2023-08-28T17:21:34-05:00 2022-12-31 420714325 RSM US LLP 1250 H STREET SUITE 700 WASHINGTON DC 20005 990 2022-01-01 270386722 CHILD HEALTH PATIENT SAFETY ORGANIZATION CHIL 9132621436 16011 COLLEGE BLVD 250 LENEXA KS 66219 MICHELLE HOGERTY CHIEF FIN & ADMIN OFFICER 9132621436 2023-08-25 1 MICHELLE HOGERTY 999009999 0 MEREDITH BELL P01696827 2022932200 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z MARK WIETECHA 16011 COLLEGE BLVD 250 LENEXA KS 66219 1022819 0 X WWW.CHILDRENSHOSPITALS.ORG X 2010 KS TO IMPROVE THE SAFETY AND QUALITY OF CHILD HEALTH CARE DELIVERY BY CREATING A SECURE ENVIRONMENT WHERE CLINICIANS AND HEALTH CARE ORGANIZATIONS CAN COLLECT, AGGREGATE, AND ANALYZE DATA THAT WILL ENABLE THE IDENTIFICATION AND REDUCTION OF RISKS AND HAZARDS ASSOCIATED WITH PATIENT CARE. 6 6 0 6 0 0 0 0 996300 1022775 0 39 0 5 996300 1022819 0 0 0 0 0 0 0 0 0 975779 1037771 975779 1037771 20521 -14952 325211 247401 229242 166249 95969 81152 X TO IMPROVE THE SAFETY AND QUALITY OF CHILD HEALTH CARE DELIVERY BY CREATING A SECURE ENVIRONMENT WHERE CLINICIANS AND HEALTH CARE ORGANIZATIONS CAN COLLECT, AGGREGATE, AND ANALYZE DATA THAT WILL ENABLE THE IDENTIFICATION AND REDUCTION OF RISKS AND HAZARDS ASSOCIATED WITH PATIENT CARE. 0 0 882105 1022775 THE CHILD HEALTH PATIENT SAFETY ORGANIZATION, INC. (PSO) WAS ORGANIZED TO IMPROVE THE SAFETY OF CHILDREN'S HOSPITALS BY SHARING DATA AND EXPERIENCES. MANDATED BY THE PATIENT SAFETY AND QUALITY IMPROVEMENT ACT (PSQIA), THE PSO PROVIDES FEDERAL PROTECTIONS FOR CHILDREN'S HOSPITALS TO LEAD IN PATIENT SAFETY AND ELIMINATE HARM, UTILIZING COLLABORATIVE INITIATIVES AND NATIONAL EXPERTS. 882105 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 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 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 X 6 6 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X MICHELLE HOGERTY CFAO 9132621436 16011 COLLEGE BLVD 250 LENEXA KS 66219 THOMAS SHUFFLEBARGER CHAIR 1.00 X X 0 0 0 CAROL KEMPER VICE-CHAIR, SECRETARY/TREASURER 1.00 X X 0 0 0 PATRICIA DEPOMPEI MEMBER 1.00 X 0 0 0 JAMES FORTENBERRY MEMBER 1.00 X 0 0 0 BARBARA JOERS MEMBER 1.00 X 0 0 0 JOHN NICKENS MEMBER 1.00 X 0 0 0 MARK WIETECHA CEO 1.00 39.00 X 30893 1204844 335035 AMY KNIGHT PRESIDENT 5.00 35.00 X 99276 694929 232667 MICHELLE HOGERTY CFAO 1.00 39.00 X 7820 304937 20866 TOREY MACK CHIEF QUALITY & SOLUTIONS OFFICER 4.00 36.00 X 35358 318219 4030 LORI HOTZEL CTO 5.00 35.00 X 33869 237088 38736 KASSANDRA K JENSEN VP, EDUCATION & EXECUTIVE LEARNING 1.00 39.00 X 6958 271362 41990 DAVID BERTOCH VP, INFO & COMP DATA (THRU 2/11/22) 1.00 39.00 X 6031 235182 6778 AIMEE OSSMAN VP, POLICY 1.00 39.00 X 5917 230757 35336 KORY K KITTLE VP, ANALYTICS 1.00 39.00 X 5567 217082 37556 MATTHEW HALL PRINCIPAL, BIOSTATISTICIAN 1.00 39.00 X 5412 211033 42118 237101 3925433 795112 0 0 1 0 0 PARTICIPATION FEES 900099 1022775 1022775 1022775 39 39 MISCELLANEOUS 900099 5 5 5 1022819 1022775 0 44 X 395447 336130 59317 4465 3795 670 2435 2070 365 105280 89488 15792 812 690 122 26014 22112 3902 153 130 23 12234 10399 1835 36639 31143 5496 1520 1292 228 CONTRACTED STAFF 452772 384856 67916 1037771 882105 155666 0 325211 130056 0 6421 0 75174 0 35750 325211 247401 188100 106551 41142 59698 229242 166249 X 95969 81152 95969 81152 325211 247401 -14952 135 0 X 0 1 X 1 0 X 944900 