CHILDRENS HOSPITAL PEDIATRIC ASSOCIATES INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
CHILDRENS HOSPITAL PEDIATRIC ASSOCIATES INC (EIN 43-1987409)
Tax period
2010-10-01 to 2011-09-30
Filed
2012-08-13
IRS object ID
201242269349302254
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-08-13T14:31:08-05:00Timestamp
Tax Period End Date2011-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BAKER NEWMAN & NOYES LLCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1280 FORE STREETAddressLine1
CityPORTLANDCity
StateMEState
ZIP Code04101ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN431987409EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCHILNameControl
Phone6173551952Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line120 OVERLAND STREETAddressLine1
CityBOSTONCity
StateMAState
ZIP Code02215ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameGARY R FLEISHER MDName
TitlePRESIDENTTitle
Phone6179192822Phone
Date Signed2012-08-13DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone8002447444Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGARY R FLEISHER MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line120 OVERLAND STREETAddressLine1
CityBOSTONCity
StateMAState
ZIP Code02215ZIPCode
FieldValueIRS element (for citing)
Gross Receipts259869923GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2002YearFormation
State Legal DomicileMAStateLegalDomicile
Activity Or Mission DescriptionTHE FOUNDATION PROVIDES MEDICAL, HEALTH CARE SERVICES, AND EDUCATIONAL SERVICES TO CHILDREN'S HOSPITAL AND HARVARD MEDICAL SCHOOL. THE FOUNDATION ALSO PROVIDES CARE FOR PATIENTS LOCATED IN MASSACHUSETTS IN NEED OF HEALTH CARE SERVICES, REGARDLESS OF THEIR ABILITY TO PAY, AS WELL AS PROVIDING COMMUNITY BASED SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body18NbrVotingMembersGoverningBody
Nbr Independent Voting Members1NbrIndependentVotingMembers
Total Nbr Employees335TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI-191TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year6982000ContributionsGrantsCurrentYear
Program Service Revenue Prior Year187241007ProgramServiceRevenuePriorYear
Program Service Revenue CY191869937ProgramServiceRevenueCY
Investment Income Prior Year7446877InvestmentIncomePriorYear
Investment Income Current Year8012482InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year194687884TotalRevenuePriorYear
Total Revenue Current Year206864419TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year21017115GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY24269327GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year132729914SalariesEtcPriorYear
Salaries Etc Current Year144167458SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year38347475OtherExpensePriorYear
Other Expenses Current Year31343477OtherExpensesCurrentYear
Total Expenses Prior Year192094504TotalExpensesPriorYear
Total Expenses Current Year199780262TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2593380RevenuesLessExpensesPriorYear
Revenues Less Expenses CY7084157RevenuesLessExpensesCY
Total Assets BOY241185726TotalAssetsBOY
Total Assets EOY247204519TotalAssetsEOY
Total Liabilities BOY26149755TotalLiabilitiesBOY
Total Liabilities EOY31062144TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY215035971NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY216142375NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE FOUNDATION PROVIDES MEDICAL AND HEALTH CARE SERVICES PRIMARILY TO PATIENTS AT CHILDREN'S HOSPITAL, AND OTHER HEALTH CARE PROVIDERS AT SATELLITE LOCATIONS. THE FOUNDATION CARRIES ON AND PROMOTES BASIC AND APPLIED MEDICAL RESEARCH AND EDUCATION IN THE FIELD (SEE SCHEDULE O) OF PEDIATRIC CARE BY TEACHING STUDENTS AND OTHER MEDICAL AND SCIENTIFIC PERSONNEL. THE FOUNDATION ALSO PROVIDES CARE FOR PATIENTS IN MASSACHUSETTS REGARDLESS OF THEIR ABILITY TO PAY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense150214028Expense
Grants24269327Grants
Revenue159459679Revenue
DescriptionTHE FOUNDATION WAS ORGANIZED EXCLUSIVELY FOR CHARITABLE, SCIENTIFIC, AND EDUCATIONAL PURPOSES. THE FOUNDATION PROVIDES MEDICAL AND HEALTH CARE SERVICES PRIMARILY TO PATIENTS AT CHILDREN'S HOSPITAL, AND OTHER HEALTH CARE PROVIDERS AT SATELLITE LOCATIONS. THE FOUNDATION MAY CHARGE FOR PATIENT CARE, OTHER MEDICAL SERVICES, AND RELATED PRODUCTS, PROVIDED THAT ANY NET INCOME BE USED FOR THE CHARITABLE, SCIENTIFIC, AND EDUCATIONAL PURPOSES FOR WHICH THE FOUNDATION WAS CREATED. THE FOUNDATION ALSO PROVIDES CARE FOR PATIENTS IN MASSACHUSETTS REGARDLESS OF THEIR ABILITY TO PAY, AS WELL AS PROVIDING AND SUBSIDIZING HOSPITAL AND COMMUNITY BASED SERVICES THAT ARE EITHER UNAVAILABLE OR LIMITED ELSEWHERE IN THE COMMUNITY.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense12783299Expense
Revenue5349529Revenue
DescriptionTHE FOUNDATION RECEIVES INCOME FROM CHILDREN'S HOSPITAL FOR PROVIDING ADMINISTRATION, SUPERVISION, AND TEACHING SERVICES. THE FOUNDATION CARRIES ON AND PROMOTES BASIC AND APPLIED MEDICAL RESEARCH AND EDUCATION IN THE FIELD OF PEDIATRIC CARE BY TEACHING STUDENTS AND OTHER MEDICAL AND SCIENTIFIC PERSONNEL; BY PROVIDING OR SUPPLEMENTING INCOME TO RESEARCH PERSONNEL THROUGH FELLOWSHIPS, RESEARCH GRANTS, AND STIPENDS; AND BY GIVING LECTURES AND PUBLISHING INFORMATION CONCERNING PROBLEMS AND RESEARCH RESULTS IN THE FIELD OF PEDIATRIC CARE IN ORDER TO EDUCATE THE GENERAL PUBLIC AND THE MEDICAL PROFESSION.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense24155178Expense
Revenue27060729Revenue
DescriptionTHE FOUNDATION RECEIVES REIMBURSEMENT OF CERTAIN SALARY AND FRINGE COSTS FROM GRANTS FROM CHILDREN'S HOSPITAL.Description
FieldValueIRS element (for citing)
Total Program Service Expense187152505TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096157NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees335NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members18NbrVotingGoverningBodyMembers
Number Independent Voting Members1NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledMAStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1WILLIAM TARVAINENBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number6173551952TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line120 OVERLAND STREETAddressLine1
