2011-08-11T10:32:27-05:00 2010-09-30 Baker Newman & Noyes 280 Fore St PO Box 507 Portland ME 04101 990 2009-10-01 431987409 Children's Hospital Pediatric Associates Inc CHIL 6179192822 20 Overland Street Boston MA 022153309 Gary R Fleisher 6179192822 2011-08-10 0 E Drew Cheney 2078792100 2009 2016-02-24 21:20:13Z Gary R Fleisher 20 Overland Street Boston MA 022153309 247678170 0 X N/A X 2002 MA The Foundation provides medical, health care services and educational services to the Children's Hospital of Boston 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. 18 1 314 0 -4634 -4634 11081677 0 176149278 187241007 -10103713 7446877 0 0 177127242 194687884 1636236 21017115 0 0 119052731 132729914 0 0 0 17189591 35194681 137878558 188941710 39248684 5746174 234149463 241185726 28752718 22996960 205396745 218188766 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 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. The Foundation also provides care for patients in Massachusetts regardless of their ability to pay. 0 0 141318261 21017115 150285055 The 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 in Boston, 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. 12026266 0 12789346 The Foundation receives income from the Children's Hospital in Boston 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. 22724700 0 24166606 The Foundation receives reimbursement of certain salary and fringe costs from grants from the Hospital. 176069227 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 155 0 1 314 1 0 0 0 0 0 0 0 0 0 18 1 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 0 1 1 1 0 MA X William Tarvanien 6179192822 20 Overland Street Boston MA 022153309 Gary R Fleisher MD 60.00 X X 635918 0 90907 William E Harmon MD 60.00 X X 327100 0 90260 S Jean Emans MD 60.00 X 282593 0 89630 Raif S Geha MD 60.00 X 285789 0 88074 Craig Gerard MD 60.00 X 263934 0 76515 Stella Kourembanas MD 60.00 X 358451 0 79398 Alan Leichtner MD 60.00 X 347351 0 79787 Wayne Lencer MD 60.00 X 335076 0 75560 Joseph Majzoub MD 60.00 X 278467 0 87864 Leonard Rappaport MD 60.00 X 306607 0 74367 Mark Schuster MD 60.00 X 397350 0 73445 Christopher Walsh MD 60.00 X 0 0 0 William Tarvanien 60.00 X X 297699 0 81749 Michael Wessels MD 60.00 X 283795 0 79866 David Williams MD 60.00 X 541130 0 74604 Richard Bachur MD 60.00 X 323640 0 64317 Frederick Lovejoy MD 60.00 X 241910 0 52014 Physicians' Org at Children's Hospi 2.00 X 0 0 0 Michael Agus MD 60.00 X 309008 0 73344 Marilyn Liang MD 60.00 X 324618 0 53146 Samuel Nurko MD 60.00 X 361892 0 52657 Isaac Kohane MD 60.00 X 322430 0 58445 Jackson Wong MD 60.00 X 333674 0 58269 7158432 0 1554218 261 0 1 0 Dana Farber Cancer Institute 44 Binney Street Boston MA 02115 Oncology Services 1684991 Marcam Associates 396 High Street Somersworth NH 03878 Billing/Collections 497651 Boston Private Bank Ten Post Office Square Boston MA 02109 Investment Fees 327799 Bank of New York One Boston Place Boston MA 02108 Investment Fees 191972 Jill K Shivapour 175 Blossom Street Boston MA 02114 Physician Services 122002 5 Net Patient Service Re 621300 140814522 140814522 Grant Revenue 900009 24166605 24166605 Service, Research, & O 611710 10240496 10240496 Contract Revenue 900099 9470534 9470534 Teaching, Admin. and S 611710 2548850 2548850 187241007 3678207 -4634 3682841 56758956 52990286 3768670 3768670 3768670 194687884 187241007 -4634 7451511 21017115 21017115 7176432 6817610 358822 108901483 101134851 7766632 7252519 6889893 362626 6494275 5520134 974141 2905205 2469424 435781 773761 773761 24770 24770 519771 519771 46675 46675 112781 112781 983686 690559 293127 130961 130961 2582019 2582019 454207 340655 113552 237222 237222 86495 86495 2621377 2621377 Research Expense 19599339 19599339 Bad Debt Expense 3386323 3386323 Physicians' Organizatio 1587621 1587621 Patient Staff Relations 727508 727508 Billing and Collections 496255 496255 823910 479554 344356 188941710 176069227 12872483 0 11702362 8292467 34475077 22767761 13793224 15444253 1050550 748440 3460757 3663824 571416 752310 542812 186747 66745 356065 110569950 135289449 35359976 38987565 23099406 14883592 234149463 241185726 6666392 7343453 22086326 15653507 28752718 22996960 X 193021745 215005816 12375000 3182950 205396745 218188766 234149463 241185726 X 0 1 1 X 0 X 3350000 2550000 5449762 11081677 22431439 107374971 130305603 152826834 176149278 187241007 753897693 110724971 132855603 158276596 187230955 187241007 776329132 0 0 0 776329132 2357229 4394481 4737274 3861758 3682841 19033583 2357229 4394481 4737274 3861758 3682841 19033583 -6282 -4634 -10916 113082200 137250084 163013870 191086431 190919214 795351799 0.97610 0.97620 0.02390 0.02830 X 0 12375000 9192050 3182950 2509857 11081677 1216534 12375000 0.00000 0.00000 