2013-11-07T14:33:37-06:00 2012-12-31 454084437 WARREN AVERETT LLC 2500 ACTON ROAD BIRMINGHAM AL 35243 990 2012-01-01 630307306 THE CHILDREN'S HOSPITAL OF ALABAMA CHIL 2056389100 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 DAWN WALTON 2059399100 2013-10-31 1 JC ROUSE P00081132 2059794100 2012 2016-02-25 16:41:14Z WILLIAM MICHAEL WARREN J 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 580762082 0 X WWW.CHILDRENSAL.ORG X 1911 AL SPECIALTY ACUTE-CARE HOSPITAL PROVIDING INPATIENT AND OUTPATIENT MEDICAL SERVICES TO PEDIATRIC PATIENTS. 35 28 4714 1227 0 0 2774425 2662935 536126146 562332168 -672747 1810088 10364751 10093502 548592575 576898693 0 0 0 0 224521458 245736280 0 0 0 248941893 296977182 473463351 542713462 75129224 34185231 668797176 774438516 415187509 417710863 253609667 356727653 X THE MISSION OF THE CHILDREN'S HOSPITAL OF ALABAMA (THE HOSPITAL) IS TO PROVIDE THE FINEST PEDIATRIC HEALTH SERVICES TO ALL CHILDREN IN AN ENVIRONMENT THAT FOSTERS EXCELLENCE IN RESEARCH AND MEDICAL EDUCATION. THE HOSPITAL WILL BE AN ADVOCATE FOR ALL CHILDREN AND WORK TO EDUCATE THE PUBLIC ABOUT ISSUES AFFECTING CHILDREN'S HEALTH AND WELL-BEING. 0 0 285920318 337239257 THE HOSPITAL IS THE 14TH LARGEST AND THE 10TH BUSIEST PEDIATRIC MEDICAL CENTER IN THE UNITED STATES. IT IS THE ONLY LEVEL I PEDIATRIC TRAUMA CENTER, THE ONLY PEDIATRIC RENAL CARE CENTER, AND THE LARGEST PEDIATRIC BURN CENTER IN THE SOUTHEAST. THE HOSPITAL OPERATES 350 BEDS, WHICH INCLUDES 48 NICU BASSINETS AND 98 CRITICAL CARE BEDS IN THE FOLLOWING UNITS: CARDIOVASCULAR, PEDIATRIC, NEONATAL, SPECIAL CARE, CRITICAL CARE, BURN AND STEM CELL TRANSPLANTS. IN 2012, THE HOSPITAL HAD 13,595 INPATIENT CASES AND 81,579 PATIENT DAYS. INPATIENT SURGERY CASES TOTALED 5,171 FOR 2012. THE HOSPITAL CRITICAL CARE TRANSPORT TEAM PROVIDES HELICOPTER, JET AND GROUND TRANSPORT FOR CRITICALLY ILL AND INJURED CHILDREN. 161449145 188003315 THE HOSPITAL OPERATES 13 OUTPATIENT SPECIALTY CLINICS THAT HANDLE FOLLOW-UP VISITS FOR PATIENTS AS WELL AS REFERRALS FROM HEALTH DEPARTMENTS ACROSS THE STATE. THESE CLINICS PROVIDE SERVICES IN HEMODIALYSIS, GASTROENTEROLOGY, HEMATOLOGY/ONCOLOGY, ORTHOPEDICS, UROLOGY, OTORINOLARYNGOLOGY, NEUROLOGY, PULMONARY FUNCTION, GENERAL SURGERY, DENTAL, BEHAVIORAL SERVICES, SPEECH AND HEARING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND OTHERS. IN 2012, THESE CLINICS HAD 240,293 VISITS AND 16,427 OUTPATIENT SURGERIES WERE PERFORMED. THE HOSPITAL ALSO PROVIDES A STATEWIDE AND REGIONAL REFERRAL SITE FOR COMPLEX EMERGENCY PATIENTS. THE EMERGENCY DEPARTMENT HAD 51,259 VISITS IN 2012. 41072660 44144184 THE HOSPITAL HAS A NETWORK OF PRIMARY CARE PRACTICES THROUGHOUT THE STATE KNOWN AS PEDIATRIC PRACTICE SOLUTIONS. IT CONSISTS OF 13 PRACTICES SUPPORTING 60 GENERAL PEDIATRICIANS. IN 2012 THESE PRACTICES PROVIDED 359,066 VISITS. 488442123 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 237 0 1 4714 1 0 1 CJ 0 0 0 0 0 0 0 0 X 35 28 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JENNY WAKEFORD 2056386778 1600 7TH AVENUE SOUTH BIRMINGHAM AL 35233 WILLIAM MICHAEL WARREN JR 40.00 X X 557394 0 192564 RAYMOND J HARBERT 0.50 X 0 0 0 C PHILLIP MCWANE 0.50 X 0 0 0 W CHARLES MAYER 0.50 X 0 0 0 SUSAN N HASKELL 0.50 X 0 0 0 RICHARD J BIELEN 0.50 X 0 0 0 J DAVID BROWN III 0.50 X 0 0 0 THOMAS N CARRUTHERS JR 0.50 X 0 0 0 GAYLE CUNNINGHAM 0.50 X 0 0 0 DERROL DAWKINS MD 0.50 X 0 0 0 DAVID E DIXON MD 0.50 X 0 0 0 BETH G DUBINA 0.50 X 0 0 0 DAVID M FIELDS 0.50 X 0 0 0 RALPH FROHSIN JR 0.50 X 0 0 0 GILLIAN W GOODRICH 0.50 X 0 0 0 OB GRAYSON