CityBOSTONCity
StateMAState
ZIP Code02215ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationInstitutional TrusteeInstitutionalTrusteeHighest Compensated EmployeeHighestCompensatedEmployee
GARY R FLEISHER MD
PRESIDENT60.00XX683427094274
WILLIAM E HARMON MD
TREASURER/CLERK60.00XX328396093625
WILLIAM TARVAINEN
CHIEF FINANCIAL OFFICER60.00XX277383086599
RICHARD BACHUR MD
TRUSTEE60.00X385866076851
S JEAN EMANS MD
TRUSTEE60.00X299371092995
RAIF S GEHA MD
TRUSTEE60.00X305804092953
CRAIG GERARD MD
TRUSTEE60.00X272550082394
STELLA KOUREMBANAS MD
TRUSTEE60.00X355054083732
ALAN LEICHTNER MD
TRUSTEE60.00X327162084154
WAYNE LENCER MD
TRUSTEE60.00X341109079926
FREDERICK LOVEJOY MD
TRUSTEE60.00X244169055413
JOSEPH MAJZOUB MD
TRUSTEE60.00X263743092623
LEONARD RAPPAPORT MD
TRUSTEE60.00X309894078734
MARK SCHUSTER MD
TRUSTEE60.00X450988077623
MICHAEL WESSELS MD
TRUSTEE60.00X289623084604
DAVID WILLIAMS MD
TRUSTEE60.00X551202078909
CHRISTOPHER WALSH MD
TRUSTEE60.00X000
PHYSICIANS' ORGANIZATION AT CH INC
INSTITUTIONAL TRUSTEE2.00000X
GARY VISNER MD
PHYSICIAN60.00352411058974X
CHARLES NELSON MD
PHYSICIAN60.00378861058215X
ISAAC KOHANE MD
PHYSICIAN60.00355759059054X
PATRICIA ELLEN GRANT MD
PHYSICIAN60.00372348060935X
WILLIAM BARBARESI MD
PHYSICIAN60.00410014073114X
FieldValueIRS element (for citing)
Total Reportable Comp From Org7555134TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation1645701TotalOtherCompensation
Number Individuals GT100 K281NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
DANA FARBER CANCER INSTITUTE
44 BINNEY STREETBOSTONMA02115ONCOLOGY SERVICES2191778
MARCAM ASSOCIATES
396 HIGH STREETSOMERSWORTHNH03878BILLING/COLLECTIONS546981
BOSTON PRIVATE BANK & TRUST
TEN POST OFFICE SQUAREBOSTONMA02109INVESTMENT FEES540194
CHMC ANESTHESIA FOUNDATION INC
300 LONGWOOD AVENUEBOSTONMA02115ANESTHESIA SERVICES336000
CH SURGICAL FOUNDATION INC
300 LONGWOOD AVENUEBOSTONMA02115PHYSICIAN SERVICES300000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
Related Organizations6982000RelatedOrganizations
Total Contributions6982000TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE RE621300151438005151438005
GRANT REVENUE6213002706072927060729
CONTRACT REVENUE90009980216738021673
TEACHING, ADMIN, & SUP61171027159732715973
SERVICE, RESEARCH, & O61171026335572633557
FieldValueIRS element (for citing)
Total Program Service Revenue191869937TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column4031994TotalRevenueColumn
Unrelated Business Revenue-191UnrelatedBusinessRevenue
Exclusion$4,032,185ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities56985992Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities53005504Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities3980488Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column3980488TotalRevenueColumn
Exclusion$3,980,488ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column206864419TotalRevenueColumn
Related Or Exempt Function Income191869937RelatedOrExemptFunctionIncome
Unrelated Business Revenue-191UnrelatedBusinessRevenue
Exclusion$8,012,673ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total24269327Total
Program Services24269327ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total9200821Total
Program Services8836840ProgramServices
Management And General363981ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total117505149Total
Program Services109279789ProgramServices
Management And General8225360ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total6946703Total
Program Services6599368ProgramServices
Management And General347335ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total7255509Total
Program Services6167183ProgramServices
Management And General1088326ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3259276Total
Program Services2770385ProgramServices
Management And General488891ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total403997Total
Program Services39025ProgramServices
Management And General364972ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total21218Total
Management And General21218ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total689208Total
Management And General689208ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total207376Total
Program Services207376ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total88201Total
Program Services88201ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1378664Total
Program Services805615ProgramServices
Management And General573049ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total127599Total
Program Services127599ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total2912680Total
Program Services2912680ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total366276Total
Program Services274707ProgramServices
Management And General91569ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total199403Total
Program Services199403ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total138258Total
Program Services138258ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total3020517Total
Program Services2855617ProgramServices
Management And General164900ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
RESEARCH EXPENSES1481616814816168
BAD DEBT EXPENSE38520753852075
PO DUES996704996704
PATIENT STAFF RELATIONS755396755396
BILLING AND COLLECTIONS630275630275

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total739462Total
Program Services530514ProgramServices
Management And General208948ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total199780262Total
Program Services187152505ProgramServices
Management And General12627757ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2112057BOY
EOY6082648EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY29482085BOY
EOY3914878EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY13584792BOY
EOY14140034EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY748440BOY
EOY1204330EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY3663824BOY
EOY3316986EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY752310BOY
EOY1235822EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis542811LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec325004LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY356065BOY
