2012-11-13T16:47:38-06:00 2011-12-31 391214345 KOLBCO SC 13400 BISHOPS LANE SUITE 300 BROOKFIELD WI 53005 990 2011-01-01 391500075 CHILDREN'S HOSPITAL AND HEALTH SYSTEM FOUNDATION INC CHIL 4142665420 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 WELDON GAGE 4142665420 2012-11-06 1 BRYAN L PAUTSCH CPA P00034913 2627549400 2012-11-13 2011 2016-02-24 21:20:13Z JAMES MILLER 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 136970130 0 X WWW.CHW.ORG X 1984 WI SECURE FINANCIAL SUPPORT FOR CHILDREN'S HOSPITAL AND HEALTH SYSTEM AND ITS TAX EXEMPT AFFILIATES. 32 22 42 639 1338 313 19029223 13591720 0 0 14261575 15999853 -9029 61142 33281769 29652715 10043995 10661369 0 0 3712866 3906525 90747 67756 3464610 2023214 2345497 15870822 16981147 17410947 12671568 414801758 412337698 26248566 24471347 388553192 387866351 X CHILDREN'S HOSPITAL AND HEALTH SYSTEM FOUNDATION, INC. IS A 501(C)(3) ORGANIZATION THAT EXISTS TO FUNDRAISE FOR CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. AND ITS NOT-FOR-PROFIT AFFILIATES INCLUDING CHILDREN'S HOSPITAL OF WISCONSIN, INC., CHILDREN'S MEDICAL GROUP, INC., AND CHILDREN'S SERVICE SOCIETY OF WISCONSIN. 0 0 3132627 3132627 IN COLLABORATION WITH CHILDREN'S HOSPITAL OF WISCONSIN, INC. ("CHW" OR "THE HOSPITAL") AND ITS AFFILIATES, CHILDREN'S HOSPITAL AND HEALTH SYSTEM FOUNDATION, INC. ("CHHSF" OR "THE FOUNDATION") RAISES FUNDS TO SUPPORT FREE OR BELOW-COST COMMUNITY PROGRAMS SUCH AS HEALTH EDUCATION, CHILD ABUSE PREVENTION, PARENTING EDUCATION AND INJURY PREVENTION PROGRAMS. FUNDING ALSO SUPPORTS SCHOOL BASED HEALTH CENTERS IN MILWAUKEE SCHOOLS, AND SUPPORTS SOCIAL SERVICES PROVIDED TO WISCONSIN CHILDREN AND FAMILIES BY CHILDREN'S SERVICE SOCIETY OF WISCONSIN. 2004139 2004139 THE FOUNDATION PROVIDES RESOURCES ESSENTIAL TO SUPPORT THE OPERATIONS OF CHW. 2516645 2516645 IN COLLABORATION WITH CHW AND ITS AFFILIATES, THE FOUNDATION RAISES FUNDS TO SUPPORT INNOVATIVE NEW BIOMEDICAL, CLINICAL AND TRANSLATIONAL RESEARCH. 3007958 3007958 PHILANTHROPIC SUPPORT RECEIVED BY THE FOUNDATION SUPPORTS CAPITAL EXPENDITURES SUCH AS FACILITIES EXPANSION, RENOVATION AND EQUIPMENT. 3007958 3007958 10661369 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 1 0 1 0 1 0 0 0 0 0 0 0 1 1 0 0 0 0 1 0 0 0 0 1 26 1 1 42 1 1 1 0 0 0 0 1 1 0 0 0 0 X 32 22 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 WI MN AZ FL X MR JASON PELSIS 4142665997 9000 W WISCONSIN AVENUE MILWAUKEE WI 53201 JASON ALLEN 1.00 X 0 0 0 THOMAS E ARENBERG 1.00 X X 0 0 0 ELLIS D AVNER MD 1.00 X 0 0 0 KELLY J CLEARY-REBHOLZ 1.00 X 0 0 0 GLOSTER B CURRENT 1.00 X 0 0 0 MARC H GORELICK MD 1.00 X 0 0 0 SCOTT R HAAG 1.00 X 0 0 0 JACQUELINE HERD-BARBER 1.00 X 0 0 0 MARY M HOSMER 1.00 X 0 0 0 TED D KELLNER 1.00 X 0 0 0 BERNARD S KUBALE 1.00 X 0 0 0 JOHN D LUBOTSKY 1.00 X 0 0 0 KARIM J MACLEOD 1.00 X 0 0 0 KIM M MAROTTA 1.00 X 0 0 0 JOHN S MCGREGOR 1.00 X 0 0 0 JOHN M NOEL 1.00 X 0 0 0 LARRY J POLACHECK MD 1.00 X 0 0 0 LARRY A RAMBO 1.00 X 0 0 0 TODD M REARDON 1.00 X 0 0 0 MARY ANN RENZ 1.00 X 0 0 0 GREG W RENZ 1.00 X 0 0 0 JAY O ROTHMAN 1.00 