2012-11-02T15:31:39-05:00 2011-12-31 861065772 DELOITTE TAX LLP 50 SOUTH SIXTH STREET MINNEAPOLIS MN 55402 990 2011-01-01 411814223 Children's Health Care Foundation CHIL 6128136000 2525 Chicago Avenue South Minneapolis MN 55404 JERRY MASSMANN 6128136000 2012-10-30 1 Kristina Rasmussen P00143920 6123974000 2011 2016-02-24 21:20:13Z Jerry Massmann 2525 Chicago Avenue South Minneapolis MN 55404 28848999 0 X www.childrensmn.org X 1995 MN The Foundation champions raising funds in support of special health needs of children. 25 22 43 372 0 0 16552339 26288634 0 0 1949282 2229678 -37989 -197436 18463632 28320876 20573944 22580284 0 0 3033764 3263369 0 0 3338313 1806959 1949858 25414667 27793511 -6951035 527365 69452205 69773823 118722 2092665 69333483 67681158 X Children's Health Care Foundation supports the mission of Children's Health Care by raising financial resources from the community that are leveraged to provide high-quality, family centered pediatric healthcare. 0 0 10771859 10771859 Children's Health Care Foundation ("The Foundation") supports the mission of Children's Health Care d.b.a. Children's Hospitals and Clinics ("Children's"), by obtaining financial resources that are leveraged to champion the special needs of children and their families and to improve children's health by providing high-quality, family centered pediatric services.The Foundation is the fundraising arm for Children's, which formed in 1924, and is one of the largest children's health care organization in the U.S., with 332 staffed beds at our two hospital campuses in St. Paul and Minneapolis. See Schedule O.An independent, not-for-profit health care system, Children's provides care through over 13,500 inpatient visits and more than 228,000 emergency room and other outpatient visits each year.The three largest services that the Foundation provides are to fund capital expenses, research and annual expenses for programs. These funds are transferred to Children's throughout the year and provide needed support to champion the special health needs of children.Programs:Annual operations support for programs support expert interdisciplinary teams of physicians, nurses, and health care professionals able to address the most complex and difficult pediatric medical problems. A majority of program support is provided to non-reimbursable services that are essential in the healing process for children and families. 1046426 1046426 Research - The purpose of funding research at Children's Health Care is to support a systematic investigation, including research development, testing, and evaluation, designed to develop or contribute to generalized knowledge. Currently, Children's has more than 300 ongoing research studies and programs. 10761999 10761999 Capital - Capital support provides funds to purchase equipment and related supplies and services, or to make capital improvements. Such activities must 1) advance the mission of Children's and 2) have the potential for significant or long-term impact. 22580284 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 0 0 43 1 0 0 0 0 0 1 1 0 0 0 0 0 X 25 22 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X Jerry Massmann 6128136113 2525 Chicago Avenue South Minneapolis MN 554041844 X Alan Goldbloom 1.00 X X 0 873504 524472 Raymond L Barton 1.00 X 0 0 0 Russell Becker 1.00 X 0 0 0 Michael V Ciresi 1.00 X 0 0 0 Molly Culligan 1.00 X 0 0 0 Michael B Fiterman 1.00 X 0 0 0 Greg Goven 1.00 X 0 0 0 Sharon Jaeger 1.00 X 0 0 0 Bill Jeatran 1.00 X 0 0 0 Mary L Jeffries 1.00 X 0 0 0 Andrea Kmetz-Sheehy 1.00 X X 0 0 0 Cynthia L Lesher 1.00 X 0 0 0 Chad Lindbloom 1.00 X 0 0 0 Matt Majka 1.00 X X 0 0 0 Gaye Adams Massey 1.00 X 0 0 0 Richard J Migliori MD 1.00 X 0 0 0 David Miller 1.00 X X 0 0 0 Michael J Ott 1.00 X 0 0 0 Timothy J Pabst 1.00 X 0 0 0 Ryan D Robinson 1.00 X 0 0 0 Patrick G Ryan 1.00 X 0 0 0 Susan Sencer 1.00 X 0 312584 54125 Robert Segal 1.00 X 0 275323 48923 Sandra Sackett 1.00 X 0 0 0 James D Sidman MD 1.00 X 0 0 0 Jerry Massmann 1.00 X 0 567380 49379 Theresa Pesch 25.00 X 181223 181224 34584 Maria Christu 1.00 X 0 300892 43012 Carley Stuber 50.00 X 100852 0 20860 Jennifer Peterson 50.00 X 105158 0 11593 Jeffrey Weness 50.00 X 168276 0 31843 Heather Riddle 50.00 X 113096 0 23011 668605 2510907 841802 5 0 1 0 Bentz Whaley Flessner 7251 Ohms Lane Minneapolis MN 55439 Consulting Services 175881 Blackbaud Inc PO Box 930256 Atlanta GA 31193 Data Base Maintenance 133271 2 1874180 24414454 158346 26288634 1001011 1001011 1228667 0 1228667 1228667 1228667 327927 1874180 525101 -197174 -197174 2760 3022 -262 -262 28320876 0 0 2032242 22580284 22580284 198516 99258 99258 2433871 508948 1924923 450141 119676 330465 180841 36517 144324 34445 34445 604720 290166 314554 3511 3511 304127 76654 227473 83416 83416 126902 66047 60855 71309 43035 28274 106702 72172 34530 Purch Svcs to/Frm Affil 205368 0 205368 0 Dues & Licenses 