EOY217807EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY134755535BOY
EOY159574969EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY38987565BOY
EOY38631766EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY16743053BOY
EOY18885279EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY241185726BOY
EOY247204519EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY7343453BOY
EOY7325615EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY18806302BOY
EOY23736529EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY26149755BOY
EOY31062144EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY211853021BOY
EOY211537066EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3182950BOY
EOY4605309EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY215035971BOY
EOY216142375EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY241185726BOY
EOY247204519EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses7084157ReconcilationRevenueExpenses
Reconcilation Other Changes-5977753ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2550000CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years5449762CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years11081677CurrentTaxYearMinus2Years
Current Tax Year6982000CurrentTaxYear
Total26063439Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years130305603CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years152826834CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years176149278CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year187241007CurrentTaxYearMinus1Year
Current Tax Year191869937CurrentTaxYear
Total838392659Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years132855603CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years158276596CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years187230955CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year187241007CurrentTaxYearMinus1Year
Current Tax Year198851937CurrentTaxYear
Total864456098Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509864456098PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4394481CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4737274CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3861758CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3682841CurrentTaxYearMinus1Year
Current Tax Year4032185CurrentTaxYear
Total20708539Total

Post1975 UBTI Post1975UBTI

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years-6282CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year-4634CurrentTaxYearMinus1Year
Current Tax Year-191CurrentTaxYear
Total-11107Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years4394481CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years4737274CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years3855476CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year3678207CurrentTaxYearMinus1Year
Current Tax Year4031994CurrentTaxYear
Total20697432Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years137250084CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years163013870CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years191086431CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year190919214CurrentTaxYearMinus1Year
Current Tax Year202883931CurrentTaxYear
Total885153530Total
FieldValueIRS element (for citing)
Public Support Percentage5090.97660PublicSupportPercentage509
Prior Year Support Percentage0.97610PriorYearSupportPercentage
Investment Income Percentage0.02340InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.02390PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance3182950BeginningOfYearBalance
Contributions6982000Contributions
Other Expenditures5559641OtherExpenditures
End Of Year Balance4605309EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance12375000BeginningOfYearBalance
Other Expenditures9192050OtherExpenditures
End Of Year Balance3182950EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2509857BeginningOfYearBalance
Contributions11081677Contributions
Other Expenditures1216534OtherExpenditures
End Of Year Balance12375000EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis67011OtherCostOrOtherBasis
Depreciation33505Depreciation
Book Value33506BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis475800OtherCostOrOtherBasis
Depreciation291499Depreciation
Book Value184301BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings217807TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
CH POOLED INVESTMENT1644808F
PO POOLED INVESTMENT FUND36986958F
FieldValueIRS element (for citing)
Total Of Book Value Securities38631766TotalOfBookValueSecurities

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
DUE FROM PO1278190
DUE FROM CHILDREN'S HOSPITAL14265940
OTHER RECEIVABLES1834149
CONTRIBUTION FROM CHILDREN'S HOSPITAL1507000
FieldValueIRS element (for citing)
Total Book Value Other Assets18885279TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (5 entries)

DescriptionDescriptionAmountAmount
DUE TO CHILDREN'S HOSPITAL$12,012,275
DUE TO PO$1,035,729
DUE TO COMMUNITY HOSPITALS$1,589,618
DEFERRED COMPENSATION PLANS$5,656,410
ACCRUED PROFESSIONAL LIABILITY$3,442,497
FieldValueIRS element (for citing)
Total Of Amounts23736529TotalOfAmounts
Total Revenue206864419TotalRevenue
Total Expenses199780262TotalExpenses
Excess Or Deficit For Year7084157ExcessOrDeficitForYear
Net Unrealized GL On Investments-5977753NetUnrealizedGLOnInvestments
Total Adjustments-5977753TotalAdjustments
Excess Or Deficit Per FS1106404ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt206446307TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-5977753NetUnrealizedGainsInvestments
Other Revenues5559641OtherRevenues
Revenue Not Rptd F990-418112RevenueNotRptdF990
Revenue Subtotal206864419RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form990206864419TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt199780262TotExpensesEtcAuditedFinclStmt
Expenses Not Rptd F9900ExpensesNotRptdF990
Expenses Subtotal199780262ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form990199780262TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:THE FOUNDATION HAS PLANS TO USE ITS ENDOWMENT FUNDS FOR THE QUALITY AND CHARGE CAPTURE PROJECT, PHYSICIAN RECRUITMENT EXPENSES, AND RESEARCH INITIATIVES.