HALL JR 0.50 X 0 0 0 JOHN O HUDSON III 0.50 X 0 0 0 DONALD M JAMES 0.50 X 0 0 0 VIRGINIA WALKER JONES 0.50 X 0 0 0 PHILIPPE W LATHROP 0.50 X 0 0 0 JAMES C LEE III 0.50 X 0 0 0 THOMAS H LOWDER 0.50 X 0 0 0 ROBERT S MCANNALLY 0.50 X 0 0 0 L GWALTNEY MCCOLLUM JR 0.50 X 0 0 0 CHARLES D MCCRARY 0.50 X 0 0 0 ANN D MCMILLAN 0.50 X 0 0 0 BEVERLY B MCNEIL 0.50 X 0 0 0 HUGH J MORGAN JR 0.50 X 0 0 0 W JERRY OAKS MD 0.50 X 0 0 0 CRAFT O'NEAL 0.50 X 0 0 0 MARGARET M PORTER 0.50 X 0 0 0 FREDERICK W RENNEKER III 0.50 X 0 0 0 STUART A ROYAL MD 0.50 X 0 0 0 BEN RUSSELL 0.50 X 0 0 0 SERGIO B STAGNO MD 0.50 X 0 0 0 LEE J STYSLINGER III 0.50 X 0 0 0 TEMPLE W TUTWILER III 0.50 X 0 0 0 MARC BRYANT TYSON 0.50 X 0 0 0 THOMAS G SHUFFLEBARGER 40.00 X 721581 0 118456 JAMES MICHAEL BURGESS 40.00 X 573801 0 110316 MIKE MCDEVITT 40.00 X 472691 0 108138 DOUGLAS DEAN 40.00 X 514045 0 79831 JAMES PETER VANPELT 40.00 X 451212 0 61344 LORI DENICE MOLER 40.00 X 441137 0 53140 COKE MATTHEWS 40.00 X 363396 0 71091 AUDIE WOOLLEY 40.00 X 1080524 0 118629 JIMMY SCOTT HILL 40.00 X 1352183 0 178628 BRIAN WIATRAK 40.00 X 993160 0 178628 WILLIAM PEYTON SHIRLEY 40.00 X 482112 0 21129 JOHN D SIMPSON 40.00 X 424874 0 21129 8428110 0 1313023 259 0 1 0 HOARBE&K JOINT VENTURE TWO METROPLEX DRIVE STE 400 BIRMINGHAM AL 35209 CONSTRUCTION 38073320 UNIVERSITY OF ALABAMA HEALTH SERVICES FO 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 SUBSPECIALTY, MOONLIGHTING, AFTER HOURS, 16659468 VITALIZE CONSULTING SOLUTIONS INC 1710 SAIC DRIVE MCLEAN VA 22102 CONSULTING 9648171 ARAMARK PO BOX 651009 CHARLOTTE NC 282651009 CAFETERIA, CENTRAL TRANSPORT 6479458 SIEMENS MEDICAL SOLUTIONS PO BOX 120001 DALLAS TX 753120733 SOARIAN DESIGN, IT WORK 6293307 327 1883622 779313 2662935 PATIENT SERVICE 900099 562329756 562329756 MEDICAID DISPROPORTIONATE SHARE 900099 2412 2412 562332168 1094186 1094186 248259 248259 2817149 3688889 -871740 -871740 -871740 642143 174500 467643 467643 467643 GRADUATE MEDICAL 900099 4467092 4467092 CAFETERIA/VENDING 900099 2745302 2745302 PARKING 900099 1085103 1085103 2667745 2587496 80249 10965242 576898693 569386756 0 4849002 X 4095258 3685732 409526 200322641 180290377 20032264 27373984 24636586 2737398 13944397 12549957 1394440 420096 378086 42010 276576 248918 27658 48222624 43400362 4822262 8498589 7648730 849859 3043922 2739530 304392 3764830 3388347 376483 41034983 36931485 4103498 7551576 6796418 755158 MEDICAL SUPPLIES 38779658 34901692 3877966 DRUGS 29854274 26868847 2985427 PROVIDER TAX 29485344 26536810 2948534 BAD DEBT EXPENSE 16522069 14869862 1652207 69522641 62570384 6952257 542713462 488442123 54271339 0 15680465 68874018 36736664 16909131 37278069 40839232 7524546 11512787 10879861 10756549 1025240671 425217518 497310657 600023153 63386914 25523646 668797176 774438516 43921857 48967664 7238 304903715 292851574 66361937 75884387 415187509 417710863 X 253609667 356727653 253609667 356727653 668797176 774438516 X 34185231 68932755 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 267916 267916 546134435 546402351 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 293157 230070 249541 267916 1040684 250000 250000 250000 250000 1000000 1500000 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE HOSPITAL BELONGS TO CERTAIN ORGANIZATIONS THAT ENGAGE IN LOBBYING ACTIVITIES ON BEHALF OF THEIR HOSPITAL MEMBERS. SINCE THIS IS A NONALLOWABLE EXPENSE, THESE ORGANIZATIONS INFORM THEIR MEMBERS THE PORTION OF THEIR DUES THAT SHOULD BE CONSIDERED APPLICABLE TO LOBBYING EXPENSES SO THAT THE APPROPRIATE ADJUSTMENT CAN BE MADE. IN AN EFFORT TO DETERMINE WHICH DUES INCLUDE LOBBYING EXPENSES, WE REVIEWED THE INVOICES FOR ALL DUES PAYMENTS IN EXCESS OF $10,000 AND SCHEDULED ALL OTHER PAYMENTS WE WERE MADE AWARE OF THROUGH VARIOUS INQUIRY. 