67203 0 33310 33893 Bank Charges 63385 0 63385 0 Other Fees 56468 0 41143 15325 222302 97863 124439 27793511 22580284 1874914 3338313 570064 774258 977919 304 22001365 21470063 828160 331029 399583 497131 39246193 41229870 6218700 5777744 38381 24453 69452205 69773823 118722 2092665 118722 2092665 X 1814592 85283 40704791 40477466 26814100 27118409 69333483 67681158 69452205 69773823 X 527365 -2179690 X 0 1 1 X 0 X 24505420 25475961 24826975 16552339 26288634 117649329 24505420 25475961 24826975 16552339 26288634 117649329 18737449 98911880 1493469 1446451 1124070 789462 1001011 5854463 225340 377913 300485 490185 330687 1724610 125228402 1721850 0.78990 0.76270 X Schedule A, Part IV, Supplemental Information: Part II, Section B: Gross Income form fundraising activities: $327,927 Gross income from gaming activities : $ 2,760 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 30881650 883411 -267697 1211560 30285804 28645602 371730 2991850 1127532 30881650 23511131 1160044 4333957 359530 28645602 35160520 819502 -10484516 1984375 23511131 0.10000 0.79000 0.11000 1 0 408401 46825 361576 103991 61950 42041 315768 222254 93514 497131 Small Capital 60000 F Remainder Trust 546282 F Perpetual Trust 4037558 F Irrevocable Planned Giving 703845 F Life Insurance Planned Giving 430059 F 5777744 Payable to Children's Health Care 2092665 2092665 28320876 27793511 527365 -1822690 -357000 -2179690 -1652325 26669309 -1822690 -357000 528123 -1651567 28320876 0 28320876 28321634 528123 528123 27793511 0 27793511 Description of Intended Use of Endowment Funds: Part V, Line 4: The intended use of the Foundation's endowments is to support the programs at Children's Health Care. There are also two endowment funds that are held and administered by US Bank, an unrelated organization, which are also used to support the programs at Children's Health Care. Refer to Part III, Line 4 for a description of the programs of Children's Health Care which are supported by the Foundation. Description of Uncertain Tax Positions Under FIN 48: Part X: The Internal Revenue Service (IRS) has determined that Children's and its subsidiaries are exempt organizations as described in Section 501(C)(3) of the IRC. Children's believes that it continues to meet the requirements of the IRC to sustain its tax-exempt status. There are no federal income tax expenses, penalties, or interest recognized in the consolidated statements of operations and no unrecognized tax benefits for the years ended December 31, 2011 and 2010. Part XI, Line 8 - Other Adjustments: Change in Perpetual Trust -357,000. Part XII, Line 2d - Other Adjustments: Special Events Expense $525,101 Gaming Activity Expense $3,022 Part XIII, Line 2d - Other Adjustments: Special Events Expense $525,101 Gaming Activity Expense $3,022 MN Thank God For Kids 1250612 1064412 186200 257674 Pine Tree Apple Tennis Classic 319708 277264 42444 87780 5 631787 532504 99283 179647 2202107 1874180 327927 525101 525101 -197174 1 Children's Health Care 2525 Chicago Ave S Minneapolis MN 55404 411754276 501(c)(3) 21175351 1392872 FMV Toys and Other Items for Children Healthcare 1 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: During calendar year 2011, grants were made to Children's Health Care ("Children's") for support of programs, research and capital. Since these grants were made to Children's, a related organization of the Foundation, employees of the Foundation were able to verify the use of the monies contributed. Also, occasionally the Foundation grants monies to other tax-exempt organizations conducting programs and/or research that will ultimately benefit those served by Children's and affiliates. 0 1 0 0 0 0 0 1 0 Alan Goldbloom 0 733610 0 0 0 139894 0 508256 0 16216 0 1397976 0 122034 Susan Sencer 0 281776 0 0 0 30808 0 33580 0 20545 0 366709 0 18783 Robert Segal 0 225595 0 0 0 49728 0 28801 0 20122 0 324246 0 28972 Jerry Massmann 0 402239 0 0 0 165141 0 33180 0 16199 0 616759 0 44459 Theresa Pesch 145755 145756 0 0 35468 35468 9216 9216 8076 8076 198515 198516 10924 10924 Maria Christu 0 277006 0 0 0 23886 0 22115 0 20897 0 343904 0 20110 Jeffrey Weness 150826 0 0 0 17450 0 13141 0 18702 0 200119 0 0 0 Part I, Line 4b Certain employees of Children's Health Care, parent of the Foundation, are provided the opportunity to participate in the Supplemental Executive Retirement Plan ("the SERP"). The SERP requires that the employee have an agreement in order to be eligible to participate in the SERP. Payments from the SERP occur at retirement and are based on years of service and percentage of salary. The following amount represents the amount deferred under the SERP in 2011. Alan Goldbloom $485,866 Certain employees of Children's Health Care, parent of the Foundation, are provided the opportunity to participate in the Capital Accumulation Plan ("the Capital Plan"). The Capital Plan requires that the employee