2024-08-12T11:31:26-05:00 2023-09-30 010494526 Baker Newman & Noyes LLC 280 Fore Street Portland ME 04101 990 2022-10-01 042767602 CHMC Surgical Foundation Inc CHMC 6173554022 300 Longwood Avenue Fegan3 Boston MA 02115 Steven J Fishman MD President 6173554022 2024-07-30 0 0 Nicholas E Porto P01310283 8002447444 2024-07-30 2022 2024-08-08 14:25:15Z Steven J Fishman MD 300 Longwood Avenue Fegan3 Boston MA 02115 67279111 0 X N/A X 1982 MA The Foundation provides surgical services and educational services to Boston (see Schedule O) Children's Hospital and Harvard Medical School. The Foundation also provides care for patients 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. 7 0 31 0 7484 447 609215 274142 30233407 41333050 1042563 17358682 2120956 919779 34006141 59885653 19431 25164 0 0 26492910 35886124 0 0 0 4131705 6508177 30644046 42419465 3362095 17466188 83277496 95368583 20938690 23264886 62338806 72103697 X The Foundation provides surgical services primarily to patients at Boston Children's Hospital and at satellite locations. The Foundation carries on and promotes basic and applied medical research and education in the field of surgery by teaching (see Schedule O) students and other medical and scientific personnel. The Foundation also provides care for patients regardless of their ability to pay. 0 0 34356271 25164 33179245 The Foundation was organized to operate for the benefit of Boston Children's Hospital and Harvard Medical School, to provide surgical services to patients, and to conduct and promote research and education in the field of pediatric surgery. The Foundation may charge for patient care and other medical services, 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 many patients regardless of their ability to pay, as well as providing hospital and community based services that are either unavailable or limited elsewhere in the community. 772051 1726854 The Foundation receives income from Boston Children's Hospital for providing administration services. The Foundation carries on and promotes basic and applied medical research and education in the field of surgery 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 conditions and research results in the field of pediatric surgery in order to educate the general public and the medical profession. 3474230 6426951 The Foundation provides clinical services in certain clinics and satellite locations of Boston Children's Hospital (the Hospital) at agreed upon rates for reimbursement. 38602552 1 1 0 0 0 0 0 0 0 1 1 1 0 1 1 1 0 1 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 0 0 1 31 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Tom Jaksic MD 6173554022 300 Longwood Avenue Boston MA 02115 Steven J Fishman MD President 55.00 5.00 X X 1561228 0 108319 Heung Bae Kim MD Clerk 60.00 0.00 X X 1038272 0 110115 Tom Jaksic MD Treasurer 60.00 0.00 X X 813084 0 106862 Craig W Lillehei MD Director (10/22-2/23) 60.00 0.00 X 610698 0 107006 Shawn J Rangel MD Director (2/23-9/23) 60.00 0.00 X 837661 0 107231 Biren P Modi MD Director 60.00 0.00 X 900615 0 250277 Brent Weil MD Director 60.00 0.00 X 850601 0 283253 Jill M Zalieckas MD Director (10/22-2/23) 48.00 0.00 X 697668 0 252283 Terry L Buchmiller MD Director (2/23-9/23) 60.00 0.00 X 1081150 0 81409 Physicians Org at CH Inc Institutional Trustee 2.00 0.00 X 0 0 0 Marc R Laufer MD Dept. Chief 60.00 0.00 X 946958 0 108889 Konstantinos Papadakis MD Physician 60.00 0.00 X 912779 0 109165 Benjamin Zendejas-Mummert MD Physician 60.00 0.00 X 831027 0 259814 Belinda Hsi Dickie MD Physician 60.00 0.00 X 848562 0 275988 Farokh R Demehri MD Physician 60.00 0.00 X 791105 0 232506 Somala Mohammed MD Physician 60.00 0.00 X 790288 0 259626 13511696 0 2652743 30 0 1 0 Brigham and Women's Physician Organizati PO Box 3684 Boston MA 02241 Physician services 379313 AskMueller Consulting LLC 204 E Locust Street Lenzburg IL 62255 Billing Services 108201 Weatherby Locums Inc PO Box 972633 Dallas TX 653972633 Physician services 103148 3 274142 274142 Patient service revenue 621300 33185271 33185271 Clinical and other revenue 621300 6420925 6420925 Education and research 611710 1726854 1726854 41333050 752140 7484 744656 24000000 7393458 16606542 16606542 16606542 Non-operating pension gains 900099 919779 919779 919779 59885653 41333050 7484 18270977 25164 25164 9707983 9707983 19072342 16527579 2544763 3752451 3752451 2610671 1719891 890780 742677 675836 66841 15402 15402 69714 69714 48855 48855 115756 115756 9423 9423 1349251 1234532 114719 442232 442232 1550 1550 303550 303550 5070 5070 779851 723435 56416 Coordinated Specialty P 1105464 1105464 PO management services 851225 851225 Billing and collection 733338 