2012-08-06T15:55:01-05:00 2011-12-31 273605969 CBIZ KIRKLAND RUSS MURPHY & TAPP 13577 FEATHER SOUND DRIVE SUITE 400 CLEARWATER FL 33762 990 2011-01-01 362193608 SHRINERS HOSPITALS 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 5556128717 0 X HTTP://WWW.SHRINERSHQ.ORG/ X 1925 CO WE PROVIDE PEDIATRIC SPECIALTY CARE WITHOUT FINANCIAL OBLIGATION TO PATIENTS OR THEIR FAMILIES. 20 18 5416 5000 0 0 222674207 197275442 4622016 66934531 303705276 669350342 39410003 30087050 570411502 963647365 50000 45805 0 0 319832503 344911456 2017626 6638399 20795726 251481507 268785988 573381636 620381648 -2970134 343265717 8198274933 7907745025 867428438 959112907 7330846495 6948632118 X SEE SCHEDULE OSHRINERS HOSPITALS FOR CHILDREN OFFERS "CHARITY CARE" THROUGH AN INTERNATIONAL NETWORK OF PEDIATRIC HOSPITALS DEDICATED TO PROVIDING EXCELLENT PATIENT CARE, RESEARCH, AND EDUCATION FOR ORTHOPAEDIC CONDITIONS, BURNS, SPINAL CORD INJURIES AND CLEFT LIP AND PALATE. OUR SPECIALIZED MEDICAL CARE, BACKED BY THE SKILLS AND KNOWLEDGE OF THE STAFF IN 18 HOSPITALS, DELIVERS EXPERT, FAMILY-FOCUSED CARE AT NO CHARGE. ...AS A 501(C)3 NON-PROFIT ORGANIZATION, SHRINERS HOSPITALS RELIES ON THE GENEROUS DONATIONS OF SHRINERS AND THE GENERAL PUBLIC TO CARRY OUT OUR MISSION AND CHANGE THE LIVES OF CHILDREN EVERY DAY. FOR MORE INFORMATION ABOUT SUPPORTING SHRINERS HOSPITALS, PLEASE VISIT WWW.SHRINERSHQ.ORG OR CALL 1-800-241-GIFT. 0 0 93483041 12494134 TREATMENT OF PEDIATRIC BURN VICTIMS ADMISSIONS: 927.OUTPATIENT CLINIC VISITS: 9,624 AT 2 BURNS HOSPITALS AND ONE HOSPITAL THAT SPECIALIZES IN BOTH BURNS AND ORTHOPAEDIC SERVICES.OUTPATIENT CLINIC SURGERIES: 1,512. 407331442 54440397 TREATMENT OF ORTHOPAEDIC PATIENTS ADMISSIONS: 9,271. OUTPATIENT CLINIC VISITS: 197,931 AT 16 ORTHOPAEDIC HOSPITALS AND ONE HOSPITAL THAT SPECIALIZES IN BOTH ORTHOPAEDIC AND BURNS SERVICES.OUTPATIENT CLINIC SURGERIES: 7,544. 21216051 MEDICAL RESEARCH IS CONDUCTED AND PROVIDES A STRONG, POSITIVE IMPACT ON THE CARE AND CURE OF CHILDREN WITH ORTHOPAEDIC PROBLEMS, BURN AND SPINAL CORD INJURIES. 111 RESEARCH PROJECTS WERE FUNDED, AND 31 RESEARCH FELLOWSHIPS WERE PROVIDED. 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. 522030534 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 0 0 1 0 0 1 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 X 4309 0 1 5416 1 0 1 BU CA EZ DA HU IS JA KS MY PL AS BR FI FR GM HK ID MX NL NZ NO PO SN SF SP SW SZ UK 0 0 0 1 1 0 0 0 1 1 0 X 20 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY X X SHARON RUSSELL 8132810300 2900 ROCKY POINT DRIVE TAMPA FL 33607 JACK JONES 15.00 X 0 158833 0 DOUGLAS MAXWELL 35.00 X X 18000 0 0 GEORGE MITCHELL 15.00 X 0 96800 0 GENE BRACEWELL 35.00 X X 3745 1155 0 MICHAEL SEVERE 5.00 X X 0 49000 0 ALAN MADSEN 5.00 X X 0 1800 0 JOHN CINOTTO 5.00 X X 0 0 0 DALE STAUSS 5.00 X X 0 0 0 JERRY GANTT 5.00 X X 0 0 0 CHRIS SMITH 5.00 X 0 0 0 GARY BERGENSKE 5.00 X 0 0 0 JIM CAIN 5.00 X 0 0 0 JEFFREY SOWDER 5.00 X 0 0 0 WAYNE