is a physician or executive and is a .5 FTE or more in order to be eligible to participate in the Capital Plan. Payments from the Capital Plan occur at vesting and are based on percentage of salary. The following amounts represent the amount paid under the Capital Plan in 2011. Alan Goldbloom $122,034 Jerry Massmann $44,459 Maria Christu $20,110 Theresa Pesch $21,848 Susan Sencer $18,783 Robert Segal $18,319 Certain employees of Children's Health Care, parent of the Foundation, are provided the opportunity to participate in the Deferral Account Pay Plan ("the Deferral Plan"). The Deferral Plan requires that the employee is a physician or executive and is a .5 FTE or more in order to be eligible to participate in the Deferral Plan. Payments from the Deferral Plan occur at vesting and are based on percentage of salary. The following represent the amount paid under the Deferral plan in 2011: Robert Segal $10,653 Supplemental Information Part III Part I, Line 3: The Foundation relies on Children's Health Care, the parent of the Foundation, to establish the compensation of the organization's CEO. Children's Health Care uses the following methods to establish the compensation of the CEO: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board or compensation committee. Part I, Line 7: Certain executives and physicians are eligible for participation in the Executive Incentive Plan (EIP) or Physician Incentive Plan (PIP). The EIP and PIP provide eligible participants with the opportunity to receive an incentive payment based on attainment of established organization and individual goals. X 10000 Cost or selling price X 34852 Cost or selling price X 11 11755 Cost or selling price X Other: 1 13000 Cost or selling price X Entertainment 6 3700 Cost or selling price X Media 7 85040 Cost or selling price 0 0 1 1 Third Party Use: Part I, Line 32b: The Foundation uses a third party vendor to facilitate the sale of auction items at fundraising events and to process payments. Form 990, Part VI, Section A, line 2 The following people have a business relationship : Raymond L. Barton Russell Becker Michael V. Ciresi Molly Culligan Michael B. Fiterman Greg Goven Sharon Jaeger Bill Jeatran Mary L. Jeffries Andrea Kmetz-Sheehy Cynthia L. Lesher Chad Lindbloom Matt Majka Gaye Adams Massey Richard J. Migliori, MD David Miller Michael J. Ott Timothy J. Pabst Ryan D. Robinson Patrick G. Ryan Susan Sencer Robert Segal Sandra Sackett James D. Sidman, MD Alan Goldbloom Jerry Massmann Theresa Pesch Maria Christu Form 990, Part VI, Section A, line 4 The Foundation's bylaws were amended in 2011 for the following significant changes: 1. Election of directors beyond the six-year term limit. The bylaws currently provide for election of directors for an additional year or two beyond the six-year term limit in certain circumstances. Specifically, this is allowed in situations where the director is serving as chair or vice chair of the board during his or her sixth year and so needs to serve an additional term to complete the appointment as chair or vice chair, and also in situations where the board desires to elect an immediate past chair for an additional term. The amendment clarifies the language in the Foundation bylaws so that a director serving as chair or vice-chair of either the Foundation or Hospital are eligible to be elected for and additional term. 2. Removal of Conflict of Interest Policy. A number of years ago the conflict of interest policy was included as part of both the Hospital and Foundation bylaws. Children's is not required by any regulatory agency to maintain the policy as part of the bylaws and has determined, based on consultation with outside counsel, that common law practice today among tax-exempt healthcare entities is to maintain the policy as a stand along policy, not part of the bylaws. This allows, among other things, the ability to modify the policy without the requirement of a bylaw amendment. The resolutions delete the conflict of interest policy from the bylaws of the Foundation, and require the corporations to maintain the policy a separate organizational policy. Form 990, Part VI, Section A, line 6 The Foundation has a sole member, Children's Health Care, a Minnesota nonprofit corporation. Form 990, Part VI, Section A, line 7a The Foundation's sole member, Children's Health Care, is authorized under the Foundation's bylaws to elect directors of the Foundation, after approval by the board of directors of the Foundation. Form 990, Part VI, Section A, line 7b The Foundation's sole member, Children's Health Care, Inc., maintains a number of "reserved powers" including but not limited to election of directors, approval of annual budgets, approval of amendments to the Articles of Incorporation and Bylaws. Form 990, Part VI, Section B, line 11 The senior management of Children's Health Care, the parent of the Foundation, reviews