2011-07-20T14:46:12-05:00 2010-12-31 CBIZ KIRKLAND RUSS MURPHY & TAPP 13577 FEATHER SOUND DRIVE SUITE 400 CLEARWATER FL 33762 990 2010-01-01 042121377 THE SHRINERS' HOSPITAL FOR CHILDREN SHRI 8132810300 POST OFFICE BOX 31356 TAMPA FL 336313356 DOUGLAS MAXWELL 8132810300 2011-07-15 1 NATHAN SMITH 7275721400 2010 2016-02-24 21:20:13Z DOUGLAS MAXWELL 2900 ROCKY POINT DRIVE TAMPA FL 33607 733533200 0 X HTTP://WWW.SHRINERSHQ.ORG/ X 1925 MA WE PROVIDE PEDIATRIC SPECIALTY CARE WITHOUT FINANCIAL OBLIGATION TO PATIENTS OR THEIR FAMILIES. 19 19 607 1000 0 0 44200641 39827375 0 0 -9001764 42638994 177514 1000324 35376391 83466693 0 0 0 0 37532512 34806138 0 0 0 29694122 28483283 67226634 63289421 -31850243 20177272 789665666 852520775 4101819 3283579 785563847 849237196 X SEE SCHEDULE OSHRINERS HOSPITALS FOR CHILDREN IN BOSTON AND SPRINGFIELD OFFER "CHARITY CARE" AS PART OF AN INTERNATIONAL NETWORK OF PEDIATRIC HOSPITALS DEDICATED TO PROVIDING EXCELLENT PATIENT CARE, RESEARCH, AND EDUCATION FOR ORTHOPAEDIC CONDITIONS AND BURNS.SHRINERS HOSPITALS FOR CHILDREN-BOSTON SPECIALIZES IN PROVIDING COMPREHENSIVE ACUTE CARE AND RECONSTRUCTIVE AND REHABILITATIVE CARE TO CHILDREN WHO HAVE BEEN BURNED, INCLUDING ACUTE BURNS, SMOKE INHALATION INJURY, RECONSTRUCTIVE SURGERY FOR HEALED BURNS, AND OTHRE RELATED CONDITIONS.SHRINERS HOSPITALS FOR CHILDREN-SPRINGFIELD SPECIALIZES IN CARING FOR CHILDREN WITH ORTHOPAEDIC CONDITIONS AND INJURIES SUCH AS SCOLIOSIS, CLUBFOOT, AND ORTHOPAEDIC CONDITIONS RELATED TO CEREBRAL PALSY AND SPINAL BIFIDA. FOR MORE INFORMATION, VISIT HTTP://WWW.SHRINERSHQ.ORG/ OR CALL 1-800-241-GIFT. 0 1 37947803 0 TREATMENT OF PEDIATRIC BURN VICTIMS: ADMISSIONS: 1,160OUTPATIENT CLINIC VISITS: 5,478 20795904 0 TREATMENT OF ORTHOPEDIC PEDIATRIC PATIENTS: ADMISSIONS: 707OUTPATIENT CLINIC VISITS: 18,096 4545714 MEDICAL RESEARCH IS PERFORMED AND HAS A STRONG, POSITIVE IMPACT ON THE CARE AND CURE OF CHILDREN WITH ORTHOPAEDIC PROBLEMS, BURN AND SPINAL CORD INJURIES. SHRINERS HOSPITALS FOR CHILDREN IS COMMITTED TO THE SUSTAINED INVESTMENT IN CLINICALLY USEFUL RESEARCH SO THAT FUNDAMENTAL KNOWLEDGE CAN BE ACQUIRED, IMPROVING THE QUALITY OF LIFE FOR CHILDREN WITH ORTHOPAEDIC PROBLEMS, BURN AND SPINAL CORD INJURIES. 63289421 1 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 101 0 1 607 1 0 0 0 0 0 1 1 0 0 0 1 1 0 X 19 19 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X SHARON RUSSELL 8132810300 2900 ROCKY POINT DR TAMPA FL 336071435 RALPH SEMB 5.00 X 0 0 0 W BRANDT BEDE MD 5.00 X 0 0 0 CHARLES CLAYPOOL 5.00 X 0 0 0 BOB SMITH 5.00 X 0 0 0 GARY DUNWOODY 5.00 X 0 0 0 RAOUL L FREVAL 5.00 X 0 0 0 DOUGLAS MAXWELL 20.00 X X 0 0 0 GEORGE MITCHELL 5.00 X X 0 3900 0 GENE BRACEWELL 5.00 X X 0 8400 0 FRANK PREBLE 5.00 X 0 0 0 GERALD A ROBERTS 5.00 X X 0 0 0 RODNEY PINKHAM 5.00 X 0 0 0 DAVID S MCKECHNIE 5.00 X 0 0 0 HAROLD F JENNINGS CPA 5.00 X 0 0 0 JACK H JONES 35.00 X X 0 111540 0 MICHAEL G SEVERE 5.00 X 0 3600 0 DAVID H BURSTEIN 5.00 X 0 0 0 KEVIN J HECHT ESQ 5.00 X 0 0 0 JULIAN S WHITE JR 5.00 X 0 0 0 CHARLES H WEAVER 5.00 X 0 0 0 NICHOLAS THOMAS 5.00 X 0 0 0 DAVID M DRVARIC MD 40.00 X 412352 0 2648 PETER D MASSO MD 40.00 X 289043 0 22260 PHILIP W MACK MD 40.00 X 282083 