2023-07-05T10:14:57-05:00 2022-12-31 273605969 CBIZ MHM LLC 140 FOUNTAIN PKWY N STE 410 ST PETERSBURG FL 33716 990 2022-01-01 042121377 THE SHRINERS' HOSPITAL FOR CHILDREN SHRI 8132810300 POST OFFICE BOX 31356 TAMPA FL 336313356 JERRY GANTT PRESIDENT 8132810300 2023-06-30 1 JERRY GANTT XXX-XX-XXXX 1 PAUL DUNHAM P00100222 7275721400 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JOHN MCCABE 2900 N ROCKY POINT DRIVE TAMPA FL 33607 146321381 0 X WWW.SHRINERSCHILDRENS.ORG X 1925 MA WE OFFER FAMILY-CENTERED PEDIATRIC SPECIALTY CARE REGARDLESS OF FAMILIES' ABILITY TO PAY. 23 21 481 1000 0 0 21457154 22160849 12307874 10029950 47164646 16437163 2315016 1742579 83244690 50370541 0 0 0 0 34273253 32930224 0 0 784142 30060840 29555850 64334093 62486074 18910597 -12115533 587730249 509724974 5841739 6111653 581888510 503613321 X SHRINERS CHILDREN'S IS COMMITTED TO COMPASSIONATE, HIGH-QUALITY CARE THAT IMPROVES CHILDREN'S LIVES, IN A FAMILY-CENTERED AND COLLABORATIVE ENVIRONMENT. (CONTINUED ON SCHEDULE O) 0 0 54955467 10378102 STATE-OF-THE-ART MEDICAL CARE:SHRINERS HOSPITALS FOR CHILDREN, COMPRISED OF A NETWORK OF HOSPITALS (SEE SCHEDULE R), SERVES 179 COUNTRIES, TREATING MORE THAN 150,000 UNIQUE CHILDREN EACH YEAR. OUR ORGANIZATIONAL MISSION IS TO PROVIDE THE HIGHEST QUALITY OF CARE TO CHILDREN WITHIN A COMPASSIONATE, FAMILY-CENTERED AND COLLABORATIVE CARE ENVIRONMENT. OUR TEAM OF HIGHLY-SKILLED MEDICAL PROFESSIONALS ARE AMONG SOME OF THE MOST RECOGNIZED INDIVIDUALS IN THE FIELDS OF PEDIATRIC BURN CARE AND PEDIATRIC ORTHOPEDIC CARE. CONTINUED ON SCHEDULE O OUR SPECIALIZED CARE EXTENDS BEYOND THE CONVENTIONAL WALLS OF THE HOSPITAL. SHRINERS HOSPITALS FOR CHILDREN ALSO SEEKS TO DELIVER CARE TO THOSE INTERNATIONALLY THROUGH OUR TELEHEALTH PROGRAM, WHICH ALLOWS PATIENTS TO RECEIVE OUR WRAP-AROUND CARE VIA VIDEO CONFERENCING. WE ALSO STRIVE TO HELP THOSE IN NEED - ESPECIALLY WHEN DISASTER STRIKES. 4873812 RESEARCH:SHRINERS HOSPITALS FOR CHILDREN PRIDES ITSELF ON THE WRAP-AROUND CARE THAT IT PROVIDES TO PATIENTS AND FAMILIES. AS A HEALTH CARE SYSTEM WITH 20 LOCATIONS IN THE U.S., CANADA AND MEXICO (2 OPERATED BY THIS ORGANIZATION), OUR STAFF IS DEDICATED TO IMPROVING THE LIVES OF CHILDREN BY PROVIDING PEDIATRIC SPECIALTY CARE, CONDUCTING INNOVATIVE RESEARCH, AND OFFERING OUTSTANDING TEACHING PROGRAMS FOR MEDICAL PROFESSIONALS. CONTINUED ON SCHEDULE OOUR RESEARCH TEAM IS AMONG THE MOST HIGHLY RENOWNED, GAINING NATIONAL RECOGNITION FOR CLINICAL RESEARCH. SIX SHC LOCATIONS ARE MAJOR RESEARCH HOSPITALS (ONE OPERATED BY THIS ORGANIZATION), WORKING TO DEVELOP NEW TREATMENTS AND TECHNOLOGICAL ADVANCES WITHIN THE MEDICAL COMMUNITY. 