4800118 4800118 669854753 212095483 457759270 7390857 4343394 3047463 324507308 208778641 115728667 18687635 18687635 600023153 SALARIES PAYABLE 25477754 ACCRUED INTEREST PAYABLE 995638 PROFESSIONAL LIABILITY ACCRUAL 3574278 TEBA LIABILITY 17829445 DUE TO AFFILIATE 28007272 75884387 X DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE COMPANY IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3). THE COMPANY ADHERES TO THE PROVISIONS OF THE ACCOUNTING STANDARDS CODIFICATION RELATING TO UNCERTAINTY IN INCOME TAXES THAT REQUIRES ENTITIES TO ASSESS THEIR UNCERTAIN TAX POSITIONS FOR THE LIKELIHOOD THAT THEY WOULD BE OVERTURNED UPON INTERNAL REVENUE SERVICE (IRS) EXAMINATION OR UPON EXAMINATION BY STATE TAXING AUTHORITIES. THE COMPANY HAS DETERMINED THAT IT DOES NOT HAVE ANY POSITIONS AT DECEMBER 31, 2012, THAT IT WOULD BE UNABLE TO SUBSTANTIATE. THE COMPANY HAS FILED ITS TAX RETURNS THROUGH DECEMBER 31, 2011. THE TAX RETURNS FOR THE YEARS ENDED DECEMBER 31, 2009, AND THEREAFTER ARE SUBJECT TO AUDIT BY THE TAXING AUTHORITIES. 1 1 1 X 250.000000000000 1 X 1 0 0 864194 864194 0.00160 280640956 267654665 12986291 0.02470 17753808 19085596 -1331788 0.00000 299258958 286740261 12518697 0.02630 5976724 667138 5309586 0.01010 12490787 1670370 10820417 0.02060 3872935 2450816 1422119 0.00270 772479 0 772479 0.00150 469 0 469 0.00000 23113394 4788324 18325070 0.03490 322372352 291528585 30843767 0.06120 0 6271777 4617559 1824678 2478639 -653961 X 1 0 1 1 CHILDREN'S HOSPITAL OF ALABAMA

1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233

X X X X X X THE CHILDREN'S HOSPITAL OF ALABAMA 1 0 1 1 250.000000000000 1 400.000000000000 1 X X X X X 1 1 X X X 1 X 1 X X X X 1 X 0 0 PART I, LINE 7: THE COSTING METHODOLOGY USED TO COMPLETE LINE 7 WAS AN OVERALL COST-TO-CHARGE RATIO COMPUTED USING THE IRS FORM 990 WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 16522069. PART II: WHILE THE HOSPITAL DID NOT HAVE SYSTEMS IN PLACE TO FORMALLY TRACK COMMUNITY BUILDING ACTIVITIES FOR 2012, HOSPITAL EXECUTIVES AND VICE PRESIDENTS SERVED ON A VARIETY OF COMMUNITY BOARDS INCLUDING MAGIC MOMENTS AND RONALD MCDONALD HOUSE. IN ADDITION, APPROXIMATELY 50 ADMINISTRATIVE INTERNS AND AIDES WERE EDUCATED BY HOSPITAL EMPLOYEES DURING THE YEAR. PART III, LINE 4: RECEIVABLES FROM PATIENTS, INSURANCE COMPANIES AND THIRD-PARTY CONTRACTUAL AGENCIES ARE STATED AT NET REALIZABLE VALUE. THE HOSPITAL EVALUATES THE COLLECTABILITY OF ITS PATIENT ACCOUNTS RECEIVABLE BASED ON THE LENGTH OF TIME THE RECEIVABLE IS OUTSTANDING, HISTORICAL COLLECTION EXPERIENCE, REVIEW OF LARGE BALANCE ACCOUNTS AND TRENDS IN HEALTH CARE INSURANCE PROGRAMS TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WITH THIRD-PARTY INSURERS, THE HOSPITAL ESTIMATES CONTRACTUAL ALLOWANCES BASED ON THE TERMS OF THIRD-PARTY INSURED CONTRACTS AND ESTIMATES AN ADDITIONAL ALLOWANCE FOR DOUBTFUL ACCOUNTS ON PATIENT RESPONSIBLE BALANCES AFTER THIRD-PARTY PAYMENTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THESE ALLOWANCES ARE RECORDED ON AN ESTIMATED BASIS AND ADJUSTED AS NEEDED IN FUTURE PERIODS. DOUBTFUL ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE AFTER ADEQUATE COLLECTION EFFORT IS EXHAUSTED AND RECORDED AS RECOVERIES OF BAD DEBTS IF SUBSEQUENTLY COLLECTED. PART III, LINE 2: THE COST OF BAD DEBT WRITE-OFFS AND THE RELATED COSTS ON LINE 3 WERE