2011-07-22T16:26:21-07:00 2010-09-30 990 2009-10-01 060646755 CONNECTICUT CHILDRENS MEDICAL CENTER CONN 8605459000 282 Washington Street Hartford CT 061063322 Gerald Boisvert 8605458557 2011-07-22 2009 2016-02-24 21:20:13Z Martin J Gavin 282 Washington Street Hartford CT 06106 210546129 0 X www.connecticutchildrens.org X 1921 CT Connecticut Children's Medical Center is an acute care children's hospital. 22 18 1566 283 388200 0 12379532 13267972 179148344 185903704 137171 127018 1157113 10790382 192822160 210089076 0 0 0 0 100732779 109227896 0 0 2152571 85112619 90741424 185845398 199969320 6976762 10119756 193060869 221478565 105950749 112744077 87110120 108734488 Connecticut Children's Medical Center is dedicated to improving the physical and emotional health of children through family-centered care, research, education and advocacy. We embrace discovery, teamwork, integrity and excellence in all that we do. 0 0 162972270 0 185903704 Acute Care Children's Hospital: To provide acute care inpatient and outpatient services to children from Connecticut and the surrounding area. In fiscal year 2010 there were 6,753 inpatient admissions and 145,134 outpatient visits. 0 0 0 162972270 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 264 0 1566 1 0 1 BD 0 0 0 22 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Patrick Garvey 8606105689 282 Washington Street Hartford CT 06106 Martin J Gavin 40 X X 430591 0 20202 Gerald J Boisvert 40 X X 333981 0 31753 Anne P Sargent 1 X 0 0 0 Cato Laurencin 1 X 0 0 0 Charles Shivery 1 X X 0 0 0 Donald Hight 1 X 0 439479 30347 E Clayton Gengras III 1 X 0 0 0 H Mark Lunenburg 1 X X 0 0 0 Harlan Kent 1 X 0 0 0 Jeffrey Hoffman 1 X 0 0 0 Jennifer Berlin 1 X 0 0 0 Katie Nixon 1 X 0 0 0 Louis Hernandez Jr 1 X 0 0 0 Lynda B Smith 1 X 0 0 0 Marilyn Bacon 1 X 0 0 0 Pamela Trotman Reid 1 X 0 0 0 Robert M Le Blanc 1 X 0 0 0 Robert Shanfield 1 X X 0 0 0 Soren Torp Laursen 1 X 0 0 0 Stephen J Sills 1 X 0 0 0 Thomas O Barnes 1 X 0 0 0 William Popik 1 X X 0 0 0 Fernando Ferrer 20 X 0 572285 35157 Paul Dworkin 40 X 366849 0 19676 Wendy Warring 40 X 327873 0 31320 Robert Englander 40 X 283590 0 23043 Ann Taylor 40 X 232565 0 29494 Theresa Hendricksen 40 X 212283 0 29013 Elizabeth Rudden 40 X 196041 0 20302 Linda Groom 40 X 161089 0 23933 Robert Fraleigh 40 X 143702 0 10178 Donna Megliola 40 X 141719 0 26267 Marlene Ferris 40 X 139701 0 21883 Christine Erikson 40 X 139107 0 17426 Karen O'Brien 40 X X 110981 35628 17295 Stephanie Capps 40 X X 110833 31662 24521 Stephanie McGuire 40 X X 109378 31723 26151 Patricia Trehey 40 X X 108823 34298 20033 3549106 1145075 457994 87 1 1 0 Hartford Hospital 80 Seymour Street Hartford CT 061025037 Medical supplies and support services 13931883 University of Connecticut Health Ce 270 Middle Turnpike Unit 5210 Storrs CT 062695210 Interns & Residents 6362092 Robinson Cole 280 Trumbull Street Hartford CT 06103 Legal Services 533817 Towers Perrin Forster Crosby Inc PO Box 850 S 6110 Philidelphia PA 19178 Actuarial Services 571467 Aramark Healthcare Support Systems PO Box 651009 Charlotte NC 282651009 Healthcare Support Services 1537892 33 0 0 0 0 6839320 6428652 0 13267972 Acute Care Children's Hospital 622000 185903704 185903704 0 0 0 0 0 0 185903704 127018 0 0 127018 0 0 0 0 0 0 0 0 362539 0 327266 0 35273 0 35273 0 0 35273 0 0 0 238391 129787 108604 0 25642 82962 Food Services 453000 1122763 0 0 1122763 Equity Swap 525990 8846725 0 0 8846725 Consulting 541900 367267 4709 362558 0 309750 0 0 309750 10646505 210089076 185908413 388200 10524491 3612586 3612586 0 83430266 73462051 8471938 1496277 3722927 3278737 377515 66675 12865973 11330909 1304644 230420 5596144 4928458 567463 100223 1034232 563315 470917 0 679384 0 679384 0 249900 0 249900 0 32715642 25796132 6903362 16148 1094122 16558 1077564 0 19323633 18473403 813840 36390 998290 850135 130867 17288 6606716 4190576 2358021 58119 390685 329575 57872 3238 416410 278939 116089 21382 1388163 881755 494227 12181 9775741 6209507 3480450 85784 5095569 4909887 185682 0 Indirect Cost Allocation 0 1038316 -1038316 0 Dues and Fees 1020072 236994 774869 8209 Bad Debt 3444264 0 3444264 0 