59829279 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 75 0 1 481 1 0 0 0 0 0 0 0 0 0 0 0 0 X 23 21 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X RACHEL MEHLENBACHER 8135187845 2900 N ROCKY POINT DR TAMPA FL 336071435 WILLIAM S BAILEY CHAIRMAN OF THE BOARD 2.00 15.00 X X 0 47500 0 JERRY G GANTT PRESIDENT 2.00 9.00 X X 0 18000 0 KENNETH G CRAVEN VICE PRESIDENT 2.00 11.00 X X 0 0 0 BRAD T KOEHN TREASURER 2.00 23.00 X X 0 0 0 CRAIG A KAZIN ASSISTANT TREASURER 2.00 0.00 X X 0 0 0 CHARLES H WEAVER CLERK 2.00 0.00 X X 0 0 0 JIM CAIN ASSISTANT SECRETARY 2.00 10.00 X X 0 0 0 ANTHONY M WEST TRUSTEE 2.00 5.00 X 0 0 0 JAMES A DOEL TRUSTEE 2.00 5.00 X 0 0 0 CHUCK PITTMAN TRUSTEE 2.00 5.00 X 0 0 0 PAUL F POULIN TRUSTEE 2.00 5.00 X 0 0 0 LESLIE D STEWART TRUSTEE 2.00 5.00 X 0 0 0 KENNETH J GUIDERA TRUSTEE 2.00 5.00 X 0 0 0 RICAURTE A ARROCHA TRUSTEE (7/1/22-12/31/22) 2.00 5.00 X 0 0 0 JAMES E STOLZE JR TRUSTEE (7/1/22-12/31/22) 2.00 11.00 X 0 0 0 JAMES R SMITH TRUSTEE 2.00 39.00 X 0 0 0 EDWARD W GEOFFRION TRUSTEE 2.00 0.00 X 0 0 0 JOHN J EDWARDS JR TRUSTEE 2.00 0.00 X 0 0 0 GERALD R DIEVENDORF TRUSTEE (7/1/22-12/31/22) 2.00 0.00 X 0 0 0 DEAN M WHALEN TRUSTEE 2.00 0.00 X 0 0 0 DAVID A FOYE TRUSTEE 2.00 0.00 X 0 0 0 GREG A FELDMAN TRUSTEE 2.00 0.00 X 0 0 0 DAVID C SULLIVAN TRUSTEE 2.00 0.00 X 0 0 0 JEFFREY L SOWDER TRUSTEE (1/1/22-7/1/22) 2.00 0.00 X 0 0 0 BRADFORD LACHUT TRUSTEE (1/1/22-7/1/22) 2.00 0.00 X 0 0 0 JOHN MCCABE EXECUTIVE VICE PRESIDENT 2.00 40.00 X 0 986324 21193 CHIEN-WEI LIAO CHIEF OF STAFF 40.00 0.00 X 518281 0 0 AHMAD BAYOMY ORTHOPEDIC SURGEON, SPORTS 40.00 0.00 X 368582 0 39190 JAMES F MOONEY III CHIEF OF STAFF 40.00 0.00 X 364910 0 32959 RUBINI PATHY ORTHOPEDIC SURGEON, ASST PROF 40.00 0.00 X 345072 0 26498 FRANCES MARTHONE MARKET ADMINISTRATOR 40.00 0.00 X 203790 0 42093 1800635 1051824 161933 79 0 1 0 THE GENERAL HOSPITAL CORPORATION 55 FRUIT ST BOSTON MA 02114 OUTSIDE PATIENT SERVICES 6134822 SPRINGFIELD ANESTHESIA SERVICES PO BOX 1330 SPRINGFIELD MA 011011330 ANESTHESIOLOGY SERVICES 496382 DR EDWARD BITTNER 36 GARDEN ST BOSTON MA 02114 MEDICAL SERVICES 485074 BERNSTEIN-MAGOON-GAY LLC 900 E 8TH AVE STE 200 KING OF PRUSSIA PA 19406 LAUNDRY SERVICES 277727 DR CHRISTINA KIM GRANGER 15 ORCHARD LN SIMSBURY CT 06070 MEDICAL SERVICES 192473 10 14056730 60124 8043995 22160849 PATIENT SERVICE 621110 10029950 10029950 10029950 11073222 11073222 1279754 0 1279754 1279754 1279754 101040740 7916 95684715 