LACHUT 5.00 X 0 0 0 JAMES SMITH 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 BOBBY SIMMONS 5.00 X 0 0 0 PETER DIAZ 5.00 X 0 0 0 KEITH GARDNER 40.00 X 362359 0 25360 KENNETH GUIDERA 40.00 X 428771 0 946225 RICHARD KAGAN 40.00 X 408892 0 626637 JACQUES D'ASTOUS 40.00 X 429752 0 541293 PHILLIP GATES 40.00 X 405233 0 487233 JOHN SCAVONE 40.00 X 736348 0 64705 2793100 307588 2691453 383 0 1 0 DICKERSONS REFRIGERATION 1931 LIBERTY ROAD LEXINGTON KY 40505 HVAC CONTRACTOR SERVICES 8775228 JJ HEALTHCARE SYSTEMS 425 HOES LANE PISCATAWAY TOWNSHIP NJ 08854 MEDICAL SUPPLIES 7877060 OWENS & MINOR 9120 LOCKWOOD BLVD MECHANICSVILLE VA 23116 MEDICAL SERVICES 6771504 UC DAVIS MEDICAL CENTER 2315 STOCKTON BLVD SACRAMENTO CA 95817 MEDICAL SERVICES 5901146 WASHINGTON UNIVERSITY ONE BROOKINGS DRIVE ST LOUIS MO 63130 MEDICAL SERVICES 5239223 408 1528499 1594204 194152739 197275442 PATIENT SERVICE 621110 66934531 66934531 66934531 202896219 202896219 56812 56812 319696 0 319696 319696 319696 5058361481 4590983397 923961 467378084 -923961 466454123 466454123 28536721 573994 27962727 27962727 OTHER INCOME 900099 1747815 1747815 1747815 963647365 66934531 0 699437392 45805 45805 409464 352139 57325 253570955 232527351 18794161 2249443 34348311 33385320 962991 39277367 35306024 3971343 17305359 15830764 1474595 1541396 1027000 514396 301941 301941 6638399 6638399 9514081 9514081 75269615 57593767 16832010 843838 493931 419491 73004 1436 10029613 9746040 235679 47894 4124394 368695 3754685 1014 22895299 12985803 9906430 3066 5261324 3068230 1972487 220607 395397 395020 377 207112 207112 42002197 36014325 5987872 5697667 5579406 118261 MEDICAL SUPPLIES 73432206 73432206 PGA EVENT EXPENSES 7930771 7930771 PATIENT COSTS 2212031 1386991 825040 DUES AND REGISTRATIONS 1989644 1816121 169229 4294 5487369 1964944 1182234 2340191 620381648 522030534 77555388 20795726 2966948 7536575 5255703 5252278 35608841 20340713 18143097 6052215 4955391 1146285318 527932767 624978323 618352551 5981349414 5663335353 187687976 213688724 1362110491 1348405365 8198274933 7907745025 236269702 229218190 10404922 36008585 36706503 595150151 682783292 867428438 959112907 X 5983080147 5632700282 377403553 308388249 970362795 1007543587 7330846495 6948632118 8198274933 7907745025 X 343265717 -725480094 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 6598994424 3569133 262161909 6340401648 6299536273 696982199 397524048 6598994424 5604239809 995576563 300280099 6299536273 8060241165 424544778 5604239809 0.79000 0.16000 0.05000 0 0 18138235 18138235 789890089 300877115 489012974 10082403 8144545 1937858 280849989 218911107 61938882 47324602 47324602 618352551 BENEFICIAL INTERESTS IN TRUSTS 461074207 ESTATES IN PROCESS 283302303 PATIENT TRANSPORTATION FUNDS 48942199 COLLATERAL CASH AND SECURITIES 552783292 RECEIVABLES FROM INCOME TRUSTS 2303364 1348405365 LIABILITY UNDER SEC. LENDING 682783292 682783292 963647365 620381648 343265717 -656643636 -68836458 -725480094 -382214377 