2023-11-14T19:28:13-06:00 2022-12-31 135565207 KPMG LLP 90 S 7TH ST STE 4200 MINNEAPOLIS MN 55402 990 2022-01-01 453765330 CHILDREN'S CLINIC NETWORK CHIL 6128136113 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 BRENDA MCCORMICK SVP & CFO 6128136113 2023-11-14 1 BRENDA MCCORMICK 999009999 0 HOLLY MOEN P01800653 6123055000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z BRENDA MCCORMICK 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 33576368 0 X CHILDRENSMN.ORG X 2011 MN CHILDREN'S CLINIC NETWORK CHAMPIONS THE SPECIAL HEALTH NEEDS OF CHILDREN AND THEIR FAMILIES. 5 3 186 0 0 0 152218 661797 38185021 32401283 226701 -25921 -2197676 -1740086 36366264 31297073 12606 10458 0 0 10169309 10871980 0 0 0 26776258 22185197 36958173 33067635 -591909 -1770562 16399110 11862724 9522998 6757175 6876112 5105549 X CHILDREN'S CLINIC NETWORK CHAMPIONS THE SPECIAL HEALTH NEEDS OF CHILDREN AND THEIR FAMILIES. WE ARE COMMITTED TO IMPROVING CHILDREN'S HEALTH BY PROVIDING HIGH-QUALITY, FAMILY-CENTERED PEDIATRIC SERVICES AT OUR SEVEN CLINICS. 0 0 31953356 10458 32399783 CHILDREN'S CLINIC NETWORK 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 TO CARE FOR THE SPECIAL PHYSICAL AND EMOTIONAL NEEDS OF CHILDREN. OUR SEVEN NETWORK CLINICS, AT THEIR LOCATIONS (SEE SCHEDULE O FOR LOCATIONS) PROVIDED 123,862 CLINIC VISITS. 31953356 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 186 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 & CFO 6128136000 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 MARC GORELICK MD PRESIDENT & CEO 1.00 49.00 X X 0 1935831 42171 ANDREW PUGH BOARD SECRETARY & SVP CHIEF LE 1.00 49.00 X X 0 506040 41189 GARY BLACKFORD BOARD MEMBER, BOARD VICE CHAIR 1.00 3.00 X X 0 0 0 HENRY CHANG FORMER BOARD MEMBER & ELECT (2/22) 0.00 0.00 X X 0 0 0 CHARLIE MAXWELL FORMER BOARD MEMBER, TREASURER (2/22) 0.00 0.00 X X 0 0 0 MATTHEW BILUNAS BOARD MEMBER, TREASURER (3/22) 1.00 2.00 X X 0 0 0 ARCHELLE GEORGIOU BOARD MEMBER, BOARD CHAIR (3/22) 1.00 3.00 X X 0 0 0 JENNIFER OLSON MARKET SVP & COO 1.00 49.00 X 0 1068566 41821 BRENDA MCCORMICK SVP & CFO 1.00 49.00 X 0 962479 45702 PAMELA GIGI CHAWLA MD VP CHIEF OF GENERAL PEDIATRICS 10.00 40.00 X 100635 425553 40709 MONICA SCHILLER VP AMBULATORY SERVICES 18.00 32.00 X 138433 267946 38883 KRISTIN HEUERMANN MD CLINIC PHYSICIAN 50.00 0.00 X 209332 0 38914 PAMELA NIKSICH MD STAFF PHYSICIAN 50.00 0.00 X 261795 0 21880 CYNTHIA KRULL MD CLINIC PHYSICIAN 50.00 0.00 X 230288 0 35625 CATHERINE BEDFORD MD MEDICAL DIRECTOR 50.00 0.00 X 239049 0 36403 NEETI PRADIP KAMBALE MD CLINIC PHYSICIAN 50.00 0.00 X 180894 0 34891 1360426 5166415 418188 10 0 1 0 PARTNERS IN PEDIATRICS 12720 BASS LAKE ROAD MAPLE GROVE MN 55369 PHYSICIAN & STAFF 10222431 ECLINICALWORKS LLC 2 TECHNOLOGY DRIVE WESTBOROUGH MA 01581 TECHNOLOGY MAINT. 234490 2 38967 622830 661797 PATIENT SERVICE 621498 28281054 28281054 MEDICAID 621498 3931403 3931403 PAY FOR PERF. BONUS 621498 187326 187326 PARKNG RAMP 621498 1500 1500 32401283 513288 2253374 -1740086 -1740086 -1740086 25921 -25921 -25921 -25921 31297073 32399783 0 -1764507 X 10458 10458 239068 239068 8024496 7666996 357500 382328 369568 12760 1696649 1550206 146443 529439 511769 17670 18616 18616 63005 63005 1146 1146 12213178 12186648 26530 354 354 196594 196594 240613 8280 232333 162864 162864 8968 8968 71302 71302 775073 775073 236532 236532 MEDICAL EXPENSES 6875043 6875043 MN CARE & SALES TAX 671384 671384 BAD DEBT EXPENSE 360144 360144 MISCELLANEOUS EXPENSES 164597 