2013-11-08T10:49:27-06:00 2012-12-31 861065772 DELOITTE TAX LLP 50 SOUTH SIXTH STREET MINNEAPOLIS MN 55402 990 2012-01-01 411754276 Children's Health Care CHIL 6128136000 2525 Chicago Avenue South Minneapolis MN 554041844 ALEC MAHMOOD 6128136000 2013-10-30 1 Kristina Rasmussen P00143920 6123974000 2012 2016-02-24 21:20:13Z Children's Hospitals and Clinics of Minnesota Alec Mahmood 2525 Chicago Avenue South Minneapolis MN 554041844 650780645 0 X www.childrensmn.org X 1995 MN Children's Hospitals and Clinics of Minnesota champions the special needs of children. 28 24 4653 1499 148068 39714 32929702 32929958 555819124 591438384 25409612 23039145 2647188 2823951 616805626 650231438 634284 422439 0 0 340044362 358520203 0 0 0 240176829 249698486 580855475 608641128 35950151 41590310 931983450 989666159 426913792 416015398 505069658 573650761 X Children's Hospitals and Clinics of Minnesota champions the special health needs of children and their families. We are committed to improving children's health by providing family centered pediatric services. We advance these efforts through research and education. 0 0 517103415 422439 590341592 Hospital program services: Families look to Children's Hospitals and Clinics of Minnesota ("Children's") for the finest in pediatric care. With two pediatric hospital facilities and 381 staffed beds, we champion the special health needs of children and their families and are committed to providing high-quality, family centered pediatric services.The Leapfrog Group's annual list of top hospitals named Children's Minneapolis and St. Paul hospitals as two of the top ten pediatric hospitals in the country for quality and efficiency. This is the fourth year in a row Children's has been recognized by the Leapfrog Group. See Schedule O.Children's was the only pediatric hospital in the five-state-region to receive a 2012 Leapfrog award.For the seventh year in a row, Children's has been named one of the top pediatric hospitals in the nation according to the 2013-2014 U.S. News Media Group's Best Children's Hospitals rankings. This year Children's ranked in three categories - cardiology and heart surgery, neonatology and pulmonology. The U.S. News rankings give Children's high marks for patient volumes, safety, and overall outcomes in each of the clinical areas. Children's also received high marks for nurse-to-patient staffing levels that continue to be among the nation's highest.We are Minnesota's largest provider of care to children with complex surgical conditions, heart disease, cancer, diabetes, and extreme pre-maturity. In 2012, Children's cared for 12,218 inpatient admissions representing 79,736 patient days, performed 20,435 surgical cases, treated 88,674 emergency room visits and cared for 148,973 outpatient clinic visits, many of which provided to inner city Minneapolis and St. Paul residents. Children's continues to serve a diverse population with 60,985 family encounters for language interpretation utilizing 46 different languages interpreted.Children's designates certain major programs as a "Cornerstone program". These programs meet rigorous criteria for excellence, including outstanding use of evidence-based practices, clinical research, and advanced technologies. These Cornerstone programs include:- Cardiovascular : Children's pediatric cardiovascular program is one of the largest in the region with some of the most impressive outcomes in the U.S. Team members care for thousands of the region's sickest children with heart conditions, including fetuses, newborns, infants, children, adolescents, and adult, long-term patients with pediatric cardiovascular conditions. - Neonatal Intensive Care : Children's specializes in caring for multiples, babies with congenital anomalies, very premature and very low birth weight babies, and infants born with other complex diagnoses. We offer exceptional tertiary and quaternary care for babies, with survival outcomes among the best in the world. Children's neonatal program is one of the nation's largest programs with 138 staffed beds and more than 35,000 patient days. Our neonatal team includes highly-trained and experienced professionals from a full spectrum of medical specialties. - Hematology/Oncology : The hematology/oncology program at Children's is the largest in the upper Midwest with treatment outcomes that consistently rank Children's as one of the top ten programs in the U.S. In our nationally unique model, your child's or teen's care is spearheaded and coordinated by a board-certified hematologist/oncologist, who leads a highly experienced team of multidisciplinary professionals.- Cystic Fibrosis : The Cystic Fibrosis (CF) Center at Children's diagnoses and treats children in all stages of CF. Our dedication to family-centered care and education helps children and their families learn to live with CF. Care at Children's for patients with CF ranks among the top 10 programs nationally in key outcomes measured by the National Cystic Fibrosis Registry. Children's provides a continuum of care through coordinated inpatient and outpatient services, from diagnosis through long-term follow-up. The Cystic Fibrosis Center of Children's provides state-of-the art comprehensive care for children with CF.- Diabetes/Endocrinology : The McNeely Pediatric Diabetes Center is the only diabetes center in the region to specialize in working solely with children and teens. The staff provide expert health care to help maintain a child's targeted blood sugar ranges. Most children seen in the diabetes center have Type 1 diabetes. A small but growing number have Type 2. In addition to diabetes, the clinic provides diagnostic services and treatment for children with disorders of growth, advanced or delayed sexual development, pituitary disorders, thyroid abnormalities, disorders of calcium balance, adrenal disorders, and hypoglycemia. The McNeely Pediatric Diabetes Center has received recognition for its diabetes education program from the American Diabetes Association, by meeting the association's high educational standards.- In addition to the Cornerstone programs, Children's provides other high quality programs such as Surgery. Children's surgery teams deliver next-generation care in an award-winning environment that is exclusively dedicated to pediatrics. Health professionals of many disciplines work together to provide children with the best possible surgery experience. Children's bodies are different than adult's. For example, they often require specially-sized surgical equipment. They react differently to anesthesia and to pain. Their bodies respond differently to illness and treatment, in part because they are still growing. That's why children benefit from our highly accomplished, pediatric-specific surgery teams. At Children's, over 20,000 surgeries are performed each year on fetuses, newborns, children, adolescents, and young adults from throughout the Upper Midwest. Surgical treatment results rank Children's among the top hospitals in the U.S. in pediatric surgical care. Children's has some of the lowest rates in the U.S. of post-surgery complications and some of the highest rates of patient and family satisfaction. As a charitable organization, Children's also provides a broad spectrum of benefits to the communities we serve. These services and donations account for a measureable portion of the hospital's costs and help to promote healthy lifestyles, community development, health education, and affordable access to care. Please see IRS Form 990, Schedule H for a summary of these community benefits. 