2013-11-14T10:01:39-06:00 2012-12-31 861065772 Deloitte Tax LLP 50 South Sixth Street STE 2800 Minneapolis MN 55402 990 2012-01-01 411200302 Gillette Children's Hospital Foundation GILL 6512912848 200 University Avenue East St Paul MN 55101 James Haddican 6512912848 2013-10-29 1 Kristina Rasmussen P00143920 6123974000 2012 2016-02-24 21:20:13Z James Haddican 200 University Avenue East St Paul MN 55101 16101652 0 X www.gillettechildrens.org X 1985 MN The Foundation raises money for and otherwise supports Gillette Children's Specialty Healthcare. 25 21 0 103 0 0 7925252 6577377 0 0 803004 1014302 -17235 -247813 8711021 7343866 6222699 1497294 0 0 2055205 2072455 107540 335034 2357751 1695321 1256847 10080765 5161630 -1369744 2182236 13425785 15469199 1405834 696684 12019951 14772515 X The mission of Gillette Children's Hospital Foundation (Foundation) is to raise money, build awareness, and develop relationships so the mission of Gillette Children's Specialty Healthcare (Gillette) can be fulfilled. 0 0 1067235 1067235 Patient care:The Foundation raises money to support Gillette's patient-care needs. This fundraising area in 2012 involved charitable support for Gillette's outpatient clinics. In 2012, Gillette had 137,626 outpatient visits-excluding casting, X-ray, advanced imaging, and neurodiagnostic services-from children and adults with many chronic and acquired conditions, including cerebral palsy, spinal cord injuries, spina bifida, brain injuries, complex orthopedic needs, neurological disorders, craniofacial anomalies and juvenile arthritis. Outpatient appointments for all services came to 147,984. See Statement O.In addition, Gillette offers financial assistance to patients who need it-whether or not they have health insurance. Gillette evaluates each situation based on a patient's income, assets and other resources, and the hospital helps patients set up manageable payment plans (including co-pays and co-insurance). For people who don't have insurance, Gillette charges for care in accordance with the 501(r) guidelines. No one who needs medically necessary care at Gillette has ever been turned away because of their inability to pay. In 2012, Gillette also increased the number of Mobile Outreach Clinic visits it conducts in 16 communities in greater Minnesota. The Mobile Outreach Clinic offers assistive technology and some specialty medical services from nurse practitioners, seating and adaptive equipment specialists, and rehabilitation engineering technologists. The outreach services provide patients with more convenient and timely health care appointments, helping them achieve more active, daily participation in the community. They also enhance the knowledge base of community providers and improve the quality of ongoing care available in greater Minnesota. 372904 372904 Capital:The Foundation raises money to support Gillette in providing specialty health care for people who have disabilities. In 2012, the Foundation's largest capital fundraising expenditures involved supporting renovation of Gillette's facilities in St. Paul, including creating additional private inpatient rooms and adding a new playroom in the surgery waiting area. 57155 57155 Research & Education:The Foundation also raises money to support Gillette's ongoing research projects and education programs.During 2012, Gillette researchers focused on studies related to neurosciences and motion analysis. For example, one looked at using a scale to prove reliable, reproducible quantitative assessments of lower-extremity spasticity in children, ages 4 to 17, who have cerebral palsy. See Schedule OOne of the primary Foundation grants in the area of education involved funding an academically affiliated spasticity management fellowship. The fellowship helps prepare physicians who are highly qualified in spasticity management to incorporate spasticity management therapies (including, but not limited to, intrathecal baclofen therapy) into their clinical practices. 1497294 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 X 25 21 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 1 1 0 MN WI X Scott Ryberg 6512912848 200 University Avenue East St Paul MN 55101 Scott Ward 1.00 1.00 X X 0 0 0 Dale Schoonover 1.00 1.00 X X 0 0 0 James Hynes 1.00 1.00 X X 0 0 0 Robert Folkes 1.00 1.00 X X 0 0 0 Margaret E Perryman 15.00 40.00 X X 0 2252312 222973 Chuck Amos 1.00 1.00 X 0 0 0 Fay DeBellis 1.00 1.00 X 0 0 0 Wendy Dumke 1.00 1.00 X 0 0 0 John Ellenberger 1.00 1.00 X 0 0 0 Jeff Evanson 1.00 1.00 X 0 0 0 Todd Fisher 1.00 1.00 X 0 0 0 John Guider 1.00 1.00 X 0 0 0 Diane Harper 1.00 1.00 X 0 0 0 Braxton Haulcy 1.00 1.00 X 0 0 0 Jerome Kahnke 1.00 1.00 X 0 0 0 Brad Keil 1.00 1.00 X 0 0 0 Mark Kimball 1.00 1.00 X 0 0 0 Angie Lalor 1.00 1.00 X 0 0 0 Dan Monson 1.00 1.00 X 0 0 0 Deborah S Quanbeck MD 1.00 40.00 X 0 513286 60552 Kristin Rassmussen 1.00 1.00 X 0 0 0 Julie Rechtiene 1.00 1.00 X 0 0 0 Scott Robinson 