Miscellaneous 6040364 5728786 311341 237 Unrelated business expenses for UBIT 468237 468237 0 0 199969320 162972270 34844479 2152571 2144261 3137285 20178554 18519560 603360 626751 5201612 4712943 166152830 75036632 93962849 91116198 70970233 103365828 193060869 221478565 44503106 47780634 35203820 32906457 8563351 13253385 17680472 18803601 105950749 112744077 X 23838478 26159891 8633094 12419785 54638548 70154812 87110120 108734488 193060869 221478565 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 1 0 0 1 27792 1 238250 0 0 266042 0 SchC_P2B_S00_L01 Schedule C, Part II-B, Line 1 Fees were paid to consulting firms to lobby on behalf of the hospital for legislation affecting children's health ($112,250). Membership and dues are paid to organizations for speeches, lectures and seminars ($27,792). Compensation is paid to employees for lobbying activity ($126,000). volunteers: Lobbying activities including phone calls, emails and letters to legislators and federal and state policy makers regarding various child related issues. There was no money involved in these transactions 61271367 6460674 5328006 0 0 0 73060047 57449645 1497728 2323994 0 0 0 61271367 0.41 0.22 0.37 0 1 1 0 0 0 0 102641438 36017211 66624227 0 8453464 2020076 6433388 0 52819691 36967887 15851804 0 2238237 31458 2206779 91116198 Funds held by trustee under revenue agreement 10424098 Due from Affiliated Entities 3731723 Funds Held in Trust by Others 70154812 Investment in Insurance Captive 15449496 Non Compete Agreement 800000 Rabbi Trust 372224 Other Assets 150604 Other Receivables 2282871 103365828 Due to Third Parties 1654459 Due to CCMC Affiliates 642915 Other Long-Term Liabilities 16506227 18803601 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Endowment and other funds are held and administered by Connecticut Children's Medical Center Foundation to be utilized to support and further the mission of Connecticut Children's Medical Center by providing funds in support of operations and capital purchases of Connecticut Children's Medical Center. SchD_P10_S00_L00 Schedule D, Part X Connecticut Children's Medical Center does not have uncertain tax positions under FIN 48. 1 1 1 X 2.5 1 X 0 1 0 1 1 83 663256 0 663256 0.0034 30237 93968961 76744552 17224409 0.0876 0 30320 94632217 76744552 17887665 0.0910 3870876 65421 3805455 0.0194 8178839 1281158 6897681 0.0351 1666924 49667 1617247 0.0082 3297345 96957 3200388 0.0163 11797 0 11797 0.0001 0 0 17025781 1493203 15532568 0.0791 0 30320 111657998 78237755 33420233 0.1701 2816397 0 2816397 0.0143 1991948 9677 1982271 0.0101 121385 0 121385 0.0006 27088 0 27088 0.0001 581289 7671 573618 0.0029 0 0 5538107 17348 5520759 0.0280 1 3444264 0 189858 189700 158 X 1 1 Connecticut Children's Medical Center

282 Washington Street Hartford CT 06106

X X X X X X Bad Debt of 3,444,264 was removed from the total expenses line 25 of the 990 for the calculations of the percent of total expenses in column (f). All other benefits (lines 7e to 7j) were reported as true costs not using a cost to charge ratio. Bad Debt is based upon historical collection percentage analysis of accounts written off. The sources of information for line 5 and 6 is the Medicare Cost Report. Connecticut Children's will only refer those accounts to collection agencies when it has been determined that the individual has the means to pay the balance, either through insurance or with their own funds, and has chosen not to apply for or is ineligible for patient financial assistance. Part I, Line 6a: Connecticut Children's Medical Center published a 2009/2010 Community Benefit Report - "Healthy Kids, Healthy Communities." The report was distributed as follows: * Copies were mailed to state government officials * Copies were mailed to local leaders and organizations * Copies were distributed at community meetings * Copies were made available to families, employees and visitors at kiosks throughout the medical center. * The report was put on our web-site. We service the entire state of Connecticut. Our approach to assessing community need during 2009 included the following elements that allowed us to look at neighborhood