2012-08-06T15:54:48-05:00 2011-12-31 273605969 CBIZ KIRKLAND RUSS MURPHY & TAPP 13577 FEATHER SOUND DRIVE SUITE 400 CLEARWATER FL 33762 990 2011-01-01 042121377 THE SHRINERS' HOSPITAL FOR CHILDREN SHRI 8132810300 POST OFFICE BOX 31356 TAMPA FL 336313356 DOUGLAS MAXWELL 8132810300 2012-07-23 1 NATHAN SMITH P00543757 7275721400 2011 2016-02-24 21:20:13Z DOUGLAS MAXWELL 2900 ROCKY POINT DRIVE TAMPA FL 33607 602242638 0 X HTTP://WWW.SHRINERSHQ.ORG/ X 1925 MA WE PROVIDE PEDIATRIC SPECIALTY CARE WITHOUT FINANCIAL OBLIGATION TO PATIENTS OR THEIR FAMILIES. 19 19 569 1000 0 0 39827375 42742971 0 3056204 42638994 74899338 1000324 223337 83466693 120921850 0 0 0 0 34806138 35707985 0 0 0 28483283 26050145 63289421 61758130 20177272 59163720 852520775 865660518 3283579 32939050 849237196 832721468 X SEE SCHEDULE OSHRINERS HOSPITALS FOR CHILDREN IN BOSTON AND SPRINGFIELD OFFER "CHARITY CARE" AS PART OF AN INTERNATIONAL NETWORK OF PEDIATRIC HOSPITALS DEDICATED TO PROVIDING EXCELLENT PATIENT CARE, RESEARCH, AND EDUCATION FOR ORTHOPAEDIC CONDITIONS AND BURNS.SHRINERS HOSPITALS FOR CHILDREN-BOSTON SPECIALIZES IN PROVIDING COMPREHENSIVE ACUTE CARE AND RECONSTRUCTIVE AND REHABILITATIVE CARE TO CHILDREN WHO HAVE BEEN BURNED, INCLUDING ACUTE BURNS, SMOKE INHALATION INJURY, RECONSTRUCTIVE SURGERY FOR HEALED BURNS, AND OTHRE RELATED CONDITIONS.SHRINERS HOSPITALS FOR CHILDREN-SPRINGFIELD SPECIALIZES IN CARING FOR CHILDREN WITH ORTHOPAEDIC CONDITIONS AND INJURIES SUCH AS SCOLIOSIS, CLUBFOOT, AND ORTHOPAEDIC CONDITIONS RELATED TO CEREBRAL PALSY AND SPINAL BIFIDA. FOR MORE INFORMATION, VISIT HTTP://WWW.SHRINERSHQ.ORG/ OR CALL 1-800-241-GIFT. 0 0 36198803 1921860 TREATMENT OF PEDIATRIC BURN VICTIMS: ADMISSIONS: 582OUTPATIENT CLINIC VISITS: 5,535OUTPATIENT CLINIC SURGERIES: 476 21365704 1134344 TREATMENT OF ORTHOPEDIC PEDIATRIC PATIENTS: ADMISSIONS: 359OUTPATIENT CLINIC VISITS: 15,699OUTPATIENT CLINIC SURGERIES: 240 4193623 MEDICAL RESEARCH IS PERFORMED AND HAS A STRONG, POSITIVE IMPACT ON THE CARE AND CURE OF CHILDREN WITH ORTHOPAEDIC PROBLEMS, BURN AND SPINAL CORD INJURIES. SHRINERS HOSPITALS FOR CHILDREN IS COMMITTED TO THE SUSTAINED INVESTMENT IN CLINICALLY USEFUL RESEARCH SO THAT FUNDAMENTAL KNOWLEDGE CAN BE ACQUIRED, IMPROVING THE QUALITY OF LIFE FOR CHILDREN WITH ORTHOPAEDIC PROBLEMS, BURN AND SPINAL CORD INJURIES. 61758130 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 450 0 1 569 1 0 0 0 0 0 1 1 0 0 0 1 1 0 X 19 19 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X SHARON RUSSELL 8132810300 2900 ROCKY POINT DR TAMPA FL 336071435 RALPH SEMB 5.00 X 0 0 0 W BRANDT BEDE MD 5.00 X 0 0 0 CHARLES CLAYPOOL 5.00 X 0 0 0 GARY DUNWOODY 5.00 X 0 0 0 RAOUL L FREVAL 5.00 X 0 0 0 DOUGLAS MAXWELL 20.00 X X 0 18000 0 GEORGE MITCHELL 5.00 X X 0 96800 0 GENE BRACEWELL 5.00 X X 0 4900 0 FRANK PREBLE 5.00 X 0 0 0 RODNEY PINKHAM 5.00 X 0 0 0 DAVID S MCKECHNIE 5.00 X 0 0 0 HAROLD F JENNINGS CPA 5.00 X 0 0 0 MICHAEL G SEVERE 5.00 X X 0 49000 0 DAVID H BURSTEIN 5.00 X 0 0 0 KEVIN J HECHT ESQ 5.00 X 0 0 0 RICHARD E JOHNSON 5.00 X X 0 0 0 BOBBY B SIMMONS 5.00 X 0 0 0 G STEPHEN GETMAN ESQ 5.00 X 0 0 0 ALAN W MADSEN 5.00 X 0 1800 0 JACK H JONES 35.00 X 0 158833 0 CHARLES H WEAVER 5.00 X 0 0 0 DAVID M DRVARIC MD 40.00 X 