0 5356025 7916 5363941 5363941 322862 266125 56737 56737 406088 348152 57936 406088 50370541 10378102 0 17831590 X 24905710 24202920 219496 483294 2617268 2543414 23066 50788 3541238 3441311 31209 68718 1866008 1813353 16445 36210 718025 718025 13383959 13370612 13347 15115 5105 10010 1230229 1161648 12124 56457 14456 14456 3840222 3840222 274882 170896 99257 4729 86240 84707 239 1294 3967254 3967254 671687 671687 MEDICAL SUPPLIES 3616690 3604792 3017 8881 TAXES AND FEES RELATED 830111 830111 PATIENT TRAVEL COSTS 252491 252491 DUES AND REGISTRATIONS 123349 76005 42482 4862 531140 449982 35606 45552 62486074 59829279 1872653 784142 904009 231086 2096842 1661378 483268 379511 440504 429059 162833941 109590202 56375281 53243739 418520138 358052494 108910207 95727707 587730249 509724974 5841739 6111653 5841739 6111653 X 581888510 503613321 581888510 503613321 587730249 509724974 -12115533 -66159656 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 10377704400 -1302487721 305558738 8769657941 9453971934 1193283135 269550669 10377704400 8692027438 1014092512 252148016 9453971934 7766597471 676246306 1301738707 1052556046 8692026438 8555565788 -437967191 351001126 7766597471 0.93951 0.05200 0.00849 0 1 1 303990 303990 109536117 67611715 41924402 49583674 41561162 8022512 3410160 417325 2992835 53243739 RECEIVABLES FROM INCOME TRUSTS 322673 LOANS TO OTHER ORGANIZATIONS - SHRINERS CO 95405034 95727707 -474231387 -66159656 -457319358 -523479014 49247627 718025 404889 1122914 50370541 1053274606 992336668 992336668 60937938 718025 830111 1548136 62486074 PART V, LINE 4: IN ACCORDANCE WITH THE FORM INSTRUCTIONS, PART V HAS BEEN UPDATED TO REPORT AGGREGATE ENDOWMENT FUNDS. IN PRIOR YEARS THE ENDOWMENT WAS ALLOCATED BETWEEN RELATED ORGANIZATIONS SHRINERS HOSPITALS FOR CHILDREN (EIN 36-2193608) AND THE SHRINERS' HOSPITALS FOR CHILDREN (EIN 04-2121377). THE ENDOWMENT FUNDS ARE HELD IN THE AGGREGATE FOR THE BENEFIT OF THE COMBINED ORGANIZATION AS A WHOLE. THE ENDOWMENT FUNDS (INCLUDING UNRESTRICTED FUND BALANCES) ARE A SIGNIFICANT SOURCE OF SUPPORT FROM WHICH SHRINERS HOSPITALS FOR CHILDREN PERFORMS ITS PROGRAM SERVICES TO ACHIEVE ITS PRIMARY EXEMPT PURPOSE. IN ADDITION, AS PATIENTS OFTEN COME TO SHRINERS HOSPITALS FOR CHILDREN AS AN INFANT AND REMAIN PATIENTS THROUGHOUT THEIR CHILDHOOD, A STRONG ENDOWMENT IS REQUIRED TO ENSURE FUNDS ARE AVAILABLE TO SUPPORT THE MISSION AND HEALTH NEEDS OF THE PATIENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: TAXES AND FEES RELATED TO TANGIBLE PERSONAL PROPERTY -830,111. COLORADO