2014-08-12T10:57:22-05:00 2013-09-30 010494526 Baker Newman & Noyes LLC 280 Fore Street Portland ME 04101 990 2012-10-01 431987409 Children's Hospital Pediatric Associates Inc CHIL 6173551952 20 Overland Street Boston MA 02215 Gary R Fleisher MD 6179192822 2014-08-05 Nicholas E Porto P01310283 8002447444 2012 2015-11-30 17:44:51Z Gary R Fleisher MD 20 Overland Street Boston MA 02215 331888508 0 X N/A X 2002 MA The Foundation provides medical, health care services, and educational services to (see Schedule O) Boston Children's Hospital and Harvard Medical School. The Foundation also provides care for patients in need of health care services, regardless of their ability to pay, as well as providing community based services. 18 1 404 0 -1839 -1839 2480000 2200000 204330252 209998431 7514638 16227424 0 0 214324890 228425855 4535808 8479150 0 0 154580801 162450702 0 0 0 27259042 31545148 186375651 202475000 27949239 25950855 318259044 351666171 49156494 45799186 269102550 305866985 X The Foundation provides medical and health care services primarily to patients at Boston Children's Hospital, and other health care providers at satellite locations. The Foundation carries on and promotes basic and applied medical research and (see Schedule O) education in the field of pediatric care by teaching students and other medical and scientific personnel. The Foundation also provides care for patients regardless of their ability to pay. 0 0 152721845 8479150 170622207 The Foundation was organized exclusively for charitable, scientific, and educational purposes. The Foundation provides medical and health care services primarily to patients at Boston Children's Hospital, and other health care providers at satellite locations. The Foundation may charge for patient care, other medical services, and related products, provided that any net income be used for the charitable, scientific, and educational purposes for which the Foundation was created. The Foundation also provides care for patients regardless of their ability to pay, as well as providing and subsidizing hospital and community based services that are either unavailable or limited elsewhere in the community. 4880157 5452154 The Foundation receives income from Boston Children's Hospital for providing administration, supervision, and teaching services. The Foundation carries on and promotes basic and applied medical research and education in the field of pediatric care by teaching students and other medical and scientific personnel; by providing or supplementing income to research personnel through fellowships, research grants, and stipends; and by giving lectures and publishing information concerning problems and research results in the field of pediatric care in order to educate the general public and the medical profession. 30365019 33924070 The Foundation receives reimbursement of certain salary and fringe costs from grants from Boston Children's Hospital. 187967021 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 69 0 1 404 1 0 0 0 0 0 0 0 0 0 0 X 18 1 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X William Tarvainen 6173551952 20 Overland Street Boston MA 02215 Gary R Fleisher MD 55.00 5.00 X X 767311 0 91786 Vincent Chiang MD 55.00 5.00 X X 295751 0 65985 William E Harmon MD 45.00 15.00 X X 336358 0 93861 Richard Bachur MD 60.00 X 371821 0 78861 S Jean Emans MD 60.00 X 296193 0 93861 Raif S Geha MD 60.00 X 302913 0 94976 Craig Gerard MD 60.00 X 259631 0 86976 Stella Kourembanas MD 60.00 X 334936 0 86653 Alan Leichtner MD 60.00 X 332888 0 86861 Wayne Lencer MD 60.00 X 324259 0 84999 Frederick Lovejoy MD 60.00 X 220268 0 52720 Joseph Majzoub MD 60.00 X 262644 0 93527 Stephen Harrison MD 60.00 X 0 0 0 Mark Schuster MD 60.00 X 514215 0 82291 Michael Wessels MD 60.00 X 265246 0 86851 David Williams MD 60.00 X 513621 0 80861 Christopher Walsh MD 60.00 X 0 0 0 Freidhelm Hildebrandt MD 60.00 X 0 0 0 Leonard Rappaport MD 60.00 X 347668 0 80109 Michael Agus MD 60.00 X 355201 0 78861 Physicians' Organization at CH Inc 2.00 X 0 0 0 William Tarvainen 60.00 X 312548 0 60044 Patricia Ellen Grant MD 60.00 X 385259 0 61863 Issac Kohane MD 60.00 X 362827 0 62905 Luigi Notarangelo MD 60.00 X 382557 0 58089 Scott Snapper MD 60.00 X 390022 0 61861 Gary Visner MD 60.00 X 361985 0 61861 8296122 0 1786662 281 0 1 0 Dana Farber Cancer Institute 44 Binney Street Boston MA 02115 Oncology services 2240562 Boston Private Bank & Trust Ten Post Office Square Boston MA 02109 Investment fees 676082 Delta Dental 465 Medford Street Boston MA 02129 Dental Insurance 618192 Marcam Associates 396 High Street Somersworth NH 03878 Billing/Collections 562563 IDX Systems Corp 15724 Collections Center Chicago IL 60693 Software Services 195713 8 2200000 2200000 Patient serv. rev., net of contr. 