982750 995350 996300 1022775 4942075 944900 982750 995350 996300 1022775 4942075 0 380858 375220 397210 408483 419323 1981094 380858 375220 397210 408483 419323 1981094 2960981 39 39 39 39 5 5 944900 982750 995350 996300 1022819 4942119 0.59910 0.60040 0.00000 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME 0 DUE FROM AFFILIATES 35750 35750 DUE TO AFFILIATES 59698 59698 1022954 135 135 1022819 0 1022819 1037771 0 1037771 0 1037771 1 1 0 0 0 0 0 0 0 MARK WIETECHA CEO 22097 861782 8625 336375 171 6687 7880 307320 496 19339 39269 1531503 0 0 AMY KNIGHT PRESIDENT 73683 515779 25438 178064 155 1086 25888 181217 3195 22367 128359 898513 0 0 TOREY MACK CHIEF QUALITY & SOLUTIONS OFFICER 33673 303056 1650 14851 35 312 226 2029 178 1597 35762 321845 0 0 MICHELLE HOGERTY CFAO 7309 285038 478 18623 33 1276 171 6665 351 13679 8342 325281 0 0 KASSANDRA K JENSEN VP, EDUCATION & EXECUTIVE LEARNING 5805 226399 1140 44460 13 503 628 24481 422 16459 8008 312302 0 0 LORI HOTZEL CTO 28507 199552 5250 36750 112 786 2732 19123 2110 14771 38711 270982 0 0 AIMEE OSSMAN VP, POLICY 5066 197583 840 32760 11 414 489 19078 394 15375 6800 265210 0 0 KORY K KITTLE VP, ANALYTICS 4623 180278 925 36075 19 729 517 20158 422 16459 6506 253699 0 0 MATTHEW HALL PRINCIPAL, BIOSTATISTICIAN 4602 179458 800 31200 10 375 459 17911 594 23154 6465 252098 0 0 DAVID BERTOCH VP, INFO & COMP DATA (THRU 2/11/22) 1154 44997 745 29055 4132 161130 95 3714 74 2895 6200 241791 0 0 PART I, LINE 3 THE NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS, INC. (NACHRI) ACTS AS THE "COMMON PAYMASTER" FOR CHILD HEALTH PATIENT SAFETY ORGANIZATION (CHPSO). NACHRI ISSUES ALL W-2S FOR ALL EMPLOYEES OF THIS GROUP. THE W-2S ARE REPORTED ONLY ON THE NACHRI RETURN, WHILE COMPENSATION ALLOCATED BY TIME-SPENT IS REPORTED ON THE NACHRI AND CHPSO RETURNS. THE PROCESS FOR DETERMINING COMPENSATION FOR OFFICERS AND STAFF IS DONE THROUGH THE NACHRI BOARD. THEREFORE, ALL QUESTIONS REGARDING COMPENSATION POLICY ARE ANSWERED ON THE NACHRI RETURN. METHODS USED BY NACHRI INCLUDE COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, AND APPROVAL BY BOARD OR COMPENSATION COMMITTEE. PART I, LINES 4A-B DAVID BERTOCH RECEIVED SEVERANCE PAYMENTS TOTALING $165,133 DURING THE CALENDAR YEAR. THE PAYMENT IS INCLUDED IN PART VII, COLUMN D AND SCHEDULE J, PART II, COLUMN BIII. THE TERMS AND CONDITIONS OF THE CONFIDENTIAL SEVERANCE AGREEMENT ARE AVAILABLE TO THE INTERNAL REVENUE SERVICE UPON REQUEST. THE FOLLOWING LISTED EMPLOYEES PARTICIPATED IN A 457(F) PLAN DURING THE YEAR: - MARK WIETECHA (NO DISTRIBUTION IN 2022, $269,100 WAS CONTRIBUTED TO THE PLAN) - AMY KNIGHT (NO DISTRIBUTION IN 2022, $181,410 WAS CONTRIBUTED TO THE PLAN) FORM 990, PART VI, SECTION A, LINE 3 THERE IS AN OFFICE SHARING AND ADMINISTRATIVE SERVICES AGREEMENT WITH NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS, INC., A RELATED NOT-FOR-PROFIT GEORGIA CORPORATION. FORM 990, PART VI, SECTION A, LINE 6 THE NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS, INC., A SECTION 501(C)(6) ORGANIZATION, IS THE PSO'S SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7A AS SOLE MEMBER, THE NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS, INC. MAY APPOINT MEMBERS OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION B, LINE 11B INITIAL COMPILATION OF INFORMATION IS COMPLETED BY