CALCULATED BY APPLYING THE OVERALL COST TO CHARGE RATIO OF THE ORGANIZATION TO THE CHARGES WRITTEN OFF. PART III, LINE 3: BAD DEBTS ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE WERE CALCULATED BASED ON THE OUTSTANDING PATIENT BALANCE IN EXCESS OF A REASONABLE AMOUNT THE AVERAGE PERSON COULD PAY WITHOUT CREATING A MEDICAL HARDSHIP. FOR 2012 THIS AMOUNT IS $20,000, WHICH APPROXIMATES THE INCOME LIMIT FOR A FAMILY OF 4 IN THE FEDERAL POVERTY GUIDELINES. CHARITY CARE DETERMINATIONS ARE BASED ON COMPLETING THE REQUIRED APPLICATION AND MEETING DEFINED CRITERIA OF THE HOSPITAL. MANY TIMES PATIENTS FAIL TO COMPLETE PAPERWORK REQUIRED DESPITE EFFORTS TO EDUCATE AND INFORM PATIENTS OF THIS OPTION. HOWEVER BASED ON SOCIO-ECONOMIC AND OTHER KNOWN FACTORS, IT IS HIGHLY LIKELY THAT THESE PATIENTS WOULD MEET ESTABLISHED CHARITY CARE CRITERIA IF THE APPLICATION PROCESS WAS COMPLETED. THE CHILDREN'S HOSPITAL OF ALABAMA PART V, SECTION B, LINE 14G: THE DETAIL FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON THE HOSPITAL'S WEBSITE AS WELL AS UPON REQUEST. SIGNAGE REFERENCING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE EMERGENCY DEPARTMENT, WAITING AND ADMITTING AREAS. IN ADDITION, THERE IS LANGUAGE INCLUDED ON ALL BILLING INVOICES INFORMING THE GUARANTOR OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. THE CHILDREN'S HOSPITAL OF ALABAMA PART V, SECTION B, LINE 18E: SIGNAGE IS POSTED IN THE EMERGENCY DEPARTMENT, WAITING AND ADMITTING AREAS NOTIFYING PATIENTS AND GUARANTORS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. PART VI, LINE 2: THE HOSPITAL ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES BY EVALUATING DISEASE AND INJURY DATA OF PATIENTS THAT ARE SERVED IN THE HOSPITAL'S CLINICS AND THAT PRESENT IN THE EMERGENCY DEPARTMENT, PARTICULARLY AROUND INJURY CARE. IN ADDITION, THE HOSPITAL CONSIDERS INFORMATION PROVIDED BY LOCAL PEDIATRICIANS, THE CENTER FOR DISEASE CONTROL, AND OTHER NATIONAL, STATE, AND LOCAL HEALTHCARE GROUPS. PART VI, LINE 3: EACH PATIENT THAT PRESENTS AS A SELF PAY PATIENT IS DIRECTED TO A FINANCIAL COUNSELOR. THE FINANCIAL COUNSELOR EDUCATES PATIENTS AND THEIR FAMILIES ABOUT GOVERNMENT AND FINANCIAL ASSISTANCE PROGRAMS AND ASSISTS WITH RELATED APPLICATIONS. IF A PATIENT IS NOT COUNSELED BY A FINANCIAL COUNSELOR ON THE DATE OF SERVICE, FOLLOW UP ATTEMPTS ARE MADE BY THE FINANCIAL COUNSELORS AND THE BUSINESS OFFICE TO CONTINUE TO INFORM AND EDUCATE PATIENTS RELATED TO AVAILABLE PROGRAMS. IN ADDITION, THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE AND THERE IS SIGNAGE THROUGHOUT THE HOSPITAL INFORMING PATIENTS OF THE AVAILABILITY OF A FINANCIAL ASSISTANCE PROGRAM. PART VI, LINE 4: THE HOSPITAL'S PRIMARY SERVICE AREA IS BIRMINGHAM-HOOVER METROPOLITAN STATISTICAL AREA AS DEFINED BY THE U.S. OFFICE OF MANAGEMENT AND BUDGET. THE HOSPITAL'S SECONDARY SERVICE AREA IS DEFINED AS THE REST OF THE STATE, AND WE CARE FOR PATIENTS FROM EVERY COUNTY IN THE STATE. DEMOGRAPHIC DATA INCLUDING RACE, GENDER, AND AGE IS CAPTURED THROUGH THE REGISTRATION PROCESS. FOR 2012, CAUCASIANS, AFRICAN-AMERICANS, HISPANICS, AND OTHER RACES ACCOUNTED FOR 58%, 36%, 2%, AND 4%, RESPECTIVELY, OF THE PATIENTS SERVED WHILE 40%, 37%, AND 23% WERE AGES 0-4, 5-12, AND 13+ YEARS, RESPECTIVELY. ECONOMIC DEMOGRAPHIC DATA IS NOT SPECIFICALLY CAPTURED HOWEVER, IN 2012 GREATER THAN 60% OF THE HOSPITAL'S PATIENTS QUALIFIED FOR GOVERNMENTAL MEANS-TESTED PROGRAMS SUCH AS MEDICAID AND SCHIP. PART VI, LINE 5: THE HOSPITAL IS THE PRIMARY SOURCE OF PEDIATRIC HEALTHCARE AND PEDIATRIC HEALTH