challenges, the city of Hartford, the Greater Hartford area, and the State of Connecticut: * We partnered with Hartford Hospital and Trinity College to form Southside Institutions Neighborhood Alliance (SINA). Throughout the year, SINA has engaged residents and local service providers in formal discussions regarding the needs of the neighborhood, public health issues included. * We sat on the city's Health and Human Services' Public Health Advisory Committee. * The Children's Center for Community Research - A program at CT Children's - conducted community based collaborative research with the goal of improving the health of children and families. * We collected information about trends from our clinics and Emergency Department. * We collected state wide admission data. * We researched national and local health related issues. * We participated on neighborhood, local, state-wide, and national committees, coalitions, and networks, using those opportunities to help guide decision making. * We responded to grant opportunities, which required us to assess specific needs related to specific grant proposals. * We continued to develop a relationship with the local United Way to look at identified needs of the community. * We began discussions with the City of Hartford's Health and Human Services Department, Hartford Hospital, and St. Francis Hospital to collaborate on a city-wide community health needs assessment. The agreement to pursue this took place in 2009, the assessment was designed in 2010 and conducted in 2011. The goal was to have it completed October 1, 2011. This will be our first formal needs assessment, and it will include interviews with approximately 100 Key Informants from around the city. When complete, we plan to put the assessment on our web-site and make it available throughout the community. Once the assessment is completed, we hope to use information to determine gaps in services and develop strategies to respond to newly identified problems. We also expect that the city's Public Health Advisory Committee, which includes all three city hospitals, shall look at collaborative approaches to addressing health needs. As written in the Credits and Collections policy: Posted text in general public areas and other communications (in English and Spanish) will notify patient and their guarantor of the availability of hospital-based assistance and other programs of public assistance. If the hospital determines that a patient or guarantor is potentially eligible for the Medicaid or other government program, it will encourage the patient or guarantor to apply for such program and the Financial Counselors will assist patient guarantors in applying for Medicaid, hospital-based assistance, or other assistance and payment plan programs when appropriate. Connecticut Children's offers hospital-based assistance for medically necessary inpatient and outpatient services for those patients unable to pay who can demonstrate financial need according to Connecticut Children's Patient Financial Assistance eligibility determination methodology. It is available as a last resort after all other third party resources have been exhausted. Once approved, the duration for eligibility for financial assistance is 6 (six) months. Connecticut Children's main campus is located in one of the poorest neighborhoods in one of the state's poorest cities. Neighborhood - 2500 families reside in the 14 block SINA neighborhood. 75 % are Latino. 44% have household incomes below $20,000. 45% of the residents 18 and older have less than a high school education. (SINA Neighborhood survey 2005) Hartford - is made up of 124,512 residents, 38% of whom are African American or Black, while 40% are of Latino origin. The median household income is $24,820 and 60% of the population 25 and over have a high school diploma. Connecticut has a population of 3,518,288. 