733338 BCH Tax 665151 665151 12345 12345 42419465 38602552 3816913 0 9022105 3045733 341502 5902612 4760169 4466724 221000 274841 911889 695971 236804 284969 65960 47311 6299 18649 32860397 38090319 22869516 24516190 12047815 18072575 83277496 95368583 271448 1218849 199921 100001 20467321 21946036 20938690 23264886 X 56144023 66565552 6194783 5538145 62338806 72103697 83277496 95368583 X 17466188 -11865642 4164345 X X 0 1 X 1 0 X 3347679 714591 3623459 609215 274142 8569086 30861882 29249164 35545476 30233407 41330050 167219979 34209561 29963755 39168935 30842622 41604192 175789065 0 0 0 175789065 470035 478371 420302 406859 744656 2520223 470035 478371 420302 406859 744656 2520223 -6156 -10935 143 -265 7484 -9729 1096463 1033335 2120956 4250754 34673440 31527654 40622715 33370172 42356332 182550313 0.96300 0.96060 0.01380 0.01290 X Schedule A, Part III, Line 12, Explanation of Other Income: Insurance rebate - 2019 Amount: $ 284,139. Non-operating pension gains - 2019 Amount: $ 812,324. 2020 Amount: $ 1,033,335. 2021 Amount: $ 2,120,956. 2022 Amount: $ 0. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 6494783 100000 756639 5838144 6250144 463470 518830 6494783 4474276 3552652 1776784 6250144 4462943 681949 670617 4474276 1883909 3167000 587966 4462943 0.00000 0.00000 1.00000 0 0 65960 47311 18649 18649 Interest in the P.O. Pooled Investment Fund 24516190 F 24516190 Due from Boston Children's Hospital 325951 Due from Physicians Org. at CH, Inc. 1112461 Due from Dana Farber Cancer Institute 93944 Due from Harvard Medical School 241455 Due from Boston Medical Center 103361 Due from New England Organ Bank 31739 Due from Children's Hospital Pediatric Associates, Inc. 297 Malpractice Claims receivable 3114004 Due from BCH - Egan Family Charitable Fund 300000 Due from Brigham & Women's 95158 Due from CHMC Anesthesia Foundation, Inc. 106200 Due from Otolaryngology 425 Prepaid defined benefit pension plan 12354952 Due from Tufts Medical Center 177916 Due from Beth Israel 12933 Due from Boston Pediatric Neurosurgical Foundation, Inc. 1779 18072575 Due to Boston Children's Hospital 2176975 Due to Physicians Org. at CH, Inc 67074 Due to Boston Medical Center 16833 Accrued salaries and benefits 4019195 Accrued deferred compensation 11126417 Accrued professional liability 4394466 Due to Brigham & Women's 31275 Due to CHMC Otolaryngologic Foundation, Inc. 13239 Due to Boston Children's Hospital - Vascular Biology 100000 Due to Boston Pediatric Neurosurgical Foundation, Inc. 676 Due to Children's Orthopedic Surgery Foundation, Inc. 2768 Due to Children's Hospital Pathology Foundation, Inc. -3299 Due to Boston Plastic & Oral Surgery Foundation, Inc. 417 21946036 X 52135501 -11865642 4164345 -7701297 59836798 48855 48855 59885653 42370610 0 42370610 48855 48855 42419465 Part V, Line 4: The endowment funds represent assets held in trust that are available to pay for future benefits to participants for a deferred compensation benefit plan and investments whose use have been restricted by donors to a specific time period and purpose. Part X, Line 2: The Foundation is a tax-exempt corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code), and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. In addition, the Foundation qualifies for the charitable contribution deduction under Section 170(b)(1)(A), and has been classified as an organization that is not a private foundation under Section 509(a)(2). Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items, including unrelated business income or tax status. Management of the Foundation has evaluated the positions taken on the Foundation's filed tax returns and has concluded that no uncertain income tax positions exist at September 30, 2023. Part XI, Line 2d - Other Adjustments: Pension adjustment 4,164,345. 1 Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 501(c)(3) 12183 0 N/A N/A General Support 1 0 Part I, Line 2: Monitoring is provided by CHMC Surgical Foundation, Inc. (the 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, 2023, the Foundation only provided grant donations to other 501(c)(3) organizations. X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 Steven J Fishman MD President 1226000 0 273829 0 61399 0 61000 0 47319 0 1669547 0 0 0 Terry L Buchmiller MD Director (2/23-9/23) 713128 0 322360 0 45662 0 61000 0 20409 0 1162559 0 0 0 Biren P Modi MD Director 548633 0 308063 0 43919 0 202284 0 47993 0 1150892 0 0 0 Heung Bae Kim MD Clerk 743316 0 243477 0 51479 0 61000 0 49115 0 1148387 0 0 0 Brent Weil MD Director 478137 0 319941 0 52523 0 194525 0 88728 0 1133854 0 0 0 Belinda Hsi Dickie MD Physician 494664 0 287508 0 66390 0 203145 0 72843 0 1124550 0 0 0 