the draft Form 990 with the Audit and Compliance Committee of the governing body of the Foundation and Children's Health Care, the parent of the Foundation, prior to the filing of the Form. This review includes an overview of the Form and discussions related to key sections. Copies of the final Form 990 are made available to members of the committee and all the Foundation's directors prior to the Form being filed. The Audit and Compliance Committee has been delegated the authority to oversee the completion and filing of the Form 990 by the full Foundation Board, and the committee reports the results of its review and approval to the full board at a regularly scheduled board meeting. Form 990, Part VI, Section B, line 12c Management of Children's Health Care, the parent of the Foundation, ensures that conflict of interest disclosure forms are completed by all members of the governing body and board committees at least annually. Forms are completed at the beginning of the year, and directors and committee members are instructed to provide additional disclosures if necessary during the course of the year. The Governance Committee of the governing body of Children's Health Care, along with senior management (CEO and General Counsel) of Children's Health Care, review all disclosures provided by governing board members. The results of this review and any concerns, limitations, etc. are reported by the Governance Committee to the full board. If conflicts are identified, the Governance Committee and management work to ensure that directors do not participate in discussion or voting on the affected matter. Form 990, Part VI, Section B, line 15 Children's Health Care, the parent of the Foundation, follows the requirements set forth in the IRS rebuttable presumption of reasonableness in determining compensation for the President and other officers and executive leaders of the Foundation. This function is performed by the Compensation Committee of the governing board of Children's Health Care, which is composed of only independent directors. The process includes review of comparability data, retention of an outside compensation consultant and contemporaneous substantiation of the deliberation and decision through detailed minutes of the Compensation Committee and full board meetings where executive compensation is considered. Form 990, Part VI, Section C, line 19 Children's Health Care, the parent of the Foundation, makes financial statement information public through a summary of financial performance in its annual report. In addition, financial statements are provided to Children's Health Care's bond trustees, who thereafter make this information publicly available. The Foundation relies on the Conflict of Interest Policy of Children's Health Care, the parent of the Foundation. Children's Health Care does not make the Conflict of Interest Policy available to the public. The governing documents of the Foundation are not available to the public. Form 990, Part VII: The following individuals held positions at both Children's Health Care Foundation and Children's Health Care, the parent of Children's Health Care Foundation. The hours listed on Part VII are the average hours per week these individuals devoted to Children's Health Care Foundation during the year. In addition, these individuals also devoted the following average hours per week to Children's Health Care. Alan Goldbloom 50.0 hours Maria Christu 50.0 hours Jerry Massmann 50.0 hours Theresa Pesch 25.0 hours Raymond Barton 1.0 hour Russell Becker 1.0 hour Michael Ciresi 1.0 hour Molly Culligan 1.0 hour Michael Fiterman 1.0 hour Greg Goven 1.0 hour Sharon Jaeger 1.0 hour Bill Jeatran 1.0 hour Mary Jeffries 1.0 hour Andrea Kmetz-Sheehy 1.0 hour Cynthia Lesher 1.0 hour Chad Lindbloom 1.0 hour Matt Majka 1.0 hour Gaye Adams Massey 1.0 hour Richard Migliori 1.0 hour David Miller 1.0 hour Michael Ott 1.0 hour Timothy Pabst 1.0 hour Ryan Robinson 1.0 hour Patrick Ryan 1.0 hour Sandra Sackett 1.0 hour James Sidman 1.0 hour Susan Sencer 1.0 hour Robert Segal 1.0 hour The following individual held positions at both Children's Health Care Foundation and Children's - Minnetonka. The hours listed on part VII are the average hours per week this individual devoted to Children's Health Care Foundatin during the year. In addition, this individual also devoted the following average hours per week to Childrens' - Minnetonka. Jerry Massmann 1.5 hours Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -1,822,690. Change in Perpetual Trust -357,000. Total to Form 990, Part XI, Line 5: -2,179,690. Children's Health Care Services Inc DBA Minnetonka 2525 Chicago Avenue South Minneapolis MN 55404 411756478 Healthcare MN 501(c)(3) Line 3: 170(b)(1)(a) N/A 1 Children's Health Care 2525 Chicago Avenue South Minneapolis MN 55404 411754276 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 1 0