HOSPITAL GROUP REVENUES -539,373,493. FOREIGN HOSPITAL REVENUES 82,884,246. PART XI, LINE 4B - OTHER ADJUSTMENTS: CAFETERIA INCOME RECLASSIFIED OUT OF EXPENSES 56,737. OTHER REVENUE RECLASSIFIED OUT OF EXPENSES 348,152. PART XII, LINE 2D - OTHER ADJUSTMENTS: CAFETERIA INCOME RECLASSIFIED OUT OF EXPENSES -56,737. OTHER REVENUE RECLASSIFIED OUT OF EXPENSES -348,152. COLORADO HOSPITAL GROUP EXPENSES 932,112,580. FOREIGN HOSPITAL EXPENSES 60,628,977. PART XII, LINE 4B - OTHER ADJUSTMENTS: TAXES AND FEES RELATED TO TANGIBLE PERSONAL PROPERTY 830,111. 1 1 X 1 X 400.000000000000 0 1 1 0 1 1 21981913 4011930 17969983 0.28760 32973554 6018020 26955534 0.43140 54955467 10029950 44925517 0.71900 4873812 4873812 0.07800 4873812 4873812 0.07800 59829279 10029950 49799329 0.79700 0 0 2 1 SHRINERS HOSPITAL FOR CHILDREN-BOSTON 51 BLOSSOM STREET BOSTON MA 021142699 WWW.SHRINERSCHILDRENS.ORG 2316 X X X X A 2 SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIELD 516 CAREW STREET SPRINGFIELD MA 01104 WWW.SHRINERSCHILDRENS.ORG 2152 X X X CONVERTED TO CLINIC 12/31/22 A GROUP A 0 0 1 X X X X X X X X X 22 1 1 1 1 X WWW.SHRINERSCHILDRENS.ORG 1 22 1 WWW.SHRINERSCHILDRENS.ORG 0 1 X 400.000000000000 0.000000000000 X X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X 0 0 0 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: SHRINERS HOSPITAL FOR CHILDREN-BOSTON, - FACILITY 2: SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIELD GROUP A-FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN-BOSTON PART V, SECTION B, LINE 5: THE SHRINERS HOSPITALS FOR CHILDREN TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY FOR ITS MOST RECENT CHNA THROUGH SURVEYS AND FOCUS GROUPS. GROUP A-FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN-BOSTON PART V, SECTION B, LINE 6A: THE CHNA WAS PREPARED IN COLLABORATION WITH BOSTON CHNA-CHIP COLLABORATIVE, A GROUP OF BOSTON HEALTH CENTERS, COMMUNITY-BASED ORGANIZATIONS, COMMUNITY RESIDENTS, HOSPITALS, AND THE BOSTON PUBLIC HEALTH COMMISSION. PARTICIPATING FACILITIES AND ORGANIZATIONS CAN BE FOUND ON THE COLLABORATIVE'S WEBSITE AT WWW.BOSTONCHNA.ORG/MEMBERSHIP/ GROUP A-FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN-BOSTON PART V, SECTION B, LINE 6B: SEE RESPONSE TO LINE 6A GROUP A-FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN-BOSTON PART V, SECTION B, LINE 11: AFTER CONDUCTING THE 2022 CHNA, SHRINERS HOSPITALS FOR CHILDREN CONTINUED A MULTIFACETED APPROACH THAT INCLUDES AFFILIATE AND COMMUNITY PROVIDERS IN COMMUNITY OUTREACH, COMMUNITY INVOLVEMENT, AND COMMUNITY