10% of the population is African American or Black, while 9.4% are of Latino origin. The median household income throughout the state is $68,294 and 84% of persons 25 and older are high school graduates. There are a number of vehicles used to promote community health. Our Corporate Communications department coordinated all external communications, many of which were designed for that purpose (public service announcements and various reports). Our Annual Report informed the community of CT Children's latest advancements in caring for and curing childhood illnesses and diseases. "Pediatric Matters" was a publication sent out 4 times to over 33,000 readers, and it contained information about services and programs at the medical center. "Connecticut Children's Medical News" offered a more clinical perspective on activities and programs and was sent to referring providers. Safe Kids sent out newsletters to hundreds of coalition members throughout the state, featuring safety tips and research based information on preventable childhood safety issues. Our Continuing Medical Education office held 41 Pediatric Grand Round lectures during the year. These were open to community providers, and we began a registration process for Grand Rounds online. To date over 300 physicians and mid-level practitioners were registered. Public Safety on a local level is promoted through our participation with Southside Institution's Neighborhood Alliance (SINA). Trough SINA we participate at our local Neighborhood Revitalization Zone (NRZ) and its Public Safety Committee which addresses many public health issues, both to inform the neighborhood, and develop strategies to address problems. Our Government Relations Department participated in Advocacy efforts to ensure that the voices of children and their families were heard on healthcare issues that directly affected them. The department functioned as an expert resource with regard to pediatric health care issues for policy makers. Staff, Doctors, and families were able to leverage their experiences at CT Children's to provide expert testimony whenever possible. Connecticut Children's publishes a number of reports that get distributed to various community groups throughout the year. Our Annual Report is a publication to the community that discusses Connecticut Children's latest advances in caring for and curing childhood illnesses and diseases. "Pediatric Matters" is sent out four times during the year to over 33,000 readers, containing information on many different services and programs available at the Medical Center. Our Community Benefit report is done every other year, reflecting the numerous ways we help in the community outside of the clinical care we provide. "Connecticut Children's Medical News" offers a more clinical perspective of the happenings at the Medical Center and is sent out four times each year to referring providers. The Safe Kids program sends out a newsletter twice a year to coalition members throughout the state. Connecticut Children's also has a Government relations office which is responsible for much of the children's advocacy that we do. Though, some of their time is spent on working with government on our institutional needs, much of their efforts are on behalf of children throughout the state. A couple of examples of their work include organizing efforts to get our experts to help educate elected officials on various health risks of children, working to create new teen driver laws, and coordinating efforts to establish improved child seat safety laws. In addition to research activities that qualify as community benefit, there was an additional $773,000 worth of work with private companies to study clinical trials. All of our research informs an audience of various communities. CT X X X X X 0 1 0 0 0 0 0 0 0 Martin J Gavin 396394 0 13786 0 20411 0 4900 0 15302 0 450793 0 0 0 Gerald J Boisvert 317239 0 0 0 16742 0 4900 0 26852 0 365733 0 0 0 Fernando Ferrer 0 437401 0 133965 0 919 0 4900 0 30257 0 607442 0 0 Paul Dworkin 341300 0 4932 0 20617 0 4900 0 14776 0 386525 0 0 0 Wendy Warring 315074 0 0 0 12798 0 4900 0 26420 0 359192 0 0 0 Robert Englander 277146 0 500 0 5945 0 4900 0 18142 0 306633 0 0 0 Ann Taylor 226995 0 1060 0 4510 0 4672 0 24822 0 262059 0 0 0 Theresa Hendricksen 210139 0 0 0 2144 0 4288 0 24725 0 241296 0 0 0 Elizabeth Rudden 194000 0 0 0 2042 0 3934 0 16368 0 216344 0 0 0 Linda