FINANCE STAFF FOR TRANSMISSION TO AN OUTSIDE FIRM FOR TAX RETURN PREPRATION. THE DRAFT RETURN IS REVIEWED BY FINANCE STAFF AND THE CFAO. THE DRAFT RETURN IS PROVIDED TO THE BOARD OF TRUSTEES; ANY BOARD COMMENTS OR QUESTIONS ARE CLEARED PRIOR TO FILING THE FINAL RETURN. FORM 990, PART VI, SECTION B, LINE 12C PERIODICALLY, THE BOARD OF TRUSTEES MUST FILL OUT A CONFLICT OF INTEREST QUESTIONNAIRE AND ALSO SUBMIT TO BACKGROUND CHECKS OF VARYING DEGREES. THE RESULTS ARE REVIEWED BY THE CEO. AT THE START OF ALL BOARD AND COMMITTEE MEETINGS, THE PARTICIPATING MEMBERS ARE ASKED TO DECLARE ANY CONFLICT OF INTEREST ACCORDINGLY. PERIODICALLY, ALL STAFF MUST FILL OUT A CONFLICT OF INTEREST FORM AND MUST ADHERE TO THE ASSOCIATION'S CONFLICT OF INTEREST POLICY. ANY CONFLICTS OF INTEREST ARE RESOLVED AS APPROPRIATE. THE HUMAN RESOURCE DEPARTMENT ENCOURAGES STAFF TO BRING ANY SITUATIONS TO THEIR ATTENTION AND MAKE PROMPT AND FULL DISCLOSURE OF ANY POTENTIAL SITUATIONS THAT MAY INVOLVE A CONFLICT OF INTEREST. THE POLICY IS INCLUDED IN OUR EMPLOYEE MANUAL AND WHISTLEBLOWER POLICY. FORM 990, PART VI, SECTION B, LINE 15 THE CURRENT CEO WAS HIRED IN SEPTEMBER 2011 AND THE CURRENT PRESIDENT WAS HIRED IN DECEMBER 2011. THIS PROCESS INVOLVED A NATIONAL SEARCH FIRM THAT WAS CLOSELY MONITORED BY A TASK FORCE AND THE BOARD OF TRUSTEES. IN ADDITION, THE GOVERNANCE COMMITTEE ALSO ACTS AS THE COMPENSATION COMMITTEE AND REVIEWS ALL COMPENSATION RELATED MATTERS. THE CEO AND PRESIDENT'S COMPENSATION WAS BASED ON MARKET COMPARABLES OF SIMILAR SIZED ORGANIZATIONS AND RESPONSIBILITIES. THE COMPENSATION IS ALSO INCLUDED IN A WRITTEN EMPLOYMENT AGREEMENT. A COMPLETE REVIEW OF EXECUTIVE (CEO AND PRESIDENT) SALARIES OCCURRED DURING 2022. SALARY INCREASES FOR THE CEO ARE RECOMMENDED BY THE GOVERNANCE COMMITTEE TO THE FULL BOARD FOR APPROVAL IN EXECUTIVE SESSION WITHOUT THE CEO PRESENT. THE CEO UTILIZES THE MARKET STUDY TO DETERMINE AND APPROVE COMPENSATION FOR THE PRESIDENT. FOR ALL OTHER STAFF, THE ASSOCIATION PERIODICALLY ENGAGES AN OUTSIDE CONSULTANT FOR COMPENSATION STUDIES TO REVIEW ALL JOB DESCRIPTIONS AND SALARIES. THIS CONSULTANT HAS EXPERTISE IN THE NON-PROFIT AND HEALTH FIELDS AND IS VERY FAMILIAR WITH THE COMPENSATION PRACTICES. THE CONSULTANT REVIEWS THE COMPENSATION OF OTHER NATIONAL ASSOCIATIONS AND PEER GROUPS. A FORMAL EVALUATION OF ALL CURRENT SALARIES OCCURRED DURING 2022. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS AND CONFLICT OF INTREST POLICY ARE NOT GENERALLY MADE AVAILABLE TO THE PUBLIC. AUDITED FINANCIAL STATEMENTS AND FORM 990 ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G CONSULTING FEES: PROGRAM SERVICE EXPENSES 89,488. MANAGEMENT AND GENERAL EXPENSES 15,792. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 105,280. NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS INC (NACH) 600 13TH STREET NW SUITE 500 WASHINGTON DC 20005 582176067 ASSIST CHILDREN'S HOSPITALS IN COMMON BUSINESS INTEREST AND ECON. WELFARE GA 501(C)(6) N/A N/A 0 NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS INC 600 13TH STREET NW SUITE 500 WASHINGTON DC 20005 510120256 TO PROMOTE SUPPORT OF CHILDREN'S HOSPITALS GA 501(C)(3) 509(A)(2) NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS INC N 395447 ACTUAL COST NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS INC O 452772 ACTUAL COST