2023-11-14T19:29:04-06:00 2022-12-31 135565207 KPMG LLP 90 S 7TH ST STE 4200 MINNEAPOLIS MN 55402 990 2022-01-01 411756478 CHILDREN'S HEALTH CARE SERVICES INC CHIL 6128136000 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 BRENDA MCCORMICK SVP AND CFO 6128136000 2023-11-14 1 BRENDA MCCORMICK 999009999 0 HOLLY MOEN P01800653 6123055000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CHILDREN'S - MINNETONKA BRENDA MCCORMICK 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 5942901 0 X CHILDRENSMN.ORG X 1994 MN WE SERVE THE COMMUNITY'S CHILDREN AS A SUPERIOR, PEDIATRIC SPECIALTY HEALTH CARE PROVIDER. 5 3 31 11 0 0 623704 1857224 182028 3367187 6200 -6551 790785 336168 1602717 5554028 7190 964 0 0 49265 1351424 0 0 0 442177 2230594 498632 3582982 1104085 1971046 24230614 26248064 18996 65400 24211618 26182664 WE SERVE THE COMMUNITY'S CHILDREN AS A SPECIALTY PEDIATRIC AMBULATORY SURGERY CENTER AND DIAGNOSTIC AND TREATMENT FACILITY. 0 0 3172837 964 3366714 CHILDREN'S HEALTH CARE SERVICES, INC. (CHILDREN'S MINNETONKA) PROVIDES STATE-OF-THE-ART, COMPASSIONATE PEDIATRIC SPECIFIC OUTPATIENT CARE. OUR FACILITIES AND SERVICES ARE DESIGNED EXCLUSIVELY FOR THE NEEDS OF CHILDREN AND THEIR FAMILIES. OUR MEDICAL EQUIPMENT IS TAILORED TO FIT CHILDREN, AND OUR STAFF IS TRAINED AND EXPERIENCED TRO CARE FOR THE SPECIAL PHYSICAL AND EMOTIONAL NEEDS OF CHILDREN. WE PROVIDE A LOWER COST ENVIRONMENT AND OPTION TO THE COMMUNITY WE SERVE THAN WHAT CAN GENERALLY BE PROVIDED IN A HOSPITAL SETTING. 880 SURGICAL CASES AND 1,344 RADIOLOGICAL TESTS WERE PERFORMED IN 2022. CHILDREN'S MINNETONKA OPENED FOR PATIENT CARE IN JULY 2022 AFTER CLOSING IN 2020 IN RESPONSE TO THE COVID-19 PANDEMIC. 3172837 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 1 31 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X BRENDA MCCORMICK SVP AND CFO 6128136000 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 MARC GORELICK MD PRESIDENT & CEO 1.00 49.00 X X 0 1935831 42171 AARON BOUW BOARD SECRETARY & SR DIR, FR 1.00 49.00 X X 0 217962 21937 GARY BLACKFORD VICE CHAIR 1.00 3.00 X X 0 0 0 HENRY CHANG BOARD MEMBER THRU FEB 2022 0.00 0.00 X X 0 0 0 CHARLES MAXWELL TREASURER THRU FEB 2022 0.00 0.00 X X 0 0 0 MATTHEW BILUNAS TREASURER AS OF MARCH 2022 1.00 2.00 X X 0 0 0 ARCHELLE GEORGIOU BOARD CHAIR AS OF MARCH 2022 1.00 3.00 X X 0 0 0 BRENDA MCCORMICK SVP AND CFO 1.00 49.00 X 0 962479 45702 JENNIFER OLSON MARKET SVP & COO 1.00 49.00 X 0 1068566 41821 BRENDA BECKWITH SR DIRECTOR PERIOPERATIVE SVCS 13.00 37.00 X 23700 159419 33779 JANICE ANDERSON NURSE ANESTHETIST (CRNA) 50.00 0.00 X 214038 0 34095 237738 4344257 219505 1 0 1 0 MCGOUGH CONSTRUCTION 2737 FAIRVIEW AVENUE ST PAUL MN 55113 CONSTRUCTION 619637 FALLS & NYHUSMOEN CONSTRUCTION PO BOX 278 ROSEMOUNT MN 55068 CONSTRUCTON 409780 MSP COMMERCIAL 1215 TOWN CENTRE DRIVE SUITE 130 EAGAN MN 55123 REAL ESTATE 349881 GE PRECISION HEALTHCARE LLC PO BOX 96483 CHICAGO IL 60693 MAINT CONTRACT 109152 METRO ANESTHESIA NETWORK 14700 - 27TH AVENUE NORTH SUITE 20 PLYMOUTH MN 55447 PHYSICIAN SERVICES 100316 5 1857224 1857224 PROGRAM SERV REVENUE 621400 2651982 2651982 MEDICARE/MEDICAID PAY 621400 714732 714732 COMMISSION MAC REVENUE 621400 473 473 3367187 718490 382322 336168 336168 336168 0 6551 -6551 -6551 -6551 5554028 3366714 0 330090 X 964 964 23700 23700 1065043 1065043 43540 43540 146078 146078 73063 73063 46394 46394 22102 22102 723629 564419 159210 70917 49690 21227 37818 37818 131749 131749 376794 239282 137512 8413 8413 MEDICAL SUPPLIES 612373 612373 BAD DEBT 109696 109696 MN CARE TAX 72806 72806 ALL OTHER 17903 17903 3582982 3172837 410145 0 0 0 0 0 0 0 45267 1413453 0 0 0 0 22190790 20769715 0 0 0 0 27723146 23658250 1994557 4064896 0 0 0 0 0 0 0 0 0 0 24230614 26248064 13667 914 0 0 5329 0 0 0 0 0 0 0 0 0 0 0 0 64486 18996 65400 X 24211618 26182664 0 0 24211618 26182664 24230614 26248064 1971046 0 X 0 1 X 1 1 1 X FORM 990, SCHEDULE A, SUPPLEMENTAL INFORMATION: CHILDREN'S HEALTH CARE SERVICES, INC. HAS OBTAINED TAX-EXEMPT STATUS AS AN ORGANIZATION WHOSE MAIN PURPOSE IS TO PROVIDE MEDICAL CARE. HOWEVER, CHILDREN'S HEALTH CARE SERVICES, INC. IS NOT REQUIRED TO BE LICENSED, REGISTERED, OR SIMILARLY RECOGNIZED BY THE STATE OF MINNESOTA AS A HOSPITAL AND IS NOT REQUIRED TO FILE SCHEDULE H. 675764 675764 17376699 15299703 2076996 9670683 8358547 1312136 4064896 RESERVE FOR MNCARE TAX 64486 64486 X PART X, LINE 2: THE IRS HAS DETERMINED THAT CHILDREN'S AND ITS SUBSIDIARIES ARE EXEMPT ORGANIZATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE IRC. CHILDREN'S BELIEVES THAT IT CONTINUES TO MEET THE REQUIREMENTS OF THE IRC TO SUSTAIN ITS TAX-EXEMPT STATUS. IN ACCORDANCE WITH ASC SUBTOPIC 740-10, INCOME TAXES OVERALL, CHILDREN'S RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. MANAGEMENT DETERMINED THERE ARE NO MATERIAL INCOME POSITIONS FOR THE YEARS ENDED DECEMBER 31, 2022 AND 2021. CHILDREN'S IS NOT SUBJECT TO AN INCOME TAX EXAMINATION FOR YEARS BEFORE 2019. 0 1 0 0 0 0 0 0 0 MARC GORELICK MD PRESIDENT & CEO 0 1169891 0 746536 0 19404 0 18300 0 23871 0 1978002 0 0 JENNIFER OLSON MARKET SVP & COO 0 640152 0 343601 0 84813 0 18300 0 23521 0 1110387 0 81330 BRENDA MCCORMICK SVP AND CFO 0 618281 0 250618 0 93580 0 18300 0 27402 0 1008181 0 83200 JANICE ANDERSON NURSE ANESTHETIST (CRNA) 205197 0 8841 0 0 0 13557 0 20538 0 248133 0 0 0 AARON BOUW BOARD SECRETARY & SR DIR, FR 0 167647 0 50125 0 190 0 13295 0 8642 0 239899 0 0 BRENDA BECKWITH SR DIRECTOR PERIOPERATIVE SVCS 23700 121895 0 37163 0 361 0 7584 0 26195 23700 193198 0 0 PART I, LINE 3 CHILDREN'S - MINNETONKA RELIES ON CHILDREN'S HEALTH CARE, INC., THE PARENT OF CHILDREN'S - MINNETONKA, TO ESTABLISH THE COMPENSATION OF THE TO ESTABLISH COMPENSATION OF THE CEO: COMPENSATION COMMITTEE, INDEPENDENT OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART-I LINE-4B CERTAIN EMPLOYEES OF CHILDREN'S HEALTH CARE ARE PROVIDED THE OPPORTUNITY TO PARTICIPATE IN THE 457(F) DEFERRAL PLAN (THE DEFERRAL PLAN). THE DEFERRAL PLAN REQUIRES THAT THE EMPLOYEE IS A PHYSICIAN OR EXECUTIVE AND IS A .5 FTE OR MORE IN ORDER TO BE ELIGIBLE TO PARTICIPATE IN THE DEFERRAL PLAN. PAYMENTS FROM THE DEFERRAL PLAN OCCUR AT VESTING AND ARE BASED ON PERCENTAGE OF SALARY. THE FOLLOWING AMOUNTS REPRESENT THE AMOUNT PAID UNDER THE DEFERRAL PLAN IN 2022: BRENDA MCCORMICK - $83,200 JENNIFER OLSEN MARKET - $81,330 FORM 990 PART V LINE 1C PAYMENTS TO VENDORS ARE MADE FROM CHILDREN'S HEALTH CARE, INC., THEREFORE NO FORM 1099S ARE ISSUED BY CHILDREN'S HEALTH CARE