EDUCATION TO ADDRESS IDENTIFIED HEALTH CARE NEEDS WITHIN EACH MARKET. HEALTH CARE NEEDS THAT ARE IDENTIFIED BUT NOT ADDRESSED WITHIN ANY ACTION PLAN FALL OUTSIDE OF THE SERVICE OFFERINGS PROVIDED AT SHRINERS HOSPITALS FOR CHILDREN. SOME OF THE NEEDS IDENTIFIED BUT NOT ADDRESSED ARE MENTAL HEALTH, DIABETES, OBESITY, ASTHMA, AND DRUG AND ALCOHOL ABUSE. THEREFORE, PATIENTS/FAMILIES PRESENTING WITH HEALTH CARE NEEDS WHICH ARE OUTSIDE OF THE HOSPITAL SERVICE OFFERINGS WILL RECEIVE CARE COORDINATION AND BE REFERRED TO THE APPROPRIATE PROFESSIONALS WITHIN THE COMMUNITY FOR PROVISION OF SERVICES. GROUP A-FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIE PART V, SECTION B, LINE 5: THE SHRINERS HOSPITALS FOR CHILDREN TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY FOR ITS MOST RECENT CHNA THROUGH SURVEYS AND FOCUS GROUPS. GROUP A-FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIE PART V, SECTION B, LINE 6A: BAYSTATE MEDICAL CENTER, BAYSTATE FRANKLIN MEDICAL CENTER, BAYSTATE NOBLE HOSPITAL, BAYSTATE WING HOSPITAL, COOLEY DICKINSON HOSPITAL, MERCY MEDICAL CENTER, SHRINERS CHILDREN'S NEW ENGLAND, HEALTH NEW ENGLAND, AND BERKSHIRE HEALTH SYSTEMS GROUP A-FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIE PART V, SECTION B, LINE 6B: UTILIZED DATA FROM CHNA CONDUCTED BY PUBLIC HEALTH INSTITUTE OF WESTERN MASSACHUSETTS GROUP A-FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIE PART V, SECTION B, LINE 11: AFTER CONDUCTING THE 2022 CHNA, SHRINERS HOSPITALS FOR CHILDREN CONTINUED A MULTIFACETED APPROACH THAT INCLUDES AFFILIATE AND COMMUNITY PROVIDERS IN COMMUNITY OUTREACH, COMMUNITY INVOLVEMENT, AND COMMUNITY EDUCATION TO ADDRESS IDENTIFIED HEALTH CARE NEEDS WITHIN EACH MARKET. HEALTH CARE NEEDS THAT ARE IDENTIFIED BUT NOT ADDRESSED WITHIN ANY ACTION PLAN FALL OUTSIDE OF THE SERVICE OFFERINGS PROVIDED AT SHRINERS HOSPITALS FOR CHILDREN. SOME OF THE NEEDS IDENTIFIED BUT NOT ADDRESSED ARE MENTAL HEALTH, DIABETES, OBESITY, ASTHMA, AND DRUG AND ALCOHOL ABUSE. THEREFORE, PATIENTS/FAMILIES PRESENTING WITH HEALTH CARE NEEDS WHICH ARE OUTSIDE OF THE HOSPITAL SERVICE OFFERINGS WILL RECEIVE CARE COORDINATION AND BE REFERRED TO THE APPROPRIATE PROFESSIONALS WITHIN THE COMMUNITY FOR PROVISION OF SERVICES. PART V, SECTION B, LINE 16A: WWW.SHRINERSCHILDRENS.ORG/EN/PATIENT-INFORMATION/BILLING-INSURANCE-AND-FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16B: WWW.SHRINERSCHILDRENS.ORG/EN/PATIENT-INFORMATION/BILLING-INSURANCE-AND-FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16C: WWW.SHRINERSCHILDRENS.ORG/EN/PATIENT-INFORMATION/BILLING-INSURANCE-AND-FINANCIAL-ASSISTANCE/FINANCIAL-ASSISTANCE PART I, LINE 3C: SHRINERS HOSPITALS FOR CHILDREN OFFERS SPECIALIZED MEDICAL SERVICES PERTAINING TO ORTHOPEDIC CONDITIONS, BURNS, SPINAL CORD INJURIES AND CLEFT LIP AND PALATE. UPON PATIENT ADMITTANCE FOR ONE OF THESE CONDITIONS, SHRINERS HOSPITALS FOR CHILDREN REVIEWS THE PATIENT'S "ABILITY TO PAY" USING THE FEDERAL POVERTY GUIDELINES SPECIFIED IN SCHEDULE H, PART I, LINE 3A, AND PROVIDES FREE CARE PURSUANT TO THESE GUIDELINES. NEVERTHELESS, SHRINERS HOSPITALS FOR CHILDREN WILL ALWAYS SERVE THESE SPECIALIZED NEEDS FOR ALL OF ITS PATIENTS, REGARDLESS OF THEIR "ABILITY TO PAY." AS SUCH, 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 2022. 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. PART III, LINE 4: BAD DEBT EXPENSE IS NOT APPLICABLE TO SHRINERS HOSPITALS FOR CHILDREN, AND AS SUCH, IS NOT PART OF THE FOOTNOTES TO ITS FINANCIAL STATEMENTS. SHRINERS HOSPITALS FOR CHILDREN PROVIDES PATIENT CARE REGARDLESS OF THEIR ABILITY TO PAY. AS SUCH, THERE ARE NO REVENUES AGAINST WHICH A BAD DEBT COULD ARISE. PART III, LINE 9B: SHRINERS HOSPITALS FOR CHILDREN PROVIDES PATIENT CARE REGARDLESS OF THEIR ABILITY TO PAY. AS SUCH, THERE IS NO DEBT COLLECTION POLICY. PART VI, LINE 2: SHRINERS HOSPITALS FOR CHILDREN WORKS CLOSELY WITH A NUMBER OF NATIONAL, STATE, AND LOCAL ORGANIZATIONS IN EFFORT TO SUPPORT THE HEALTH OF THE CHILDREN AND FAMILIES BOTH IN THEIR CARE AND THOSE IN THE COMMUNITIES THEY SERVE. SOME EXAMPLES INCLUDE: WORKING WITH THE CHILDREN HOSPITAL ASSOCIATION NATIONALLY VIA DATA SHARING TO ENSURE THAT COMPLEX CARE FOR CHILDREN IN NEED CONTINUES TO BE AT THE FOREFRONT OF HEALTHCARE CONVERSATIONS NOW AND INTO THE FUTURE. ADDITIONALLY, MANY SHRINERS HOSPITALS FOR CHILDREN PHYSICIANS AND CARE PROVIDERS SERVE AS BOTH MEMBERS AND LEADERS OF NATIONAL, STATE, AND LOCAL ORGANIZATIONS AIMED AT THE IMPROVEMENT OF PATIENT OUTCOMES VIA STANDARDIZED PRACTICES AND INFORMATION SHARING. PART VI, LINE 3: SHRINERS HOSPITALS FOR CHILDREN POSTS ITS CHARITY CARE POLICY IN ADMISSION AREAS 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 ORTHOPEDIC AND BURN CARE ACROSS THE UNITED STATES AND WORLD-WIDE. SERVICES ARE PROVIDED TO ALL CHILDREN IN NEED. SHRINERS HOSPITALS FOR CHILDREN DOES NOT EXCLUDE, DENY BENEFITS TO, OR OTHERWISE DISCRIMINATE AGAINST ANY PERSON ON THE BASIS OF RACE, COLOR, NATIONAL ORIGIN, AGE, SEX OR DISABILITY IN ADMISSION TO, PARTICIPATION IN, OR RECEIPT OF THE SERVICES AND BENEFITS UNDER ANY OF ITS PROGRAMS AND ACTIVITIES, WHETHER