2012-11-01T16:53:43-05:00 2011-12-31 861065772 DELOITTE TAX LLP 50 SOUTH SIXTH STREET STE 2800 MINNEAPOLIS MN 55402 990 2011-01-01 411200302 Gillette Children's Hospital Foundation GILL 6512912848 200 University Avenue East St Paul MN 55101 JAMES HADDICAN 6512912848 2012-10-25 1 Kristina Rasmussen P00143920 6123974000 2011 2016-02-24 21:20:13Z James Haddican 200 University Avenue East ST Paul MN 55101 18536634 0 X WWW.GILLETTECHILDRENS.ORG X 1985 MN The Foundation raises money for and otherwise supports Gillette Children's Specialty Healthcare. 25 21 0 87 0 0 6758539 7925252 0 0 493383 803004 -27440 -17235 7224482 8711021 3966306 6222699 0 0 1982285 2055205 72136 107540 2660898 1880527 1695321 7901254 10080765 -676772 -1369744 15317321 13425785 783419 1405834 14533902 12019951 X The mission of Gillette Children's Hospital Foundation (Foundation) is to raise money, build awareness, and develop relationships so the mission of Gillette Children's Specialty Healthcare (Gillette) can be fulfilled. 0 0 4061599 4061559 Patient care:The Foundation also raises money to support Gillette's patient-care needs. This fundraising area in 2011 involved charitable support for Gillette's outpatient clinics. In 2011, Gillette had 129,562 outpatient visits-excluding casting, X-ray, advanced imaging, and neurodiagnostic services-from children and adults with many chronic and acquired conditions, including cerebral palsy, spinal-cord injuries, spina bifida, brain injuries, complex orthopedic needs, neurological disorders, craniofacial anomalies and juvenile arthritis. Outpatient appointments for all services came to 138,381. 2130934 2130934 Capital:The Foundation raises money to support Gillette in providing specialty health care for people who have disabilities. In 2011, the Foundation's largest capital fundraising expenditures involved renovating and expanding Gillette's facilities in St. Paul. Gillette's new state-of-the-art surgery space has been carefully designed for children who have disabilities. Its extra-large surgical suites provide room for interdisciplinary surgical teams and new technology, which helps Gillette surgeons provide the best in patient care and safety. See Schedule OPositive distraction features in our pre- and postsurgical bays and perianesthesia care unit help ease children's anxieties before and after surgery. Gillette's surgery simulation center enables staff to plan complex surgeries and to teach staff and medical residents. Gillette's new Neurosciences Unit offers expert care for children who have complex neurological conditions and injuries. With nurses stationed outside each room, the unit's design allows for close monitoring while maintaining patient privacy. Private patient rooms feature bathrooms, sleeping accommodations for family members, and colorful light displays in the ceilings to entertain and distract patients. Expanded family-friendly spaces include the Ronald McDonald Family Room (TM), which features a common space that's open to the families of children staying overnight at the hospital, along with facilities for up to four families to stay overnight in private rooms. In addition, the St. Paul campus has added therapeutic play areas, including a play therapy room, where a certified play therapist encourages children to express their feelings through activities; an inpatient play room, which offers activities for younger children, along with computers and age-appropriate video games for teens; and the Peggy King Healing Garden, which lets patients enjoy being outdoors and practice skills, such as walking, climbing, and navigating uneven surfaces.Gillette's new patient care building opened in January 2011. The new location of the James R. Gage Center for Gait and Motion Analysis has twice the patient testing space it did previously. It allows Gillette to meet patient demand in a space designed for privacy and comfort. More testing space also allows for additional research, including studies of outcomes following selective dorsal rhizotomy surgery-a procedure that permanently reduces spasticity in children who have cerebral palsy. Patients who need rehabilitation therapy also have an expanded space to work on skills, with new equipment including a robotic-assisted locomotor training system. 30166 30166 Research & Education:The Foundation also raises money to support Gillette's ongoing research projects and education programs. During 2011, Gillette researchers focused on studies including the use of gabapentin in nonverbal children who exhibit pain behaviors and the characteristics of a successful transition to adult independence for young adults who have spina bifida. Through its priority areas for coordinated research, Gillette is working to increase the amount and quality of clinically relevant research conducted in the organization. Each year, Gillette doctors and staff publish research studies in medical journals and speak at medical conferences.See Schedule OOne of the primary Foundation grants in the area of education involved funding an academically affiliated spasticity management fellowship. The fellowship helps prepare physicians who are highly qualified in spasticity management to incorporate spasticity management therapies (including, but not limited to intrathecal baclofen therapy) into their clinical practices. 