PART XII, LINE 2D - OTHER ADJUSTMENTS:NET ASSETS RELEASED FROM RESTRICTIONS 5,559,641.
PART X, FIN 48 FOOTNOTE: THE FOUNDATION IS A TAX-EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE), AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. IN ADDITION, THE FOUNDATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(2). TAX-EXEMPT ORGANIZATIONS COULD BE REQUIRED TO RECORD AN OBLIGATION FOR INCOME TAXES AS THE RESULT OF A TAX POSITION THEY HAVE HISTORICALLY TAKEN ON VARIOUS TAX EXPOSURE ITEMS, INCLUDING UNRELATED BUSINESS INCOME OR TAX STATUS. MANAGEMENT OF THE FOUNDATION HAS EVALUATED THE POSITIONS TAKEN ON THE FOUNDATION'S FILED TAX RETURNS AND HAS CONCLUDED THAT NO UNCERTAIN INCOME TAX POSITIONS EXIST AT SEPTEMBER 30, 2011. THE FOUNDATION'S TAX YEARS FROM 2008 THROUGH 2011 ARE POTENTIALLY SUBJECT TO EXAMINATION.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistancePurpose Of GrantPurposeOfGrant
CHILDREN'S HOSPITAL
300 LONGWOOD AVENUEBOSTONMA02115042774441501(C)(3)24239931N/AN/AGENERAL SUPPORT
PRESIDENTS & FELLOWS OF HARVARD COLLEGE
75 FRANCIS STREETBOSTONMA02115042103580501(C)(3)29396N/AN/AGENERAL SUPPORT
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: MONITORING IS PROVIDED BY CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INC. (THE FOUNDATION) THROUGH OVERSIGHT OF THE TERMS AND CONDITIONS OF A WRITTEN GRANT AGREEMENT. MULTIYEAR AGREEMENTS REQUIRE YEARLY PROGRESS AND FINANCIAL REPORTS FOR CONTIUATION OF FUNDING. DURING THE YEAR ENDED SEPTEMBER 30, 2011, THE FOUNDATION ONLY PROVIDED GRANT DONATIONS TO OTHER 501(C)(3) ORGANIZATIONS.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Compensation SurveyXCompensationSurvey
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (21 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
GARY R FLEISHER MD
67835600050710692770249970777701000
WILLIAM E HARMON MD
2596100454120233740692770243480422021000
WILLIAM TARVAINEN
250544025350014890622770243220363982000
RICHARD BACHUR MD
3383500483180-8020522770245740462717000
S JEAN EMANS MD
2596100185730211880692770237180392366000
RAIF S GEHA MD
2450000450000158040692770236760398757000
CRAIG GERARD MD
245000021109064410592770231170354944000
STELLA KOUREMBANAS MD
2967150417510165880592770244550438786000
ALAN LEICHTNER MD
31499606195059710602770238770411316000
WAYNE LENCER MD
2807690381560221840582770216490421035000
FREDERICK LOVEJOY MD
21420003500296190318260235870299582000
JOSEPH MAJZOUB MD
245000050000137430692770233460356366000
LEONARD RAPPAPORT MD
29747005000074240542770244570388628000
MARK SCHUSTER MD
24500001188000871880542770233460528611000
MICHAEL WESSELS MD
2523660263250109320602770243270374227000
DAVID WILLIAMS MD
35831305854601343430542770246320630111000
GARY VISNER MD
297470018500530910372770216970411385000
CHARLES NELSON MD
25269202535001008190372770209380437076000
ISAAC KOHANE MD
3252090103500202000372770217770414813000
PATRICIA ELLEN GRANT MD
3535000203500-15020372770236580433283000
WILLIAM BARBARESI MD