CARRIED OUT BY SHRINERS HOSPITALS DIRECTLY OR THROUGH A CONTRACTOR OR ANY OTHER ENTITY WITH WHICH SHRINERS HOSPITALS ARRANGES TO CARRY OUT ITS PROGRAMS AND ACTIVITIES. PART VI, LINE 7: COMMUNITY BENEFIT REPORTS ARE FILED IN STATES WHERE SHRINERS HOSPITALS FOR CHILDREN HAS FACILITIES BASED ON THE INDIVIDUAL STATE REQUIREMENTS. X X X 1 1 X X X X 0 0 0 0 0 0 0 0 0 JOHN MCCABE EXECUTIVE VICE PRESIDENT 0 961280 0 0 0 25044 0 9150 0 12043 0 1007517 0 0 CHIEN-WEI LIAO CHIEF OF STAFF 517546 0 0 0 735 0 0 0 0 0 518281 0 0 0 AHMAD BAYOMY ORTHOPEDIC SURGEON, SPORTS 350885 0 0 0 17697 0 18300 0 20890 0 407772 0 0 0 JAMES F MOONEY III CHIEF OF STAFF 344062 0 0 0 20848 0 18300 0 14659 0 397869 0 0 0 RUBINI PATHY ORTHOPEDIC SURGEON, ASST PROF 324219 0 0 0 20853 0 17589 0 8909 0 371570 0 0 0 FRANCES MARTHONE MARKET ADMINISTRATOR 202610 0 0 0 1180 0 2850 0 39243 0 245883 0 0 0 PART I, LINE 1A FIRST CLASS TRAVEL IS AVAILABLE ONLY TO BOARD MEMBERS AND EXECUTIVE STAFF AND ONLY IF THE FLIGHT IS LONGER THAN ONE AND A HALF HOURS. A COMPANION ONLY QUALIFIES FOR TRAVEL IF HE OR SHE IS A COMPANION OF A BOARD MEMBER AND IS ACTIVELY PARTICIPATING IN SHRINE BUSINESS DURING THE TRIP. FOR SOME KEY EMPLOYEES, IF RELOCATION IS REQUIRED, A TEMPORARY HOUSING ALLOWANCE MAY BE PROVIDED AS A MEANS TO RECRUIT TOP INDIVIDUALS. FORM 990, PART III, LINE 1 SHRINERS HOSPITALS FOR CHILDREN IN BOSTON AND SPRINGFIELD OFFER "CHARITY CARE" THROUGH AN INTERNATIONAL NETWORK OF PEDIATRIC HOSPITALS DEDICATED TO PROVIDING EXCELLENT PATIENT CARE, RESEARCH, AND EDUCATION FOR ORTHOPEDIC CONDITIONS AND BURNS REGARDLESS OF THE FAMILY'S ABILITY TO PAY. 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 OTHER RELATED CONDITIONS. SHRINERS HOSPITALS FOR CHILDREN-SPRINGFIELD SPECIALIZES IN CARING FOR CHILDREN WITH ORTHOPEDIC CONDITIONS AND INJURIES SUCH AS SCOLIOSIS, CLUBFOOT, AND ORTHOPEDIC CONDITIONS RELATED TO CEREBRAL PALSY AND SPINA BIFIDA. FOR MORE INFORMATION, VISIT HTTP://WWW.SHRINERSHOSPITALSFORCHILDREN.ORG/ OR CALL 1-800-241-GIFT. 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 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 11B A COMPLETE COPY OF FORM 990 IS REVIEWED BY THE AUDIT AND FINANCE COMMITTEE. SUBSEQUENTLY, A COMPLETE COPY OF FORM 990 IS PROVIDED TO THE FULL BOARD. MANAGEMENT REVIEWS THE FORM WITH THE BOARD PRIOR TO 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. POTENTIAL CONFLICTS ARE DETERMINED BY THE BOARD OF DIRECTORS. THE PERSON(S) HAVING A POTENTIAL CONFLICT OF INTEREST ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS/DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 A SALARY AND 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 18 THE ORGANIZATION'S FORM 990 CAN BE FOUND ONLINE AT LOVETOTHERESCUE.ORG/FINANCIALS-2/#FIN-DOCS. THIS SITE CAN BE ACCESSED FROM THE MAIN WEBSITE WWW.SHRINERSCHILDRENS.ORG. 