621300 162548477 162548477 Grant revenue 621300 33924070 33924070 Contract revenue 621300 8073729 8073729 Teaching, admin, & supervision re 611710 2826033 2826033 Service, research, & other revenu 611710 2626122 2626122 209998431 4456800 -1839 4458639 115233277 103462653 11770624 11770624 11770624 228425855 209998431 -1839 16229263 8479150 8479150 10072785 9700193 372592 131613771 122400807 9212964 8231724 7820138 411586 8597083 7307521 1289562 3935339 3345038 590301 560578 560578 40830 40830 836951 836951 378516 378516 99985 99985 2144924 1313520 831404 162114 162114 2460495 2460495 326901 245176 81725 226734 226734 69852 69852 3264249 3150030 114219 Research expenses 12603938 12603938 Bad debt expense 4652547 4652547 PO dues 1553701 1553701 Patient staff relations 680747 680747 1482086 1316819 165267 202475000 187967021 14507979 0 10723870 12709797 7146203 4169143 15700126 15521875 399910 1385814 6235012 3847400 854207 776186 893538 526608 86055 366930 200987069 239209757 45676193 49737131 30450399 23942138 318259044 351666171 7100571 8934452 42055923 36864734 49156494 45799186 X 265178675 302617485 3923875 3249500 269102550 305866985 318259044 351666171 25950855 10813580 0 X X 0 1 X 1 0 X 11081677 6982000 2480000 2200000 22743677 176149278 187241007 191869937 204330253 209998431 969588906 187230955 187241007 198851937 206810253 212198431 992332583 0 0 0 992332583 3861758 3682841 4032185 3931452 4458639 19966875 -6282 -4634 -191 6037 -1839 -6909 3855476 3678207 4031994 3937489 4456800 19959966 191086431 190919214 202883931 210747742 216655231 1012292549 0.98030 0.97890 0.01970 0.02110 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3923875 2200000 2874375 3249500 4605309 2480000 3161434 3923875 3182950 6982000 5559641 4605309 12375000 9192050 3182950 2509857 11081677 1216534 12375000 1.00000 0 0 67011 67011 0 826527 459597 366930 366930 BCH Pooled Investment 2025124 F PO Pooled Investment Fund 47712007 F 49737131 Due from Boston Children's Hospital 12422294 Malpractice insurance receivable 9051327 Other receivables 2450319 Due from PO 18198 23942138 Due to Boston Children's Hospital 11842358 Due to PO 920895 Due to community hospitals 1442958 Deferred compensation plans 9276652 Accrued professional liability 13332871 Due to other Foundations 49000 36864734 X 242113812 10813582 2874375 13687957 228425855 0 228425855 202475000 0 202475000 0 202475000 Description of Intended Use of Endowment Funds: Part V, Line 4: The Foundation has plans to use its endowment funds for the Quality and Charge Capture Project, physician recruitment expenses, education programs, and research initiatives. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Foundation is a tax-exempt corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code), and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. In addition, the Foundation qualifies for the charitable contribution deduction under Section 170(b)(1)(A) and has been classified as an organization that is not a private foundation under Section 509(a)(2). Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items, including unrelated business income or tax status. Management of the Foundation has evaluated the positions taken on the Foundation's filed tax returns and has concluded that no uncertain income tax positions exist at September 30, 2013. The Foundation's tax years from 2010 through 2013 are potentially subject to examination. Part XI, Line 2d - Other Adjustments: Net assets released from restrictions 2,874,375. 1 Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 501(c)(3) 8430000 17786 Book Donation of equipment General Support Presidents & Fellows of Harvard College Massachusetts Hall Cambridge MA 02138 042103580 501(c)(3) 25364 N/A N/A General Support 2 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Monitoring is provided by Children's Hospital Pediatric Associates, Inc. (the Foundation) through oversight of the terms and conditions of a written grant agreement. Multiyear agreements require yearly progress and financial reports for contiuation of funding. During the year ended September 30, 2013, the Foundation only provided grant donations to other 501(c)(3) organizations. X X X 0 1 0 0 0 0 0 1 0 Gary R Fleisher MD 489575 0 0 0 277736 0 65889 