EDUCATION IN THE STATE OF ALABAMA THROUGH ITS AFFILIATION WITH THE SCHOOL OF MEDICINE AT THE UNIVERSITY OF ALABAMA AT BIRMINGHAM. THE HOSPITAL OPERATES AN OPEN MEDICAL STAFF, HAS A BOARD COMPRISED OF COMMUNITY MEMBERS, AND OPERATES AN OPEN EMERGENCY DEPARTMENT THAT TREATS ALL EMERGENT PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL OPERATES THE ONLY LEVEL 1 PEDIATRIC TRAUMA CENTER, THE ONLY PEDIATRIC RENAL CARE CENTER, AND THE ONLY INPATIENT CHILDREN'S PSYCHIATRIC UNIT IN THE STATE. IN ADDITION, THE HOSPITAL OPERATES THE LARGEST PEDIATRIC BURN CENTER IN THE SOUTHEAST. THE HOSPITAL IS EDUCATION AND RESEARCH FOCUSED AND COLLABORATES WITH LOCAL UNIVERSITIES, AS WELL AS THOSE THROUGHOUT THE STATE, TO TRAIN AND EDUCATE FUTURE HEALTHCARE PROFESSIONALS. THIS IS REFLECTED BY THE FACT THAT APPROXIMATELY 50-60% OF THE PEDIATRICIANS PRACTICING IN THE STATE OF ALABAMA TRAINED AT THE HOSPITAL AND THAT THE HOSPITAL TRAINED NURSING STUDENTS FROM 9 DIFFERENT COLLEGES AND UNIVERSITIES DURING 2012. IN ADDITION, THE HOSPITAL PARTICIPATES IN APPROXIMATELY 225 CLINICAL RESEARCH STUDIES ON AN ANNUAL BASIS. X X X X 0 1 0 0 0 0 0 0 0 WILLIAM MICHAEL WARREN JR 556158 0 0 0 1236 0 177076 0 15488 0 749958 0 0 0 THOMAS G SHUFFLEBARGER 346891 0 161000 0 213690 0 95304 0 23152 0 840037 0 212408 0 JAMES MICHAEL BURGESS 328083 0 152000 0 93718 0 86037 0 24279 0 684117 0 92418 0 MIKE MCDEVITT 321404 0 150000 0 1287 0 88005 0 20133 0 580829 0 0 0 DOUGLAS DEAN 236891 0 98000 0 179154 0 55268 0 24563 0 593876 0 179154 0 JAMES PETER VANPELT 186805 0 48000 0 216407 0 39833 0 21511 0 512556 0 215102 0 LORI DENICE MOLER 165978 0 42000 0 233159 0 35828 0 17312 0 494277 0 231852 0 COKE MATTHEWS 226683 0 90000 0 46713 0 58547 0 12544 0 434487 0 45430 0 AUDIE WOOLLEY 517356 0 408946 0 154222 0 78750 0 39879 0 1199153 0 152972 0 JIMMY SCOTT HILL 512320 0 408946 0 430917 0 78750 0 99878 0 1530811 0 429685 0 BRIAN WIATRAK 517758 0 408946 0 66456 0 78750 0 99878 0 1171788 0 65223 0 WILLIAM PEYTON SHIRLEY 335949 0 144927 0 1236 0 0 0 21129 0 503241 0 0 0 JOHN D SIMPSON 302289 0 121278 0 1307 0 0 0 21129 0 446003 0 0 0 PART I, LINE 4B PART I, LINE 4B: WILLIAM MICHAEL WARREN, JR. - $177,076 THOMAS G. SHUFFLEBARGER - $95,304 JAMES MICHAEL BURGESS - $86,037 JAMES PETER VANPELT - $39,833 DOUGLAS B. DEAN - $55,268 LORI DENICE MOLER - $35,828 MIKE MCDEVITT - $88,005 AUDIE WOOLLEY - $78,750 JIMMY SCOTT HILL - $78,750 BRIAN WIATRACK - $78,750 COKE MATTHEWS - $58,547 A SPECIAL CARE FACILITIES FINANCING AUTH OF THE CTY OF BHAM - CHILDREN'S HOSP 631005621 090929FV7 2009-09-01 233179363 CONSTRUCT AND EQUIP FACILITY 0 0 0 B SPECIAL CARE FACILITIES FINANCING AUTH OF THE CTY OF BHAM - CHILDREN'S HOSP 631005621 090929FZ8 2012-02-24 26250000 FINANCE EXPANSION FACILITY 0 0 0 C SPECIAL CARE FACILITIES FINANCING AUTH OF THE CTY OF BHAM - CHILDREN'S HOSP 631005621 2012-06-28 74600000 FINANCE EXPANSION FACILITY 0 0 0 A 75265000 233179363 15973687 25538118 3480828 4329725 176300761 726331 0 0 1 1 B 26250000 26250000 0 0 1 1 C 74600000 74600000 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 0 0 BUFFALO ROCK ENTITY MORE THAN 35% OWNED BY JAMES C. LEE, III, DIRECTOR 151496 VENDING 0 ALABAMA POWER CHARLES D. MCCRARY & DONALD JAMES ARE DIRECTORS OF THE ABOVE ENTITY 4507609 ELECTRICITY PROVIDER 0 ALABAMA GAS CORPORATION ROBERT MCANNALLY IS EMPLOYED BY THE ABOVE ENTITY 1358009 GAS UTILITY 0 REGIONS BANK CHARLES D. MCCRARY & LEE STYSLINGER ARE DIRECTORS OF THE ABOVE ENTITY 175574 BANKING SERVICES 0 REGIONS BANK O.B. GRAYSON HALL, JR. IS THE CEO OF THE ABOVE ENTITY 