297881501 -656643636 -9514081 -666157717 964039218 -391853 -391853 963647365 608578946 573994 573994 608004952 12376696 12376696 620381648 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 XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN PENSION FUNDING OBLIGATION -11,307,912. TRANSFERS TO RELATED ENTITIES -64,696,301. CHANGE IN PATIENT TRANSPORTATION FUNDS HELD BY SHRINE TEMPLES 1,563,662. OTHER CHANGE IN FUNDS 5,604,093. TOTAL TO SCHEDULE D, PART XI, LINE 8: -68,836,458. PART XII, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT MGMT FEES RECLASSIFIED TO EXPENSES -9,514,081. PART XII, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSES RECLASSIFIED FROM EXPENSES -573,994. LIFE MEMBERSHIPS INCOME FROM CHANGE IN FUND BALANCE 182,141. PART XIII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSES RECLASSIFIED TO NET WITH REVENUES 573,994. PART XIII, LINE 4B - OTHER ADJUSTMENTS: BANK FEES RECLASSIFIED FROM REVENUES 9,514,081. MEDICAL EXPENSES RECLASSED OUT OF REVENUE 2,862,615. PART XI, LINE 8 : CHANGE IN MINIMUM PENSION LIABILITY : (5,915,142) TRANSFERS: SHRINERS HOSPITALS FOR CHILDREN, A MASSACHUSETTS CORPORATION = (38,546,048) SHRINERS HOSPITALS FOR CHILDREN, A CANADIAN CORPORATION = (9,343,774) HOSPITAL SHRINERS PARA NINOS = (12,530,809) SUBTOTAL TRANSFERS : (60,420,631) CHANGE IN PATIENT TRANSPORTATION FUNDS HELD BY SHRINE TEMPLES : 3,933,691 OTHER CHANGE IN FUND BALANCE : (1,359,474) TOTAL : (63,761,556) PART IV, LINE 2B EXPLANATION: THE AMOUNT INCLUDED ON FORM 990, PART X, LINE 21 CONSISTS OF ANNUITY LIABILITIES ASSOCIATED WITH CHARITABLE REMAINDER TRUSTS HELD BY SHRINERS HOSPITALS FOR CHILDREN, WHICH ARE DETERMINED BASED ON PRESENT VALUE OF THE ESTIMATED FUTURE PAYMENTS TO BE PAID TO THE DESIGNATED BENEFICIARIES. DEFERRED INCOME IS RECOGNIZED ON GIFTS TO SHRINERS HOSPITALS FOR CHILDREN POOLED INCOME FUNDS WHICH REPRESENT THE DISCOUNTED VALUE OF THE ASSETS FOR THE ESTIMATED TIME PERIOD UNTIL THE DONOR'S DEATH. 1 MEXICO 0 0 FUNDING TO HOSPITAL SHRINERS PARA NINOS, A RELATED NONPROFIT ORGANIZATION. 12995198 CANADA 0 0 FUNDING TO SHRINERS HOSPITALS FOR CHILDREN, A RELATED NONPROFIT ORGANIZATION. 11903675 0 0 0 0 0 0 24898873 0 24898873 0 0 0 0 0 0 PROCEDURE FOR MONITORING GRANTS OUTSIDE THE U.S.: SCHEDULE F, PART I, LINE 2: THE FOREIGN ORGANIZATIONS RECEIVING FUNDING ARE ENTIRELY CONTROLLED BY THIS ORGANIZATION'S OFFICERS. THE SAME PROTOCOLS FOR THIS ORGANIZATION'S PROGRAM SERVICE INITIATIVES APPLY TO THE FOREIGN ORGANIZATIONS. X X X X X X 0 AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY PAPER CRUSADE 9894950 9894950 199029 FOOTBALL GAME 4431055 4431055 89127 30 14210716 14210716 285838 28536721 28536721 573994 573994 27962727 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 500814483 66934531 433879952 0.69940 500814483 66934531 433879952 0.69940 21216051 21216051 0.03420 21216051 21216051 0.03420 522030534 66934531 455096003 0.73360 0 0 19 1 SHRINERS HOSPITAL FOR CHILDREN-CHICAGO