2424000953510722630488170242970483128000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 4BTHE CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INC. (THE FOUNDATION) ESTABLISHED THE INELIGIBLE DEFERRED COMPENSATION PLAN. THIS PLAN IS INTENDED TO QUALIFY UNDER SECTION 457(F) OF THE CODE, AND IS INTENDED TO CONSTITUTE A "TOP-HAT PLAN" DESCRIBED IN SECTION 201(2) OF ERISA. THE PAYMENT OF BENEFITS UNDER THE PLAN IS AT THE SOLE DISCRETION OF THE FOUNDATION. IN MEETING ITS FUNDING OBLIGATION, THE EMPLOYER WILL HOLD EMPLOYEE CONTRIBUTIONS IN A RABBI TRUST. EACH EMPLOYEE WHO IS A) AN OFFICER OR HIGHLY COMPENSATED EMPLOYEE OF THE FOUNDATION; B) A PROFESSOR AT HARVARD UNIVERSITY, OR ITS PROFESSIONAL EQUIVALENT; AND C) DETERMINED BY THE FOUNDATION'S PRESIDENT TO BE ELIGIBLE, MAY PARTICIPATE IN THE PLAN. ADDITIONALLY, EACH TRUSTEE OF THE FOUNDATION WHO IS DETERMINED BY THE FOUNDATION'S PRESIDENT TO BE ELIGIBLE MAY PARTICIPATE IN THE PLAN. PARTICIPANTS MAY ELECT TO DEFER COMPENSATION BY A SPECIFIC AMOUNT WHICH, FOR ANY TAXABLE YEAR, SHALL NOT EXCEED AN AMOUNT ESTABLISHED BY THE PLAN ADMINISTRATOR. THE FOUNDATION MAY, BUT IS NOT REQUIRED TO, CONTRIBUTE AN AMOUNT DETERMINED IN THE SOLE DISCRETION OF THE FOUNDATION, ON BEHALF OF ONE OR MORE ELIGIBLE PARTICIPANTS FOR A PLAN YEAR. PARTICIPANTS ARE FULLY VESTED IN THE FUNDS CREDITED TO THEIR ACCOUNTS AFTER SEVEN CONSECUTIVE YEARS OF SERVICE. THE FOUNDATION MADE THE FOLLOWING CONTRIBUTIONS TO THE 457(F) PLAN FOR THE EMPLOYEES LISTED ON PART VII, PAGE 7: GARY R. FLEISHER, MD, $32,000; WILLIAM E. HARMON, MD, $32,000; WILLIAM TARVAINEN, $25,000; RICHARD BACHUR, MD, $15,000; S. JEAN EMANS, MD, $32,000; RAIF S. GEHA, MD, $32,000; CRAIG GERARD, MD, $22,000; STELLA KOUREMBANAS, MD, $22,000; ALAN LEICHTNER, MD, $23,000; WAYNE LENCER, MD, $21,000; JOSEPH MAJZOUB, MD, $32,000; LEONARD RAPPAPORT, MD, $17,000; MARK SCHUSTER, MD, $17,000; MICHAEL WESSELS, MD, $23,000; DAVID WILLIAMS, MD, $17,000; AND WILLIAM BARBARESI, MD, $12,000.
PART I, LINE 7THE CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INC. (THE FOUNDATION) PAID THE FOLLOWING BONUS COMPENSATION TO ELIGIBLE EMPLOYEES: A) AMBULATORY CLINIC BONUS - PARTICIPANTS ARE ELIGIBLE FOR THIS BONUS IF THEY WORK A MINIMUM OF 0.2 FTES IN THE CLINIC AND HAVE AN OVERALL SURPLUS THAT IS GREATER THAN 2.2 TIMES THE SALARY CHARGED TO THE FOUNDATION OR THE SERVICE FUND. THE ELIGIBLE PARTICIPANT CAN RECEIVE 22% OF THEIR FIRST $100,000 SURPLUS, 17% OF THEIR SURPLUS BETWEEN $100,000 AND $200,000, AND 24% OF ANY SURPLUS GREATER THAT $200,000. THE BONUS AWARD IS SUBJECT TO THE PARTICIPANT'S TOTAL DIRECT COMPENSATION NOT EXCEEDING THE HARVARD MEDICAL SCHOOL'S COMPENSATION GUIDELINES; B) ACADEMIC BONUS - 7.5% OF THE DEPARTMENT'S SURPLUS HAS BEEN SET ASIDE TO AWARD ACADEMIC BONUSES. THE BONUS POOL HAS BEEN DISTRIBUTED TO THE DIVISIONS BASED ON ITS REVENUE. THE DIVISION CHIEF MAY DISTRIBUTE HIS/HER BONUS POOL AT THEIR DISCRETION. FACULTY AND STAFF ARE ELIGIBLE TO RECEIVE THIS BONUS AS LONG AS THEY ARE ON THE PAYROLL FOR CHILDREN'S HOSPITAL OR THE FOUNDATION; AND C) BONUSES FOR EMERGENCY, NEWBORN, INPATIENT PROGRAMS, AND PHA ARE BASED ON 13% OF THE DIVISION/PROGRAM SURPLUS. BONUS COMPENSATION IS USUALLY APPROVED BY THE DIVISION CHIEFS AND THE PRESIDENT OF THE FOUNDATION.

