSTON SPECIALIZES IN PROVIDING COMPREHENSIVE ACUTE CARE AND RECONSTRUCTIVE AND REHABILITATIVE CARE TO CHILDREN WHO HAVE BEEN BURNED, INCLUDING ACUTE BURNS, SMOKE INHALATION INJURY, RECONSTRUCTIVE SURGERY FOR HEALED BURNS, AND OTHER RELATED CONDITIONS.SHRINERS HOSPITALS FOR CHILDREN-SPRINGFIELD SPECIALIZES IN CARING FOR CHILDREN WITH ORTHOPAEDIC CONDITIONS AND INJURIES SUCH AS SCOLIOSIS, CLUBFOOT, AND ORTHOPAEDIC CONDITIONS RELATED TO CEREBRAL PALSY AND SPINAL BIFIDA. FOR MORE INFORMATION, VISIT HTTP://WWW.SHRINERSHQ.ORG/ OR CALL 1-800-241-GIFT. 0 0 43918808 7513838 TREATMENT OF PEDIATRIC BURN VICTIMS: ADMISSIONS: 515OUTPATIENT CLINIC VISITS: 5,314OUTPATIENT CLINIC SURGERIES: 524 22599995 3866515 TREATMENT OF ORTHOPEDIC PEDIATRIC PATIENTS: ADMISSIONS: 160OUTPATIENT CLINIC VISITS: 13,603OUTPATIENT CLINIC SURGERIES: 300 4014713 MEDICAL RESEARCH IS PERFORMED AND HAS A STRONG, POSITIVE IMPACT ON THE CARE AND CURE OF CHILDREN WITH ORTHOPAEDIC PROBLEMS, BURN AND SPINAL CORD INJURIES. 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. 70533516 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 70 0 1 503 1 0 0 0 0 0 1 1 0 0 0 1 1 0 X 20 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X SHARON RUSSELL 8132810300 2900 ROCKY POINT DR TAMPA FL 336071435 CHARLES CLAYPOOL TRUSTEE 5.00 X 0 0 0 GARY DUNWOODY TRUSTEE 5.00 X 0 0 0 RAOUL L FREVAL TRUSTEE 5.00 X 0 0 0 DOUGLAS MAXWELL PRESIDENT, TRUSTEE 20.00 X X 0 18000 0 MICHAEL G SEVERE TRUSTEE 5.00 X 0 0 0 DAVID H BURSTEIN TRUSTEE 5.00 X 0 0 0 KEVIN J HECHT ESQ TRUSTEE 5.00 X 0 0 0 RICHARD E JOHNSON ASSISTANT TREASURER, TRUSTEE 5.00 X X 0 0 0 BOBBY B SIMMONS TRUSTEE 5.00 X 0 0 0 ALAN W MADSEN CHAIRMAN, TRUSTEE 20.00 X X 0 47500 0 SKIP DF STANAWAY TRUSTEE 5.00 X 0 0 0 PETER P DIAZ MD TRUSTEE 5.00 X 0 0 0 JOHN A CINOTTO VICE PRESIDENT, TRUSTEE 5.00 X X 0 71250 0 STEVEN E BEHE TRUSTEE 5.00 X 0 0 0 JAMES L MCCONNELL TREASURER 5.00 X X 0 0 0 DALE W STAUSS TRUSTEE 5.00 X 0 0 0 ROGER SUMNER BABB TRUSTEE 5.00 X 0 0 0 ROBERT L BAKER TRUSTEE 5.00 X 0 0 0 BARRY J GATES TRUSTEE 5.00 X 0 0 0 G STEPHEN GETMAN ESQ TRUSTEE 5.00 X 0 0 0 JACK H JONES ASSISTANT SECRETARY 35.00 X 0 149289 0 CHARLES H WEAVER CLERK 5.00 X 0 0 0 DAVID M DRVARIC MD CHIEF OF STAFF 40.00 X 421060 0 20943 PETER D MASSO MD ASSISTANT CHIEF OF STAFF 40.00 X 306352 0 24953 CLIFFORD D'ESMOND ADMINISTRATOR 40.00 X 218973 0 2841 ALAN J FISCHMAN SR. INVESTIGATOR 40.00 X 193805 0 2031 DEBORAH ROTHMAN PEDIATRICIAN, RHEMATOLOGY 40.00 X 181344 0 1541 1321534 286039 52309 46 0 1 0 MASSACHUSETTS GENERAL HOSPITAL PO BOX 350096 BOSTON MA 02241 OUTSIDE PATIENT CARE 6513622 HEALTH NEW ENGLAND 1 MONARCH PLACE 1500 SPRINGFIELD MA 01144 EMPLOYEE BENEFITS 1335318 OWENS & MINOR 9120 LOCKWOOD BLVD MECHANICSVILLE VA 23116 MEDICAL SUPPLIES 889525 HOWMEDICA OSTEONICS CORP 750 TRADE CENTRE WAY STE 200 MAHWAH NJ 07430 MEDICAL EQUIPMENT 629001 CARDINAL HEALTH PHARMACEUTICAL 7000 CARDINAL PLACE DUBLIN OH 43017 PHARMACEUTICAL SUPPLIES 431598 32 22336842 1828353 23550 24165195 PATIENT SERVICE 621110 11380353 11380353 11380353 26717263 26717263 1167540 0 1167540 1167540 1167540 458143855 405679975 152 52463880 -152 52463728 52463728 117815 17771 100044 100044 MISCELLANEOUS 900099 140939 140939 140939 116135062 11380353 0 80589514 X 1321534 1321534 21966259 21966259 4014291 4014291 2915707 2915707 1791530 1791530 1787848 1787848 10735943 10735943 307461 307461 158824 158824 3765499 3765499 326499 326499 4983941 4983941 387841 387841 OTHER MEDICAL CHARGES 9446473 9446473 MEDICAL SUPPLIES 5882265 5882265 PATIENT TRAVEL COSTS 534324 534324 DUES AND REGISTRATIONS 142124 142124 65153 65153 70533516 70533516 0 0 701420 183133 426431 2037066 938039 911403 483136 421009 147291603 73443176 77653247 73848427 861238972 965692730 115052 64912 941556297 1043158680 2266797 3364903 906169 1216616 10503000 12868016 13675966 