4183444 1633 Research: In 2012 Children's conducted 403 research projects, 204 of which were clinical trials to examine the effectiveness of diagnostic, therapeutic, and preventive services. In addition 70 peer-reviewed manuscripts were published. Children's was awarded more than $12 million in funding from government, industry, foundation, and academic sub-awards for its research initiatives. We continue to participate in multiple prestigious national collaborations and clinical trials. We are also generating landmark investigator-initiated research, aimed at novel ways to deliver life-saving treatments, manage pain and symptoms and develop new methods for preventing or treating childhood diseases. Every day, Children's researchers express their commitment to building better outcomes for our children. These outcomes will have both immediate and lasting impact for children receiving state of the science care at our specialty centers. Children with cardiac disease, cancer, genetic and blood disorders, diabetes, cystic fibrosis, and other life-impacting conditions all have benefited from research at Children's. The vision and strategic innovation of our research leaders have brought us to impressive milestones in the past year. We continue to take steps toward advancing our research and committed to thriving into the future with our children and families. 4737310 1095159 Education: Many efforts to improve the health and well being of children and youth require long-term investment in their future. Children's provides education and training programs for providers, health care students, and other health professionals in the following areas:1)Community medical education for community physicians: During the 2012 calendar year, Children's provided training to 380 individual residents and 35 individual fellows who performed one or more rotations at Children's Minneapolis, Children's St Paul, or both locations. Full time equivalent (FTE) numbers were 43.2 FTEs for the residents and 7.1 FTEs for the fellows. The rotations were performed in Children's Emergency Department, inpatient medical/surgical, PICU and neonatal inpatient care units, surgery and anesthesia, ENT surgery, urology, and subspecialty clinics.The residents and fellows came from 38 different medical educational programs. 27 of those programs were from the University of Minnesota, 3 from Mayo Clinic, 2 from Regions Hospital, 1 from United Hospital, 1 from HCMC, 1 from Rapid City Regional Hospital, 1 from UW Eau Claire, 1 from Jackson Memorial Hospital in Miami, and 1 from St John Hospital in Detroit. Additionally, 195 medical students rotated to Children's Minneapolis, Children's St Paul, or both locations.2)Education and training of health care and other providers of services to children:i)The Midwest Regional Children's Advocacy Center at Children's is a leader in improving the care of abused and neglected children whose goal is to improve services for abused children in local communities throughout the region. The Center offers information, consultation, technical assistance, and training to physicians, nurses, and non-medical members of community child abuse teams, including law enforcement personnel, attorneys and child protection workers.ii)Recognized, as the nation's leader in palliative care education, Children's Institute for Palliative Care (CIPC) developed a model for a regional training and consultation center. CIPC develops and leads training seminars using recognized curriculum for pediatric palliative care, provides hospital-based consultation to children who are in need of hospice or palliative care while they are hospitalized, offers a regional 24/7 telephone consultation program providing education, support, and guidance to families and professional providers, and serves as a resource center for pediatric palliative care. iii)The Minnesota Sudden Infant Death Syndrome (SID) Center is a statewide program that provides information, counseling, and support to anyone experiencing a sudden and unexpected infant death from any cause. The SID Center is the state's resource for information on Sudden Infant Death Syndrome (SIDS) and SIDS risk reduction. The Center conducts training and educational programs for health care providers, child-care workers, and other professional and community groups. The Center also tracks and reports infant mortality trends in Minnesota and participates in local, state, and national initiatives to reduce the risk of sudden, unexpected infant death. The Minnesota SID Center collaborates with the Minnesota Department of Health, county public health nurses, and medical examiners in every county throughout Minnesota.iv)The Emergency Medical Services for Children (EMSC) Resource Center housed at Children's creates awareness regarding the special needs of children in emergency medical situations. EMSC educational programs are designed to train pre-hospital personnel, first responders, physicians, nurses, and school nurses in the unique needs of infants and children in emergency situations. The EMSC Resource Center also provides technical assistance, participates in statewide pediatric emergency/disaster preparedness planning, develops and disseminates pediatric emergency are guidelines, and conducts mortality reviews and research.3)Education and employment - Because disparities in child health are so closely associated with low educational attainment and poor job skills, Children's is engaged in several key community partnerships to improve educational success and earning potential among youth and adults. Examples include the Roosevelt High School Health Careers Program that provides students interested in health care careers the opportunity to receive health care specific education and obtain internships with health care organizations, the Achieve Minneapolis/Step-up Summer Jobs Program that places youth in supervised summer internships at participating companies and organizations, and a partnership with Project for Pride in Living that recognizes that a healthy, sustainable community requires residents with well-paying jobs. 526024169 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 1 408 0 4653 1 1 1 1 CJ 0 0 0 0 0 0 0 0 0 X 28 24 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X Alec Mahmood CFO 6128136113 2525 Chicago Avenue S Minneapolis MN 55404 Alan Goldbloom 50.00 2.00 X X 1288893 0 151662 Susan Sencer 50.00 1.00 X 326773 0 55652 Robert Segal 50.00 2.00 X 254004 0 55817 Patrick Ryan 1.00 1.00 X X 0 0 0 Raymond Barton 1.00 1.00 X 0 0 0 J Hayes Batson 1.00 1.00 X 0 0 0 Russ Becker 1.00 2.00 X X 0 0 0 Michael V Ciresi 1.00 2.00 X 0 0 0 Molly Culligan 1.00 1.00 X 0 0 0 George Goven 1.00 2.00 X 0 0 0 Sharon Jaeger 1.00 1.00 X 0 0 0 William Jeatran 1.00 1.00 X 0 0 0 Mary L Jeffries 1.00 1.00 X 0 0 0 Andrea Kmetz-Sheehy 1.00 2.00 X 0 0 0 Cynthia Lesher 1.00 1.00 X 0 0 0 Chad M Lindbloom 1.00 2.00 X 0 0 0 Matt Majka 1.00 2.00 X 0 0 0 Gaye Adams Massey 1.00 2.00 X 0 0 0 Richard Migliori 1.00 1.00 X 0 0 0 Richard T Murphy Jr 1.00 1.00 X 0 0 0 Michael J Ott 1.00 1.00 X 0 0 0 Timothy J Pabst 1.00 1.00 X 0 0 0 James D Sidman MD 1.00 1.00 X 0 0 0 Judge Pamela Alexander 1.00 1.00 X 0 0 0 James T Prokopanko 