Schedule L IRS990ScheduleL

Loan Table LoanTable (6 entries)

Purpose Of LoanPurposeOfLoanLoan From OrganizationLoanFromOrganizationOriginal PrincipalOriginalPrincipalAmountBalance DueBalanceDueDefaultDefaultApproved By BoardApprovedByBoardWritten AgreementWrittenAgreement
CHRISTOPHER WALSH MD
PHYSICIAN RECRUITMENTX$300,000300000011
MARK SCHUSTER MD
PHYSICIAN RECRUITMENTX$400,000160000011
DAVID WILLIAMS MD
PHYSICIAN RECRUITMENTX$650,000335000011
ISAAC KOHANE MD
PHYSICIAN RECRUITMENTX$85,55051330011
WILLIAM BARBARESI MD
PHYSICIAN RECRUITMENTX$428,000308000011
GARY VISNER MD
PHYSICIAN RECRUITMENTX$250,00050000011
FieldValueIRS element (for citing)
Total Balance Due1204330TotalBalanceDue

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
ExplanationSCHEDULE L, PART II:THE CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INC. (THE FOUNDATION) HAS DEVELOPED A RECRUITMENT LOAN PROGRAM FOR ELIGIBLE EMPLOYEES AS INCENTIVE FOR QUALIFIED EMPLOYEES TO RELOCATE TO CERTAIN FACILITIES AS DEMANDS OF THE FOUNDATION'S PRACTICE ARISE. THE LOAN PROCEEDS ARE TO BE USED FOR THE PURCHASE OF A PRINCIPAL PERSONAL RESIDENCE. THE LOANS ARE SECURED BY A PROMISSORY NOTE AND A SECOND MORTGAGE ON THE RESIDENCE. THE FOUNDATION HAS PROVIDED FOUR LOANS TO THREE MEMBERS OF THE BOARD. HOWEVER, THE FOUNDATION HAS PROVIDED DEMAND LOANS TO OTHER EMPLOYEES. THE LOANS WERE MADE FOR RECRUITMENT AND RELOCATION PURPOSES, TO ASSIST THE PHYSICIAN EMPLOYEES IN THE PURCHASE OF THEIR PRIMARY RESIDENCE. THE AMOUNTS FOR THE RECRUITMENT LOANS WERE ORIGINALLY FUNDED BY RESTRICTED DONATIONS PROVIDED BY CHILDREN'S HOSPITAL FOR USE IN RECRUITMENT. THE LOANS WILL BE FORGIVEN OVER THE TERMS OF THE NOTES IF THE RECIPIENTS REMAIN EMPLOYED AT THE FOUNDATION OR ITS AFFILIATES. IF ANY BORROWER TERMINATES THEIR EMPLOYMENT, THE REMAINING BALANCE BECOMES IMMEDIATELY DUE. THE AMOUNT OF THE LOAN FORGIVENESS WILL BE INCLUDED WITH ACCRUED INTEREST, IF APPLICABLE, AS COMPENSATION IN THE YEAR FORGIVEN.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (11 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 1A MAJORITY OF THE CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INC. (THE FOUNDATION) BOARD MEMBERS ARE PHYSICIANS WHO ARE NOT INDEPENDENT FROM THE FOUNDATION. HOWEVER, THE FOUNDATION IS PART OF AN INTEGRATED DELIVERY SYSTEM WITH CHILDREN'S HOSPITAL (THE HOSPITAL) WHICH DOES HAVE A COMMUNITY BOARD. THE FOUNDATION WAS ORGANIZED IN 2002. AT THAT TIME, THE BOARD WAS COMPOSED ENTIRELY OF PHYSICIANS, A BOARD STRUCTURE THAT WAS APPROVED BY THE INTERNAL REVENUE SERVICE. THE FOUNDATION HAS SINCE ADJUSTED THE BOARD STRUCTURE TO MAKE IT MORE RESPONSIVE TO THE HOSPITAL BY ADDING THE PHYSICIANS' ORGANIZATION AT CHILDREN'S HOSPITAL, INC. (THE PO) AS A MEMBER. SEE SCHEDULE O, PART VI, QUESTIONS 3, 6, 7B, AND 12 FOR MORE DETAILS OF THE PO'S RIGHTS.
FORM 990, PART VI, SECTION A, LINE 3THE PHYSICIANS' ORGANIZATION AT CHILDREN'S HOSPITAL, INC. (THE PO) IS A CLASS "C" MEMBER OF CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATION, INC. (THE FOUNDATION). THE PO IS RESPONSIBLE FOR ALL THIRD PARTY CONTRACTING FOR THE FOUNDATION. THE PO HAS THE POWER TO SELECT THE INDEPENDENT AUDITOR AND LEGAL COUNSEL OF THE FOUNDATION FROM AN APPROVED LIST OF FIRMS MUTUALLY AGREED TO BY THE PO AND THE FOUNDATION. THE PO ALSO HAS THE RIGHT TO REVIEW, BUT NOT TO APPROVE, THE ANNUAL OPERATING BUDGET AND ALL CAPITAL BUDGETS OF THE FOUNDATION. LASTLY, THE PO HAS THE RIGHT TO REVIEW FOR COMPLIANCE WITH APPLICABLE LAW, THE GENERAL TERMS OF AND ANY MODIFICATION TO PHYSICIAN COMPENSATION AND BENEFIT PLANS FOR ALL PHYSICIAN EMPLOYEES OF THE FOUNDATION. THE PO IS CONSIDERED THE COMPENSATION COMMITTEE OF THE FOUNDATION.