1.00 1.00 X 0 0 0 David Saggau 1.00 1.00 X 0 0 0 Robert Wagner MD 1.00 40.00 X 0 234395 48510 Warren Watson 1.00 1.00 X 0 0 0 Beverly Wical MD 1.00 40.00 X 0 322106 45873 Jon Galloway 40.00 0.00 X 271556 0 41451 James Haddican 5.00 40.00 X 0 368954 65520 Darlis Clausen 40.00 0.00 X 126230 0 16233 Blaine Thrasher 40.00 0.00 X 114802 0 32663 512588 3691053 533775 3 0 1 0 NNE Marketing 754 Massachusetts Avenue Arlington MA 02476 Direct Marketing 195514 Strategic Fundraising 7591 Ninth Street North Oakdale MN 55128 Professional Telemarketing 141020 Russ Reid 14384 Collections Center Drive Chicago IL 60693 Direct Mail 105524 3 864198 5713179 48188 6577377 267768 267768 9081682 8335148 746534 746534 746534 168886 864198 422376 -253490 -253490 5939 262 5677 5677 7343866 0 0 766489 X 1489950 1489950 3344 3344 4000 4000 313007 313007 1759448 402181 1357267 13135 7881 5254 335034 335034 56194 17420 38774 650941 396201 254740 64494 10319 54175 50168 22508 27660 26733 14240 12493 47736 27903 19833 53034 15347 37687 2300 1380 920 Dues & Memberships 225508 47611 177897 Meals 26330 12501 13829 Misc. Expense 12483 6229 6254 Bad Debt 7868 0 7868 19923 11857 8066 5161630 1497294 1306585 2357751 X 79711 201151 1253960 1467327 1148415 1162570 70253 47364 195283 210331 98501 95961 4840 2540 10368688 12042316 304635 335600 13425785 15469199 0 29939 1405834 666745 1405834 696684 X 6971327 8613712 2814759 3924688 2233865 2234115 12019951 14772515 13425785 15469199 2182236 570328 0 X 0 1 X 1 0 X X X 0 0 0 Gillette Children's Specialty Healthcare 363379150 3 1 1 1 1444061 1 1444061 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3365786 79278 480113 446878 112681 3365618 3791838 8432 56433 369299 121618 3365786 3708926 7209 402507 180146 146658 3791838 3346189 67528 445743 48639 101895 3708926 0 4179288 -667021 63695 102383 3346189 0.66000 0.34000 0 0 98501 95961 2540 2540 Gift Annuity Liability - Wisc 68847 Gift Annuity Liability 66773 Due to Medical Center 531125 666745 X 8367123 570328 30553 422376 1023257 7343866 0 7343866 5614559 30553 422376 452929 5161630 0 5161630 Description of Intended Use of Endowment Funds: Part V, Line 4: The Foundation has endowment funds for capital, charity care, patient care, research and education, and unrestricted needs. These funds are used to improve and provide health care and related services to patients of Gillette. Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: As a result of the implementation of the authoritative guidance on the accounting for uncertainty in income taxes, the organization was not required to recognize a liability. There were no unrecognized tax liabilities for the years ended December 31, 2012 and 2011. Part XI, Line 2d - Other Adjustments: Special events expense 422,376. Part XII, Line 2d - Other Adjustments: Special events expense 422,376. X X X X X X 1 Strategic Fundraising 7591 Ninth St No Oakdale MN 55128 Telefundraising 0 134734 141020 -6286 NNE Marketing 754 Massachusetts Avenue Arlington MA 02476 Direct Mail 0 120537 195514 -74977 Russ Reid 14348 Collections Center Drive Chicago IL 60693 Direct Mail 0 79763 105524 -25761 335034 442058 -107024 MN WI Friends of Gillette Event 291194 238394 52800 82266 Laugh out Loud 270120 224840 45280 136333 5 471770 400964 70806 203777 1033084 864198 168886 422376 422376 -253490 Explanation of Fundraising Payments Schedule G, Part I, Line 2b, Column (v) Gillette pays its telemarketing vendor on a per-call basis, meaning every phone call completed is paid for regardless of the outcome of those calls. There are two ways in which Gillette uses telemarketing: 1) to solicit additional donations from current donors and 2) to ask people who have previously never given to Gillette to donate. While the first strategy is extremely effective and the revenues raised exceed the cost, the second strategy requires a high number of phone calls made in order to get a small percentage of people to donate for the first time. Therefore, the second strategy is an investment to add new donors. This is a strategic decision, as those new donors will become valuable in due time, and is less expensive than acquiring new donors through direct mail or other channels. Gillette has retained NNE Marketing, a direct response agency, to help with fundraising efforts. Gillette ended a relationship with Russ Reid in June 2012 and began work with NNE Marketing in July 2012. The strategy within Gillette's direct response program is twofold: 1) to acquire new donors at an acceptable new donor investment level and 2) to increase the number of donors who support the Foundation year over year and create positive giving relationships with those donors. Gillette is measuring and seeing improvement in both of these strategic initiatives. In 2012 the revenue generated by people whose first gift came through the direct response program was $1.54 million. That number is not reflected here because subsequent giving from those people came through fundraising opportunities outside the direct response program. It is, however, an example of how investment in direct response fundraising leads to additional revenue for the Foundation in total. SFI Nonprofit is a telefundraising firm that Gillette retains to execute a telefundraising program. We use telefundraising to gain additional gifts from current donors at a net profit. We also use telefundraising to acquire new donors, an investment we intentionally make in order to increase the number of people donating to Gillette. This is a necessary investment to raise even more money in future years. 