175574 BANKING SERVICES 0 FORM 990, PART VI, SECTION A, LINE 2 THOMAS N. CARRUTHERS, JR. IS A PARTNER IN A FIRM WHICH ACTS AS GENERAL COUNSEL FOR THE HOSPITAL AS WELL AS COUNSEL TO THE OBLIGATED GROUP AND BOND COUNSEL. DERROL DAWKINS, M.D. HAS ADMITTING PRIVILEGES TO THE HOSPITAL. GILLIAN W. GOODRICH'S DAUGHTER IS A MEMBER OF THE UAB MEDICAL STAFF AND PROVIDES SERVICES AT THE HOSPITAL. IN ADDITION, MS. GOODRICH'S SPOUSE WAS AN OWNER OF A CONSTRUCTION COMPANY THAT WAS A PARTNER IN THE LEAD CONTRACTOR PARTNERSHIP ON A MAJOR EXPANSION PROJECT AT THE TIME THE PROJECT WAS BID. O.B. GRAYSON HALL, JR. IS THE CEO OF A BANK THAT PROVIDES THE MAJORITY OF THE BANKING SERVICES TO THE HOSPITAL. RAYMOND J. HARBERT OWNS AN INVESTMENT COMPANY THAT MANAGES A HEDGE FUND IN WHICH THE HOSPITAL HAS INVESTED THROUGH A FUND OF FUNDS. DONALD M. JAMES IS A DIRECTOR OF A BANK WHICH WAS AN UNDERWRITER FOR THE HOSPITAL BONDS. MR. JAMES IS ALSO A DIRECTOR FOR THE PARENT COMPANY OF AN ELECTRIC UTILITY THAT PROVIDES UTILITY SERVICES TO THE HOSPITAL. IN ADDITION, MR. JAMES IS A TRUSTEE FOR UAB HEALTH SYSTEM AND UAB HEALTH SERVICES FOUNDATION BOTH OF WHICH HAVE AN AFFILIATION AGREEMENT TO PROVIDE MEDICAL SERVICES TO THE HOSPITAL. VIRGINA WALKER JONES IS EMPLOYED BY A COMPANY THAT PROVIDES CERTAIN VENDING SERVICES TO THE HOSPITAL. IN ADDITION, MARGARET M. PORTER AND THE SPOUSE OF MS. JONES ARE MEMBERS OF AN ADVISORY BOARD FOR A BANK THAT WAS AN UNDERWRITER AND THAT CURRENTLY PROVIDES THE MAJORITY OF THE BANKING SERVICES TO THE HOSPITAL. MARGARET M. PORTER'S SPOUSE HOLDS A MINORITY OWNERSHIP IN A REAL ESTATE CONSULTING FIRM THAT PROVIDES SERVICES TO THE HOSPITAL. JAMES C. LEE, III IS THE OWNER OF A COMPANY THAT PROVIDES VENDING SERVICES TO THE HOSPITAL. THOMAS H. LOWDER SERVES ON THE BOARD OF TWO ORGANIZATIONS THAT MAKE CONTRIBUTIONS TO THE FOUNDATION. ROBERT S. MCANNALLY IS EMPLOYED BY THE PARENT COMPANY OF A GAS UTILITY THAT PROVIDES UTILITY SERVICES TO THE HOSPITAL. L. GWALTNEY MCCOLLUM, JR. IS EMPLOYED BY AN ORGANIZATION THAT SERVED AS CUSTODIAN TO THE INVESTMENT PORTFOLIO FOR THE HOSPITAL AND FOUNDATION THROUGH JUNE 2012. CHARLES D. MCCRARY IS THE CEO OF AN ELECTRIC UTILITY WHICH PROVIDES UTILITY SERVICES TO THE HOSPITAL AS WELL AS SERVES AS A BOARD MEMBER FOR A BANK THAT WAS AN UNDERWRITER AND THAT CURRENTLY PROVIDES THE MAJORITY OF THE BANKING SERVICES TO THE HOSPITAL. W. JERRY OAKES, M.D. OCCUPIED THE DAN HENDLEY ENDOWED CHAIR, WHICH IS FUNDED BY THE FOUNDATION, DURING 2012. STUART A. ROYAL, M.D. IS EMPLOYED BY AN ORGANIZATION THAT PROVIDES SERVICES TO THE HOSPITAL AND SERVES ON AN ADVISORY COMMITTEE FOR A COMPANY THAT PROVIDES SOFTWARE SYSTEMS AND RELATED CONSULTING TO THE HOSPITAL. IN ADDITION, THE FOUNDATION FUNDS THE HARRY BURNS ENDOWED CHAIR WHICH WAS OCCUPIED BY DR. ROYAL DURING 2012. BEN RUSSELL IS THE FOUNDER AND CHAIRMAN OF THE BOARD OF A NON-PROFIT ORGANIZATION THAT LEASES SPACE FROM THE HOSPITAL TO PROVIDE FAMILY SERVICE ACTIVITIES TO PATIENTS AND THEIR FAMILIES. SERGIO B. STAGNO, M.D. IS THE CHAIRMAN OF THE UAB DEPARTMENT OF PEDIATRICS WHICH HAS AN AFFILIATION AGREEMENT WITH THE HOSPITAL TO PROVIDE CERTAIN MEDICAL SERVICES. LEE J. STYSLINGER, III SERVES AS A BOARD MEMBER FOR A BANK THAT IS AN UNDERWRITER AND THAT CURRENTLY PROVIDES THE MAJORITY OF THE BANKING SERVICES TO THE HOSPITAL. MARC TYSON IS THE CEO OF A COMPANY, WHICH PROVIDED CONCRETE FOR THE EXPANSION FACILITY. THE HOSPITAL BELIEVES THAT ALL BUSINESS WITH SUCH FIRMS AND BUSINESSES IS CONDUCTED ON TERMS AND CONDITIONS NO LESS FAVORABLE TO THE HOSPITAL