FORM 990, PART VI, SECTION A, LINE 6THE CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INC. (THE FOUNDATION) HAS FOUR CLASSES OF MEMBERS. THE PEDIATRICIAN-IN-CHIEF OR ANY ACTING PEDIATRICIAN-IN-CHIEF, AS CHIEF OF THE DEPARTMENT OF MEDICINE (THE DEPARTMENT) OF CHILDREN'S HOSPITAL (THE HOSPITAL), IS A CLASS "A" MEMBER. ANY PERSON WHO (I) IS A PHYSICIAN-EMPLOYEE OF THE FOUNDATION WITH AN ACTIVE MEDICAL STAFF APPOINTMENT FROM THE HOSPITAL, AND (II) EITHER (A) IS A DIVISION CHIEF OF A DIVISION OF THE DEPARTMENT WHOSE FACULTY ARE ON THE FOUNDATION'S PAYROLL OR (B) FUNCTIONS AS A DIVISION CHIEF OF A DIVISION OF THE DEPARTMENT WHOSE FACULTY ARE NOT ON THE FOUNDATION PAYROLL, OR (C) HAS A FACULTY APPOINTMENT FROM HARVARD MEDICAL SCHOOL SHALL BE A CLASS "B" MEMBERS. THE PHYSICIANS' ORGANIZATION AT CHILDREN'S HOSPITAL, INC. (THE PO) IS A CLASS "C" MEMBER. ALL OTHER INDIVIDUALS WHO HOLD HARVARD APPOINTMENTS OTHER THAN THE CLASS "A" AND "B" MEMBERS SHALL BE CLASS "D" MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7ATHE PEDIATRICIAN-IN-CHIEF OR ANY ACTING PEDIATRICIAN-IN-CHIEF, AS CHIEF OF THE DEPARTMENT OF MEDICINE OF CHILDREN'S HOSPITAL (THE HOSPITAL), IS THE CLASS "A" MEMBER OF CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INC. (THE FOUNDATION). ACCORDING TO THE ARTICLES OF ORGANIZATION, THE CLASS "A" MEMBER APPOINTS THE BOARD'S MEMBERS OF THE FOUNDATION FOR A 3-YEAR TERM AT THE FOUNDATION'S ANNUAL MEETING.
FORM 990, PART VI, SECTION A, LINE 7BTHE PHYSICIANS' ORGANIZATION AT CHILDREN'S HOSPITAL, INC. (THE PO) IS A CLASS "C" MEMBER OF THE CHILDREN'S HOSPITAL PEDIATRIC ASSOCIATES, INC. (THE FOUNDATION). THE PO IS RESPONSIBLE FOR ALL THIRD PARTY CONTRACTING FOR THE FOUNDATION. THE PO HAS THE POWER TO SELECT THE INDEPENDENT AUDITOR AND LEGAL COUNSEL OF THE FOUNDATION FROM AN APPROVED LIST OF FIRMS MUTUALLY AGREED TO BY THE PO AND THE FOUNDATION. THE PO ALSO HAS THE RIGHT TO REVIEW, BUT NOT TO APPROVE, THE ANNUAL OPERATING BUDGET AND ALL CAPITAL BUDGETS OF THE FOUNDATION. LASTLY, THE PO HAS THE RIGHT TO REVIEW FOR COMPLIANCE WITH APPLICABLE LAWS, THE GENERAL TERMS OF AND ANY MODIFICATION TO PHYSICIAN COMPENSATION AND BENEFIT PLANS FOR ALL PHYSICIAN EMPLOYEES OF THE FOUNDATION. THE PO IS CONSIDERED THE COMPENSATION COMMITTEE OF THE FOUNDATION. AS A CLASS "C" MEMBER OF THE FOUNDATION, THE PO ATTENDS THE FOUNDATION'S ANNUAL MEETING AND HAS CERTAIN VOTING RIGHTS. THE PO AS A CLASS "C" MEMBER HAS ONE OF THE 18 VOTES.
FORM 990, PART VI, SECTION B, LINE 11THE DETAILED REVIEW WILL BE CONDUCTED BY THE PRESIDENT OF THE FOUNDATION, GARY R. FLEISHER, MD AND THE CHIEF FINANCIAL OFFICER, WILLIAM TARVAINEN. AN ELECTRONIC COPY WILL BE PROVIDED TO THE BOARD ALONG WITH A HARD COPY OF FORM 990 PRIOR TO FILING. THE DETAILED REVEIW WILL BE CONDUCTED BEFORE FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE.