X X 0 0 0 JOHN S SHIELY 1.00 X 0 0 0 THELMA A SIAS 1.00 X 0 0 0 MARY ELLEN B STANEK 1.00 X 0 0 0 JOHN W STEINER 1.00 X 0 0 0 CURT B TRAU 1.00 X 0 0 0 JAMES S TWEDDELL MD 1.00 X 0 0 0 PATRICIA L VAN KAMPEN 1.00 X 0 0 0 LES J WEIL 1.00 X 0 0 0 JAMES MILLER 40.00 X X 465450 0 71182 MARGARET TROY 40.00 X 0 1179464 273322 TIMOTHY L BIRKENSTOCK 40.00 X 0 758474 35788 MARC CADIEUX 40.00 X 0 249193 22555 CHAD LINZY 40.00 X 70648 0 6739 SHEILA REYNOLDS 40.00 X 0 386500 71192 JEFFREY STEWART 40.00 X 198672 0 30403 PATRICIA STONEBRAKER 40.00 X 196180 0 27854 MARTIN VOGEL 40.00 X 271240 0 37650 KELLY SACHSE 40.00 X 158280 0 29131 JON E VICE 0.00 X 0 261357 0 1360470 2834988 605816 5 1 1 0 CHILDREN'S MIRACLE NETWORK 4525 SOUTH 2300 EAST SALT LAKE CITY UT 84117 HOSPITAL AWARENESS NETWORK 205227 M&I BANK 111 EAST KILBOURN AVENUE SUITE 200 MILWAUKEE WI 53202 INVESTMENT FEES 201962 FIDUCIARY MANAGEMENT INC (FMI) 100 EAST WISCONSIN AVENUE SUITE 22 MILWAUKEE WI 53202 INVESTMENT FEES 154811 BLACKBAUD 2000 DANIEL ISLAND DRIVE CHARLESTON SC 29492 SOFTWARE MAINTENANCE 127343 ROBERT W BAIRD & CO INC 777 EAST WISCONSIN AVENUE MILWAUKEE WI 53202 INVESTMENT FEES 112377 5 283429 3090224 10218067 624339 13591720 9266580 1338 9265242 113378521 106645248 6733273 6733273 6733273 707301 3090224 656068 51233 51233 26008 16099 9909 9909 29652715 0 1338 16059657 10661369 10661369 1563427 765706 797721 1615788 275672 1340116 88100 24187 63913 447718 114619 333099 191492 49129 142363 706656 706656 160 160 67756 67756 596125 596125 107500 107500 8182 8182 18813 16298 2515 115466 115466 27881 27881 60610 14919 45691 7186 2835 4351 33876 33876 PURCHASED SERVICES 469050 68752 400298 DUES,POSTAGE,DONOR REL 102781 46768 56013 PRINTING & PUBLICATION 76859 21239 55620 SUPPLIES 12808 2921 9887 1544 1544 16981147 10661369 2855168 3464610 2025785 2680957 16847770 11890811 255697 260092 260739 155195 83876 105544 392708622 394698247 2880008 2702047 414801758 412337698 899914 1012257 25348652 23459090 26248566 24471347 X 232411896 232463463 40628553 38368946 115512743 117033942 388553192 387866351 414801758 412337698 X 12671568 -13358409 X 0 1 1 X 0 X 25191173 25297386 18200957 19029223 13591720 101310459 25191173 25297386 18200957 19029223 13591720 101310459 12780464 88529995 19525055 10393359 9198668 8169203 9266580 56552865 157863324 5270292 0.56080 0.56280 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 329141297 10288629 552574 10661369 918243 328402888 310455790 15473320 14110135 10043995 853953 329141297 254107258 14374062 50354147 8379677 310455790 304292256 22231792 -55658236 16758554 254107258 0.52700 0.35600 0.11700 0 0 260739 155195 105544 105544 PAYABLE TO AFFILIATES 23459090 23459090 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: CHHSF HOLDS ENDOWMENT FUNDS ON BEHALF OF CHW AND RELATED ENTITIES. INTENDED USES OF THE FUNDS INCLUDE VARIOUS HEALTH-RELATED SERVICES, EDUCATION, CAPITAL PROJECTS, RESEARCH, AND SOCIAL SERVICES TO CHILDREN AND FAMILIES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: FOOTNOTE 2 INCOME TAXES: CHHS EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2011 OR 2010. X X X X X X 1 VITAL DATA MANAGEMENT 591 NORTH AVENUE WAKEFIELD MA 01880 DIRECT MAIL 0 161109 67756 93353 161109 67756 93353 WI FL AZ MN AL'S RUN AND WALK 960482 607772 352710 30303 13570 869 274459 MIRACLE MARATHON 1533303 1424761 108542 27385 56523 12 1303740 1057691 246049 32850 1642 50429 2150 165888 3797525 3090224 707301 90538 15212 51298 2150 496870 656068 51233 26008 16099 0 26008 16099 16099 9909 WI 1 0 1 0 1.00000 ELISABETH THOMSEN SPECIAL EVENTS M 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 0 ELISABETH THOMSEN SPECIAL EVENTS M 47688 RESPONSIBILITIES AS SPECIAL EVENTS MANAGER INCLUDE OVERSIGHT OF ALL ASPECTS OF FUNDRAISING EVENTS, INCLUDING RAFFLES. HER PERCENTAGE OF TIME SPENT COORDINATING RAFFLES IS ABOUT 2%. X 0 SCHEDULE G, PART I, LINE 2B, COLUMN III, CUSTODY/CONTROL OF CONTRIBUTIONS: VITAL DATA MANAGEMENT, INC. DOES NOT ACCEPT OR PROCESS DONATIONS ON BEHALF OF CHHSF. ALL CONTRIBUTIONS ARE DIRECTED TO AND RECEIVED BY CHHSF. DURING 2011, THE ORGANIZATION PAID VITAL DATA MANAGEMENT, INC. $67,756 FOR SERVICES AND $7,728 FOR DIRECT EXPENSES, FOR A TOTAL OF $75,484. 1 CHILDREN'S HOSPITAL OF WISCONSIN INC 9000 W WISCONSIN AVENUE PO BOX 1997 1997 MILWAUKEE WI 53201 390812532 501(C)(3) 4826255 OPERATION & CAPITAL SUPPORT CHILDREN'S HOSPITAL AND HEALTH SYSTEM INC 9000 W WISCONSIN AVENUE PO BOX 1997 1997 MILWAUKEE WI 53201 391500074 501(C)(3) 3832957 MEDICAL RESEARCH, CHILD ABUSE PREVENTION, HEALTH EDUCATION, SCHOOL BASED CLINICS CHILDREN'S SERVICE SOCIETY OF WISCONSIN 9000 W WISCONSIN AVENUE PO BOX 1997 1997 MILWAUKEE WI 53201 390806380 501(C)(3) 2002157 CHILD & FAMILY SOCIAL SERVICES PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: IN COLLABORATION WITH CHW, CHHSF AWARDS GRANTS TO ITS TAX-EXEMPT AFFILIATES. GRANTS ARE AWARDED BASED ON THE STRATEGIC INITIATIVES OF THE HEALTH SYSTEM, THE NEEDS OF THE AFFILIATES, AND ANY PURPOSE RESTRICTIONS SET BY THE DONORS. THE NEEDS OF THE AFFILIATES ARE EVALUATED IN THE ANNUAL BUDGET PROCESS. FINAL BUDGETS REQUIRE APPROVAL FROM MANAGEMENT, THE ENTITY'S BOARD OF DIRECTORS AND THE CHHS BOARD OF DIRECTORS AND SENIOR MANAGEMENT. IN ADDITION, THE OPERATIONS OF ALL AFFILIATES ARE SUBJECT TO SYSTEM CONTROLS, POLICIES AND PROCEDURES, AND ARE REFLECTED IN THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS OF CHHS AND ITS AFFILIATES. 1 1 0 0 0 0 0 1 0 JAMES MILLER 310117 0 56375 0 98958 0 45950 0 25232 0 536632 0 28801 0 MARGARET TROY 0 736762 0 336229 0 106473 0 241301 0 32021 0 1452786 0 70103 TIMOTHY L BIRKENSTOCK 0 163222 0 130024 0 465228 0 20500 0 15288 0 794262 0 118537 MARC CADIEUX 0 169387 0 66000 0 13806 0 15600 0 6955 0 271748 0 0 SHEILA REYNOLDS 0 237263 0 68372 0 80865 0 44305 0 26887 0 457692 0 21941 JEFFREY STEWART 163511 0 21414 0 13747 0 10091 0 20312 0 229075 0 0 0 PATRICIA STONEBRAKER 29480 0 13335 0 153365 0 3327 0 24527 0 224034 0 23106 0 MARTIN VOGEL 195144 0 33438 0 42658 0 18050 0 19600 0 308890 0 13339 0 KELLY SACHSE 140487 0 10223 0 7570 0 12849 0 16282 0 187411 0 0 0 JON E VICE 0 0 0 