SERVICES, INC. CHILDREN'S HEALTH CARE, INC. FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS. THE 1099S ISSUED BY CHILDREN'S HEALTH CARE, INC. ON BEHALF OF CHILDREN'S HEALTH CARE SERVICES, INC. ARE REPORTED TO THE IRS. FORM 990, PART VI, SECTION A, LINE 6 CHILDREN'S - MINNETONKA HAS A SOLE MEMBER, CHILDREN'S HEALTH CARE, INC., A MINNESOTA NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A CHILDREN'S - MINNETONKA'S SOLE MEMBER, CHILDREN'S HEALTH CARE, INC., IS AUTHORIZED UNDER CHILDREN'S - MINNETONKA'S BYLAWS TO ELECT DIRECTORS OF CHILDREN'S - MINNETONKA, AFTER APPROVAL BY THE BOARD OF DIRECTORS OF CHILDREN'S - MINNETONKA. FORM 990, PART VI, SECTION A, LINE 7B CHILDREN'S MINNETONKA'S SOLE MEMBER, CHILDREN'S HEALTH CARE, INC., MAINTAINS A NUMBER OF RESERVED POWERS INCLUDING BUT NOT LIMITED TO ELECTION OF DIRECTORS, APPROVAL OF ANNUAL BUDGETS, AND APPROVAL OF AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE SENIOR MANAGEMENT OF CHILDREN'S HEALTH CARE, INC., THE PARENT OF CHILDREN'S - MINNETONKA, REVIEWS ALL DRAFTS OF THE FORM 990S WITH THE AUDIT AND COMPLIANCE COMMITTEE OF CHILDREN'S HEALTH CARE'S GOVERNING BODY PRIOR TO THE FILING OF THE FORM. THIS REVIEW INCLUDES AN OVERVIEW OF THE FORM AND DISCUSSION RELATED TO KEY SECTIONS. THE AUDIT AND COMPLIANCE COMMITTEE OF CHILDREN'S HEALTH CARE'S BOARD OF DIRECTORS HAS BEEN DELEGATED THE CHILDREN'S HEALTH CARE SERVICES, INC. 41-1756478 AUTHORITY TO OVERSEE THE COMPLETION AND FILING OF THE FORM 990 BY THE FULL CHILDREN'S HEALTH CARE BOARD, AND THE COMMITTEE REPORTS THE RESULTS OF ITS REVIEW AND APPROVAL TO THE FULL BOARD AT A REGULARLY SCHEDULED BOARD MEETING. COPIES OF THE FINAL FORM 990 ARE MADE AVAILABLE TO MEMBERS OF THE COMMITTEE AND ALL DIRECTORS PRIOR TO THE FORM BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C MANAGEMENT OF CHILDREN'S HEALTH CARE, INC., THE PARENT OF CHILDREN'S -MINNETONKA, ENSURES THAT CONFLICT OF INTEREST DISCLOSURE FORMS ARE COMPLETED BY ALL MEMBERS OF THE GOVERNING BODY AND BOARD COMMITTEES AT LEAST ANNUALLY. FORMS ARE COMPLETED AT THE BEGINNING OF THE YEAR, AND DIRECTORS AND COMMITTEE MEMBERS ARE INSTRUCTED TO PROVIDE ADDITIONAL DISCLOSURES IF NECESSARY DURING THE COURSE OF THE YEAR. THE GOVERNANCE COMMITTEE OF THE GOVERNING BODY OF CHILDREN'S HEALTH CARE, INC., ALONG WITH SENIOR MANAGEMENT (CEO AND GENERAL COUNSEL) OF CHILDREN'S HEALTH CARE, INC., REVIEWS ALL DISCLOSURES PROVIDED BY GOVERNING BOARD MEMBERS. THE RESULTS OF THIS REVIEW AND ANY CONCERNS, LIMITATIONS, ETC. ARE REPORTED BY THE GOVERNANCE COMMITTEE TO THE FULL BOARD. IF CONFLICTS ARE IDENTIFIED, THE GOVERNANCE COMMITTEE AND MANAGEMENT WORK TO ENSURE THAT DIRECTORS DO NOT PARTICIPATE IN DISCUSSION OR VOTING ON THE AFFECTED MATTER. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION FOR THE PRESIDENT OF CHILDREN'S - MINNETONKA IS ESTABLISHED BY CHILDREN'S HEALTH CARE, INC. AS PART OF ITS EXECUTIVE COMPENSATION PROCESS. CHILDREN'S HEALTH CARE, INC. FOLLOWS THE REQUIREMENTS SET FORTH IN THE IRS REBUTTABLE PRESUMPTION OF REASONABLENESS IN DETERMINING COMPENSATION FOR THE PRESIDENT AND OTHER OFFICERS AND EXECUTIVE CHILDREN'S HEALTH CARE SERVICES, INC. 41-1756478 LEADERS OF CHILDREN'S - MINNETONKA. THIS FUNCTION IS PERFORMED BY THE COMPENSATION