164597 125784 125784 33067635 31953356 1114279 0 100 800 0 0 0 0 5410792 3182598 0 0 0 0 0 0 651403 635681 554830 72844 9250741 6179996 3650814 3070745 0 0 0 0 0 0 0 0 6131171 4900056 16399110 11862724 243752 343096 0 0 622830 0 0 0 0 0 0 0 0 0 0 0 8656416 6414079 9522998 6757175 X 6876112 5105550 0 0 6876112 5105550 16399110 11862725 -1770562 0 X 0 1 X 1 1 1 X FORM 990, SCH A. SUPPLEMENTAL INFORMATION CHILDREN'S CLINIC NETWORK HAS OBTAINED TAX-EXEMPT STATUS AS AN ORGANIZATION WHOSE MAIN PURPOSE IS TO PROVIDE MEDICAL CARE. HOWEVER, CHILDREN'S CLINIC NETWORK 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. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1146 1146 0 SCHEDULE C, PART II-B MN CHAPTER OF THE AMERICAN ACADEMY OF PEDIATRICS (MNAAP): $200 MINNESOTA MEDICAL ASSOCIATION (MMA): $736 AMERICAN MEDICAL ASSOCIATION (AMA): $210 5535958 3136474 2399484 3714783 3043522 671261 3070745 RIGHT OF USE - BASE OPERATING ASSET 4900056 4900056 MNCARE TAX 73074 LEASE LIABILITY 6076608 INTERCOMPANY PAYABLE 264397 6414079 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 JUDGMENT 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. 1 CHARITY CARE ASSISTANCE TO INDIVIDUALS 39 10458 COST CHARITY CARE TO INDV PART I, LINE 2: CHILDREN'S CLINIC NETWORK PROVIDES CHARITY CARE ASSISTANCE TO INDIVIDUALS OUTLINED IN OUR POLICY WHICH IS CLOSELY MONITORED BY MANAGEMENT. 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 81300 BRENDA MCCORMICK SVP & CFO 0 618281 0 250618 0 93580 0 18300 0 27402 0 1008181 0 83200 PAMELA GIGI CHAWLA MD VP CHIEF OF GENERAL PEDIATRICS 100635 269436 0 128376 0 27741 0 20964 0 19745 100635 466262 0 24848 ANDREW PUGH BOARD SECRETARY & SVP CHIEF LE 0 404631 0 97930 0 3479 0 18300 0 22889 0 547229 0 0 MONICA SCHILLER VP AMBULATORY SERVICES 138433 147658 0 104979 0 15309 0 18170 0 20713 138433 306829 0 13032 PAMELA NIKSICH MD STAFF PHYSICIAN 214484 0 34800 0 12511 0 12396 0 9484 0 283675 0 10714 0 CATHERINE BEDFORD MD MEDICAL DIRECTOR 201334 0 35357 0 2358 0 10852 0 25551 0 275452 0 0 0 CYNTHIA KRULL MD CLINIC PHYSICIAN 206417 0 16499 0 7372 0 8543 0 27082 0 265913 0 7012 0 KRISTIN HEUERMANN MD CLINIC PHYSICIAN 188646 0 19670 0 1016 0 13034 0 25880 0 248246 0 0 0 NEETI PRADIP KAMBALE MD CLINIC PHYSICIAN 149423 0 12497 0 18974 0 11480 0 23411 0 215785 0 4007 0 PART I, LINE 3 CHILDREN'S CLINIC NETWORK RELIES ON CHILDREN'S HEALTH CARE, THE PARENT OF CHILDREN'S CLINIC NETWORK, TO ESTABLISH THE COMPENSATION OF THE CEO: COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. PART-I LINE-4B CERTAIN EMPLOYEES OF CHILDREN'S HEALTH CARE, PARENT OF CHILDREN'S CLINIC NETWORK, 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: JENNIFER OLSON MARKET - $81,330 BRENDA MCCORMICK - $83,200 CYNTHIA KRULL MD - $7,012 NEETI PRADIP KAMBALE MD - $4,007 MONICA SCHILLER - $13,032 PAMELA GIGI CHAWLA MD - $24,848 PAMELA NIKSICH 0 $10,714 FORM 990, PART III, LINE 4A: PROGRAM SERVICE ACCOMPLISHMENTS PROGRAM SERVICE ACCOMPLISHMENTS: LOCATIONS - ADDRESSES OF OUR SEVEN NETWORK CLINICS 963 S. ROBERTS ST. WEST ST. PAUL, MN 55118 14701 VICTOR HUGO BLVD N HUGO, MN 55038 EDINBURGH MEDICAL AND DENTAL PLAZA 8500 EDINBROOK PARKWAY BROOKLYN PARK, MN 55443 3910 EXCELSIOR BOULEVARD ST. LOUIS PARK, MN 55416 BASS LAKE CENTER 12720 BASS LAKE ROAD MAPLE GROVE, MN 55369 WEST HEALTH CAMPUS 2855 CAMPUS DRIVE, SUITE 350 PLYMOUTH, MN 55441 13980 NORTHDALE BOULEVARD ROGERS, MN 55374 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 CLINIC NETWORK. 