2211 NORTH OAK PARK AVENUE CHICAGO IL 607073392

X X X X 2 SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT

3229 BURNET AVENUE CINCINNATI OH 452293095

X X X X 3 SHRINERS HOSPITAL FOR CHILDREN-ERIE

1645 WEST 8TH STREET ERIE PA 16505

X X X X 4 SHRINERS HOSPITAL FOR CHILDREN-GALVESTON

815 MARKET STREET GALVESTON TX 77550

X X X X 5 SHRINERS HOSPITAL FOR CHILDREN-GREENV

950 WEST FARIS ROAD GREENVILLE SC 29605

X X X X 6 SHRINERS HOSPITAL FOR CHILDREN-HONOLULU

1310 PUNAHOU STREET HONOLULU HI 968261099

X X X X 7 SHRINERS HOSPITAL FOR CHILDREN-HOUSTON

6977 MAIN STREET HOUSTON TX 770303701

X X X X 8 SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON

1900 RICHMOND ROAD LEXINGTON KY 40502

X X X X 9 SHRINERS HOSPITAL FOR CHILDREN-LA

3160 GENEVA STREET LOS ANGELES CA 90020

X X X X 10 SHRINERS HOSPITAL FOR CHILDREN-POPS

2425 STOCKTON BOULEVARD SACRAMENTO CA 95817

X X X X 11 SHRINERS HOSPITAL FOR CHILDREN-PHILADELP

3551 NORTH BROAD STREET PHILADELPHIA PA 191404131

X X X X 12 SHRINERS HOSPITAL FOR CHILDREN-PORTLAND

3101 SW SAM JACKSON PARK RD PORTLAND OR 972393095

X X X X 13 SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE

FAIRFAX ROAD AT VIRGINIA STREET SALT LAKE CITY UT 84103

X X X X 14 SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR

3100 SAMFORD AVENUE SHREVEPORT LA 71103

X X X X 15 SHRINERS HOSPITAL FOR CHILDREN-SPOKANE

911 WEST 5TH AVENUE SPOKANE WA 99204

X X X X 16 SHRINERS HOSPITAL FOR CHILDREN-ST LOUIS

2001 S LINDBERGH BOULEVARD ST LOUIS MO 631313597

X X X X 17 SHRINERS HOSPITAL FOR CHILDREN-TAMPA

12502 USF PINE DRIVE TAMPA FL 336129499

X X X X 18 SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY

2025 EAST RIVER PARKWAY MINNEAPOLIS MN 55414

X X X X 19 SHRINERS HOSPITAL FOR CHILDREN-N CALI

2425 STOCKTON BOULEVARD SACRAMENTO CA 95817

X X X X SHRINERS HOSPITAL FOR CHILDREN - CHICAGO 1 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT 2 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-ERIE 3 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-GALVESTON 4 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-GREENV 5 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-HONOLULU 6 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-HOUSTON 7 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON 8 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN - LA 9 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-POPS 10 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-PHILADELP 11 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-PORTLAND 12 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE 13 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR 14 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-SPOKANE 15 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-ST LOUIS 16 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-TAMPA 17 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY 18 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 SHRINERS HOSPITAL FOR CHILDREN-N CALI 19 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 THE 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. 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 OR THE PATIENT'S FAMILY. 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 - CHICAGO 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-CINCINNAT 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-ERIE 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-GALVESTON 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-GREENV 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-HONOLULU 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-HOUSTON 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-LEXINGTON 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 - L.A. 