412354 0 19288 PETER D MASSO MD 40.00 X 300880 0 22883 CLIFFORD D'ESMOND 40.00 X 212607 0 2454 ALAN J FISCHMAN 40.00 X 181138 0 6774 PHILIP W MACK MD 40.00 X 262293 0 5585 1369272 329333 56984 42 1 1 0 MASSACHUSETTS GENERAL HOSPITAL PO BOX 350096 BOSTON MA 02241 OUTSIDE PATIENT CARE 8068201 HEALTH NEW ENGLAND 1 MONARCH PLACE 1500 SPRINGFIELD MA 01144 EMPLOYEE BENEFITS 1627922 SPRINGFIELD ANESTHESIA SERVICE 908 ALLEN ST SPRINGFIELD MA 01101 ANESTHESIOLOGY SERVICES 1052691 OWENS & MINOR 9120 LOCKWOOD BLVD MECHANICSVILLE VA 23116 MEDICAL SUPPLIES 948744 PHILIPS ELECTRONICS 22100 BOTHELL EVERTT HWY BOTHELL WA 98041 MEDICAL SUPPLIES 610561 37 39797428 2945543 1226900 42742971 PATIENT SERVICE 621110 3056204 3056204 3056204 25908370 25908370 530300636 481264694 44974 49035942 -44974 48990968 48990968 89620 11120 78500 78500 MISCELLANEOUS 900099 144837 144837 144837 120921850 3056204 0 75122675 25918755 25918755 4958065 4958065 2960611 2960611 1870554 1870554 547612 547612 10773024 10773024 35412 35412 128954 128954 3483161 3483161 273909 273909 4374246 4374246 452784 452784 MEDICAL SUPPLIES 5270742 5270742 PATIENT COSTS 486465 486465 DUES AND REGISTRATIONS 149100 149100 POSTAGE 66239 66239 8497 8497 61758130 61758130 0 0 490797 382551 87207 0 887932 884084 807719 635784 145182720 65213611 81161618 79969109 769085502 783580205 0 208785 852520775 865660518 2946045 32411880 337534 527170 3283579 32939050 X 849237196 832721468 849237196 832721468 852520775 865660518 X 59163720 -75679448 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 760025402 29611840 14805920 774831322 698824389 83046382 21845369 760025402 604354755 117592699 23123065 698824389 834575000 -216021898 14198347 604354755 1.00000 0.00000 0.00000 0 1 1 303990 303990 107659792 37044597 70615195 416959 374151 42808 36466676 27794863 8671813 335303 335303 79969109 120921850 61758130 59163720 -75679448 -75679448 -16515728 4908482 -75679448 -547612 -76227060 81135542 39786308 39786308 120921850 61221638 11120 11120 61210518 547612 547612 61758130 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS (INCLUDING UNRESTRICTED FUND BALANCES) ARE THE PRIMARY SOURCE OF SUPPORT FROM WHICH SHRINERS HOSPITALS FOR CHILDREN PERFORMS ITS PROGRAM SERVICES TO ACHIEVE ITS PRIMARY EXEMPT PURPOSE. PART XII, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEES RECLASSIFIED TO EXPENSES -547,612. PART XII, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSES RECLASSIFIED FROM EXPENSES -11,120. FUNDING REVENUES RECLASSIFIED FROM OTHER CHANGES IN FUND BALANCE 39,797,428. PART XIII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSES RECLASSIFIED TO NET WITH REVENUES 11,120. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEES RECLASSIFIED FROM REVENUES 547,612. GOLF TOURNAMENT 15311 15311 1900 FOOTBALL GAMES 52947 52947 6570 6 21362 21362 2650 89620 89620 11120 11120 78500 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 57564507 3056204 54508303 0.88260 57564507 3056204 54508303 0.88260 4193623 4193623 0.06790 4193623 4193623 0.06790 61758130 3056204 58701926 0.95050 0 0 2 1 SHRINERS HOSPITAL FOR CHILDREN

51 BLOSSOM STREET BOSTON MA 021142699

X X X X 2 SHRINERS HOSPITAL FOR CHILDREN

516 CAREW STREET SPRINGFIELD MA 01104