0 25897 0 859097 0 0 0 Vincent Chiang MD 228974 0 18452 0 48325 0 40253 0 25732 0 361736 0 0 0 William E Harmon MD 269430 0 46787 0 20141 0 69089 0 24772 0 430219 0 0 0 Richard Bachur MD 350277 0 4500 0 17044 0 54089 0 24772 0 450682 0 0 0 S Jean Emans MD 269430 0 6622 0 20141 0 69089 0 24772 0 390054 0 0 0 Raif S Geha MD 247500 0 40500 0 14913 0 69089 0 25887 0 397889 0 0 0 Craig Gerard MD 247500 0 6684 0 5447 0 61089 0 25887 0 346607 0 0 0 Stella Kourembanas MD 308055 0 11339 0 15542 0 61089 0 25564 0 421589 0 0 0 Alan Leichtner MD 325862 0 0 0 7026 0 62089 0 24772 0 419749 0 0 0 Wayne Lencer MD 291389 0 28482 0 4388 0 60089 0 24910 0 409258 0 0 0 Frederick Lovejoy MD 194600 0 0 0 25668 0 28168 0 24552 0 272988 0 0 0 Joseph Majzoub MD 247500 0 4500 0 10644 0 69089 0 24438 0 356171 0 0 0 Mark Schuster MD 247500 0 186976 0 79739 0 56089 0 26202 0 596506 0 0 0 Michael Wessels MD 247499 0 8339 0 9408 0 62089 0 24762 0 352097 0 0 0 David Williams MD 372331 0 30765 0 110525 0 56089 0 24772 0 594482 0 0 0 Leonard Rappaport MD 307956 0 4500 0 35212 0 56089 0 24020 0 427777 0 0 0 Michael Agus MD 318909 0 11524 0 24768 0 54089 0 24772 0 434062 0 0 0 William Tarvainen 284042 0 0 0 28506 0 37089 0 22955 0 372592 0 0 0 Patricia Ellen Grant MD 365961 0 15000 0 4298 0 37089 0 24774 0 447122 0 0 0 Issac Kohane MD 336672 0 7000 0 19155 0 37089 0 25816 0 425732 0 0 0 Luigi Notarangelo MD 235751 0 20000 0 126806 0 35452 0 22637 0 440646 0 0 0 Scott Snapper MD 301500 0 22478 0 66044 0 37089 0 24772 0 451883 0 0 0 Gary Visner MD 306424 0 36 0 55525 0 37089 0 24772 0 423846 0 0 0 Part I, Line 4b The Children's Hospital Pediatric Associates, Inc. (the Foundation) established the Ineligible Deferred Compensation Plan. This plan is intended to qualify under Section 457(f) of the Code, and is intended to constitute a "top-hat plan" described in Section 201(2) of ERISA. The payment of benefits under the plan is at the sole discretion of the Foundation. In meeting its funding obligation, the employer will hold employee contributions in a Rabbi Trust. Each employee who is: a) an officer or highly compensated employee of the Foundation; b) a professor at Harvard University, or its professional equivalent; and c) determined by the Foundation's President to be eligible, may participate in the plan. Additionally, each Trustee of the Foundation who is determined by the Foundation's President to be eligible may participate in the plan. Participants may elect to defer compensation by a specific amount which, for any taxable year, shall not exceed an amount established by the Plan Administrator. The Foundation may, but is not required to, contribute an amount determined in the sole discretion of the Foundation, on behalf of one or more eligible participants for a plan year. Participants are fully vested in the funds credited to their accounts after seven consecutive years of service. The Foundation made the following contributions to the 457(f) plan for the employees listed on Part VII, Page 7: Gary R. Fleisher, MD, $28,800; William E. Harmon, MD, $32,000; Richard Bachur, MD, $17,000; S. Jean Emans, MD, $32,000; Raif S. Geha, MD, $32,000; Craig Gerard, MD, $24,000; Stella Kourembanas, MD, $24,000; Alan Leichtner, MD, $25,000; Wayne Lencer, MD, $23,000; Joseph Majzoub, MD, $32,000; Mark Schuster, MD, $19,000; Michael Wessels, MD, $25,000; David Williams, MD, $19,000; Leonard Rappaport, MD, $19,000; Vincent Chiang, MD, $6,000; and Michael Agus, MD, $17,000. Part I, Line 7 The Children's Hospital Pediatric Associates, Inc. (the Foundation) paid the following bonus compensation to eligible employees: a) Ambulatory Clinic Bonus - participants are eligible for this bonus if they work a minimum of 0.2 FTEs in the clinic and have an overall surplus that is greater than 2.2 times the salary charged to the Foundation or the service fund. The eligible participant can receive 22% of their first $100,000 surplus, 17% of their surplus between $100,000 and $200,000, and 24% of any surplus greater that $200,000. The bonus award is subject to the participant's total direct compensation not exceeding the Harvard Medical School's compensation guidelines; b) Academic Bonus - 7.5% of the department's surplus has been set aside to award academic bonuses. The bonus pool has been distributed to the divisions based on its revenue. The division chief may distribute his/her bonus pool at their discretion. Faculty and staff are eligible to receive this bonus as long as they are on the payroll for Boston Children's