1.00 1.00 X 0 0 0 Sandra Sackett MD 1.00 1.00 X 0 0 0 Brian F Sullivan 1.00 1.00 X 0 0 0 Jonathan Wood 1.00 1.00 X 0 0 0 Maria Christu 50.00 1.00 X 467220 0 44427 Phil Kibort 50.00 1.50 X 674587 0 52212 Jerry Massmann 50.00 3.50 X 646564 0 50702 David Brumbaugh 50.00 0.00 X 368958 0 44147 Theresa Pesch 25.00 25.00 X 212982 212981 33116 Bjorn Gunnerud 50.00 0.00 X 220905 0 34594 David Overman 50.00 0.00 X 689587 0 38787 Roxanne Fernandes 50.00 0.00 X 352402 0 47529 Gloria Drake 50.00 6.00 X 177844 28456 46003 Pamala VanHazinga 50.00 0.00 X 172078 0 40351 Becky Bedore 50.00 0.00 X 171817 0 36616 Jennifer Olson 50.00 0.00 X 211931 0 36666 Joseph Petronio 50.00 0.00 X 844274 0 51612 Aaron Friedkin 50.00 0.00 X 519420 0 27795 Karen Blumberg 50.00 0.00 X 530971 0 28450 William Mize 50.00 0.00 X 516714 0 40362 James Engels 50.00 0.00 X 547954 0 40418 9195878 241437 956918 551 0 1 0 Cerner Corp PO Box 412702 Kansas City MO 64141 Hardware & Software Maintenance 6354334 Children's Respiratory & Critical Specia 2530 Chicago Avenue South Suite 400 Minneapolis MN 55404 Physician Services 3796451 Children's Heart Clinic 2530 Chicago Avenue South Suite 500 Minneapolis MN 55404 Physician Services 3765139 Dell Marketing LLP 7489 Collections Center Drive Chicago IL 60693 Patient Billing 3294298 Pediatric Surgical Assoc Ltd 2530 Chicago Avenue South Suite 550 Minneapolis MN 55404 Physician Services 2982568 85 22533423 10396535 1215932 32929958 Patient Service Revenu 621400 418999962 418999962 Medicare/Medicaid paym 621400 168728257 168728257 Parking 812930 2334907 -6338 2341245 Pharmacy Revenue 621400 695212 695212 Lab Revenue 621500 261519 154406 107113 418527 418527 591438384 14142708 14142708 1408039 399016 1009023 1009023 1009023 8989529 57099 0 150191 8989529 -93092 8896437 8896437 Cafeteria 722210 1521176 1521176 Marketplace 453220 247585 247585 Vending Machines 722210 20994 20994 25173 25173 1814928 650231438 588146746 148068 29006666 422439 422439 8401215 1974555 6426660 271304475 243366136 27938339 22191792 20591322 1600470 37814069 31082600 6731469 18808652 16887477 1921175 8062720 7648158 414562 319424 2725 316699 378679 378679 158817 158817 2681674 2681674 60364073 54847244 5516829 3920233 168859 3751374 7493278 5393612 2099666 12053405 12053405 13925508 12540508 1385000 1596679 1255596 341083 1539723 1281953 257770 10821652 10821652 35127193 26912031 8215162 1740467 1740467 Medical Supplies 57626179 57626179 0 0 MNCare Tax 10879676 10879676 0 0 Medicaid Surcharge 7242049 7242049 0 0 Temp Labor 4599079 3823217 775862 0 9167978 6834040 2333938 608641128 526024169 82616959 0 10778117 18543844 66371874 62569754 1770298 1330455 68185487 90289056 4402071 4659862 3552999 5984147 653723038 281330499 372623345 372392539 234284179 260408346 56424914 60564539 18615187 17647059 94974979 95276558 931983450 989666159 77959661 56125962 5370488 6450304 298890538 289288363 368426 337174 44324679 63813595 426913792 416015398 X 437473783 504289894 40477466 41687204 27118409 27673663 505069658 573650761 931983450 989666159 X 41590310 22651432 4339361 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 143889 0 1 14928 158817 0 Explanation of Lobbying Activities: Part II-B, Line 1: Children's retains a lobbyist to assist directly with lobbying efforts at the state level. Children's Director of Child Health Policy also occasionally will meet with state legislators, provide testimony on child health issues, or otherwise provide information to state lawmakers and their staffs. With respect to federal lobbying efforts, Children's Director of Child Health Policy and CEO will occasionally travel to Washington to meet with federal lawmakers. This is generally done in collaboration with industry organizations, such as NACHRI, who indirectly provide federal lobbying support on behalf of Children's. Children's is a member of the National Association of Children's Hospitals (NACH). $14,928 of membership dues paid to NACH relate to lobbying activities. 30285804 421789 3955151 1084240 33578504 30881650 883411 -267697 1211560 30285804 28645602 371730 2991850 1127532 30881650 23511131 1160044 4333957 359530 28645602 35160520 819502 -10484516 1984375 23511131 0.18000 0.82000 1 1 1 11019261 11019261 421869795 117310142 304559653 2067820 1447599 620221 213343524 158308144 55035380 5422638 4264614 1158024 372392539 Brandywine 60564539 F 60564539 Assets of executive benefit plans 10287001 Unamortized bond insurance and deferred finance costs 5068445 Investment in land for possible expansion 3240298 Intercompany receivable 1052092 Nursing education loans receivable 201837 Pharmaceutical services deposit 1826551 Physician relocation loans receivable 193675 Facility deposit 134000 United shared service arrangement 2939984 Beneficial interest in net asets of Foundation 69399458 Investment in HSCL 566946 Mother/Baby other assets 366271 95276558 MN Care tax payable 2544951 Self-insurance reserve 956715 RSVP retirement plan 24837705 Executive benefits liability 8072320 Post retirement benefits 4563201 Workers comp liability 2193365 Self-insurance equipment reserve 289070 Accrual VERP 879127 Intercompany payable 19435619 Other 41522 63813595 X 675996037 22651431 2621060 25272491 650723546 -492108 -492108 650231438 609133236 492108 492108 608641128 0 608641128 Description of Intended Use of Endowment Funds: Part V, Line 4: The majority of endowment funds are held by Children's Health Care Foundation, a related organization. The intended use of the funds is to support the programs at Children's Health Care. There are also two endowment funds that are held and administered by US Bank, an unrelated organization, which are also used to support the programs at Children's Health Care. Refer to Part III, Line 4 for a description of the programs of Children's Health Care. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Internal Revenue Service (IRS) has determined that Children's and its subsidiaries are exempt organizations as described in Section 501(C)(3) of the IRC. Children's believes that it continues to meet the requirements of the IRC to sustain its tax-exempt status. There are no federal income tax expenses, penalties, or interest recognized in the consolidated statements of operations and no unrecognized tax benefits for the years ended December 31, 2012 and 2011. Part XI, Line 2d - Other Adjustments: RSVP retirement plan-related charges 455,547 Change in unrealized interest rate swap valuation 2,165,513 Part XI, Line 4b - Other Adjustments: Loss on sale of assets (93,092) Rental expense (399,016) Part XII, Line 2d - Other Adjustments: Loss on sale of assets 93,092 Rental expense 399,016 Central America & the Caribbean Self Insurance for Medical Claims N/A 92019 Central America & the Caribbean Investments N/A 6377940 0 0 0 0 0 0 6469959 0 6469959 0 0 1 0 0 0 1 1 X 1 X 1 X 1 1 0 1 1 939526 939526 0.00150 246471541 181356911 65114630 0.10700 0.00000 247411067 181356911 66054156 0.10850 9496358 208336 9288022 0.01530 6178481 1191676 4986805 0.00820 32678541 19730885 12947656 0.02130 4705141 900 4704241 0.00770 341739 341739 0.00060 53400260 21131797 32268463 0.05310 300811327 202488708 98322619 0.16160 5400 5400 0.00000 0.00000 1947782 22977 1924805 0.00320 0.00000 0.00000 21800 21800 0.00000 0.00000 53500 53500 0.00010 0.00000 2028482 22977 2005505 0.00330 1 4819630 1204908 349403 426398 -76995 X 1 1 1 1 Children's Health Care