X X X X SHRINERS HOSPITAL FOR CHILDREN 1 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN 2 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 PART I, LINE 3C: SHRINERS HOSPITALS FOR CHILDREN OFFERS SPECIALIZED MEDICAL SERVICES PERTAINING TO ORTHOPAEDIC CONDITIONS, BURNS, SPINAL CORD INJURIES AND CLEFT LIP AND PALATE. UPON PATIENT ADMITTANCE FOR ONE OF THESE CONDITIONS, SHRINERS HOSPITALS FOR CHILDREN REVIEWS THE PATIENT'S "ABILITY TO PAY" USING FEDERAL POVERTY GUIDELINES SPECIFIED IN SCHEDULE H, PART I, LINES 3A AND 3B, AND PROVIDES FREE OR DISCOUNTED CARE PURSUANT TO THESE GUIDELINES. NEVERTHELESS, SHRINERS HOSPITALS FOR CHILDREN WILL ALWAYS SERVE THESE SPECIALIZED NEEDS FOR ALL OF ITS PATIENTS, REGARDLESS OF THEIR "ABILITY TO PAY". AS SUCH, SHRINERS HOSPITALS FOR CHILDREN DID NOT APPLY ANY INCOME-BASED CRITERIA, ASSET TEST, OR OTHER MEANS TEST OR THRESHOLD FOR PROVIDING FREE CARE TO PATIENTS IN 2011. PART I, LINE 7: A GENERAL LEDGER ACCOUNTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7. THE SYSTEM ADDRESSES ALL PATIENT SEGMENTS (INPATIENT AND OUTPATIENT). A COST-TO-CHARGE RATIO IS NOT PART OF THE SYSTEM AND IS NOT APPLICABLE TO SHRINERS HOSPITALS FOR CHILDREN. PART III, LINE 4: BAD DEBT EXPENSE IS NOT APPLICABLE TO SHRINERS HOSPITALS FOR CHILDREN, AND AS SUCH, IS NOT PART OF THE FOOTNOTES IN ITS FINANCIAL STATEMENTS. SHRINERS HOSPITALS FOR CHILDREN PROVIDES PATIENT CARE WITHOUT COST TO THE PATIENT. AS SUCH, THERE ARE NO REVENUES AGAINST WHICH A BAD DEBT COULD ARISE. PART III, LINE 9B: SHRINERS HOSPITALS FOR CHILDREN PROVIDES PATIENT CARE WITHOUT COST TO THE PATIENT OR THE PATIENT'S FAMILY. AS SUCH, THERE IS NO DEBT COLLECTION POLICY. SHRINERS HOSPITAL FOR CHILDREN PART V, SECTION B, LINE 11H: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. SHRINERS HOSPITAL FOR CHILDREN PART V, SECTION B, LINE 11H: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. SHRINERS HOSPITAL FOR CHILDREN PART V, SECTION B, LINE 19D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME AND FEDERAL POVERTY GUIDELINES. SHRINERS HOSPITAL FOR CHILDREN PART V, SECTION B, LINE 19D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. PART VI, LINE 2: SHRINERS HOSPITALS FOR CHILDREN PROVIDES PEDIATRIC, ORTHOPAEDIC, AND BURN CARE AT NO COST TO ITS PATIENTS. PART VI, LINE 3: SHRINERS HOSPITALS FOR CHILDREN POSTS ITS CHARITY CARY POLICY IN ADMISSION AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT, AND PROVIDES A COPY OF ITS POLICY TO PATIENTS AS PART OF THE INTAKE PROCESS AND WITH DISCHARGE MATERIALS. PART VI, LINE 4: SHRINERS HOSPITALS FOR CHILDREN (THROUGH THIS ENTITY AND ITS RELATED ENTITY) SERVE CHILDREN IN NEED OF SPECIALIZED ORTHOPAEDIC AND BURN CARE ACROSS THE ENTIRE UNITED STATES. X X 1 1 X X 0 1 0 0 0 0 0 0 0 JACK H JONES 0 158833 0 0 0 0 0 0 0 0 0 158833 0 0 DAVID M DRVARIC MD 412354 0 0 0 0 0 16500 0 2788 0 431642 0 0 0 PETER D MASSO MD 300880 0 0 0 0 0 16500 0 6383 0 323763 0 0 0 CLIFFORD D'ESMOND 212607 0 0 0 0 0 0 0 2454 0 215061 0 0 0 ALAN J FISCHMAN 181138 0 0 0 0 0 0 0 6774 0 187912 0 0 0 PHILIP W MACK MD 262293 0 0 0 0 0 0 0 5585 0 267878 0 0 0 X MEDICAL EQUIPMENT 1 1226900 COMPARABLE SALES 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS ORGANIZED AS A NONPROFIT CORPORATION