0 0 261357 0 0 0 0 0 261357 0 259360 PART I, LINE 3 THE FOUNDATION RELIED UPON CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS"), THE CORPORATE MEMBER OF THE FOUNDATION, TO ESTABLISH THE COMPENSATION OF THE FOUNDATION'S PRESIDENT. CHHS USED ITS INDEPENDENT COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, THE FORM 990 OF OTHER ORGANIZATIONS, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY, AND APPROVAL BY THE COMPENSATION COMMITTEE TO DETERMINE THE COMPENSATION. PART I, LINES 4A-B UNTIL MARCH 2011, TIMOTHY BIRKENSTOCK SERVED AS TREASURER & CFO OF CHHS. BY VIRTUE OF THAT ROLE, MR. BIRKENSTOCK SERVED AS THE TREASURER OF THE FOUNDATION UNTIL HIS SEPARATION FROM CHHS IN 2011. CHHS PAID CERTAIN AMOUNTS AS SEVERANCE TO MR. BIRKENSTOCK PURSUANT TO A WRITTEN AGREEMENT. CASH PAYMENTS MADE TO MR. BIRKENSTOCK IN 2011 TOTALED $329,655. UNTIL JANUARY 2011, PATRICIA STONEBRAKER SERVED AS VP CAMPAIGN DEVELOPMENT OF CHHSF. THE FOUNDATION PAID CERTAIN AMOUNTS AS SEVERANCE TO MS. STONEBRAKER PURSUANT TO A WRITTEN AGREEMENT. CASH PAYMENTS MADE TO MS. STONEBRAKER IN 2011 TOTALED $126,278. PART I, LINE 4B: IN 2011, THERE WAS A CHHS FLEXIBLE BENEFIT PLAN IN PLACE WHICH WAS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (457(F)). THE ORGANIZATION CONTRIBUTES 7% OF EACH PARTICIPATING EXECUTIVE'S SALARY. THE AMOUNTS OF EMPLOYER CONTRIBUTIONS TO THIS PLAN FOR PARTICIPATING EXECUTIVES IN 2011 WERE AS FOLLOWS: J. MILLER, $32,800; M. TROY, $52,472; AND S. REYNOLDS, $26,255. AFTER A VESTING PERIOD, PARTICIPANTS MAY ELECT TO WITHDRAW AMOUNTS PREVIOUSLY CONTRIBUTED AND REPORTED. AMOUNTS WITHDRAWN BY PARTICIPANTS IN 2011 WERE: J. MILLER, $28,801; M. TROY, $70,103; T. BIRKENSTOCK $118,537; S. REYNOLDS, $21,941; P. STONEBRAKER, $23,106; M. VOGEL, $13,339; AND J. VICE, $259,360. CHHS HAS REPORTED ADDITIONAL AMOUNTS SET ASIDE FOR A NONQUALIFIED RETIREMENT PLAN ON BEHALF OF ITS PRESIDENT AND CEO. THE AMOUNT SET ASIDE IN 2011 WAS $180,579. PART I, LINE 7 CERTAIN EXECUTIVES OF CHHS AND ITS AFFILIATES (INCLUDING THE FOUNDATION) PARTICIPATE IN AN ANNUAL BONUS PLAN THAT PROVIDES COMPENSATION BASED ON ACHIEVING SPECIFIC PRE-DEFINED GOALS. BONUS CRITERIA ARE ESTABLISHED ON AN EXECUTIVE-BY-EXECUTIVE BASIS. SUCH CRITERIA PERTAIN TO MATTERS WITHIN THE EXECUTIVE'S AREA OF RESPONSIBILITY, AS WELL AS ACHIEVEMENT OF OVERALL STRATEGIC OBJECTIVES OF THE ORGANIZATION AND ITS AFFILIATES. SUPPLEMENTAL INFORMATION PART III FORM 990, PART VII, COLUMN E & SCHEDULE J, PART II: SALARIES PAID BY RELATED ORGANIZATIONS 1. MARGARET TROY, DIRECTOR OF CHHSF AND PRESIDENT & CEO OF CHHS - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SERVICES PROVIDED (40 HOURS PER WEEK) TO CHHS AND ITS AFFILIATES. THESE AMOUNTS WERE PAID BY CHHS. SERVICES AS A MEMBER OF THE BOARD OF DIRECTORS OF CHHSF WERE PROVIDED ON A PART-TIME VOLUNTARY BASIS. 