2525 Chicago Ave S Minneapolis MN 55404

X X X X X X Children's Health Care 1 0 1 1 150.000000000000 1 350.000000000000 1 X X X X X X 1 1 X X X 1 0 1 X 0 0 9 Children's Clinics - Woodwinds

1825 Woodwinds Drive Suite 400 Woodbury MN 55125

Specialty and Rehabilitation Clinic Children's - Maple Grove

7767 Elm Creek Blvd Suite 300 Maple Grove MN 55369

Specialty and Rehabilitation Clinic Rehabilitation Clinic

5950 Clearwater Drive Suite 500 Minnetonka MN 55343

Specialty and Rehabilitation Clinic Children's - Roseville

1835 W County Rd C Roseville MN 55113

Specialty and Rehabilitation Clinic McNeeley Pediatric Diabetes Center

6060 Clearwater Drive Suite 204 Minnetonka MN 55343

Pediatric Clinic Children's Primary and Specialty Clinic

347 North Smith Avenue St Paul MN 55102

Pediatric Clinic The Cntr for the Trtmt of Eating Dsordrs

910 East 26th Street Suite 410 Minneapolis MN 55404

Pediatric Clinic Children's Specialty Clinic

360 Sherman Street Suite 200 St Paul MN 55102

Pediatric Clinic Children's Specialty Clinic

310 North Smite Avenue Suite 400 St Paul MN 55102

Pediatric Clinic Part I, Line 3c: FPG is the primary measurement used to determine eligibility for charity care. However, policy exceptions may be granted for families who have medical debt exceeding 10% of their income or have other specific documented needs where they are not able to pay all or a portion of their balance. Medicaid eligibility may also be used to determine eligibility.Part I, Line 6a:Children's Hospitals and Clinics of Minnesota prepares an annual community benefits report. The community benefits report is available to the public online at childrensmn.org/about-us/health-advocacy-and-policy/community-benefit.Part I, Line 7g:Subsidized health services benefits include the subsidized costs of two physician clinics. A clinic is located on both the Minneapolis and St. Paul campuses. These clinics serve the local communities that include a high percentage of minorities and low-income families. Net community benefit expenses related to these clinics were $1,092,000 for the twelve months of 2012.Part I, Line 7: A ratio of patient care cost to charges, as calculated using Form 990, Schedule H, Worksheet 2 - Ratio of Patient Care Cost to Charges, was used to calculate community benefit costs for Schedule H, Part I, Line 7, rows (a)(c). Community benefit costs for rows (b)(e)(f)(g)(h)(i)(j) were calculated using a full-absorption costing model that combines direct costing and the allocation of indirect costs through an activity-based costing methodology. Part II: Children's provided the following community building activities in 2012:- Cristo Rey Jesuit High School is part of the nationwide Cristo Rey Network of 25 high schools that provide a quality, Catholic, college preparatory education to young people who live in urban communities with limited educational options. Children's provides financial support to the Hire4Ed Work-Study Program, which provides students with real-world work experience and pays more than half of the students cost of education. Children's also hosts some students in the program for work experience.- Project for Pride in Living: PPL helps low-income people achieve self-sufficiency through housing, employment training, support services and education. Children's partners with and provides financial support to PPL in their Train to Work initiative, which has trained hundreds of people to meet entry-level staffing needs of Children's and other major area healthcare partners. Train to Work offers training in healthcare-specific details, such as medical terminology and electronic health records, as well as a job shadowing internship that has been an essential component of the program's success. The internship gives participants hands-on experience in healthcare and gives employers an opportunity to observe potential employees. Part III, Line 4: Bad debt is defined as the unpaid obligation for care provided to patients who have been determined to be able to pay, but have not demonstrated a willingness to pay. The amounts attributable to patients eligible under the organizations charity care policy are determined by a patient's willingness to pay with a documented inability to pay per measures established by our policy. Both amounts are estimated by applying the ratio of patient care cost to charges, as calculated on Form 990, Schedule H, Worksheet 2, to the actual patient charges. The organization estimates that twenty-five percent of bad debt expenses are attributable to patients who likely would qualify for financial assistance under the organization's charity care policy (but were either unwilling or unable to provide sufficient information to make a determination of their eligibility while in our care). The estimate of twenty-five percent is based on a review of accounts classified as bad debt and management judgement. Footnote from 2012 audited financials:Patient Accounts Receivable - Patient accounts receivable represent amounts due from federal and state agencies, managed health care plans, commercial insurance companies, employers, and patients. Children's grants credit to patients, most of whom are insured under third-party payer agreements, without collateral or any other security to support amounts due. Children's determines an allowance for doubtful accounts by considering a number of factors, including, but not limited to, the length of time accounts receivable are past due, previous loss history, the existence of a third-party payer, reimbursement trends, and other collection indicators. Accounts are written off when all reasonable internal and external collection efforts have been performed and payments subsequently received on such receivables are credited to the allowance. Children's recognizes that revenues and receivables from government agencies are significant to its operations, but does not believe there are significant credit risks associated with these government agencies. In 2012, net revenue from the top four third-party payers accounted for 30%, 28%, 16%, and 11% of net patient service revenue. In 2011, net revenue from the top four third-party payers accounted for 30%, 30%, 15%, and 10% of net patient service revenue. Part III, Line 8: The organization primarily serves pediatric patients and does not generate significant Medicare revenues. The organization files a Medicare cost report annually. Form 990, Schedule H, Worksheet 3 - Unreimbursed Medicaid and Other Means-Tested Government Programs was used to calculate the costs associated with Medicare charges reported in Part III, Line 6. The organization does not report any amounts from Part III, Line 7 as community benefit. Part III, Line 9b: When collecting medical debt, Children's Hospitals and Clinics of Minnesota treats its patient families with honor, dignity, and courtesy; demonstrates compassion; and are good stewards of health care resources. There is a zero tolerance for abusive, harassing, oppressive, false, deceptive, or misleading language or collections conduct by Children's employees and contractors who collect medical debt from patient families. This policy applies broadly to all patient families we serve. Components of Children's collection