Groom 156194 0 4859 0 36 0 3303 0 20630 0 185022 0 0 0 Robert Fraleigh 143278 0 0 0 424 0 0 0 10178 0 153880 0 0 0 Donna Megliola 139086 0 1969 0 664 0 2916 0 23351 0 167986 0 0 0 Marlene Ferris 136374 0 2165 0 1162 0 1301 0 20582 0 161584 0 0 0 Christine Erikson 133707 0 5000 0 400 0 2835 0 14591 0 156533 0 0 0 Karen O'Brien 109667 34404 1050 1147 264 77 0 0 13048 4247 124029 39875 0 0 Stephanie Capps 108677 30564 2100 1082 56 16 0 0 19048 5473 129881 37135 0 0 Stephanie McGuire 107498 30239 1750 1446 130 38 770 223 19536 5622 129684 37568 0 0 Patricia Trehey 106636 32817 2100 1456 87 25 2208 696 12993 4136 124024 39130 0 0 Donald Hight 0 380852 0 50855 0 7772 0 4900 0 25447 0 469826 0 0 SchJ_P01_S00_L03 Schedule J, Part I, Line 3 Each year, TowersWatson conducts a market analysis of the organization's CEO, officers and other key employees. To augment their proprietary data and other data to which they have access, Connecticut Children's provides the results data from salary surveys in which we participate. The analysis and presentation of the data is performed by the TowersWatson representative to the Chief Executive Officer and the members of the Executive Committee of the Board of Directors. Annually the CEO and the Board then discuss salary recommendations for the officers and other key employees and sign off on the final recommendations. The Executive Committee of the Board of Directors meets independently with the CEO to discuss his individual performance. Following the performance evaluation, a salary recommendation is made and communicated to the Vice President of Human Resources to authorize processing. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 The following participated in the 457(b) retirement Plan: Gerald Boisvert $15,307.48 Paul Dworkin $16,500.00 Robert Englander $5,056.32 Martin Gavin $16,500.00 Theresa Hendrickson $1,487.18 Ann Taylor $3,381.89 Wendy Warring $11,363.52 Elizabeth Rudden $280.37 Connecticut Health and Educational Facilities Authority 2004-04-04 21285000 Refinance Series A bond, renovations of Medical Center, acquire equipment 0 0 Connecticut Health and Educational Facilities Authority 2004-04-01 23700000 Refinance Series A bond, renovations on Medical Center, acquire equipment 0 0 22254356 0 18735749 0 1088800 0 2429806 2006 1 0 1 1 23700000 0 19316324 0 1524712 35000 2823964 2006 1 0 1 1 0 1 0 1 1 0.0211 0 0.0211 1 0 1 0 1 1 0.0211 0 0.0211 1 0 0 0 0 0 0 0 1 1 Bank of America 3.7 0 0 0 Charles Shivery Chairman of Board 0 Chairmain, President and CEO of Northeast Utilities and Chariman of CL&P and Yankees Gas, all of which may do business with Connecticut Children's 0 Martin J Gavin CEO 0 Board member of CHS Insurance Limited, which oversees the malpractice insurance for physicians and other healthcare providers 0 Martin J Gavin CEO 0 Board Member of certain ING Funds, in which assets of the pension pland and CHS Insurance Limited are invested from Jan 2009 to Jun 2010 0 F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 CCMC Corporation is the Parent Corporation and sole member of Connecticut Children's Medical Center. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a Section 1.1 of the Medical Center by-laws (the "by-laws") states that CCMC Corporation is the sole member (the "Member") of the Medical Center. The Board of Directors of the Medical Center is the "governing body" of the organization. Under section 2.2(e) of the By-laws, the member elects the Board of Dorectors of the Medical Center. F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b Under Section 1.5 of the By-laws, the Member has the power to approve certain fundamental decisions of the Board of Directors of the Medical Center. F990_P06_S0B_L11 Form 990, Part VI, Section B, Line 11 The Form 990 is drafted by Connecticut Children's Medical Center staff and goes through internal review. Assistance by our attorneys and auditors is provided as needed in completing the form. It is then provided to the full board of directors of CCMC Corporation via our board website for review. The audit committee of the CCMC Corporation board of directors holds a committee meeting to review the return in further detail. Upon review and approval of the audit committee the return is filed. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c 1: Requirement to review Conflict of Interest Policy and disclose any conflicts is part of annual performance management process for all employed staff. All responses of "yes" are addressed by Director of Compliance. 2: Requirement to review Conflict of Interest Policy and disclose any conflicts is part of Internal Review Board (IRB) application for initial and continuation research studies. All responses of "yes" are addressed by Conflict of Interest (COI) Committee and IRB. 3: All Board members and Senior Management members (EMT) are required annually to review Conflict of Interest Policy and disclose any conflicts. All "yes" responses are addressed by COI Committee and CEO. 4: Selected committees (e.g., Credentials Committee, IRB, etc.) require all members to sign a committee specific conflict of interest form annually. All "yes" responses are addressed by committee chair. 5: New employees are educated on Conflict of Interest Policy and disclose any conflicts during New Employee Orientation. 6: Vendors are asked as part of contract process to review Conflict of Interest Policy and disclose any conflicts. 7: Director of Compliance acts upon self reported COI disclosures upon receipt. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Each year, TowersWatson conducts a market analysis of the organization's CEO, officers and other key employees. To augment their proprietary data and other data to which they have access, Connecticut Children's provides the results data from salary surveys in which we participate. The analysis and presentation of the data is performed by the TowersWatson representative to the Chief Executive Officer and the members of the Executive Committee of the Board of Directors. Annually the CEO and the Board then discuss salary recommendations for the officers and other key employees and sign off on the final recommendations. The Executive Committee of the Board of Directors meets independently with the CEO to discuss his individual performance. Following the performance evaluation, a salary recommendation is made and communicated to the Vice President of Human Resources to authorize processing. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 The governing policies and conflict of interest policy is available to the public on the web site, www.connecticutchildrens.org, or by request. The consolidated Audited Financials are available upon request. CCMC Corporation 282 Washington Street Hartford CT 06106 222619876 Healthcare Support CT 501(c)(3) 11b N/A Connecticut Children's Medical Center Foundation Inc 282 Washington Street Hartford CT 06106 222919869 Fundraising & Investment Mgt CT 501(c)(3) 7 N/A CCMC Affiliates Inc 282 Washington Street Hartford CT 06106 222919870 Healthcare Services CT 501(c)(3) 9 N/A Connecticut Children's Specialty Group Inc 282 Washington Street Hartford CT 06106 061446900 Physician Services CT 501(c)(3) 9 N/A Children's Fund of Connecticut Inc 270 Farmington Ave Farmington CT 06032 061364516 Healthcare Services CT 501(c)(3) 11a N/A Child Health and Development Institute of Connecticut Inc 270 Farmington Ave Farmington CT 06032 061504725 Healthcare Services CT 501(c)(3) 7 N/A CCMC Ventures Inc 282 Washington Street Hartford CT 06106 222619873 Healthcare Services CT N/A C 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 Connecticut Children's Specialty Group Inc i 676446 Connecticut Children's Specialty Group Inc n 10147009 Connecticut Children's Specialty Group Inc o 3275000 Connecticut Children's Specialty Group Inc p 10548066 Connecticut Children's Specialty Group Inc q 10511535 Connecticut Children's Medical Center Foundation Inc n 143483 Connecticut Children's Medical Center Foundation Inc o 72256 Connecticut Children's Medical Center Foundation Inc p 696051 Connecticut Children's Medical Center Foundation Inc r 7123121 CCMC Affiliates Inc n 116564 CCMC Affiliates Inc p 1558584 CCMC Affiliates Inc r 2090000 To allow adaquate time for the Board to Review the Form 990.