0 7581 CLIFFORD D'ESMOND 40.00 X 191368 0 3943 DEBORAH ROTHMAN MD 40.00 X 170755 0 1053 1345601 127440 37485 34 0 1 0 MASSACHUSETTS GENERAL HOSPITAL PO BOX 350096 BOSTON MA 02241 OUTSIDE PATIENT CARE 7935293 SPRINGFIELD ANESTHESIA SERVICE 908 ALLEN ST SPRINGFIELD MA 01101 ANESTHESIOLOGY SERVICES 1078000 CRITICAL CARE MEDFLIGHT INC PO BOX 245 LAWRENCEVILLE GA 30046 AIR AMBULANCE SERVICES 396177 APOLLO SECURITY INC 2150 PROVIDENCE HIGHWAY WALPOLE MA 02081 SECURITY AND PATROL SERVICES 276739 DR EDWARD BITTNER 36 GARDEN STREET BOSTON MA 02114 MEDICAL SERVICES 220000 9 37891778 1935597 63159 39827375 21845369 21845369 670840466 650046841 20793625 20793625 20793625 115377 19666 95711 95711 MISCELLANEOUS 900099 904613 904613 904613 83466693 0 0 43639318 25508872 25508872 3846539 3846539 3498977 3498977 1951750 1951750 1507790 1507790 10780827 10780827 26124 26124 150653 150653 3776736 3776736 244545 244545 4460381 4460381 461080 461080 MEDICAL SUPPLIES 6004913 6004913 PATIENT COSTS 641630 641630 FOOD SUPPLIES 213277 213277 DUES AND REGISTRATIONS 152094 152094 POSTAGE 63233 63233 63289421 63289421 0 0 122873 490797 825982 87207 164088 887932 655675 807719 143506184 62344566 85071536 81161618 702825512 769085502 789665666 852520775 3782782 2946045 319037 337534 4101819 3283579 X 785563847 849237196 785563847 849237196 789665666 852520775 X 20177272 43496077 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 698824389 83046382 21845369 760025402 604354755 117592699 23123065 698824389 834575000 -216021898 14198347 604354755 1.00000 0.00000 0.00000 0 1 1 303990 303990 105939734 34290125 71649609 423819 372805 51014 35016975 27681636 7335339 1821666 1821666 81161618 83466693 63289421 20177272 43509572 -13495 43496077 63673349 87596363 43509572 -1507790 42001782 45594581 37872112 37872112 83466693 61801297 19666 19666 61781631 1507790 1507790 63289421 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS (INCLUDING UNRESTRICTED FUND BALANCES) ARE THE PRIMARY SOURCE OF SUPPORT FROM WHICH SHRINERS HOSPITALS FOR CHILDREN PERFORMS ITS PROGRAM SERVICES TO ACHIEVE ITS PRIMARY EXEMPT PURPOSE. PART XI, LINE 8 - OTHER ADJUSTMENTS: OTHER CHANGES IN FUND BALANCE -13,495. PART XII, LINE 2D - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEES RECLASSIFIED TO EXPENSES -1,507,790. PART XII, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSES RECLASSIFIED FROM EXPENSES -19,666. FUNDING REVENUES RECLASSIFIED FROM OTHER CHANGES IN FUND BALANCE 37,891,778. PART XIII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSES RECLASSIFIED TO NET WITH REVENUES 19,666. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT MANAGEMENT FEES RECLASSIFIED FROM REVENUES 1,507,790. CANISTER COLLECTION 19131 19131 3261 FOOTBALL GAMES 59655 59655 10168 6 36591 36591 6237 115377 115377 19666 19666 95711 1 1 X 0 0 1 1 0 1 1 58743707 58743707 0.92820 58743707 58743707 0.92820 4545714 4545714 0.07180 4545714 4545714 0.07180 63289421 63289421 1.00000 0 0 2 1 SHRINERS HOSPITAL FOR CHILDREN

51 BLOSSOM STREET BOSTON MA 021142699

X X X X 2 SHRINERS HOSPITAL FOR CHILDREN

516 CAREW STREET SPRINGFIELD MA 01104