Benjamin Zendejas-Mummert MD Physician 451983 0 318154 0 60890 0 193011 0 66803 0 1090841 0 0 0 Marc R Laufer MD Dept. Chief 853421 0 50493 0 43044 0 61000 0 47889 0 1055847 0 0 0 Somala Mohammed MD Physician 451615 0 283325 0 55348 0 189291 0 70335 0 1049914 0 0 0 Farokh R Demehri MD Physician 457541 0 266186 0 67378 0 190141 0 42365 0 1023611 0 0 0 Konstantinos Papadakis MD Physician 578023 0 287696 0 47060 0 61000 0 48165 0 1021944 0 0 0 Jill M Zalieckas MD Director (10/22-2/23) 386844 0 266186 0 44638 0 204868 0 47415 0 949951 0 0 0 Shawn J Rangel MD Director (2/23-9/23) 528984 0 261794 0 46883 0 61000 0 46231 0 944892 0 0 0 Tom Jaksic MD Treasurer 702608 0 48610 0 61866 0 61000 0 45862 0 919946 0 0 0 Craig W Lillehei MD Director (10/22-2/23) 523793 0 49979 0 36926 0 61000 0 46006 0 717704 0 0 0 Part I, Line 1a The Foundation provides gross-up payments for mortgage forgiveness, long-term disability insurance, and life insurance. These payments are included as taxable wages during the year. All permanent full-time employees of the Foundation are eligible for the gross-up payments. Part I, Line 4b CHMC Surgical Foundation, Inc. (the Foundation) established a Defined Benefit Pension Plan, effective October 1, 2006, to provide its employees with fair and adequate retirement benefits. The plan calls for benefits to be paid to eligible employees at retirement based upon years of service with the Foundation and compensation rates near retirement. Contributions to the plan reflect benefits attributed to employees' services to date, as well as services expected to be earned in the future. During the year ended September 30, 2023, the Foundation made the following contributions to the plan: Biren P. Modi, MD, $141,284; Jill Zalieckas, MD $143,868; Belinda Hsi Dickie, MD, $142,145; Brent Weil, MD $133,525; Benjamin Zendejas-Mummert, MD, $132,011; Farokah R. Demehri, MD, $129,141; and Somala Mohammed, MD, $128,291. Part I, Line 7 Bonus compensation amounts are determined by the Chief of CHMC Surgical Foundation, Inc. (the Foundation). The amounts are discretionary based on job performance and the financial performance of the Foundation. Belinda Hsi Dickie MD Physician Housing loan X 300000 171000 0 1 1 Brent Weil MD Physician Housing loan X 100000 20000 0 1 1 Benjamin Zendejas-Mummert MD Physician Housing loan X 100000 28285 0 0 0 Farokh Demehri MD Physician Housing loan X 100000 0 0 0 0 Somala Mohammed MD Physician Housing loan X 100000 55556 0 0 0 274841 Schedule L, Part II, Loans to and from Interested Persons: CHMC Surgical Foundation, Inc. (the Foundation) has provided several secured and unsecured loans to employees. The loans were made for recruitment and retention purposes, to assist physician employees in the purchase of their primary residence. The amounts for the recruitment loans were determined by restricted donations provided by Boston 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. The amount of the loan forgiveness will be included with accrued interest, if applicable, as compensation in the year forgiven. The balance of the loans outstanding are $970,813 at September 30, 2023. Future principal amounts due are as follows $295,410 in 2024; $284,298 in 2025; $224,715 in 2026; $45,340 in 2027; $45,340 in 2028; and $75,710 in 2029 through 2030. Loan amounts to individuals reported in Part VII have been disclosed in Schedule L, Part II, the balance of the notes receivable are with individuals who are not required to be disclosed in Schedule L per the IRS instructions. Form 990, Part VI, Section A, line 1a The majority of CHMC Surgical Foundation, Inc.'s (the Foundation's) board members are physicians who are not independent from the Foundation. However, the Foundation is part of an integrated delivery system with Boston Children's Hospital (the Hospital) which does have a community board. The Foundation was organized in 1982. 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 at Children's Hospital, Inc. (the 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 Organization at Children's Hospital, Inc. (the PO) is a Class "C" member of CHMC Surgical Foundation, Inc. (the Foundation). The PO is responsible for providing management services to the Foundation. The PO has the power to approve the independent auditor and legal counsel of the Foundation from a list of firms mutually agreed to by the PO and the Foundation. The PO also has the right to review the annual budgets and review and approve the by-law changes of the Foundation. Lastly, Boston Children's Hospital 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. Form 990, Part VI, Section A, line 6 CHMC Surgical Foundation, Inc. (the Foundation) has