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 CLINIC NETWORK ARE REPORTED TO THE IRS. FORM 990, PART VI, SECTION A, LINE 6 CHILDREN'S CLINIC NETWORK HAS A SOLE MEMBER, CHILDREN'S HEALTH CARE, A MINNESOTA NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A CHILDREN'S CLINIC NETWORK'S SOLE MEMBER, CHILDREN'S HEALTH CARE, IS AUTHORIZED UNDER CHILDREN'S CLINIC NETWORK'S BYLAWS TO ELECT DIRECTORS OF CHILDREN'S CLINIC NETWORK, AFTER APPROVAL BY THE BOARD OF DIRECTORS OF CHILDREN'S CLINIC NETWORK. FORM 990, PART VI, SECTION A, LINE 7B CHILDREN'S CLINIC NETWORK'S SOLE MEMBER, CHILDREN'S HEALTH CARE, MAINTAINS A NUMBER OF RESERVED POWERS INCLUDING BUT NOT LIMITED TO ELECTION OF DIRECTORS, APPROVAL OF ANNUAL BUDGETS, 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, THE PARENT OF CHILDREN'S CLINIC NETWORK, REVIEWS THE DRAFT OF FORM 990 WITH THE AUDIT AND COMPLIANCE COMMITTEE OF CHILDREN'S HEALTH CARE GOVERNING BODY PRIOR TO THE FILING OF THE FORM. THIS REVIEW INCLUDES AN OVERVIEW OF THE FORM AND DISCUSSION RELATED TO KEY SECTIONS. COPIES OF THE FINAL FORM 990 ARE MADE AVAILABLE TO MEMBERS OF THE COMMITTEE AND ALL DIRECTORS PRIOR TO THE FORM BEING FILED. THE AUDIT AND COMPLIANCE COMMITTEE HAS BEEN DELEGATED THE 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. FORM 990, PART VI, SECTION B, LINE 12C MANAGEMENT OF CHILDREN'S HEALTH CARE, THE PARENT OF CHILDREN'S CLINIC NETWORK, ENSURE 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., REVIEW 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 CEO OF CHILDREN'S CLINIC NETWORK IS ESTABLISHED BY CHILDREN'S HEALTH CARE AS PART OF ITS EXECUTIVE COMPENSATION PROCESS. CHILDREN'S HEALTH CARE, INC. FOLLOWS THE REQUIREMENTS SET FORTH IN THE IRS REBUTTABLE PRESUMPTION OF REASONABLENESS IS DETERMINING COMPENSATION FOR THE CEO AND OTHER OFFICERS AND EXECUTIVE LEADERS OF CHILDREN'S CLINIC NETWORK. THIS FUNCTION IS PERFORMED BY THE COMPENSATION COMMITTEE OF THE GOVERNING BOARD OF CHILDREN'S HEALTH CARE, 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, THE PARENT OF CHILDREN'S CLINIC NETWORK, 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 MAKE THIS INFORMATION PUBLICLY AVAILABLE. CHILDREN'S CLINIC NETWORK RELIES ON THE CONFLICT OF INTEREST POLICY OF CHILDREN'S HEALTH CARE, THE PARENT OF CHILDREN'S CLINIC NETWORK CHILDREN'S HEALTH CARE DOES NOT MAKE THE CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE GOVERNING DOCUMENTS OF CHILDREN'S CLINIC NETWORK ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G PURCHASED LAB & MEDICAL SVCS: PROGRAM SERVICE EXPENSES 11,972,230. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,972,230. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 12,599. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,599. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 170,634. MANAGEMENT AND GENERAL EXPENSES 13,931. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 184,565. LINEN: PROGRAM SERVICE EXPENSES 30,296. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,296. LEASED EQUIPMENT: PROGRAM SERVICE EXPENSES 13,488. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,488. 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 HEALTH CARE SERVICES INC 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 411756478 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 LTD 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 MINNNEAPOLIS MN 55404 842915398 MED. EQ. SERVICES MN CHC C 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 1 1 1 1