17449535 X 927880331 1025709145 927880331 1025709145 941556297 1043158680 45601546 52227268 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 858306892 126977206 22142447 963141651 774831322 106867079 23391509 858306892 760025402 29611840 14805920 774831322 698824389 83046382 21845369 760025402 604354755 117592699 23123065 698824389 1.00000 0.00000 0.00000 0 1 1 303990 303990 414179 387411 26768 107660786 42470086 65190700 38529292 30585679 7943613 383356 383356 73848427 RELATED PARTY PAYABLES 12868016 12868016 144259056 52227268 -1787858 50439410 93819646 22315416 22315416 116135062 70551287 17771 17771 70533516 0 70533516 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 2D - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEES RECLASSIFIED TO EXPENSES -1,787,858. PART XI, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSES RECLASSIFIED FROM EXPENSES -17,771. FUNDING REVENUES RECLASSIFIED FROM OTHER CHANGES IN FUND BALANCE 22,333,187. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSES RECLASSIFIED TO NET WITH REVENUES 17,771. GOLF TOURNAMENT 9639 9639 1454 FOOTBALL GAMES 87355 87355 13176 6 20821 20821 3141 117815 117815 17771 17771 100044 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 66518803 11380350 55138453 0.78170 66518803 11380350 55138453 0.78170 4014713 4014713 0.05690 4014713 4014713 0.05690 70533516 11380350 59153166 0.83860 0 0 2 1 SHRINERS HOSPITAL FOR CHILDREN-BOSTON 51 BLOSSOM STREET BOSTON MA 021142699 X X X X A 2 SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIE 516 CAREW STREET SPRINGFIELD MA 01104 X X X X A SHRINERS HOSPITAL FOR CHILDREN-GROUP A 1 X X X X X X X X 12 1 1 1 X HTTP://WWW.SHRINERSHOSPITALFORCHILDREN.OR X X X 0 0 1 1 300.000000000000 1 400.000000000000 1 X X 1 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-BOSTON, - FACILITY 2: SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIE FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN-BOSTON PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN-BOSTON PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIE PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIE PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME 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 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 2012. 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 AND IS NOT APPLICABLE TO SHRINERS HOSPITALS FOR CHILDREN. 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 ENTIRE UNITED STATES. X X 1 1 X X 0 1 0 0 0 0 0 0 0 DAVID M DRVARIC MD CHIEF OF STAFF 421060 0 0 0 0 0 17500 0 3443 0 442003 0 0 0 PETER D MASSO MD ASSISTANT CHIEF OF STAFF 306352 0 0 0 0 0 17500 0 7453 0 331305 0 0 0 CLIFFORD D'ESMOND ADMINISTRATOR 218973 0 0 0 0 0 0 0 2841 0 221814 0 0 0 ALAN J FISCHMAN SR. INVESTIGATOR 193805 0 0 0 0 0 0 0 2031 0 195836 0 0 0 DEBORAH ROTHMAN PEDIATRICIAN, RHEMATOLOGY 181344 0 0 0 0 0 0 0 1541 0 182885 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 APPROVE 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 THE ORGANIZATION'S GOVERNING DOCUMENTS (INCLUDING ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS) ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 10,735,943. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,735,943. FORM 990, PART XII, LINE 2C EXPLANATION: 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. SHRINERS HOSPITALS FOR CHILDREN EMPLOYEE DISASTER RELIEF FUND 2900 ROCKY POINT DRIVE TAMPA FL 33607 263733381 DISASTER RELIEF DC 501(C)(3) 9 NO 0 SHRINERS HOSPITALS FOR CHILDREN POST OFFICE BOX 31356 TAMPA FL 336313356 362193608 HOSPITAL SYSTEM CO 501(C)(3) 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 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 SHRINERS HOSPITALS FOR CHILDREN C 22336842 SHRINERS HOSPITALS FOR CHILDREN O 0 SHRINERS HOSPITALS FOR CHILDREN E 12868015