1 Gillette Children's Specialty Healthcare 200 Universtity Avenue East St Paul MN 55101 363379150 501(c)(3) 1444061 FMV General Support Technology for Education 4131 Old Sibley Mem Hwy Ste 200 Eagan MN 55122 411814073 10969 FMV Grants for Adaptive Computers for Patients Starkey Hearing Foundation 6700 Washington Avenue South Eden Prairie MN 55344 363297852 501(c)(3) 5500 FMV Hearing 2 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Members of Gillette's hospital board are also members of the Foundation board, resulting in common control of both entities and the sharing of community oversight, strategic planning, financial oversight, and fundraising responsibilities equally among all board members. As a Type II support organization pursuant to IRC section 509(a)(3), Reg. 1.509(a)-4(f)(2)(ii), the Foundation grants monies to Gillette and maintains endowment funds, restricted and unrestricted assets, and contributions received to benefit Gillette. These funds held by the Foundation are granted to Gillette pursuant to the restrictions of the particular fund. Periodically, the Foundation receives financial reports from Gillette documenting the use of monies, including endowment funds, restricted funds, and unrestricted funds, received by Gillette. X X X X X 0 1 0 0 0 0 0 1 0 Margaret E Perryman 0 485857 0 168539 0 1597916 0 196782 0 26191 0 2475285 0 1521245 Deborah S Quanbeck MD 0 447820 0 625 0 64841 0 13225 0 47327 0 573838 0 15641 Robert Wagner MD 0 209987 0 625 0 23783 0 11731 0 36779 0 282905 0 1917 Beverly Wical MD 0 295749 0 625 0 25732 0 11712 0 34161 0 367979 0 9639 Jon Galloway 216512 0 23064 0 31980 0 36044 0 5407 0 313007 0 20661 0 James Haddican 0 241498 0 68968 0 58488 0 34622 0 30898 0 434474 0 20095 Part I, Line 3 The chair of Gillette's personnel committee requests information from the external consultant. The personnel committee is empowered to evaluate the reasonableness of compensation and other financial transactions in which the Foundation is engaged. It does so in all cases by referencing recognized, objective resources on the reasonableness of and market value for the types of personnel and services being considered. That data is prepared for and distributed to the personnel committee members. Compensation policy is approved by the board of directors. Actions related to CEO/president and other executive compensation are discussed and voted upon at personnel committee meetings. Meeting minutes are recorded. Part I, Line 4b Certain employees of Gillette are provided the opportunity to participate in various non-qualifed compensation plans organized under code section 457(f). The exact purpose of each plan varies but they include: compensation limitation make-up plans, supplemental retirement benefits and capital accumulation. All plans are administered by Gillette. The following amounts represent the amount deferred under the non-qualified deferred compensation plans in 2012: Margaret Perryman $183,557 James Haddican $13,214 Jon Galloway $21,406 The following employees received payments from the non-qualified deferred compensation plans in 2012, which have been previously reported as amounts deferred on a prior Form 990: Margaret Perryman $1,521,245 Deborah Quanbeck, MD $15,641 Robert Wagner, MD $1,917 Beverly Wical, MD $9,639 Jon Galloway $20,661 James Haddican $20,095 Part I, Line 7 Certain employees are eligible for an annual one-time award to recognize employees. The amount and payment of the award is made at the discretion of the Personnel Committee of the Board of Directors. X 7 48188 Cost or selling price 0 0 1 1 Method for Determining Number of Contributors: Part I, Column (b): This is the number of contributors. Third Party Use: Part I, Line 32b: The Foundation uses Wells Fargo to manage stock donations. Form 990, Part VI, Section A, line 2 The following individuals have a business relationship: Chuck Amos Fay DeBellis John Ellenberger Wendy Dumke Jeff Evanson Todd Fisher Robert Folkes John Guider Diane Harper Braxton Haulcy James Hynes Jerome Kahnke Brad Keil Mark Kimball Angie Lalor Dan Monson Margaret E. Perryman Deborah S. Quanbeck, MD Kristin Rassmussen Julie Rechtiene Scott Robinson David Saggau Dale Schoonover Robert Wagner, MD Scott Ward Warren Watson Beverly Wical, MD James Haddican Form 990, Part VI, Section