2013-04-03T18:09:57-05:00 2012-08-31 420714325 MCGLADREY LLP 1 S WACKER DRIVE STE 800 CHICAGO IL 60606 990 2011-09-01 363283051 Children's Surgical Foundation Inc CHIL 3122276420 737 N Michigan Ave Suite 2050 Chicago IL 60611 Erik King 3122276420 2013-04-02 1 Zack Fortsch P00052725 3126343400 2011 2016-02-25 16:41:14Z X William Kaplan MD 737 N Michigan Ave Suite 2050 Chicago IL 60611 37337068 0 X www.childrenssurgical.com X 1984 IL Dedicated to providing outstanding pediatric surgical services to our patients. 8 1 45 1 0 0 1080342 792112 33285102 35151808 148012 130744 328604 82141 34842060 36156805 0 0 0 0 19356970 20991594 0 0 0 12317188 13296569 31674158 34288163 3167902 1868642 7470621 9825790 1407960 1839463 6062661 7986327 X The Children's Surgical Foundation ("the Foundation" or "CSF") is dedicated to providing outstanding pediatric surgical services to our patients incorporating family-centered care, comprehensive research, and the highest quality specialized education. The latest advances in surgical treatments and state-of-the-art technology, coupled with a spirit of compassion and more years of experience than any other pediatric surgical group in the Midwest creates the vital difference to our patients and their families. More specifically, CSF is organized exclusively to:(1) Engage in the professional enterprise of furnishing information, research, clinical studies associated within all specialties of pediatric surgery;(2) Provide information and instruction to graduate physicians and other health care personnel in medical specialty education related to pediatrics and all subspecialties of pediatric surgery; 0 0 30814001 35151808 The Foundation is at the forefront of pediatric surgical care, specializing in eight surgical disciplines and a number of multidisciplinary programs. Our organization has a reputation for the finest quality care, superb teaching, and ground-breaking research. The latest advances in surgical treatments and state-of-the-art technology, coupled with a spirit of compassion and more years of experience than any other pediatric surgical group in the Midwest creates the vital difference to our patients and their families: Cardiovascular-Thoracic Surgery; Neurosurgery; Ophthalmology; Orthopedic Surgery; Otolaryngology; Pediatric Surgery; Plastic Surgery; Transplant Surgery; Urology. 30814001 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 131 0 1 45 1 0 0 0 0 0 0 0 0 0 0 X 8 1 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 0 IL X Regina Allard 3122276420 737 N Michigan Ave Suite 2050 Chicago IL 60611 Andrew Arkin 1.00 X 0 0 0 Earl Cheng MD 40.00 X X 603669 0 62515 Erik King MD 40.00 X X 493500 0 35604 John Grayhack MD 40.00 X 461876 0 70266 John Maddalozzo MD 40.00 X X 622750 0 64861 Marilyn Mets MD 40.00 X 356757 0 54064 Marleta Reynolds MD 40.00 X 793212 0 72800 William Kaplan MD 40.00 X X 735424 0 64861 Nancy Young MD 40.00 X 360019 0 51541 Arthur DiPatri MD 40.00 X 399509 0 64861 Carl Backer MD 40.00 X 863390 0 86075 James Schroeder MD 40.00 X 704998 0 46363 John Sarwark MD 40.00 X 557470 0 70477 Kathleen Billings MD 40.00 X 646000 0 53164 Riccardo Superina MD 40.00 X 622144 0 72011 8220718 0 869463 41 0 1 0 Faculty Practice Plan 737 N Michigan Ave Suite 2040 Chicago IL 60611 Credentiality Svcs, Benefit Packages 1043287 KLO Professional Billing Inc 777 Oakmont Lane Suite 1600 Westmont IL 60559 Billing and Collection Services 825339 Lauren Holinger MD 70 East Cedar Apt 501E Chicago IL 60611 Physician Services 483125 Practice Max Inc 9382 E Bahia Dr Suite B202 Scottsdale AZ 85260 Billing and Collection Services 480040 Pravin Patel MD 1826 N Mohawk Chicago IL 60614 Physician Services 141625 5 792112 792112 Program Service Revenu 900099 28719570 28719570 Other Patient Revenue 900099 6432238 6432238 35151808 211141 211141 1099866 1107571 72692 -7705 -72692 -80397 -80397 Forgiveness of Debt 900099 82141 82141 82141 36156805 35151808 0 212885 4826717 4826717 13195824 13055824 140000 1378150 1360859 17291 1010487 1000669 9818 580416 571297 9119 1553936 1394873 159063 325930 78149 247781 157325 157325 32191 32191 2000 2000 56071 56071 391701 391701 Hospital Fees 7794967 7057108 737859 Billing and Collection 1527040 0 1527040 Education and Research 889505 889505 Assessment Fees 466920 466920 0 98983 23818 75165 34288163 30814001 3474162 0 2849771 3682691 379558 130446 299235 249112 4164329 5696262 157286 197725 7470621 9825790 82141 0 1325819 1839463 1407960 1839463 X 6062661 7986327 6062661 7986327 7470621 9825790 X 1868642 55024 X 0 1 1 X 0 X 792112 1080342 792112 2664566 30000860 