2. TIMOTHY L. BIRKENSTOCK, TREASURER OF CHHSF (THROUGH MARCH 2011) AND TREASURER & CFO OF CHHS (THROUGH MARCH 2011) - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SERVICES PROVIDED (40 HOURS PER WEEK) TO CHHS AND ITS AFFILIATES. THESE AMOUNTS WERE PAID BY CHHS. 3. MARC CADIEUX, INTERIM TREASURER OF CHHSF (APRIL - DECEMBER 2011) AND INTERIM TREASURER & CFO OF CHHS (APRIL - DECEMBER 2011) - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SERVICES PROVIDED (40 HOURS PER WEEK) TO CHHS AND ITS AFFILIATES. THESE AMOUNTS WERE PAID BY CHHS. 4. SHEILA REYNOLDS, SECRETARY OF CHHSF AND CORPORATE VICE PRESIDENT & GENERAL COUNSEL OF CHHS - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SERVICES PROVIDED (40 HOURS PER WEEK) TO CHHS AND ITS AFFILIATES. THESE AMOUNTS WERE PAID BY CHHS. 5. JON E. VICE, FORMER PRESIDENT OF CHHSF AND FORMER PRESIDENT & CEO OF CHHS - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS LISTED IN PART VII AND SCHEDULE J WERE PAID BY CHHS AS PART OF THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN DESCRIBED ABOVE FOR PREVIOUS SERVICE AS THE PRESIDENT & CEO OF CHHS. BY VIRTUE OF THAT ROLE, MR. VICE PERIODICALLY SERVED AS A DIRECTOR AND/OR OFFICER OF THE FOUNDATION UNTIL HIS RETIREMENT IN JANUARY 2009. FIDUCIARY MANAGEMENT INC DIRECTOR (KELLNER) 154811 MR. KELLNER IS CHAIRMAN AND CEO OF FIDUCIARY MANAGEMENT, INC. THE ORGANIZATION PAID FIDUCIARY MANAGEMENT, INC. FOR INVESTMENT SERVICES. 0 BAIRD ADVISORS DIRECTOR (STANEK) 112377 MS. STANEK IS MANAGING DIRECTOR AND CHIEF INVESTMENT OFFICER FOR BAIRD ADVISORS. THE ORGANIZATION PAID BAIRD ADVISORS FOR INVESTMENT SERVICES. 0 SCHEDULE L, PART IV, COLUMN B, RELATIONSHIP: X 41 406060 SELLING PRICE X AUCTION/PRIZES 397 177740 FMV X FOOD/BEVERAGES 41 25100 FMV X SUPPLIES 14 14275 FMV X RAFFLES 4 1164 FMV 0 1 1 THIRD PARTY USE: PART I, LINE 32B: SCHEDULE M, LINE 32B: THE ORGANIZATION USES VARIOUS BROKERAGE FIRMS TO SELL DONATED SECURITIES. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS EXIST BETWEEN THE FOLLOWING BOARD MEMBERS: ALLEN AND ROTHMAN; AND G. RENZ AND ROTHMAN. FAMILY RELATIONSHIPS EXIST BETWEEN THE FOLLOWING BOARD MEMBERS: G. RENZ AND M.A. RENZ. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION HAS A SOLE CORPORATE MEMBER WHICH IS CHHS. FORM 990, PART VI, SECTION A, LINE 7A CHHS, THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, ELECTS THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE CORPORATE MEMBER, CHHS, HAS CERTAIN RESERVE POWERS OVER THE CORPORATION, INCLUDING AMENDMENT OF THE ARTICLES OF INCORPORATION AND BYLAWS; APPROVAL OF MERGER, CONSOLIDATION OR THE CREATION OF ANY SUBSIDIARIES BY THE CORPORATION; APPROVAL OF THE ANNUAL BUDGET AND ANY DEBT; AND SELECTION OF THE PRESIDENT. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 OF CHHSF WAS REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF CHHS AND PRIOR TO FILING, A COPY WAS MADE AVAILABLE TO ALL DIRECTORS OF CHHSF. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, ALL DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO SUBMIT A CONFLICT OF INTEREST DISCLOSURE TO THE CORPORATE VICE PRESIDENT AND GENERAL COUNSEL OF CHHS. A LIST OF POTENTIAL CONFLICTS IS PREPARED AND IS AVAILABLE AT EACH BOARD AND COMMITTEE MEETING. THE COMPLIANCE DEPARTMENT MONITORS AND PERIODICALLY REVIEWS TRANSACTIONS BETWEEN THE ORGANIZATION AND BOARD MEMBERS OR ENTITIES WITH WHICH THEY ARE AFFILIATED. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT, TREASURER, AND SECRETARY WAS REVIEWED AND APPROVED BY THE INDEPENDENT COMPENSATION COMMITTEE OF CHHS (THE ORGANIZATION'S CORPORATE MEMBER). WITH THE ASSISTANCE OF AN INDEPENDENT COMPENSATION CONSULTANT AND INFORMATION FROM A VARIETY OF EXTERNAL SOURCES (AS INDICATED ON SCHEDULE J), THE COMMITTEE CONFIRMED THAT TOTAL COMPENSATION AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. COMPENSATION OF OTHER OFFICERS WAS SET BY SUPERVISORY EXECUTIVES IN CONSULTATION WITH CHHS HUMAN RESOURCES LEADERS. THE PROCESS INVOLVED REVIEW BY INDEPENDENT PERSONS WHO CONFIRMED THAT TOTAL COMPENSATION AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. THE PROCESS AND DATA RELIED ON WERE THOROUGHLY AND TIMELY DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION OF CHHSF ARE AVAILABLE TO MEMBERS OF THE PUBLIC UPON REQUEST TO THE CHHS PUBLIC RELATIONS DEPARTMENT. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -13,358,409. FORM 990, SCHEDULE R, PART V, LINE 1D PURSUANT TO AN AMENDED AND RESTATED MASTER TRUST INDENTURE DATED MAY 1, 2004, CHW AND CHHSF ARE MEMBERS OF AN OBLIGATED GROUP WHICH JOINTLY AND SEVERALLY GUARANTEES CERTAIN DEBT ISSUED BY A MEMBER OF THE OBLIGATED GROUP THROUGH THE WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY. PAYMENT OF SCHEDULED PRINCIPAL AND INTEREST IS SECURED BY A PLEDGE OF THE HOSPITAL'S AND FOUNDATION'S GROSS UNRESTRICTED RECEIPTS. CHILDREN'S HOSPITAL AND HEALTH SYSTEM INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 391500074 OPERATIONAL SUPPORT SERVICES WI 501(C)(3) LINE 3 N/A 0 CHILDREN'S HOSPITAL OF WISCONSIN INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 390812532 PEDIATRIC HOSPITAL WI 501(C)(3) LINE 3 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 0 CHILDREN'S MEDICAL GROUP INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 391789197 PEDIATRIC PHYSICIAN SERVICES WI 501(C)(3) LINE 3 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 0 CHILDREN'S PHYSICIAN GROUP PC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 364303682 PEDIATRIC PHYSICIAN SERVICES IL 501(C)(3) LINE 9 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 0 CHILDREN'S SERVICE SOCIETY OF WISCONSIN 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 390806380 CHILD WELFARE SERVICES WI 501(C)(3) LINE 7 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 0 CHILDREN'S COMMUNITY HEALTH PLAN INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 271494977 WISCONSIN MEDICAID HMO WI 501(C)(3) LINE 9 CHILDREN'S HOSPITAL & HEALTH SYSTEM INC 0 VIRTUAL PICU SYSTEMS LLC 401 WYTHE STREET SUITE 101 ALEXANDRIA VA 22314 201414664 QUALITY/OUTCOMES ANALYSIS DE CHILDREN'S HOSPITAL & HEALTH SYSTEM INC RELATED 0 0 MED-HEALTH FINANCIAL SERVICES INC 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 391547907 COLLECTION SERVICES WI CHILDREN'S HOSPITAL & HEALTH SYSTEM INC C 0 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 0