A, line 6 The Foundation has a sole member, Gillette Children's Speciality Healthcare, a Minnesota nonprofit corporation. Form 990, Part VI, Section A, line 7a The Foundation has a sole member, Gillette Children's Specialty Healthcare, a Minnesota nonprofit corporation which elects all members of the Foundation board. Form 990, Part VI, Section A, line 7b The decisions of the governing body are subject to the approval of the Foundation's sole member, Gillette Children's Specialty Healthcare. The hospital board reserved powers are the election of board members and the Foundation board; as long as it follows its bylaws, the board has autonomy in other decisions. Form 990, Part VI, Section B, line 11 A copy of the form 990 was provided to every member of the governing body before it was filed. The form was completed by a committee that included representatives from finance, human resources, development and communications. This committee prepared all the documentation necessary; the forms were compiled by Gillette's accounting firm. The draft documents were then reviewed by the vice president of finance, the vice president of strategic planning, and the vice president of development. After all internal reviews were complete, the final version was presented to the finance committee and the board of directors for approval. Form 990, Part VI, Section B, line 12c Gillette enforces policies on external professional activities. Gillette employees, officers, volunteers, board members, and medical staff members are expected to disclose outside activities that involve potential conflicts of interests. In fact, directors must sign a conflict of interest statement acknowledging any potential conflicts related to Gillette. Gillette requires staff members to discuss potential conflicts with their immediate manager and with the compliance officer. The disclosure includes a written description of the activity, the extent of the staff member's participation, and the possible duration of the relationship. If a conflict exists, the employee must not engage in the activity. Form 990, Part VI, Section B, line 15 Foundation staff members are employed by Gillette. Gillette is the organization that actually pays the compensation and has the process for determining compensation as stated below. At the request of the personnel committee of the Gillette board, an independent consultant provides the committee with survey data along with its needs and expenses for patient care, under- and uncompensated care, and recommendations for chief executive officer (CEO)/president and other executive salary ranges. The ranges are developed by the external consultant based on Gillette's compensation philosophy, which was developed by the personnel committee and is reviewed regularly. The members of this committee determine the CEO/president's salary and the salary ranges for other executives. The committee oversees the executive incentive plan, approves any incentive plan payouts, and regularly evaluates the benefits provided to executives. The external consultant has provided an opinion that the CEO/president's total compensation is well within the standards of reasonableness and fair market value. In addition to the oversight function of executive total compensation, the personnel committee oversees any payments under any incentive compensation plans and evaluates all transactions with "disqualified persons". Form 990, Part VI, Section C, line 19 Gillette mails its annual report (which includes the audited financial statements) to Gillette employees, medical staff and board members; Gillette donors; selected state and city legislators; Minnesota pediatricians; media representatives; the Minnesota Hospital Association (MHA); and presidents and chief executive officers of members of the Children's Hospital Association and related institutions. Gillette's 990 form is available from the states of Minnesota and Wisconsin and at Guidestar.org. Gillette discloses financial statements to bondholders, the MHA and the Minnesota attorney general's office. The governing documents and conflict of interest policy are made available to the public upon request. Other Fees Form 990, Part IX, line 11g Outside Services: Program service expenses 0. Management and general expenses 213,609. Fundraising expenses 147,173. Total expenses 360,782. Outside Consultants: Program service expenses 0. Management and general expenses 182,592. Fundraising expenses 107,567. Total expenses 290,159. Form 990, Part VI, Section B, Line 14: Foundation employees are expected to follow all hospital policies. The code-of-conduct, document-retention, and document-destruction policies authorized by the hospital hence are followed by the Foundation staff. Gillette Children's Specialty Healthcare 200 University Avenue East St Paul MN 55101 363379150 Healthcare MN 501(c)(3) Line 3: 170(b)(1)(a) N/A 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1