X X X X NOT REQUIRED 1 0 0 0 0 0 0 0 0 0 0 0 PART I, LINE 3C: SHRINERS HOSPITALS FOR CHILDREN DID NOT APPLY ANY INCOME-BASED CRITERIA, ASSET TEST, OR OTHER MEANS TEST OR THRESHOLD FOR PROVIDING FREE CARE TO PATIENTS IN 2010. PART I, LINE 7: A GENERAL LEDGER ACCOUNTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7. THE SYSTEM ADDRESSES ALL PATIENT SEGMENTS (INPATIENT AND OUTPATIENT). A COST-TO-CHARGE RATIO IS NOT PART OF THE SYSTEM AND IS NOT APPLICABLE TO SHRINERS HOSPITALS FOR CHILDREN. PART III, LINE 4: BAD DEBT EXPENSE IS NOT APPLICABLE TO SHRINERS HOSPITALS FOR CHILDREN, AND AS SUCH, IS NOT PART OF THE FOOTNOTES IN ITS FINANCIAL STATEMENTS. SHRINERS HOSPITALS FOR CHILDREN PROVIDES PATIENT CARE WITHOUT COST TO THE PATIENT. AS SUCH, THERE ARE NO REVENUES AGAINST WHICH A BAD DEBT COULD ARISE. PART I, LINE 1(A):SHRINERS HOSPITALS FOR CHILDREN'S (SHC) CHARITY CARE POLICY IS TO PROVIDE SPECIALIZED ORTHOPAEDIC AND BURN CARE TO CHILDREN WITHOUT REGARD TO ONE'S ABILITY TO PAY. THIS HAS BEEN SHC'S POLICY FOR OVER 85 YEARS. PRESENTLY, SHC IS IN THE PROCESS OF IMPLEMENTING OTHER ARRANGEMENTS THAT WILL ENABLE SHC TO MAINTAIN ITS STANDARDS OF EXCELLENCE IN PROVIDING SUPERIOR PATIENT CARE, WITHOUT DISTURBING ITS FUNDAMENTAL PRINCIPLES AND MISSION IN MAKING SUCH CARE OPENLY AVAILABLE TO ALL CHILDREN. THESE OTHER ARRANGEMENTS INCLUDE PARTIAL REIMBURSEMENT UNDER MEDICARE/MEDICAID GOVERNMENT PROGRAMS, AND PARTIAL REIMBURSEMENT UNDER PRIVATE INSURANCE ARRANGEMENTS. THESE OTHER ARRANGEMENTS MAY CAUSE CERTAIN SECTIONS OF THIS SCHEDULE H TO BE NOT COMPARABLE TO YEARS WHEN THESE ARRANGEMENTS WERE NOT IN FORCE. NEVERTHELESS, THE SPIRIT OF SHC'S MISSION, AS WELL AS ITS FOUNDING PRINCIPLES, WILL BE MAINTAINED UNDER THESE ALTERNATIVE ARRANGEMENTS. PART I, LINE 7, COLUMNS (A) AND (B):SEE FORM 990, PART III, LINES 4(A) AND 4(B) FOR RELATED INFORMATION. PART VI, LINE 8:THIS ENTITY AND ITS RELATED ENTITY FILE A COMMUNITY BENEFIT REPORT IN ALL 50 STATES. PART VI, LINE 2: SHRINERS HOSPITALS FOR CHILDREN PROVIDES PEDIATRIC, ORTHOPAEDIC, AND BURN CARE AT NO COST TO ITS PATIENTS. PART VI, LINE 3: SHRINERS HOSPITALS FOR CHILDREN POSTS ITS CHARITY CARY POLICY IN ADMISSION AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT, AND PROVIDES A COPY OF ITS POLICY TO PATIENTS AS PART OF THE INTAKE PROCESS AND WITH DISCHARGE MATERIALS. PART VI, LINE 4: SHRINERS HOSPITALS FOR CHILDREN (THROUGH THIS ENTITY AND ITS RELATED ENTITY) SERVE CHILDREN IN NEED OF SPECIALIZED ORTHOPAEDIC AND BURN CARE ACROSS THE ENTIRE UNITED STATES. X X 1 1 X X 0 1 0 0 0 0 0 0 0 DAVID M DRVARIC MD 412352 0 0 0 0 0 0 0 2648 0 415000 0 0 0 PETER D MASSO MD 289043 0 0 0 0 0 16500 0 5760 0 311303 0 0 0 PHILIP W MACK MD 282083 0 0 0 0 0 0 0 7581 0 289664 0 0 0 CLIFFORD D'ESMOND 191368 0 0 0 0 0 0 0 3943 0 195311 0 0 0 DEBORAH ROTHMAN MD 170755 0 0 0 0 0 0 0 1053 0 171808 0 0 0 X 39842 COMPARABLE SALES X 1 23317 COMPARABLE SALES 0 0 0 0 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 DURING 2010, THE ORGANIZATION ESTABLISHED A BILLING POLICY THAT APPLIES EXCLUSIVELY TO PRIVATE INSURANCE AND MEDICARE/MEDICAID. THE ORGANIZATION'S MISSION (TO PROVIDE CARE AT NO CHARGE TO PATIENTS AND THEIR FAMILIES) REMAINS UNCHANGED. MOREOVER, COSTS IN EXCESS OF REIMBURSEMENTS THROUGH PRIVATE INSURANCE AND MEDICARE/MEDICAID ARE STILL PROVIDED AT NO CHARGE. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS ORGANIZED AS A NONPROFIT CORPORATION WITH MEMBERS. MEMBERS HAVE THE RIGHT TO ELECT PERSONS BELONGING TO THE GOVERNING BODY, AND TO APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY. COMPENSATION IS NOT PROVIDED FOR BEING A MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS APPROXIMATELY 1,400 MEMBERS WHOM ARE APPOINTED FROM THE TOTAL MEMBERSHIP OF SHRINERS INTERNATIONAL (A RELATED ORGANIZATION). MEMBERS MAY ELECT PERSONS ON THE ORGANIZATION'S GOVERNING BODY, AND MAY APPROVE SIGNIFICANT DECISIONS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B UNDER THE BYLAWS OF THE ORGANIZATION, SIGNIFICANT DECISIONS OF THE GOVERNING BODY REQUIRE APPROVAL BY THE ORGANIZATION'S 1,400 MEMBERS (SUCH AS CHANGES TO THE BYLAWS, OR SIGNIFICANT RESTRUCTURING OR EXTRAORDINARY EVENTS). THE ORGANIZATION'S MEMBERS ALSO MAY ELECT PERSONS TO SERVE ON THE ORGANIZATION'S GOVERNING BODY. THE ORGANIZATION'S MEMBERS DO NOT HAVE CONTROL OVER THE GENERAL OPERATIONS OR FINANCIAL MATTERS OF THE ORGANIZATION. ELECTIONS ARE HELD ANNUALLY BY THE MEMBERS AT VARYING LOCATIONS IN THE U.S.. VOTING IS DECIDED WITH SIMPLE MAJORITY, WHERE EACH MEMBER'S VOTE IS EQUAL WEIGHTED. ELECTED PERSONS SERVE A THREE-YEAR TERM ON THE BOARD OF TRUSTEES, A ONE-YEAR TERM ON THE BOARD OF DIRECTORS, A ONE-YEAR TERM FOR THE ORGANIZATION'S PRESIDENT, AND A ONE-YEAR TERM FOR THE ORGANIZATION'S TREASURER. THE ORGANIZATION'S OFFICERS ARE NOT ELECTED, AND INSTEAD ARE HIRED BY COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11 AN OVERVIEW OF THE FORM AND SCHEDULES WAS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD, ALONG WITH A COPY OF THE 990 TO BE FILED WITH THE IRS, PRIOR TO ACTUAL FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND ALL MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTING INTERESTS OR STATE "NONE" ON THE ANNUAL CONFLICT OF INTEREST FORM. FORM 990, PART VI, SECTION B, LINE 15 A SALARY & PERSONNEL COMMITTEE IS INVOLVED WITH ALL COMPENSATION AND APPROVES WAGES FOR MANAGEMENT AND COMPARES THESE SALARIES TO VARIOUS MARKET INDICATORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS (INCLUDING ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS) ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 43,509,572. OTHER CHANGES IN FUND BALANCE -13,495. TOTAL TO FORM 990, PART XI, LINE 5: 43,496,077. AUDIT COMMITTEE OVERSIGHT PROCESS FORM 990, PART XII, LINE 2C EXPLANATION: THE ORGANIZATION HAS NOT CHANGED (DURING THE CURRENT YEAR) ITS OVERSIGHT PROCESS OR ITS SELECTION PROCESS REGARDING THE COMMITTEE RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. SHRINERS HOSPITALS FOR CHILDREN EMPLOYEE DISASTER RELIEF FUND 2900 ROCKY POINT DRIVE TAMPA FL 33607 263733381 DISASTER RELIEF DC 501(C)(3) 9 NO 0 SHRINERS HOSPITALS FOR CHILDREN POST OFFICE BOX 31356 TAMPA FL 336313356 362193608 HOSPITAL SYSTEM CO 501(C)(3) 3 NO 0 SHRINERS INTERNATIONAL POST OFFICE BOX 31356 TAMPA FL 336313356 362158164 FOUNDED SHRINERS HOSPITALS FOR CHILDREN IA 501(C)(10) N/A NO 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 SHRINERS HOSPITALS FOR CHILDREN C 37891778 SHRINERS HOSPITALS FOR CHILDREN N