policy include:During the pre-registration, registration, or admission process, Children's attempts to identify and inform patient families who may be eligible for charity care or discounted care through the uninsured discount or charity care policy.All Children's employees and contracted staff who have direct contact with patients are educated on an annual basis of Children's financial assistance policies. The education informs staff of programs available and how a patient family may obtain more information and submit an application for financial assistance.A financial assistance application is sent with the initial hospital patient statement explaining the process for obtaining financial assistance to all self pay patient families. Reference to financial assistance is included on all subsequent statements. If a patient family indicates the need for financial assistance during the registration process or throughout the collection process, financial assistance information is provided to the family by staff. All patients who are registered as self pay are offered the financial assistance information at the time of registration. All correspondence seeking collection of medical debts contain a reference to the availability of financial assistance.Minnesota hospital providers have jointly developed consistent collection guidelines set out in formal agreements with the Minnesota Attorney General's Office. This agreement is consistent with Children's collection policy. The Audit and Compliance Committee of our Board of Directors annually reviews this policy and all policies concerning collection of medical debt, uninsured discount, and charity care. The Audit and Compliance Committee also reviews the results of an annual audit related to these areas in accordance with the Minnesota Attorney General's Agreement.Part V, Section B, Line 20d:We charge everybody the same, however, the discount applied to FAP eligible individuals is based on the financial assistance policy so a discount on charge between 50% and 100% based on income guidelines or 44% discount for the uninsured based on our largest commercial payer. Children's Health Care Part V, Section B, Line 14g: The policy is available upon request, however, every self pay patient at registration is given a flyer of the key items on the policy and there is a reference to the policy in every self pay statement sent in accordance with the Minnesota Attorney General's agreement. Part VI, Line 2: The health care needs of the community served by Children's Hospitals & Clinics of Minnesota is determined as follows: a. Board of Directors: the organization's governing body, comprised of community members who reside locally, provides governance that includes the health care services provided to the local community.b. Children's employed physicians, independent physicians who provide care at Children's, and numerous clinical care providers assess community needs daily through the pediatric care provided throughout the community.c. The Family Advisory Council: a diverse group of families whose children are present or past patients of Children's provide input as to Children's services. Council members represent a wide range of inpatient and outpatient experiences to help enhance the quality of child and family care experiences at Children's. Council responsibilities include:- Develop, implement, and evaluate service and facility standards.- Communicate to management the recommendations and concerns expressed by parents, family members, parent associations, and others.- Advise on policy review, promote family-centered care, and support program development.d. Community partnerships: partnerships with groups such as the Minnesota Hospital Association Policy and Advocacy Committee and the Hennepin County Health Department Community Advisory Group help the organization identify community needs. Children's also partners with several coalitions that deal with issues impacting children's health, including: Raise it for Health, a tobacco cessation coalition; the Minnesota Prematurity Coalition, a group devoted to increasing awareness of the unique health and development issues premature infants face through advocating for access to quality health care, and identification, consolidation and dissemination of resources for parents and families; and the Minnesota Healthy Kids coalition, which advocates for the prevention of childhood obesity through policy change.e. Youth Advisory Council: is a dedicated group of patients, ages 10 to 18, who help hospital staff, leaders, doctors, and parents understand what is important to children, teens, and siblings during hospital stays, clinic visits, and emergency care. YAC brings a valuable perspective and voice to Children's by participating in activities that promote discussion and thought about health care services for pediatric and young adult patients. The council also brings great perspective to let other children know how to make their stay at Children's a more comfortable and positive experience. f. Children's maintains an advocacy department that is responsible for identifying and leading efforts that advocate for pediatric health needs. Children's advocacy department maintains an advocacy database of over 400 members, all of whom can share advocacy input with the Children's Advocacy team.The advocacy department is also involved in Community Health Improvement Planning processes in both Hennepin and Ramsey counties. The advocacy department is also leading the effort to complete the first Community Health Needs Assessment conducted at Children's, which includes a comprehensive review of significant health needs in the seven-county metro area immediately surrounding the hospital campuses in St. Paul and Minneapolis. The Assessment is currently underway and will be considered conducted before the end of FY 2013. g. Other methods include and are not limited to: partnerships and projects with third party-payers and other community physicians and hospitals, monitoring and reporting of infectious disease data, disaster readiness efforts, research and education, support groups, and others. Part VI, Line 3: Patient Education of Eligibility for Assistance: Components of Children's collection policy include:During the pre-registration, registration, or admission process, Children's will attempt to identify and inform patient families who may be eligible for charity care or discounted care through the uninsured discount or charity care policy.All Children's employees and contracted staff who have direct contact with patients will be educated on an annual basis of Children's financial assistance policies. The education will inform staff of programs available and how a patient family may obtain more information and submit an application for financial assistance.A financial assistance application will be sent with the initial letter explaining the process for obtaining financial assistance to all self pay patient families. If a patient family indicates the need for financial assistance during the registration process, financial assistance information is provided to the family by the registration staff.All correspondence seeking collection of medical debts will contain a