THE PHYSICIANS' ORGANIZATION AT CHILDREN'S HOSPITAL, INC. (THE PO) ADMINISTERS AN ANNUAL CONFLICT OF INTEREST DISCLOSURE PROCESS TO ALL OF ITS MEMBER FOUNDATIONS, WHICH ASKS PHYSICIANS (OFFICERS, TOP MANAGEMENT, AND HIGHLY COMPENSATED EMPLOYEES) AND SELECTED FOUNDATION STAFF TO DISCLOSE POTENTIAL CONFLICTS. A DISCLOSURE STATEMENT WILL BE CIRCULATED ANNUALLY TO MEMBERS OF THE PO. THE PO AUDIT COMMITTEE SHALL DETERMINE THOSE INDIVIDUALS (INCLUDING MEDICAL STAFF MEMBERS) WHO SHALL BE REQUIRED TO COMPLETE THE DISCLOSURE STATEMENT. THE PO AUDIT COMMITTEE, AT ITS DISCRETION, MAY EITHER: 1) REFER ANY OR ALL DISCLOSURE STATEMENTS TO THE BOARD OF DIRECTORS; 2) APPOINT AN AD HOC COMMITTEE TO REVIEW AND RESOLVE ANY CONFLICT OF INTEREST ISSUES; OR 3) REVIEW AND RESOLVE ANY CONFLICT OF INTEREST ISSUES PERSONALLY OR THROUGH A DESIGNEE(S). ANY PERSON NOT RECEIVING A DISCLOSURE STATEMENT NEVERTHELESS HAS AN AFFIRMATIVE OBLIGATION TO DISCLOSE TO THE PO PRESIDENT, PO GENERAL COUNSEL, OR HIS/HER SUPERVISOR WHENEVER HE/SHE BELIEVES HE/SHE HAS OR MAY HAVE A CONFLICT OF INTEREST. SIMILARLY, EACH PERSON COMPLETING A DISCLOSURE STATEMENT HAS AN AFFIRMATIVE OBLIGATION TO UPDATE THE STATEMENT ANY TIME CIRCUMSTANCES CHANGE AND/OR HE/SHE BELIEVES THAT A CONFLICT OF INTEREST MAY EXIST. IN THE EVENT A CONFLICT OF INTEREST IS FOUND TO EXIST, THE FOUNDATION PROHIBITS THE MEMBER FROM VOTING ON ANY MATTER TO WHICH THE CONFLICT RELATES OR OTHERWISE INFLUENCE THE VOTING ON SUCH MATTER.FORM 990, PART VI, SECTION B, LINE 12C
ALL THE PHYSICIANS (TOP MANAGEMENT, OFFICERS, AND HIGHLY COMPENSATED INDIVIDUALS) FALL UNDER COMPENSATION GUIDELINES DETERMINED BY HARVARD UNIVERSITY, WITH LIMITATIONS ESTABLISHED FOR CERTAIN POSITIONS/RANKS WITHIN THE MEDICAL SCHOOL. ANNUALLY, COMPENSATION IS REVIEWED AND REPORTED TO THE HOSPITAL'S BOARD OF TRUSTEES TO ENSURE TOTAL DIRECT AND INDIRECT COMPENSATION DOES NOT EXCEED THE PRE-DETERMINED GUIDELINES OF HARVARD UNIVERSITY. ANY NEW INDIRECT BENEFIT PLAN REQUIRES APPROVAL BY THE FOUNDATION'S BOARD OF DIRECTORS, WHICH THEN MUST BE REVIEWED AND PERMITTED BY THE HOSPITAL. MAJOR PROCEDURES OF THE APPROVAL PROCESS INVOLVE: COMPARING COMPENSATION DATA OF PHYSICIANS WITHIN THE COMPARABLE FIELD OF MEDICINE; INDIRECT COMPENSATION CURRENTLY BEING OFFERED; AND THE FINANCIAL STABILITY OF THE FOUNDATION. THIS PROCESS WAS FOLLOWED FOR THE YEAR ENDED SEPTEMBER 30, 2011. THE PHYSICIANS' ORGANIZATION AT CHILDREN'S HOSPITAL, INC. (THE PO) IS CONSIDERED THE COMPENSATION COMMITTEE OF THE FOUNDATION.FORM 990, PART VI, SECTION B, LINE 15
THE FOUNDATION MAINTAINS ALL FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICIES, AND GOVERNING DOCUMENTS AT ITS MAIN OFFICE AT 20 OVERLAND STREET, BOSTON, MA 02215. THE DOCUMENTS ARE AVAILABLE UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED LOSSES ON INVESTMENTS: -5,977,753.FORM 990, PART XI, LINE 5:
PART VI, QUESTION 13: CURRENTLY, THE FOUNDATION DOES NOT HAVE A WHISTLEBLOWER POLICY. HOWEVER, THE BOARD COMMITTEE HAS PLANS TO DEVELOP THIS POLICY IN THE NEXT YEAR. PART X, COLUMN A: THE PRIOR YEAR COLUMN OF THE BALANCE SHEET ON FORM 990 WAS UPDATED TO AGREE TO THE AUDITED FINANCIAL STATEMENTS, IN WHICH THE PRIOR YEAR CLASSIFICATIONS WERE REVISED. THE LINES THAT WERE UPDATED ARE: LINE 1 WAS UPDATED FROM $8,292,467 TO $2,112,057; LINE 2 WAS UPDATED FROM $22,767,761 TO $29,482,085; LINE 4 WAS UPDATED FROM $15,444,253 TO $13,584,792; LINE 11 WAS UPDATED FROM $135,289,449 TO $134,755,535; LINE 15 WAS UPDATED FROM $14,883,592 TO $16,743,053; LINE 25 WAS UPDATED FROM $15,653,507 TO $18,806,302; LINE 26 WAS UPDATED FROM $22,996,960 TO $26,149,755; LINE 27 WAS UPDATED FROM $215,005,816 TO $211,853,021; AND LINE 33 WAS UPDATED FROM $218,188,766 TO $215,035,971. PART XI, QUESTION 2C: THE AUDIT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
CHILDREN'S HOSPITAL
300 LONGWOOD AVENUEBOSTONMA02115042774441HOSPITALMA501(C)(3)LINE 3N/A0
PHYSICIANS' ORGANIZATION AT CHILDREN'S HOSPITAL INC
300 LONGWOOD AVENUEBOSTONMA02115043266103PHYSICIAN ORGANIZATIONMA501(C)(3)LINE 11 TYPE III - FN/A0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.