6222699 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 1 1 0 1 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 X 25 21 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 1 1 0 MN WI X Scott Ryberg 6512912848 200 University Avenue East St Paul MN 55101 X John Diehl 1.00 X X 0 0 0 Heidi Erspamer 1.00 X 0 0 0 Todd Fisher 1.00 X 0 0 0 David Glaser 1.00 X 0 0 0 James Hynes 1.00 X 0 0 0 Margaret Perryman 15.00 X X 0 740308 214155 Jerome Kahnke 1.00 X 0 0 0 Deborah Quanbeck MD 1.00 X 0 506357 60092 Scott Ward 1.00 X X 0 0 0 Beverly Wical MD 1.00 X 0 225868 42837 Braxton Haulcy 1.00 X 0 0 0 Chuck Amos 1.00 X 0 0 0 James Bradshaw 1.00 X 0 0 0 Jeff Evanson 1.00 X 0 0 0 John Guider 1.00 X 0 0 0 Robert Folkes 1.00 X X 0 0 0 Dale Schoonover 1.00 X X 0 0 0 Wendy Dumke 1.00 X 0 0 0 Julie Rechtiene 1.00 X 0 0 0 Diane Harper 1.00 X 0 0 0 Angie Lalor 1.00 X 0 0 0 Scott Robinson 1.00 X 0 0 0 Carole Schleif 1.00 X 0 0 0 Warren Watson 1.00 X 0 0 0 Robert Wagner MD 1.00 X 0 229074 46710 James Haddican 5.00 X 0 348308 60973 Jon Galloway 40.00 X 299163 0 46090 Darlis Clausen 40.00 X 122372 0 15546 Blaine Thrasher 40.00 X 111416 0 30117 Scott Nelson 40.00 X 125444 0 30157 658395 2049915 546677 4 0 1 0 Russ Reid 14384 Collections Center Drive Chicago IL 60693 Direct Mail 362146 Gabriel Degrood Bendt LLC 608 2nd Avenue S Suite 129 Minneapolis MN 55402 Advertising 233019 2 303675 7621577 100750 7925252 228831 228831 10301871 9727698 574173 574173 574173 80680 303675 97915 -17235 -17235 8711021 0 0 785769 6204093 6204093 7606 7606 11000 11000 345253 345253 1709952 267272 1442680 25524 8865 16659 107540 107540 65871 29642 36229 846226 314205 532021 295308 114104 181204 48729 17496 31233 33050 13124 19926 49884 21141 28743 42355 8226 34129 2300 1035 1265 Dues & Memberships 211303 0 37089 174214 Bad Debt 31065 0 0 31065 Meals 25336 0 11611 13725 Misc. Expense 18370 0 8105 10265 10080765 6222699 1197168 2660898 X 173240 79711 2630994 1253960 897375 1148415 121237 70253 189595 195283 98501 93661 7140 4840 10998034 10368688 299706 304635 15317321 13425785 16004 0 767415 1405834 783419 1405834 X 8705336 6971327 3594951 2814759 2233615 2233865 14533902 12019951 15317321 13425785 X -1369744 -1144206 X 0 1 1 X 0 X X X 0 0 0 Gillette Children's Specialty Healthcare 363379150 3 1 1 1 6161494 1 6161494 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3791838 8432 56433 369299 121618 3365786 3708926 7209 402507 180146 146658 3791838 3346189 67528 445743 48639 101895 3708926 4179288 -667021 63695 102383 3346189 0.00000 0.66000 0.34000 0 0 98501 93661 4840 4840 Gift Annuity Liability - Wisc 92686 Gift Annuity Liability 83916 Due to Medical Center 1229232 1405834 8711021 10080765 -1369744 -1144206 -1144206 -2513950 7670755 -1144206 6025 97915 -1040266 8711021 0 8711021 10184705 6025 97915 103940 10080765 0 10080765 Description of Intended Use of Endowment Funds: Part V, Line 4: The Foundation has endowment funds for capital, charity care, patient care, research and education, and unrestricted needs. These funds are used to improve and provide health care and related services to patients of Gillette. Description of Uncertain Tax Positions Under FIN 48: Part X: As a result of the implementation of the authoritative guidance on the accounting for uncertainty in income taxes, the organization was not required to recognize a liability. There were no unrecognized tax liabilities for the years ended December 31, 2011 and 2010. Part XII, Line 2d - Other Adjustments: Special events expense 97,915. Part XIII, Line 2d - Other Adjustments: Special events expense 97,915. 1 North America 0 0 Grantmaking 11000 0 0 0 0 0 0 11000 0 11000 North America Adaptive Sports-Bikes 11000 Check 0 FMV 1 0 0 0 0 0 0 Procedure for Monitoring Grants Outside the U.S.: Schedule F, Part I, Line 2: Grant requests are reviewed and approved by Gillette management. Grant amounts are awarded after careful consideration of the appropriate needs and budget requirements of the organization. The Foundation ensures that the purpose of the grant is clearly understood by the recipient. X X X X X X 1 Strategic Fundraising 7591 Ninth St No Oakdale MN 55128 Telefundraising 0 102103 107540 -5437 102103 107540 -5437 MN WI Golf Event 103435 73355 30080 31698 Friends of Gillette Event 280920 230320 50600 66217 384355 303675 80680 97915 97915 -17235 Explanation of Fundraising Payments Schedule G, Part I, Line 2b, Column (v) Gillette pays its telemarketing vendor on a per-call basis, meaning every phone call completed is paid for regardless of the outcome of those calls. There are two ways in which Gillette uses telemarketing: 1) to solicit additional donations from current donors and 2) to ask people who have previously never given to Gillette to donate. While the first strategy is extremely effective and the revenues raised exceed the cost, the second strategy requires a high number of phone calls made in order to get a small percentage of people to donate for the first time. Therefore the second strategy is an investment to add new donors. This is a strategic decision, as those new donors will become valuable in due time, and is less expensive than acquiring new donors through direct mail or other channels. 