three classes of members. The Chief of the Department of Surgery (the Department) of Boston Children's Hospital (the Hospital) is a Class "A" member. Each person who is a member of the Foundation, other than the Chief of the Foundation, who holds a medical staff appointment under the auspices of the Chief Surgeon from Harvard University Medical School, and who is a full time employee at the Hospital, shall be a Class "B" member. In addition, upon the recommendation of the Chief Surgeon and with the approval of the President of the Hospital or his designee, exceptions may be made to permit other physicians who are members of the Department to be Class "B" members. The Physicians Organization at Children's Hospital, Inc. is a Class "C" member of the Foundation. Form 990, Part VI, Section A, line 7a According to the Articles of Organization, the Chief of the Department of Surgery (the Department) of Boston Children's Hospital is the Class "A" member of CHMC Surgical Foundation, Inc. (the Foundation). Each person who is a member of the Foundation, other than the Chief of the Department, is a Class "B" member of the Foundation. The Class "A and "B" members of the Foundation elect the Board of Directors from nominees presented by the Executive Committee at their annual meeting. Each member is entitled to one vote upon any question at any meeting of the members. Form 990, Part VI, Section A, line 7b The Physicians Organization at Children's Hospital, Inc. (the PO) is a Class "C" member of CHMC Surgical Foundation, Inc. (the Foundation). The PO is responsible for providing management services to the Foundation. The PO has the power to approve the independent auditor and legal counsel of the Foundation from a list of firms mutually agreed to by the PO and the Foundation. The PO also has the right to review the annual budgets and review and approve the by-law changes of the Foundation. Lastly, Boston Children's Hospital 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. As a Class "C" member of the Foundation, the PO attends the Foundation's annual meeting. Form 990, Part VI, Section B, line 11b The detailed review will be conducted by the President of the Foundation, Steven J. Fishman, MD, and the administrator, Todd Katzman. A copy of the Form 990 will be provided to the board 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 at Children's Hospital, Inc. (the PO) and Boston Children's Hospital (the Hospital) administer an annual conflict of interest disclosure process to all of their 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 audit committee shall determine those individuals (including medical staff members) who shall be required to complete the disclosure statement. The 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 influencing the voting on such matter. Form 990, Part VI, Section B, line 15 Faculty compensation must comply with the Boston Children's Hospital (the Hospital) Physician Compensation Guidelines. These guidelines are developed in consultation with an independent external compensation consulting firm and are approved by the independent Compensation Committee of the Board of Children's Medical Center Corporation and the Hospital. The guidelines set the maximum compensation limits based on a peer group analysis for the Foundation. The maximum compensation limits are based on pediatric specialty, sub-specialty, academic rank and include productivity adjustments. Any proposed compensation that exceeds the limits must be prospectively approved by the independent compensation committee of the Board of the Hospital. Annual compensation for individual faculty members is set by the President of the CHMC Surgical Foundation, Inc. (the Foundation), reviewed and approved by the Foundation in accordance with the Foundation's compensation policies and procedures. The Foundation's President's compensation is reviewed and approved annually on a prospective basis by the Boston Children's Hospital President/Chief Executive Officer. Form 990, Part VI, Section C, line 19 The Foundation maintains all financial records, conflict of interest policies, and governing documents at its main office at 300 Longwood Avenue, Boston, MA 02115. The documents are available upon request. Form 990, Part XI, line 9: Pension adjustment 4,164,345. Form 990, Part XII, Line 2c: The audit process and scope has not changed from the prior year. Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 Hospital MA 501(c)(3) Line 3 N/A 0 Physicians Organization at Children's Hospital Inc 300 Longwood Avenue Boston MA 02115 043266103 Management services MA 501(c)(3) Line 12c, III-FI N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0