Hospital or the Foundation; and c) Bonuses for emergency, newborn, inpatient programs, and PHA are based on 13% of the division/program surplus. Bonus compensation is usually approved by the division Chiefs and the President of the Foundation. David Williams MD Trustee Physician recruitment X 650000 125000 0 1 1 Isaac Kohane MD Trustee Physician recruitment X 85550 17110 0 1 1 Christopher Walsh MD Trustee Physician recruitment X 300000 240000 0 1 1 Scott Snapper MD Physician Physician recruitment X 350000 210000 0 1 1 Friedhelm Hildebrandt MD Trustee Physician recruitment X 881000 793704 0 1 1 1385814 Schedule L, Part II:The Children's Hospital Pediatric Associates, Inc. (the Foundation) has developed a recruitment loan program for eligible employees as incentive for qualified employees to relocate to certain facilities as demands of the Foundation's practice arise. The loan proceeds are to be used for the purchase of a principal personal residence. The loans are secured by a promissory note and a second mortgage on the residence. The Foundation has provided three loans to two members of the board. However, the Foundation has provided loans to other employees. The loans were made for recruitment and relocation purposes, to assist the physician employees in the purchase of their primary residence. The amounts for the recruitment loans were originally funded by restricted donations provided by Boston Children's Hospital for use in recruitment. The loans will be forgiven over the terms of the notes if the recipients remain employed at the Foundation or its affiliates. If any borrower terminates their employment, the remaining balance becomes immediately due. The amount of the loan forgiveness will be included with accrued interest, if applicable, as compensation in the year forgiven. Form 990, Part VI, Section A, line 1 The majority of the Children's Hospital Pediatric Associates, Inc. (the Foundation) board members are physicians who are not independent from the Foundation. However, the Foundation is part of an integrated delivery system with Boston Children's Hosiptal (the Hospital) which does have a community board. The Foundation was organized in 2002. At the time, the board was composed entirely of physicians, a board structure that was approved by the Internal Revenue Service. The Foundation has since adjusted the board structure by adding the Physicians' Organization at Children's Hospital, Inc. (the PO) as a member. See Schedule O, Part VI, Questions 3, 6, 7b, and 12 for more on the PO's rights. Form 990, Part VI, Section A, line 3 The Physicians' Organization at Children's Hospital, Inc. (the PO) is a Class "C" member of Children's Hospital Pediatric Associates, Inc. (the Foundation). The PO is responsible for all third party contracting for the Foundation. The PO has the power to select the independent auditor and legal counsel of the Foundation from an approved list of firms mutually agreed to by the PO and the Foundation. The PO also has the right to review, but not to approve, the annual operating budget and all capital budgets of the Foundation. Lastly, the PO has the right to review for compliance with applicable law, the general terms of and any modification to physician compensation and benefit plans for all physician employees of the Foundation. Form 990, Part VI, Section A, line 6 The Children's Hospital Pediatric Associates, Inc. (the Foundation) has four classes of members. The Pediatrician-in-Chief or any Acting Pediatrician-in-Chief, as Chief of the Department of Medicine (the Department) of Boston Children's Hospital (the Hospital), is a Class "A" member. Any person who (i) is a physician-employee of the Foundation with an active medical staff appointment from the Hospital, and (ii) either (A) is a Division Chief of a Division of the Department whose faculty are on the Foundation's payroll or (B) functions as a Division Chief of a Division of the Department whose faculty are not on the Foundation payroll, or (C) has a faculty appointment from Harvard Medical School shall be a Class "B" member. The Physicians' Organization at Children's Hospital, Inc. (the PO) is a Class "C" member. All other individuals who hold Harvard appointments other than the Class "A" and "B" members shall be Class "D" members. Form 990, Part VI, Section A, line 7a The Pediatrician-in-Chief or any Acting Pediatrician-in-Chief, as Chief of the Department of Medicine of Boston Children's Hospital (the Hospital), is the Class "A" member of Children's Hospital