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-POPS 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-PHILADELP 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-PORTLAND 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-SALT LAKE 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-SHREVEPOR 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-SPOKANE 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-ST. LOUIS 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-TAMPA 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-TWIN CITY 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-N. CALI 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 - CHICAGO 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. SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT 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. SHRINERS HOSPITAL FOR CHILDREN-ERIE 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. SHRINERS HOSPITAL FOR CHILDREN-GALVESTON 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. SHRINERS HOSPITAL FOR CHILDREN-GREENV 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. SHRINERS HOSPITAL FOR CHILDREN-HONOLULU 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. SHRINERS HOSPITAL FOR CHILDREN-HOUSTON 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. SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON 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. SHRINERS HOSPITAL FOR CHILDREN - L.A. 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. SHRINERS HOSPITAL FOR CHILDREN-POPS 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. SHRINERS HOSPITAL FOR CHILDREN-PHILADELP 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. SHRINERS HOSPITAL FOR CHILDREN-PORTLAND 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. SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE 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. SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR 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. SHRINERS HOSPITAL FOR CHILDREN-SPOKANE 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. SHRINERS HOSPITAL FOR CHILDREN-ST. LOUIS 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. SHRINERS HOSPITAL FOR CHILDREN-TAMPA 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. SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY 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. SHRINERS HOSPITAL FOR CHILDREN-N. CALI 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 CARE 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. 1 AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS 6300 NORTH RIVER ROAD ROSEMONT IL 60018 362110592 501(C)(3) 40000 SPONSORSHIP GRANT MEDICAL COLLEGE OF GEORGIA 1120 15TH STREET AUGUSTA GA 30912 591892079 501(C)(3) 5000 CONTRIBUTION PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SHRINERS HOSPITALS FOR CHILDREN IS ACTIVELY INVOLVED WITH ALL GRANT RECIPIENTS. THROUGH THIS ACTIVE INVOLVEMENT, THE ORGANIZATIONS ARE MONITORED TO ENSURE THEIR GRANT PROCEEDS ARE BEING USED APPROPRIATELY. X X 1 1 X X 0 1 0 0 0 0 0 0 0 JACK JONES 0 158833 0 0 0 0 0 0 0 0 0 158833 0 0 KEITH GARDNER 362359 0 0 0 0 0 16500 0 8860 0 387719 0 0 0 KENNETH GUIDERA 428771 0 0 0 0 0 939936 0 6289 0 1374996 0 0 0 RICHARD KAGAN 408892 0 0 0 0 0 626637 0 0 0 1035529 0 0 0 JACQUES D'ASTOUS 429752 0 0 0 0 0 535430 0 5863 0 971045 0 0 0 PHILLIP GATES 405233 0 0 0 0 0 484054 0 3179 0 892466 0 0 0 JOHN SCAVONE 736348 0 0 0 0 0 58869 0 5836 0 801053 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 APPOVE 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 THESE DOCUMENTS 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: -656,643,636. CHANGE IN PENSION FUNDING OBLIGATION -11,307,912. TRANSFERS TO RELATED ENTITIES -64,696,301. CHANGE IN PATIENT TRANSPORTATION FUNDS HELD BY SHRINE TEMPLES 1,563,662. OTHER CHANGE IN FUNDS 5,604,093. TOTAL TO FORM 990, PART XI, LINE 5: -725,480,094. FORM 990, PART XI, LINE 2C, AUDIT COMMITTEE OVERSIGHT PROCESS: 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. 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