COMMITTEE OF THE GOVERNING BOARD OF CHILDREN'S HEALTH CARE, INC., WHICH IS COMPOSED OF ONLY INDEPENDENT DIRECTORS. THE PROCESS INCLUDES REVIEW OF COMPARABILITY DATA, RETENTION OF AN OUTSIDE COMPENSATION CONSULTANT, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION THROUGH DETAILED MINUTES OF THE COMPENSATION COMMITTEE AND FULL BOARD MEETINGS WHERE EXECUTIVE COMPENSATION IS CONSIDERED. FORM 990, PART VI, SECTION C, LINE 19 CHILDREN'S HEALTH CARE, INC., THE PARENT OF CHILDREN'S - MINNETONKA, MAKES FINANCIAL STATEMENT INFORMATION PUBLIC THROUGH A SUMMARY OF FINANCIAL PERFORMANCE IN ITS ANNUAL REPORT. IN ADDITION, FINANCIAL STATEMENTS ARE PROVIDED PUBLICLY THROUGH DIGITAL ASSURANCE CERTIFICATION, A DISSEMINATION AGENT, WHO THEREAFTER MAKES THIS INFORMATION PUBLICLY AVAILABLE. CHILDREN'S - MINNETONKA RELIES ON THE CONFLICT OF INTEREST POLICY OF CHILDREN'S HEALTH CARE, INC., THE PARENT OF CHILDREN'S - MINNETONKA, CHILDREN'S HEALTH CARE, INC. DOES NOT MAKE THE CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE GOVERNING DOCUMENTS OF CHILDREN'S - MINNETONKA ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G MEDICAL DIRECTOR CONTRACTS: PROGRAM SERVICE EXPENSES 21,096. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,096. SECURITY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 7,684. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,684. LINEN: PROGRAM SERVICE EXPENSES 13,290. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,290. PURCHASED MED SERVICES: PROGRAM SERVICE EXPENSES 100,696. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 100,696. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 30,415. MANAGEMENT AND GENERAL EXPENSES 10,227. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,642. PURCH SERVICES TO/FROM AFFILIATE: PROGRAM SERVICE EXPENSES 245,501. MANAGEMENT AND GENERAL EXPENSES 8,175. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 253,676. LEASED EQUIPMENT: PROGRAM SERVICE EXPENSES 14,287. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,287. MAINTENANCE SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 131,097. MANAGEMENT AND GENERAL EXPENSES 129,660. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 260,757. EQUIPMENT REPAIR & MAINTENANCE: PROGRAM SERVICE EXPENSES 8,037. MANAGEMENT AND GENERAL EXPENSES 3,464. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,501. CHILDREN'S HEALTH CARE INC 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 411754276 HEALTHCARE MN 501(C)(3) LINE 3 N/A 0 CHILDREN'S HEALTH CARE FOUNDATION 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 411814223 HEALTHCARE MN 501(C)(3) LINE 7 CHC 0 CHILDREN'S CLINIC NETWORK 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 413765330 HEALTHCARE MN 501(C)(3) LINE 3 CHC 0 MOTHER BABY FACILITY LLC 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 454078371 HEALTHCARE MN 501(C)(3) LINE 12A CHC 0 CHILDREN'S HEALTH INSURANCE NETWORK PO BOX 30600 GRAND CAYMAN CJ INSURANCE CJ CHC C 0 CHILDREN'S HEALTH NETWORK 910 EAST 26TH STREET SUITE 330 MINNEAPOLIS MN 55404 463226418 MEDICAL SERVICES MN CHC C 0 CHILDREN'S MN HOME MEDICAL EQUIPMENT 2525 CHICAGO AVENUE MINNEAPOLIS MN 55404 842915398 MED. EQ. SERVICES MN CHC C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0