WITH MEMBERS. MEMBERS HAVE THE RIGHT TO ELECT PERSONS BELONGING TO THE GOVERNING BODY, AND TO APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY. COMPENSATION IS NOT PROVIDED FOR BEING A MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS APPROXIMATELY 1,400 MEMBERS WHOM ARE APPOINTED FROM THE TOTAL MEMBERSHIP OF SHRINERS INTERNATIONAL (A RELATED ORGANIZATION). MEMBERS MAY ELECT PERSONS ON THE ORGANIZATION'S GOVERNING BODY, AND MAY APPROVE SIGNIFICANT DECISIONS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B UNDER THE BYLAWS OF THE ORGANIZATION, SIGNIFICANT DECISIONS OF THE GOVERNING BODY REQUIRE APPROVAL BY THE ORGANIZATION'S 1,400 MEMBERS (SUCH AS CHANGES TO THE BYLAWS, OR SIGNIFICANT RESTRUCTURING OR EXTRAORDINARY EVENTS). THE ORGANIZATION'S MEMBERS ALSO MAY ELECT PERSONS TO SERVE ON THE ORGANIZATION'S GOVERNING BODY. THE ORGANIZATION'S MEMBERS DO NOT HAVE CONTROL OVER THE GENERAL OPERATIONS OR FINANCIAL MATTERS OF THE ORGANIZATION. ELECTIONS ARE HELD ANNUALLY BY THE MEMBERS AT VARYING LOCATIONS IN THE U.S.. VOTING IS DECIDED WITH SIMPLE MAJORITY, WHERE EACH MEMBER'S VOTE IS EQUAL WEIGHTED. ELECTED PERSONS SERVE A THREE-YEAR TERM ON THE BOARD OF TRUSTEES, A ONE-YEAR TERM ON THE BOARD OF DIRECTORS, A ONE-YEAR TERM FOR THE ORGANIZATION'S PRESIDENT, AND A ONE-YEAR TERM FOR THE ORGANIZATION'S TREASURER. THE ORGANIZATION'S OFFICERS ARE NOT ELECTED, AND INSTEAD ARE HIRED BY COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11 A FULL VERSION OF FORM 990 AS FILED WITH THE IRS IS MADE AVAILABLE TO EACH VOTING MEMBER OF THE GOVERNING BODY AND/OR DESIGNATED COMMITTEE RESPONSIBLE FOR PERFORMING A REVIEW PROCESS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND ALL MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTING INTERESTS OR STATE "NONE" ON THE ANNUAL CONFLICT OF INTEREST FORM. POTENTIAL CONFLICTS ARE DETERMINED BY THE BOARD OF DIRECTORS. THE PERSON(S) HAVING A POTENTIAL CONFLICT OF INTEREST ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS/DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 A SALARY & PERSONNEL COMMITTEE IS INVOLVED WITH ALL COMPENSATION AND APPROVES WAGES FOR MANAGEMENT AND COMPARES THESE SALARIES TO VARIOUS MARKET INDICATORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS (INCLUDING ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS) ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -75,679,448. AUDIT COMMITTEE OVERSIGHT PROCESS FORM 990, PART XII, LINE 2C EXPLANATION: THE ORGANIZATION HAS NOT CHANGED (DURING THE CURRENT YEAR) ITS OVERSIGHT PROCESS OR ITS SELECTION PROCESS REGARDING THE COMMITTEE RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. SHRINERS HOSPITALS FOR CHILDREN EMPLOYEE DISASTER RELIEF FUND 2900 ROCKY POINT DRIVE TAMPA FL 33607 263733381 DISASTER RELIEF DC 501(C)(3) 9 NO 0 SHRINERS HOSPITALS FOR CHILDREN POST OFFICE BOX 31356 TAMPA FL 336313356 362193608 HOSPITAL SYSTEM CO 501(C)(3) 3 NO 0 SHRINERS INTERNATIONAL POST OFFICE BOX 31356 TAMPA FL 336313356 362158164 FOUNDED SHRINERS HOSPITALS FOR CHILDREN IA 501(C)(10) N/A NO 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 SHRINERS HOSPITALS FOR CHILDREN C 39797428 SHRINERS HOSPITALS FOR CHILDREN N SHRINERS HOSPITALS FOR CHILDREN E 29832222