reference to the availability of financial assistance.Minnesota hospital providers have jointly developed consistent collection guidelines set out in formal agreements with the Minnesota Attorney General's Office. This agreement is consistent with Children's collection policy. The Board of Directors (Audit Committee) performs an annual review of this policy and all policies concerning collection of medical debt, uninsured discount, and charity care. The Audit Committee shall also review the results of an annual audit related to these areas in accordance with the Minnesota Attorney General's Agreement. Part VI, Line 4: Community information (communities we serve):Children's Hospitals & Clinics of Minnesota serves the five state area of the upper Midwest (Minnesota, North Dakota, South Dakota, Iowa, and Wisconsin). Approximately seventy-five percent of inpatient admissions are from the seven county metropolitan areas of the Twin Cities. The remaining twenty-five percent of inpatient admissions are from outstate Minnesota and the surrounding states. These patients represented one-hundred percent of Minnesota counties and sixty-four percent of the total counties in the five state area. The age of patients reflects the pediatric health services provided with seventy-six percent of patients being under the age of ten and eighty-nine percent under the age of fifteen. Patient diversity at Children's, and specifically non-Caucasion patient volumes, more than double the population demographics of the seven county metropolitan area. As such, Children's provides interpreter services for forty-six languages with the most frequent languages being Spanish, Somali, and Hmong. Children's also serves a disproportionate share of economically disadvantaged patients with forty-two percent of net patient revenues from government programs. The Minneapolis campus is located within the Phillips-Powderhorn neighborhood (MUA), home to one of the most ethnically diverse communities in Minnesota. Part VI, Line 5: Other Information:As a charitable organization, Children's provides a broad spectrum of benefits to the communities it serves that would otherwise be unavailable or insufficient to meet patient demand for the express purpose of improving the health status of children in the community. These include programs such as free clinics, health screenings, support counseling for patients and families, crisis intervention, disaster readiness and the cost of providing community health partnerships and education. These services and donations account for a measurable portion of the hospital's costs and help to promote healthy lifestyles, community development, health education and affordable access to care. Example programs include:- Children's is one of the local hospitals and health plans in the Twin Cities that advises Portico Healthnet on issues related to program services and provides funding for medical services to participants. Portico Healthnet, a nonprofit health and human services organization, serves the community by assisting children, parents and individuals who are uninsured with applications to health care programs and by offering a primary and preventive health care access program for people ineligible for public programs. - Women, Infants & Children (WIC) Program. Children's houses a Woman, Infants and Children (WIC) clinic to facilitate enrollment in the program, nutrition education, access to nutritious foods, as well as breastfeeding education and support. Additionally, the Children's WIC Program promotes healthy weight for both mother and child by offering individualized nutrition assessments, monitoring appropriate weight gain and growth, counseling families on how to help children eat a healthy diet, encouraging families to be physically active, and providing referrals to community nutrition and physical activity resources. - The EMSC Resource Center provides technical assistance to agencies to improve pediatric emergency care. The EMSC works to reduce child morbidity and mortality due to trauma and critical illness and is the only statewide program that focuses on improving pediatric components of medical care.- The Minnesota Sudden Infant Death (SID) Center: Children's houses the Minnesota SID Center, which provides support to families and promotes awareness within both the medical and lay communities of SIDS and other causes of sudden infant death. The center works to identify causes of sudden, unexpected infant death throughout Minnesota; reaches out with information and support to families; educates professionals and the public; and participates in research.- The Simulation Center is a motor coach outfitted with simulation equipment and staffed with Children's trainers that travels throughout the Midwest to train staff from hospitals in the best practices when responding to pediatric or neonatal medical emergencies.- The Midwest Children's Resource Center is a regional center providing specialty services for children who are possibly abused, their families, and the professionals who work with them. MCRC brings together a multi-disciplinary team of child abuse specialist who provide a broad range of services, including medical and psychological consultation. The center works as an advocate for the children who have been abused, seeking to significantly advance protection, treatment and healing of these children. - HealthPartners and Children's Hospital: Healthy Kids Partnership. HealthPartners and Children's Hospital and Clinics of Minnesota are collaborating with community stakeholders to help promote childhood health and prevent obesity. Physician champions in three clinics are connecting with schools, community centers, local businesses and public health. By working in partnership, we hope to promote and sustain change in the places our kids live, learn and play. In 2012, three initiatives were started in three neighborhoods that included Vida Sana (Phillips Neighborhood), White Bear Lake: Bear Power and Cedar-Riverside in Minneapolis. Children's immunization project: To increase rates of vaccination among children, particularly in low-income and underserved areas, Children's provides outreach and education on vaccinations. The program's current focus is on influenza prevention, and activities include vaccination clinics and educational outreach.- Perinatal HIV prevention program: Optimal prenatal care for women with HIV is essential in preventing transmission of the disease to infants. Children's Infection Prevention department works with HIV positive pregnant women to help them get this care by building relationships with medical providers throughout the state to refer expecting mothers into the program.