31448001 30951316 33285102 35151808 160837087 30792972 31448001 30951316 34365444 35943920 163501653 0 0 0 163501653 18435 158132 211141 387708 18435 158132 211141 387708 328604 328604 82141 739349 30792972 31448001 31298355 34852180 36237202 164628710 0.99320 0.99460 0.00240 0.00110 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13857 266 13591 365701 130180 235521 249112 Due To Ann & Robert H. Lurie Children's Hospital Of Chicago 1445616 Accrued Expenses 393847 1839463 36156805 34288163 1868642 55024 55024 1923666 36211829 55024 55024 36156805 0 36156805 34288163 0 34288163 0 34288163 Description of Uncertain Tax Positions Under FIN 48: Part X: On September 1, 2009, the Foundation adopted the Accounting Standard on Accounting for Uncertainty in Income Taxes, which addresses the determination of whether tax benefits claimed or expected to be claimed on a tax return should be recorded in the financial statements. Under this guidance, the Foundation may recognize the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merits of the position. Examples of tax positions include the tax-exempt status of the Foundation, the continued tax-exempt status of bonds issued by the Foundation, and various positions related to the potential sources of unrelated business taxable income (UBIT). The tax benefits recognized in the financial statements from such a position are measured based on the largest benefit that has a greater than 50 percent likelihood of being realized upon ultimate settlement. The guidance on accounting for uncertainty in income taxes also addresses de-recognition, classification, interest and penalties on income taxes, and accounting in interim periods. At August 31, 2012 and 2011, there were no unrecognized tax benefits identified or recorded as liabilities. In July 2011, the Foundation's received notice that the tax exempt status was revoked by the Internal Revenue Service retroactively to November 15, 2010 due to a clerical issue. An application to have the tax exempt status reinstated retroactively to November 15, 2010 was filed in October 2011. In February 2013, the Foundation received notice from the Internal Revenue Service that the application was approved and that the tax exempt status was reinstated retroactively to November 15, 2010. The Foundation files Forms 990 in the U.S. federal jurisdiction and the State of Illinois. With few exceptions, the Foundation is no longer subject to examination by the Internal Revenue Service for years before August 31, 2009. X X X 0 0 0 0 0 0 0 0 0 Earl Cheng MD 603669 0 0 0 0 0 32377 0 30138 0 666184 0 0 0 Erik King MD 493500 0 0 0 0 0 32377 0 3227 0 529104 0 0 0 John Grayhack MD 461876 0 0 0 0 0 32377 0 37889 0 532142 0 0 0 John Maddalozzo MD 622750 0 0 0 0 0 32377 0 32484 0 687611 0 0 0 Marilyn Mets MD 356757 0 0 0 0 0 32377 0 21687 0 410821 0 0 0 Marleta Reynolds MD 793212 0 0 0 0 0 32377 0 40423 0 866012 0 0 0 William Kaplan MD 735424 0 0 0 0 0 32377 0 32484 0 800285 0 0 0 Nancy Young MD 314186 0 0 0 45833 0 32377 0 19164 0 411560 0 0 0 Arthur DiPatri MD 399509 0 0 0 0 0 32377 0 32484 0 464370 0 0 0 Carl Backer MD 769171 0 0 0 94219 0 47170 0 38905 0 949465 0 0 0 James Schroeder MD 704998 0 0 0 0 0 32377 0 13986 0 751361 0 0 0 John Sarwark MD 523610 0 0 0 33860 0 32377 0 38100 0 627947 0 0 0 Kathleen Billings MD 646000 0 0 0 0 0 31477 0 21687 0 699164 0 0 0 Riccardo Superina MD 600000 0 22144 0 0 0 32377 0 39634 0 694155 0 0 0 (3) Conduct research in all branches of clinical medicine, with specialties in pediatrics and pediatric surgery; (4) Provide medical information to patients in connection with the foregoing, without regard to the patient's ability to pay; (5) Propose, encourage and stimulate research, experiments and studies related to diseases affecting pediatric patients and foster the education of the medical community and the dissemination of information relating to maladies and illnesses affecting pediatric patients and the alleviation thereof; (6) Participate in such other activities of a charitable and/or medical and educational nature as may be permitted under the provisions of the Illinois Not-for-Profit Corporation Act. Form 990, Part VI, Section A, line 6 All physicians employed by the Foundation who have been employed by the Foundation for 24 months and worked at least 50% of a full-time surgeon for the prerequisite 24 month period and are anticipated to continue to work at least 50% of a full-time surgeon for the foreseeable future. However, the Board of Directors does have the authority to waive the requirement for 24 months of the Foundation