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. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 11,532,588. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,532,588. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,456,301. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 13,347. TOTAL EXPENSES 1,469,648. AGENCY PERSONNEL: PROGRAM SERVICE EXPENSES 381,723. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 381,723. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS AN AUDIT AND FINANCE COMMITTEE RESPONSIBLE FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE COMMITTEE MEETS THREE TIMES A YEAR AND COORDINATES THE AUDIT WITH THE INDEPENDENT AUDITORS. ANY FINANCIAL CONCERN ENCOUNTERED IN THE SYSTEM IS ROUTED TO THIS COMMITTEE FOR REVIEW. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. SHRINERS HOSPITALS FOR CHILDREN EMPLOYEE DISASTER RELIEF FUND 2900 ROCKY POINT DRIVE TAMPA FL 33607 263733381 DISASTER RELIEF DC 501(C)(3) LINE 7 SHRINERS HOSPITALS FOR CHILDREN 0 SHRINERS HOSPITALS FOR CHILDREN POST OFFICE BOX 31356 TAMPA FL 336313356 362193608 HOSPITAL SYSTEM CO 501(C)(3) LINE 3 SHRINERS INTERNATIONAL 0 SHRINERS INTERNATIONAL POST OFFICE BOX 31356 TAMPA FL 336313356 362158164 FOUNDED SHRINERS HOSPITALS FOR CHILDREN IA 501(C)(10) N/A N/A 0 SHRINERS HOSPITALS FOR CHILDREN A CANADIAN CORPORATION 1003 DECARIE BLVD MONTREAL QUEBEC CA H4A 0A9 HOSPITAL SYSTEM CA 501(C)(3) EQUIVALENT LINE 3 SHRINERS HOSPITALS FOR CHILDREN 0 SHRINERS HOSPITALS FOR CHILDREN (QUEBEC) INC 1003 DECARIE BLVD MONTREAL QUEBEC CA H4A 0A9 HOSPITAL SYSTEM CA 501(C)(3) EQUIVALENT LINE 3 SHRINERS HOSPITALS FOR CHILDREN 0 SHRINERS HOSPITALS FOR CHILDREN A MEXICAN ASSOCIATION MX AV DEL IMAN NO 257 MEXICO CITY MX 04600 HOSPITAL SYSTEM MX 501(C)(3) EQUIVALENT LINE 3 SHRINERS HOSPITALS FOR CHILDREN 0 SHRINERS INTERNATIONAL EDUCATION FOUNDATION POST OFFICE BOX 25251 TAMPA FL 33622 813788196 EDUCATION AND LEADERSHIP TRAINING TX 501(C)(3) LINE 7 SHRINERS INTERNATIONAL 0 SHRINERS HOSPITALS FOR CHILDREN AMBULATORY CLINIC AT HIC AC BOSQUE DE DURAZNOS NO 61 PISO 4 BOSQUE DE LAS LOMAS MEXICO CITY MX 11700 HOSPITAL SYSTEM MX 501(C)(3) EQUIVALENT LINE 3 SHRINERS HOSPITALS FOR CHILDREN 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0