- The Advocacy and Health Policy department at Children's promotes the health of the community by participating in coalitions that advocate for the health of children in Minnesota. Some of these include: the Raise it for Health coalition, dedicated to raising the price of tobacco (a proven method for reducing the number of adolescents that become addicted smokers); the Minnesota Healthy Kids Coalition, which works for policy changes to address growing rates of childhood obesity; and the Minnesota Prematurity Coalition, which focuses on reducing premature birth and advocating for infants that are born prematurely and their families. Reports Filed With States Part VI, Line 7 MN 1 Abbott Northweatern Hospital Foundation 800 East 28th Street Minneapolis MN 554073799 043643816 501(c)(3) 10000 Table sponsorship - 2012 Medicine Ball Children's Hospital Association 2525 Chicago Ave S Minneapolis MN 55404 410711605 501(c)(3) 10000 Sponsorship - Storybook Ball fundraiser. Children's Heartlink 5075 Arcadia Ave Minneapolis MN 554362306 411307457 501(c)(3) 10000 Sponsorship - Heartlink gala Cristo Rey Jesuit High School 2924 Fourth Avenue South Minneapolis MN 55408 204548714 501(c)(3) 28500 Sponsorship - Hire for Ed program Healthteacher Inc 209 10th Ave S Suite 350 Nashville TN 37203 59527 Promotion of Health Education Make A Wish Foundation 615 First Avenue NE Suite 415 Minneapolis MN 55413 411422893 501(c)(3) 5500 Sponsorship - 2012 Wish Ball March of Dimes 5233 Edina Industrial Blvd Edina MN 55439 131846366 501(c)(3) 15500 Sponsorship - Nurse of the year, March of babies & Signature Chefs Auction Phillips West Neighborhood Org 2400 Park Avenue South Suite 152 Minneapolis MN 55404 900122796 501(c)(3) 5400 Sponsorship - Midtown safety center Portico Healthnet 2610 University Ave W Suite 550 St Paul MN 551142007 411814659 501(c)(3) 100000 Help families to get medical assistance coverage. Project for Pride in Living 1035 E Franklin Ave Minneapolis MN 55406 237232208 501(c)(3) 25000 Support Project for Pride in Livings health careers job training program. Ronald McDonald House 818 Fulton St SE Minneapolis MN 55414 411313107 501(c)(3) 12200 Sponsorships - Golf benefit & Fam Glam benefit. Smith Partners 400 Second Ave S Suite 1200 Minneapolis MN 55401 203663831 21800 Support Phillips Partnership. University of CA San Francisco 513 Parnassus Avenue San Francisco CA 94143 946036493 115 60000 Support fetal research 11 2 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: From time to time, Children's grants monies to other organizations conducting programs and/or research that will benefit the children that Children's serves. Children's also occasionally provides monetary support to organizations that promote careers in the health care field and community organizations that support the economic development of the area surrounding the Children's Minneapolis campus. Children's receives periodic updates regarding the use of the funds. X 1 0 X X X X X 0 1 0 0 0 0 0 1 0 Alan Goldbloom 759170 0 371624 0 158099 0 135140 0 16522 0 1440555 0 0 0 Susan Sencer 231204 0 79183 0 16386 0 34580 0 21072 0 382425 0 0 0 Robert Segal 196301 0 43155 0 14548 0 35077 0 20740 0 309821 0 0 0 Maria Christu 323918 0 87986 0 55316 0 22815 0 21612 0 511647 0 0 0 Phil Kibort 454271 0 137238 0 83078 0 30600 0 21612 0 726799 0 0 0 Jerry Massmann 431668 0 144159 0 70737 0 34180 0 16522 0 697266 0 0 0 David Brumbaugh 260291 0 77844 0 30823 0 22815 0 21332 0 413105 0 0 0 Theresa Pesch 149549 149548 44001 44001 19432 19432 8297 8297 8261 8261 229540 229539 0 0 Bjorn Gunnerud 189168 0 31737 0 0 0 17553 0 17041 0 255499 0 0 0 David Overman 444000 0 166955 0 78632 0 22265 0 16522 0 728374 0 0 0 Roxanne Fernandes 296774 0 55588 0 40 0 29734 0 17795 0 399931 0 0 0 Gloria Drake 150964 24157 26880 4299 0 0 25703 4112 13956 2232 217503 34800 0 0 Pamala VanHazinga 146728 0 25350 0 0 0 21086 0 19265 0 212429 0 0 0 Becky Bedore 145804 0 25754 0 259 0 28577 0 8039 0 208433 0 0 0 Jennifer Olson 185248 0 26683 0 0 0 25467 0 11199 0 248597 0 0 0 Joseph Petronio 750006 0 93855 0 413 0 30000 0 21612 0 895886 0 0 0 Aaron Friedkin 428794 0 59501 0 31125 0 18750 0 9045 0 547215 0 0 0 Karen Blumberg 425574 0 65998 0 39399 0 18750 0 9700 0 559421 0 0 0 William Mize 442792 0 44142 0 29780 0 18750 0 21612 0 557076 0 0 0 James Engels 482160 0 9574 0 56220 0 18806 0 21612 0 588372 0 0 0 Part I, Line 1a Alan Goldbloom is reimbursed for his membership fees for the Minneapolis Club, which is used solely for business purposes. Part I, Line 4b Certain employees of Children's Health Care are provided the opportunity to participate in the Supplemental Executive Retirement Plan (the SERP). The SERP requires that the employee have an agreement in order to be eligible to participate in the SERP. Payments from the SERP occur at retirement and are based on years of service and percentage of salary. The following amount represents the amount deferred under the SERP in 2012. Alan Goldbloom $112,050 Certain employee of Children's Health Care are provided the opportunity to participate in the Capital Accumulation Plan (the Capital Plan). The Capital Plan requires that the employee is a physician or executive and is a .5 FTE or more in order to be eligible to participate in the Capital Plan. Payments from the Capital Plan occur at vesting and are based on percentage of salary. The following amounts represent the amount paid under the Capital Plan in 2012. Alan Goldbloom $121,395 Jerry Massmann $47,826 Phil Kibort $65,874 David Brumbaugh $30,823 Maria Christu $48,220 Theresa Pesch $28,013 David Overman $70,149 Karen Blumberg $33,674 James Engels $28,869 Susan Sencer $15,325 Robert Segal $14,548 Aaron Friedkin $3,593 William Mize $29,780 Certain employee of Children's Health Care are provided the opportunity to participate in the Deferral Account Pay Plan (the Deferral Plan). The Deferral Plan requires that the employee is a physician or executive and is a .5 FTE or more in order to be eligible to participate in the Deferral Plan. Payments from the Deferral Plan occur at vesting and are based on percentage of salary. There were no amounts paid under the Deferral Plan in 2012. Part I, Line 7 Certain executives and physicians are eligible for participation in the Executive Incentive Plan (EIP) or Physician Incentive Plan (PIP). The EIP and PIP provide eligible participants with the opportunity to receive an incentive payment based on attainment of established organization and individual goals. A 1995B 2004A - See Part VI 416005375 603695FG7 2004-08-24 77550000 Hlth Care Equip&Bldg & Ref Bnd Issued 10/2/95 0 0 0 B 2004B - See Part VI 416005375 603695FH5 2005-05-25 51550000 Refunding of Taxable Bond Issued 8/24/04 0 0 0 C 2007A - See Part VI 416005375 603695FP7 2007-11-15 103000000 Facility Expansion and Upgrade 0 0 0 D 1995B 2004A-1 2010A - See Part VI 416005375 603695GQ4 2010-03-25 97051274 Facility Expns & Upgrd & Ref Bnd Issd 8/24/04 0 0 0 A 55700000 77550000 143 810064 1239936 50000000 25500000 2004 1 0 1 1 B 15050000 51550000 240 51550000 1 0 1 1 C 3775000 106148383 1029 862000 1582951 103703432 2009 0 0 1 1 D 5785000 97071507 980 51120684 45950823 2011 1 0 1 1 A 0 0 1 1 1 1 0.00000 0.00000 0 0 1 C 0 0 1 1 1 1 0.00000 0.00000 0 0 1 D 0 0 1 1 1 1 0.00000 0.00000 0 0 1 A 0 0 1 0 1 1 Piper Jaffray 30.200000000000 0 0 0 0 1 B 0 0 1 0 1 1 Piper Jaffray 20.200000000000 0 0 0 0 1 C 0 0 1 0 1 1 Piper Jaffray 29.800000000000 0 0 0 0 1 D 0 0 1 0 0 0 0 0 1 A 1 B 1 C 1 D 1 Schedule K, Supplemental Information The report periods selected for all four bond issues recorded on Schedule K are not the same as the fiscal year end for the rest of the Form 990. Schedule K uses the bond year ending of August 15, 2013. Part I, Column (g) A. Though these bonds are not