Pediatric Associates, Inc. (the Foundation). According to the Articles of Organization, the Class "A" member appoints the board members of the Foundation for a 3-year term at the Foundation's annual meeting. Form 990, Part VI, Section A, line 7b The Physicians' Organization at Children's Hospital, Inc. (the PO) is a Class "C" member of the Children's Hospital Pediatric Associates, Inc. (the Foundation). The PO is responsible for all third party contracting for the Foundation. The PO has the power to select the independent auditor and legal counsel of the Foundation from an approved list of firms mutually agreed to by the PO and the Foundation. The PO also has the right to review, but not to approve, the annual operating budget and all capital budgets of the Foundation. Lastly, the PO has the right to review for compliance with applicable laws, the general terms of and any modification to physician compensation and benefit plans for all physician employees of the Foundation. The PO is considered the compensation committee of the Foundation. As a Class "C" member of the Foundation, the PO attends the Foundation's annual meeting. Form 990, Part VI, Section B, line 11 The detailed review will be conducted by the President of the Foundation, Gary R. Fleisher, MD and the Chief Financial Officer, William Tarvainen. A copy of the Form 990 will be provided to the board prior to filing. The detailed review will be conducted before filing the return with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c The Physicians' Organization at Children's Hospital, Inc. (the PO) administers an annual conflict of interest disclosure process to all of its member Foundations, which asks physicians (officers, top management, and highly compensated employees) and selected Foundation staff to disclose potential conflicts. A disclosure statement will be circulated annually to members of the PO. The PO audit committee shall determine those individuals (including medical staff members) who shall be required to complete the disclosure statement. The PO audit committee, at its discretion, may either: 1) refer any or all disclosure statements to the Board of Directors; 2) appoint an ad hoc committee to review and resolve any conflict of interest issues; or 3) review and resolve any conflict of interest issues personally or through a designee(s). Any person not receiving a disclosure statement nevertheless has an affirmative obligation to disclose to the PO President, PO General Counsel, or his/her supervisor whenever he/she believes he/she has or may have a conflict of interest. Similarly, each person completing a disclosure statement has an affirmative obligation to update the statement any time circumstances change and/or he/she believes that a conflict of interest may exist. In the event a conflict of interest is found to exist, the Foundation prohibits the member from voting on any matter to which the conflict relates or otherwise influence the voting on such matter. Form 990, Part VI, Section B, line 15 All the physicians (top management, officers, and highly compensated individuals) fall under compensation guidelines determined by Harvard University, with limitations established for certain positions/ranks within the medical school. Annually, compensation is reviewed and reported to Boston Children's Hospital's Board of Trustees to ensure total direct and indirect compensation does not exceed the pre-determined guidelines of Harvard University. Any new indirect benefit plan requires approval by the Foundation's Board of Directors, which then must be reviewed and permitted by the Hospital. Major aspects of the approval process involve: comparing compensation data of physicians within the comparable field of medicine; indirect compensation currently being offered; and the financial stability of the Foundation. This process was followed for the year ended September 30, 2013. Form 990, Part VI, Section C, line 19 The Foundation maintains all financial statements, conflict of interest policies, and governing documents at its main office at 20 Overland Street, Boston, MA 02215. The documents are available upon request. Part XII, Question 2c: The audit process has not changed from the prior year. Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 Hospital MA 501(c)(3) Line 3 N/A 0 Physicians' Organization at Children's Hospital Inc 300 Longwood Avenue Boston MA 02115 043266103 Physician organization MA 501(c)(3) Line 11a, I N/A 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0