employment for a specific physician as long as that physician commits to work at least 50% of a full-time surgeon. Form 990, Part VI, Section A, line 7a At the Annual Meeting of Members, or at another designated meeting set by the Board of Directors, the Members elect the Member physicians to serve on the Board of Directors. Form 990, Part VI, Section A, line 7b The approval of the Members is needed for the following actions: - approval of the standard form of employment agreement for the Foundation physicians; - approval of a merger, consolidation, sale of all or substantially all the assets of CSF or partial or total dissolution; - approval of all amendments to the Foundation's corporate Articles of Incorporation and bylaws; - approval of the Board's selection of its Chair/President from among the physicians serving on the Board of the Foundation; - approval of the creation of any tax exempt or taxable corporations or control subsidiary, or the acquisition of any entity; - approval of all salaries and salary increases paid to the executive director, corporate officers and Board Directors for their services as executive director, officers and directors; and - approval of any obligations which require personal guarantees of the Members provided, however, for any such personal guarantees to be deemed approved there must be an affirmative vote of two-thirds (2/3) of all Members of the Foundation without regard to the number of Members attending the meeting and further provided that the Foundation shall not be authorized to require Members to sign personal guarantees joint and several liability. Form 990, Part VI, Section B, line 11 The Form 990 is sent to all members of the Finance Committee. The review of the 990 takes place at the next Finance Committee Meeting which takes place after the delivery of the 990 by the CPA firm who prepares the 990. The CSF Administrator provides a detailed written review of the 990 and compares the 2010 and 2011 990's and highlights any changes. This review is completed and the information is sent to the Finance Committee and the Board of Directors along with a copy of the 990. The Board of Directors provides the Administrator with documentation that they have reviewed the form. This documentation is maintained in corporate records. Form 990, Part VI, Section B, line 12c Annually individuals are asked to disclose or update a form provided by the Foundation regarding any interests that could give rise to conflicts of interest, such as a list of family members, substantial business or investment holdings, and other transactions or affiliations with businesses and other organizations or those of family member that may benefit them financially from a decision he or she makes in a capacity of authority within the Foundation. For each interest disclosed to the Board of Directors, the Board will determine whether to: (a) take no action; (b) assure full disclosure to the Board of Directors and other individuals covered by this policy; (c) ask the person to recues from participation in related discussions or decisions within the Organization; or (d) ask the person to resign from his or her position in the Organization or, if the person refuses to resign, become subject to possible removal in accordance with the Organization's removal procedures. The Organization's Administrator and Executive Director will monitor proposed or ongoing transactions for conflicts of interest and disclose them to the Board of Directors in order to deal with potential or actual conflicts, whether discovered before or after the transaction has occurred. CSF's Compensation Committee is made up the doctors of the CSF. Each year the Compensation Committee meets to review salaries of all employees of the organization which includes the organizations directors and key employees. The Committee strives to develop a compensation plan that encourages and recognizes physician productivity and quality; to further Corporation's mission, goals and objectives and to compensate physicians fairly in comparison to internal and external benchmarks. MGMA, AMGA and Sullivan Cotter surveys are used by the Compensation Committee. All compensation related decisions and deliberations are contemporaneously documented in the Compensation Committee and Board of Director minutes. Form 990, Part VI, Section C, line 19 Documents made available by request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 55,024. Children's Surgical Foundation LLC 737 N Michigan Ave Suite 2050 Chicago IL 60611 300550350 Activities in nonsurgical procedures IL 0 0