1.00000 0 0 67011 11169 55842 475801 175578 300223 356065 CH Pooled Investment 1641202 F Interest in the P.O. Pool Investment Fund 37346363 F 38987565 Due from Children's Hospital 13150044 Due from PO 1733548 14883592 Due to Community Hospitals 3301821 Deferred Compensation Plans 5165885 Due to Children's Hospital 7130892 Due to PO 54909 15653507 194687884 188941710 5746174 3575248 3470599 7045847 12792021 201733731 3575248 3470599 7045847 194687884 0 194687884 188941710 0 188941710 0 188941710 Part V, Line 4: Description of Intended Use of Endowment Funds: The Foundation has plans to use its endowment funds for the Quality and Charge Capture Project, physician recruitment expenses, and research initiatives. Part XI, Line 8 - Other Adjustments: Unrealized Change in Limited Liability Partnership Interest: 3470599. Part XII, Line 2d - Other Adjustments: Unrealized Change in Limited Liability Partnership Interest: 3470599. PART X, FIN 48 In June 2006, the FASB issued Financial Interpretation No. (FIN) 48, Accounting for Uncertainty in Income Taxes, which provides guidance to all enterprises, including pass-through entities, for how uncertain tax provisions should be recognized, measured, presented, and disclosed in the financial statements. On December 30, 2008, the FASB issued Financial Statement Position (FSP) FIN 48-3, Effective Date of FASB Interpretation No 48 for Certain Nonpublic Enterprises, which defers the effective date of the interpretation for certain non-public enterprises to annual financial statements for fiscal years beginning after December 15, 2008, and is to be applied to all open tax years as of the effective date. The Foundation is a non-public enterprise to which this deferral applies, and FIN 48 will be first effective for the Foundation's financial statements for fiscal year ending September 30, 2010. Management continues to evaluate the implications of the interpretation, and any impact to the future financial position and results of the operations of the Foundation has not yet been determined. 1 Children's Hospital Corporation 300 Longwood Ave Boston MA 02115 042774441 501(c) (3) 21001515 0 General Support Pres & Fellows of Harvard College 75 Francis Street Boston MA 02115 042103580 501(c) (3) 15600 0 General Support 2 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Monitoring is provided by the Children's Hospital Pediatric Associates, Inc. (Foundation) through oversight of the terms and conditions of a written grant agreement. Multiyear agreements require yearly progress and financial reports for continuation of funding. During the year ended September 30, 2010, the Foundation only provided grant donations to other 501(c) (3) organizations. X X X 0 1 0 0 0 0 0 1 0 Gary R Fleisher MD 620014 0 10833 0 5071 0 66827 0 24080 0 726825 0 0 0 William E Harmon MD 254520 0 46488 0 26092 0 66827 0 23433 0 417360 0 0 0 S Jean Emans MD 254520 0 17500 0 10573 0 66827 0 22803 0 372223 0 0 0 Raif S Geha MD 236000 0 44882 0 4907 0 65324 0 22750 0 373863 0 0 0 Craig Gerard MD 236000 0 21103 0 6831 0 54324 0 22191 0 340449 0 0 0 Stella Kourembanas MD 302906 0 39457 0 16088 0 55827 0 23571 0 437849 0 0 0 Alan Leichtner MD 309049 0 26731 0 11571 0 56827 0 22960 0 427138 0 0 0 Wayne Lencer MD 275264 0 34123 0 25689 0 54827 0 20733 0 410636 0 0 0 Joseph Majzoub MD 236000 0 2941 0 39526 0 65324 0 22540 0 366331 0 0 0 Leonard Rappaport MD 291638 0 3427 0 11542 0 50827 0 23540 0 380974 0 0 0 Mark Schuster MD 265273 0 45451 0 86626 0 50827 0 22618 0 470795 0 0 0 William Tarvanien 242157 0 20500 0 35042 0 58353 0 23396 0 379448 0 0 0 Michael Wessels MD 242848 0 24098 0 16849 0 56468 0 23398 0 363661 0 0 0 David Williams MD 374063 0 37095 0 129972 0 50827 0 23777 0 615734 0 0 0 Richard Bachur MD 274453 0 50500 0 -1313 0 40827 0 23490 0 387957 0 0 0 Frederick Lovejoy MD 212100 0 500 0 29310 0 29333 0 22681 0 293924 0 0 0 Michael Agus MD 288450 0 29730 0 -9172 0 49827 0 23517 0 382352 0 0 0 Marilyn Liang MD 236255 0 91722 0 -3359 0 33367 0 19779 0 377764 0 0 0 Samuel Nurko MD 212183 0 114245 0 35464 0 29347 0 23310 0 414549 0 0 0 Isaac Kohane MD 318832 0 1900 0 1698 0 34827 0 23618 0 380875 0 0 0 Jackson Wong MD 306275 0 29309 0 -1910 0 34827 0 23442 0 391943 0 0 0 Part I, Line 4b: 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 employer contributions in a Rabbi Trust. Each employee who is (a) an officer or highly compensated employee of the Foundation, (b) a professor at Harvard, or its professional equivalent, and/or (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: William Harmon, MD $32,000 S. Jean Emans, MD $32,000 Raif S. Geha, MD $32,000 Craig Gerard, MD $21,000 Stella Kourembanas, MD $21,000 Alan Leichtner, MD $22,000 Wayne Lencer, MD $20,000 Leonard Rappaport, MD $16,000 William Tarvainen $24,000 Michael Wessels, MD $22,000 David Williams, MD $16,000 Michael Agus, MD $15,000 Richard Bachur, MD $6,000 Gary R. Fleisher, MD $32,000 Mark Schuster, MD $16,000 Joseph Majzoub $32,000 Part I, Line 7 The Children's Hospital Pediatric Associates, Inc. (Foundation) paid bonus compensation based on the net earnings of the Foundation. a) Ambulatory Clinic Bonus - participants are eligible for this bonus if they work a minimum of 0.2 FTE 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 $100K surplus, 17% of their surplus between $100K and $200K, and 24% of any surplus greater than $200K. 