1 Regions Hospital 640 Jackson Street St Paul MN 55101 410956618 501(c)(3) 5543 FMV Cafeteria Passes Bikes for Everybody 1070 Putname Avenue Redwing MN 55066 271958997 24685 FMV Adaptive Sports-Bikes Gillette Children's Specialty Healthcare 200 University Avenue East St Paul MN 55101 363379150 501(c)(3) 6120564 40930 FMV General Support 2 1 Adaptive Sports Grant 12 7606 0 FMV N/A Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Members of Gillette's hospital board are also members of the Foundation board, resulting in common control of both entities and the sharing of community oversight, strategic planning, financial oversight, and fundraising responsibilities equally among all board members. As a Type II support organization pursuant to IRC section 509(a)(3), Reg. 1.509(a)-4(f)(2)(ii), the Foundation grants monies to Gillette and maintains endowment funds, restricted and unrestricted assets, and contributions received to benefit Gillette. These funds held by the Foundation are granted to Gillette pursuant to the restrictions of the particular fund. Periodically, the Foundation receives financial reports from Gillette documenting the use of monies, including endowment funds, restricted funds, and unrestricted funds, received by Gillette. X X X X X 0 1 0 0 0 0 0 0 0 Margaret Perryman 0 462069 0 161657 0 116582 0 189003 0 25152 0 954463 0 46744 Deborah Quanbeck MD 0 420920 0 0 0 85437 0 12961 0 47131 0 566449 0 33830 Beverly Wical MD 0 207473 0 500 0 17895 0 10716 0 32121 0 268705 0 4280 Robert Wagner MD 0 206633 0 575 0 21866 0 11382 0 35328 0 275784 0 0 James Haddican 0 236498 0 67431 0 44379 0 16804 0 44169 0 409281 0 6564 Jon Galloway 220345 0 59251 0 19567 0 33800 0 12290 0 345253 0 18554 0 Scott Nelson 124577 0 625 0 242 0 6272 0 23885 0 155601 0 0 0 Part I, Line 4b Certain employees of Gillette are provided the opportunity to participate in the pension restoration plan (The Plan). The Plan requires that the employee be an executive of Gillette in order to be eligible to participate in The Plan. Payments from The Plan occur annually by July 1 of the year following the end of The Plan year. This Plan is a "gap" plan which provides participants with a deposit that closes the gap between the limits of IRC 403(b) and the actual cash compensation of the participant. Margaret Perryman $12,485 James Haddican $4,281 Jon Galloway $1,871 Supplemental Information Part III Part I, line 3: The chair of Gillette's personnel committee requests information from the external consultant. The personnel committee is empowered to evaluate the reasonableness of compensation and other financial transactions in which the Foundation is engaged. It does so in all cases by referencing recognized, objective resources on the reasonableness of and market value for the types of personnel and services being considered. That data is prepared for and distributed to the personnel committee members. Compensation policy is approved by the board of directors. Actions related to CEO/president and other executive compensation are discussed and voted upon at personnel committee meetings. Meeting minutes are recorded. X 1 17700 Cost or selling price X 11 42120 Cost or selling price X Bldg Materials 1 40930 Cost or selling price 1 0 1 1 Third Party Use: Part I, Line 32b: In 2011, the Foundation used a car broker to sell a donated car that was received in 2011. Form 990, Part VI, Section A, line 2 The following individuals have a business relationship: John Diehl Heidi Erspamer Todd Fisher David Glaser James Hynes Margaret Perryman Jerome Kahnke Deborah Quanbeck, MD Scott Ward Beverly Wical, MD Braxton Haulcy Chuck Amos James Bradshaw Jeff Evanson John Guider Robert Folkes Dale Schoonover Wendy Dumke Julie Rechtiene Diane Harper Angie Lalor Scott Robinson Carole Schleif Warren Watson Robert Wagner, MD James Haddican Form 990, Part VI, Section A, line 6 The Foundation has a sole member, Gillette Children's Specialty Healthcare, a Minnesota nonprofit corporation. Form 990, Part VI, Section A, line 7a The Foundation has a sole member, Gillette Children's Specialty Healthcare, a Minnesota nonprofit corporation which elects all members of the Foundation board. Form 990, Part VI, Section A, line 7b The decisions of the governing body are subject to the approval of the Foundation's sole member, Gillette Children's Specialty Healthcare. The hospital board reserved powers are the election of board members and the Foundation board; as long as it follows its bylaws, the board has autonomy in other decisions. Form 990, Part VI, Section B, line 11 A copy of the form 990 was provided