THAN THAT WITH UNRELATED THIRD PARTIES. FORM 990, PART VI, SECTION B, LINE 11 THE COMPLETED FORM 990 IS REVIEWED IN DETAIL BY THE FINANCE AND AUDIT COMMITTEE, AS WELL AS THE BOARD OF TRUSTEES, PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. ANNUAL DISCLOSURE REQUESTS ARE SENT AND FOLLOWED UP ON TO ENSURE THAT ALL ARE RETURNED. RETURNED CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AND COMPLIANCE DEPARTMENT STAFF AS WELL AS OFFICERS OF THE HOSPITAL FOR ACCURACY AND COMPLETENESS. CONFLICT OF INTEREST STATEMENTS ARE MAINTAINED BY THE COMPLIANCE DEPARTMENT. THE COMPLIANCE OFFICER REPORTS ACTIVITY RELATED TO ANY POTENTIAL CONFLICTS OF INTEREST, INCLUDING CHANGES IN PREVIOUSLY REPORTED CONFLICTS TO ADMINISTRATION, THE COMPLIANCE COMMITTEE, THE FINANCE & AUDIT COMMITTEE, AND THE BOARD OF TRUSTEES ON A REGULAR BASIS. FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL MAINTAINS OVERSIGHT CONCERNING ALL EXECUTIVE COMPENSATION ACTION. THIS PROCESS IS LED BY THE HOSPITAL BOARD OF TRUSTEES COMPENSATION COMMITTEE, WHICH IS INVOLVED ANNUALLY, AND THROUGHOUT THE YEAR AS NEEDED, IN PROVIDING OVERSIGHT OF ALL EXECUTIVE COMPENSATION. TOTAL COMPENSATION (I.E. BASE SALARY, INCENTIVE COMPENSATION, AND EXECUTIVE BENEFITS) OF OFFICERS, KEY EMPLOYEES, AND OTHER VICE-PRESIDENTS IS APPROVED BY THE COMPENSATION COMMITTEE PRIOR TO SUCH COMPENSATION BEING PAID. THE TOTAL COMPENSATION THAT IS PRESENTED FOR APPROVAL IS DETERMINED BY EVALUATION OF MARKET DATA COMPARISONS ON EXECUTIVE TOTAL COMPENSATION. THIS INDEPENDENT, OBJECTIVE MARKET DATA IS PROVIDED BY THE HOSPITAL'S INDEPENDENT EXECUTIVE COMPENSATION CONSULTING FIRM, MERCER. ALL COMPENSATION COMMITTEE PROCEEDINGS, DECISIONS, AND ACTIONS ARE DOCUMENTED IN COMMITTEE MINUTES THAT ARE MAINTAINED BY THE HOSPITAL. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY IS SUMMARIZED IN THE CORPORATE CODE OF CONDUCT WHICH IS AVAILABLE ON THE HOSPITAL'S WEBSITE. THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT GENERALLY AVAILABLE TO THE PUBLIC. ALL OTHER FUNCTIONAL EXPENSES FORM 990, PART IX, LINE 24E LAB EXPENSE : PROGRAM SERVICE EXPENSES 9,101,556. MANAGEMENT AND GENERAL EXPENSES 1,011,284. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,112,840. MANAGEMENT CONTRACTS : PROGRAM SERVICE EXPENSES 8,768,327. MANAGEMENT AND GENERAL EXPENSES 974,259. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,742,586. MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 8,154,951. MANAGEMENT AND GENERAL EXPENSES 906,096. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,061,047. EQUIPMENT RENTAL AND MAINTENANCE: PROGRAM SERVICE EXPENSES 6,073,439. MANAGEMENT AND GENERAL EXPENSES 674,827. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,748,266. CONSULTING FEES: PROGRAM SERVICE EXPENSES 5,147,992. MANAGEMENT AND GENERAL EXPENSES 571,999. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,719,991. EQUIPMENT RELATED SUPPLIES: PROGRAM SERVICE EXPENSES 4,087,563. MANAGEMENT AND GENERAL EXPENSES 454,174. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,541,737. MAINTENANCE: PROGRAM SERVICE EXPENSES 3,572,690. MANAGEMENT AND GENERAL EXPENSES 396,966. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,969,656. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 3,350,624. MANAGEMENT AND GENERAL EXPENSES 372,292. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,722,916. TRANSPORTATION: PROGRAM SERVICE EXPENSES 2,847,652. MANAGEMENT AND GENERAL EXPENSES 316,406. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,164,058. MINOR MEDICAL EQUIPMENT: PROGRAM SERVICE EXPENSES 2,807,165. MANAGEMENT AND GENERAL EXPENSES 311,907. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,119,072. SUPPLIES: PROGRAM SERVICE EXPENSES 2,274,083. MANAGEMENT AND GENERAL EXPENSES 252,676. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,526,759. TELEPHONE: PROGRAM SERVICE EXPENSES 1,600,180. MANAGEMENT AND GENERAL EXPENSES 177,798. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,777,978. PROFESSIONAL DUES: PROGRAM SERVICE EXPENSES 1,336,962. MANAGEMENT AND GENERAL EXPENSES 148,551. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,485,513. SUBSCRIPTIONS AND PUBLICATIONS: PROGRAM SERVICE EXPENSES 552,018. MANAGEMENT AND GENERAL EXPENSES 61,335. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 613,353. BANKING FEES: PROGRAM SERVICE EXPENSES 489,620. MANAGEMENT AND GENERAL EXPENSES 54,402. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 544,022. PRINTING AND PUBLICATIONS: PROGRAM SERVICE EXPENSES 394,568. MANAGEMENT AND GENERAL EXPENSES 43,841. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 438,409. POSTAGE AND SHIPPING: PROGRAM SERVICE EXPENSES 348,089. MANAGEMENT AND GENERAL EXPENSES 38,677. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 386,766. COLLECTION FEES: PROGRAM SERVICE EXPENSES 344,407. MANAGEMENT AND GENERAL EXPENSES 38,267. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 382,674. REGISTRATION FEES: PROGRAM SERVICE EXPENSES 343,324. MANAGEMENT AND GENERAL EXPENSES 38,147. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 381,471. NOVELTIES: PROGRAM SERVICE EXPENSES 309,058. MANAGEMENT AND GENERAL EXPENSES 34,340. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 343,398. LODGING: PROGRAM SERVICE EXPENSES 254,414. MANAGEMENT AND GENERAL EXPENSES 28,268. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 282,682. MEALS: PROGRAM SERVICE EXPENSES 211,092. MANAGEMENT AND GENERAL EXPENSES 23,455. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 234,547. SPECIAL FUNCTIONS: PROGRAM SERVICE EXPENSES 166,400. MANAGEMENT AND GENERAL EXPENSES 18,489. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 184,889. RECOGNITIONS: PROGRAM SERVICE EXPENSES 34,210. MANAGEMENT AND GENERAL EXPENSES 3,801. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,011. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: TRANSFER FROM ALABAMA CHILDREN'S HOSPITAL FOUNDATION 68,932,755. FORM 990, PART XI, LINE 2C: THE HOSPITAL MADE NO CHANGES TO ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. ALABAMA CHILDREN'S HOSPITAL FOUNDATION 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 630879471 FUNDRAISING ACTIVITIES AL 501(C)(3) SUPPORTING ORG I THE CHILDREN'S HOSPITAL OF ALABAMA 1 THE CHILDREN'S HOSPITAL AUXILIARY 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 630774930 FUNDRAISING ACTIVITIES AL 501(C)(3) SUPPORTING ORG III N/A 0 TCH VENTURES 1600 7TH AVENUE SOUTH BIRMINGHAM AL 35233 630942442 HOLDING COMPANY AL THE CHILDREN'S HOSPITAL OF ALABAMA C 1 1.00000 1 HOLY INNOCENTS INDEMNITY LTD PO BOX 10073 APO GRAND CAYMAN GRAND CAYMAN CJ 980436612 INSURANCE CJ THE CHILDREN'S HOSPITAL OF ALABAMA C 4223329 25792048 1.00000 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 ALABAMA CHILDREN'S HOSPITAL FOUNDATION B 3721000 FAIR MARKET VALUE ALABAMA CHILDREN'S HOSPITAL FOUNDATION E 17747821 FAIR MARKET VALUE HOLY INNOCENTS INDEMNITY LLC E -427648 FAIR MARKET VALUE HOLY INNOCENTS INDEMNITY LLC R 3284313 FAIR MARKET VALUE ALABAMA CHILDREN'S HOSPITAL FOUNDATION C 72653755 FAIR MARKET VALUE TCH VENTURES D -276444 FAIR MARKET VALUE