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 Children's Hospital Boston or Children's Hospital Pediatric Associates' payroll. c) Bonuses for emergency, newborn, inpatient programs , and PHA are based on 13% of the division/program surplus. Bonus compensation are usually approved by the division chiefs and the president of the Foundation. Mark Schuster Physician Recruitment X 400000 240000 0 1 1 David Williams Physician Recruitment X 650000 440000 0 1 1 Isaac Kohane Physician Recruitment X 85550 68440 0 1 1 748440 Form 990, Part VI, Section A, line 1 A majority of the Children's Hospital Pediatric Associates, Inc. (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 of Boston (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 (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 3 The Physicians' Org. at Children's Hospital Boston (PO) is a Class "C" member of Children's Hospital Pediatric Associates, Inc. (Foundation). The PO is responsible for all 3rd 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 6 The Children's Hospital Pediatric Associates, Inc. (Foundation) has four classes of members. The Pediatrician-in-Chief or any Acting Pediatrician-in-Chief, as Chief of the Department of Medicine of the Children's Hospital in Boston, 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 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 Clas "B" member. The Physicians' Organization at Children's Hospital Boston is a Class "C" member. All other individuals who hold Harvard appointments other than the Class "A" and Class "B" members shall be Class "D" members. Form 990, Part VI, Section A, line 7a The Pediatrician-in-Chief or any Acting Pediatrician-in-Chief, as Chief of the Department of Medicine of the Children's Hospital Corporation, is the Class "A" member of Childrens Hospital Pediatric Associates, Inc. (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 7b The Physicians' Organization at Children's Hospital Boston (PO) is a Class "C" member of Children's Hospital Pediatric Associates, Inc. (Foundation). The PO is responsible for all 3rd 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 11 The detailed review will be conducted by the President of the Foundation, Gary R. Fleisher, 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 review will be conducted before filing the return with the Internal Revenue Service Form 990, Part VI, Section B, line 12c The Physicians' Organization (PO) at Children's Hospital Boston 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 15 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 year ended 9/30/2010. The Physicians' Organization at Children's Hospital, Inc. (PO) is considered the compensation committee of the Foundation. Form 990, Part VI, Section C, line 19 The Foundation maintains all financial statements, conflict of interest policies, and governing documents at its main office at 20 Overland Street, Boston, MA 02215-3309. The documents are available upon request. Form 990, Part XI, Line 2c: Oversight of Audit: The audit process has not changed from the prior year. Form 990, Part VI, Question 13 and 14 Currently, the Foundation does not have a whistleblower policy or a written document retention and destruction policy. However, the board committee has plans to develop these policies in the next year. Form 990, Part X, Column A The prior year column of the balance sheet on Form 990 was updated to agree to the amounts on the audited financial statements. The lines that were updated are: Line 11 was changed from $106,754,377 to $110,569,950 and Line 15 was changed from $26,914,979 to $23,099,406. Sch L, Part II 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 second mortgage on the residence. The Foundation has provided five 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 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. Children's Hospital Corporation 300 Longwood Ave Boston MA 02115 042774441 Hospital MA 501(c) (3) 3 N/A Physicians' Org at Children's Hospital 300 Longwood Ave Boston MA 02115 043266103 Physician Organization MA 501(c) (3) 11 N/A 0 1 1 1 1 0 0 0 0 0 0 1 1 1 1 0 0 0