to every member of the governing body before it was filed. The form was completed by a committee that included representatives from finance, human resources, development and communications. This committee prepared all the documentation necessary; the forms were compiled by Gillette's accounting firm. The draft documents were then reviewed by the vice president of finance, the vice president of strategic planning, and the vice president of development. After all internal reviews were complete, the final version was presented to the finance committee and the board of directors for approval. Form 990, Part VI, Section B, line 12c Gillette enforces policies on external professional activities. Gillette employees, officers, volunteers, board members, and medical staff members are expected to disclose outside activities that involve potential conflicts of interests. In fact, directors must sign a conflict of interest statement acknowledging any potential conflicts related to Gillette. Gillette requires staff members to discuss potential conflicts with their immediate manager and with the compliance officer. The disclosure includes a written description of the activity, the extent of the staff member's participation, and the possible duration of the relationship. If a conflict exists, the employee must not engage in the activity. Form 990, Part VI, Section B, line 15 Foundation staff members are employed by Gillette. Gillette is the organization that actually pays the compensation and has the process for determining compensation as stated below. At the request of the personnel committee of the Gillette board, an independent consultant provides the committee with survey data along with its needs and expenses for patient care, under- and uncompensated care, and recommendations for chief executive officer (CEO)/president and other executive salary ranges. The ranges are developed by the external consultant based on Gillette's compensation philosophy, which was developed by the personnel committee and is reviewed regularly. The members of this committee determine the CEO/president's salary and the salary ranges for other executives. The committee oversees the executive incentive plan, approves any incentive plan payouts, and regularly evaluates the benefits provided to executives. The external consultant has provided an opinion that the CEO/president's total compensation is well within the standards of reasonableness and fair market value. In addition to the oversight function of executive total compensation, the personnel committee oversees any payments under any incentive compensation plans and evaluates all transactions with "disqualified persons." Form 990, Part VI, Section C, line 19 Gillette mails its annual report (which includes the audited financial statements) to Gillette employees, medical staff and board members; Gillette donors; selected state and city legislators; Minnesota pediatricians; media representatives; the Minnesota Hospital Association (MHA); and presidents and chief executive officers of members of the Children's Hospital Association and related institutions. Gillette's 990 form is available from the states of Minnesota and Wisconsin and at Guidestar.org. Gillette discloses financial statements to bondholders, the MHA and the Minnesota attorney general's office. The governing documents and conflict of interest policy are made available to the public upon request. Form 990, Part VII: The following individuals held positions at both Gillette Children's Hospital Foundation and Gillette Childrens Specialty Healthcare, the parent of Gillette Children's Hospital Foundation. The hours listed on Part VII are the average hours per week these individuals devoted to Gillette Children's Hospital Foundation during the year. In addition, these individuals also devoted the following average hours per week to Gillette Children's Specialty Healthcare. Margaret E. Perryman 40.0 hours James L. Haddican 40.0 hours Deborah Quanbeck, M.D. 40.0 hours Beverly Wical, M.D. 40.0 hours Robert Wagner, M.D. 40.0 hours John Diehl 1.0 hours Heidi Erspamer 1.0 hours Todd Fisher 1.0 hours David Glaser 1.0 hours James Hynes 1.0 hours Jerome Kahnke 1.0 hours Scott Ward 1.0 hours Braxton Haulcy 1.0 hours Chuck Amos 1.0 hours James Bradshaw 1.0 hours Jeff Evanson 1.0 hours John Guider 1.0 hours Robert Folkes 1.0 hours Dale Schoonover 1.0 hours Wendy Dumke 1.0 hours Julie Rechtiene 1.0 hours Diane Harper 1.0 hours Angie Lalor 1.0 hours Scott Robinson 1.0 hours Carole Schleif 1.0 hours Warren Watson 1.0 hours Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -1,144,206. Form 990, Part VI, Section B, Line 14: Foundation employees are expected to follow all hospital policies. The code-of-conduct, document-retention, and document-destruction policies authored by the hospital hence are followed by the Foundation staff. Gillette Children's Specialty Healthcare 200 University Avenue East St Paul MN 55101 363379150 Healthcare MN 501(c)(3) 3 N/A 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 1