defeased, a portion of the bonds was currently refunded by a reissuance on 3/25/2010. Part II, Line 3 Differences between Part I, column (e) and Part II, line 3 are due to investment earnings. Schedule K, Part II, Line 13 Year of Substantial Completion B. As this bond issue consists entirely of refunding bonds, it is Children's understanding that the concept of "year of substantial completion" does not apply to this issue. Schedule K, Part I, Line 1 Column A Health Care Facilities Revenue Bonds 1995B/2004A - Issuer of the bond is City of Minneapolis, MN (41-6005375) and Housing and Redevelopment Authority of the City of St. Paul, MN (41-6005521). Schedule K, Part I, Line 2 Column A Health Care Facilities Revenue Bonds 2004B - Issuer of the bond is City of Minneapolis, MN (41-6005375) and Housing and Redevelopment Authority of the City of St. Paul, MN (41-6005521). Schedule K, Part I, Line 3 Column A Health Care Facilities Revenue Bonds 2007A - Issuer of the bond is City of Minneapolis, MN (41-6005375) and Housing and Redevelopment Authority of the City of St. Paul, MN (41-6005521). Schedule K, Part I, Line 4 Column A Health Care Facilities Revenue Bonds 1995B/2004A-1/2010A - Issuer of the bond is City of Minneapolis, MN (41-6005375) and Housing and Redevelopment Authority of the City of St. Paul, MN (41-6005521). Pediatric ENT Associates PA James Sidman, Director 170092 Payment to Pediatric ENT Associates, P.A. for Medical Director services 0 Pediatric ENT Associates PA James Sidman, Director 610425 Payment to Pediatric ENT Associates, P.A. for purchase of trade or business 0 X 72845 Cost or Selling Price X 270438 Cost or Selling Price X 29 30478 Cost or Selling Price X 3 13546 Cost or Selling Price X Entertainment 24 24823 Cost or selling price X Other 3 668502 Cost or Selling Price X Electronics 22 135301 Cost or Selling Price 0 1 0 Form 990, Part VI, Section A, line 4 The bylaws of Children's Health Care were amended during 2012 for the following significant changes: 1. Addition of new language to allow the board greater flexibility to create committees as appropriate and eliminate the concept of "standing" committees. 2. Removal of some detail from each committee description and instead a reference to the committee chair. This will provide greater flexibility to modify committee functions. Management will be working with each committee over the next several months to revise, if necessary, their charters. 3. Identified new "best practices" language to clarify that directors cannot be removed simply by voting to decrease the overall number of directors. 4. Revised language in the annual meeting section to clarify that the Children's board will elect or approve directors and officers for subsidiaries as provided in the governing documents of the subsidiaries. This allows for greater flexibility for different types of subsidiary organizations. 5. Revision to allow board meetings to be held outside of the seven county metro area. 6. Removal of duplicative language regarding CEO signing authority as this authority is set out in a different section of the bylaws. Form 990, Part VI, Section B, line 11 Children's senior management reviews the draft Form 990 with the Audit and Compliance Committee of the governing body prior to filing of the Form. This review includes an overview of the Form and discussion related to key sections. Copies of the final Form 990 are made available to members of the Committee and all directors prior to the Form being filed. The Audit and Compliance Committee has been delegated the authority to oversee the completion and filing of the Form 990 by the full board, and the Committee reports the results of its review and approval to the full board at a regularly scheduled board meeting. Form 990, Part VI, Section B, line 12c Management of Children's ensure that conflict of interest disclosure forms are completed by all members of the governing body and board committees at least annually. Forms are completed at the beginning of the year, and directors and committee members are instructed to provide additional disclosures if necessary during the course of the year. The Governance Committee of the governing body, along with senior management (CEO and General Counsel) review all disclosures provided by governing board members. The results of this review and any concerns, limitations, etc., are reported by the Governance Committee to the full board. If conflicts are identified, the Governance Committee and management work to ensure that directors do not participate in discussion or voting on the affected matter. Form 990, Part VI, Section B, line 15 Children's follows the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation for the CEO and other officers and executive leaders of Children's. This function is performed by the Compensation Committee of the governing board, which is composed of only independent directors. The process includes review of comparability data, retention of an outside compensation consultant and contemporaneous substantiation of the deliberation and decision through detailed minutes of the Compensation Committee and full board meetings where executive compensation is considered. Form 990, Part VI, Section C, line 19 Children's makes financial statement information public through a summary of financial performance in its annual report. In addition, financial statements are provided to Children's bond trustee, who therefore make this information publicly available. Children's governing documents and conflict of interest policy are not available to the public. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Change in beneficial interest in net assets of Foundation 1,718,301. RSVP Retirement plan-related changes 455,547. Change in value of interest rate swap valuation 2,165,513. Children's Health Insurance Network LTD PO Box 30600 Grand Cayman CJ KY1-1203 Insurance CJ -1284372 6377940 Children's Health Care Children's Health Care Services Inc DBA Minnetonka 2525 Chicago Ave S Minneapolis MN 55404 411756478 Healthcare MN 501(c)(3) Line 3: 170(b)(1)(a) Children's Health Care 1 Children's Health Care Foundation 2525 Chicago Ave S Minneapolis MN 554021844 411814223 Healthcare MN 501(c)(3) Line 7: 170(b)(1)(a) Children's Health Care 1 Children's Clinic Network 2525 Chicago Ave S Minneapolis MN 554041844 453765330 Healthcare MN 501(c)(3) Line 3: 170(b)(1)(a) Children's Health Care 1 Mother Baby Facility LLC 2525 Chicago Ave S Minneapolis MN 554041844 454078371 Healthcare MN 501(c)(3) Line 11: 509(a)(3) Children's Health Care 1 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 1 0 1 Children's Health Care Foundation C 22536125 Accrual Children's Health Care Foundation M 5872681 Accrual Children's Health Care Foundation P 5179939 Accrual Children's Health Care Foundation S 21966659 Accrual Children's Health Care Services Inc DBA Children's - Minnetonka J 18384 Accrual Children's Health Care Services Inc DBA Children's - Minnetonka M 272554 Accrual Children's Health Care Services Inc DBA Children's - Minnetonka O 297612 Accrual Children's Health Care Services Inc DBA Children's - Minnetonka P 8249732 Accrual Children's Health Care Services Inc DBA Children's - Minnetonka Q 6860814 Accrual