2024-11-14T17:47:43-06:00 2023-12-31 135565207 KPMG LLP 350 NORTH 5TH ST STE 600 MINNEAPOLIS MN 55401 990 2023-01-01 411756478 CHILDREN'S HEALTH CARE SERVICES INC CHIL 6128136000 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 BRENDA MCCORMICK SVP AND CFO 6128136000 2024-11-14 1 0 HOLLY K MOEN P01800653 6123055000 2024-11-07 2023 2024-10-15 13:58:12Z CHILDREN'S - MINNETONKA BRENDA MCCORMICK 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 9256223 0 X CHILDRENSMN.ORG X 1994 MN WE SERVE THE COMMUNITY'S CHILDREN AS A SUPERIOR, PEDIATRIC SPECIALTY HEALTH CARE PROVIDER. 6 3 38 0 0 0 1857224 0 3367187 8662343 -6551 2000 336168 345704 5554028 9010047 964 15402 0 0 1351424 3129957 0 0 0 2230594 3358908 3582982 6504267 1971046 2505780 26248064 28821258 65400 132814 26182664 28688444 WE SERVE THE COMMUNITY'S CHILDREN AS A SPECIALTY PEDIATRIC AMBULATORY SURGERY CENTER AND DIAGNOSTIC AND TREATMENT FACILITY. 0 0 5677006 15402 8661639 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 TO 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.CHILDREN'S MINNETONKA PERFORMED 2,646 OUTPATIENT SURGICAL CASES AND 3,907 RADIOLOGY AND SPECIAL DIAGNOSTIC TESTS. 5677006 1 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 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 1 38 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 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 1732513 356578 BRENDA MCCORMICK SVP AND CFO 1.00 49.00 X X 0 916032 44336 AARON BOUW BOARD SECRETARY & SR DIR, FINANCIAL REPORTING 1.00 49.00 X X 0 219893 18331 GARY BLACKFORD VICE CHAIR THRU MAR 2023 1.00 3.00 X X 0 0 0 MATTHEW BILUNAS TREASURER THRU AUG 2023 1.00 2.00 X X 0 0 0 ARCHELLE GEORGIOU BOARD MEMBER, BOARD CHAIR 1.00 3.00 X X 0 0 0 JJ KUHN BOARD MEMBER, CHAIR-ELECT 1.00 2.00 X X 0 0 0 JEFF VON GILLERN BOARD MEMBER, TREASURER 1.00 2.00 X X 0 0 0 JENNIFER OLSON MARKET SVP & COO THRU SEPT 2023 1.00 49.00 X 0 1174878 860360 TIM LANDER CHIEF OF SURGERY 3.00 47.00 X 27094 514786 31184 WILLIAM MIZE MEDICAL DIRECTOR OF RADIOLOGY 3.00 47.00 X 40161 763054 31184 BRENDA BECKWITH SR DIRECTOR PERIOPERATIVE SVCS 13.00 37.00 X 46486 139460 34535 ASHLEY RUE MANAGER SURGERY CENTER 50.00 0.00 X 122689 0 26398 236430 5460616 1402906 1 0 1 0 MSP COMMERCIAL 1215 TOWN CENTRE DRIVE SUITE 130 EAGAN MN 55123 CONSTRUCTION 315039 HENRY SCHEIN INC DEPT CH 10241 PALATINE IL 60055 MEDICAL EQUIPMENT 162068 STRYKER SALES LLC 22941 NETWORK PLACE CHICAGO IL 60693 MEDICAL EQUIPMENT 144749 GE PRECISION HEALTHCARE LLC PO BOX 96483 CHICAGO IL 60693 MAINT CONTRACT 108328 4 PROGRAM SERV REVENUE 621400 6179445 6179445 MEDICARE/MEDICAID PAY 621400 2482194 2482194 COMMISSION MAC REVENUE 621400 704 704 8662343 591880 246176 345704 345704 345704 2000 0 2000 2000 2000 9010047 8661639 0 348408 X 15402 15402 113741 67255 46486 2398173 2132302 265871 102477 92312 10165 352847 317855 34992 162719 146591 16128 56309 56309 38658 38658 1454215 1263541 190674 18720 18720 51464 46579 4885 75000 75000 175610 175610 50 50 494379 350010 144369 33618 33618 MEDICAL SUPPLIES 627648 627648 BAD DEBT 205287 205287 MN CARE TAX 123316 123316 4634 4630 4 6504267 5677006 827261 0 1413453 2448499 20769715 23322885 27226130 24176256 4064896 3049874 26248064 28821258 914 11155 64486 121659 65400 132814 X 26182664 28688444 26182664 28688444 26248064 28821258 2505780 0 X 0 1 X 1 0 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 16620962 15526660 1094302 9929404 8649596 1279808 3049874 RESERVE FOR MNCARE TAX 121659 121659 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, 2023 AND 2022. CHILDREN'S IS NOT SUBJECT TO AN INCOME TAX EXAMINATION FOR YEARS BEFORE 2020. 0 CHARITY CARE 21 15402 CHARGES CHARITY CARE TO INV 1 1 0 0 0 0 0 0 0 MARC GORELICK MD PRESIDENT & CEO 0 1277144 0 435965 0 19404 0 332398 0 24180 0 2089091 0 0 JENNIFER OLSON MARKET SVP & COO THRU SEPT 2023 0 326753 0 200000 0 648125 0 842586 0 17774 0 2035238 0 257514 BRENDA MCCORMICK SVP AND CFO 0 671566 0 163219 0 81247 0 16376 0 27960 0 960368 0 70901 WILLIAM MIZE MEDICAL DIRECTOR OF RADIOLOGY 40161 582517 0 132191 0 48346 0 19800 0 11384 40161 794238 0 34594 TIM LANDER CHIEF OF SURGERY 27094 401315 0 86200 0 27271 0 19800 0 11384 27094 545970 0 21311 AARON BOUW BOARD SECRETARY & SR DIR, FINANCIAL 0 197761 0 21888 0 244 0 9478 0 8853 0 238224 0 0 BRENDA BECKWITH SR DIRECTOR PERIOPERATIVE SVCS 46486 119701 0 19509 0 250 0 7705 0 26830 46486 173995 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 4A JENNIFER OLSON MARKET: $212,260. 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 2023: BRENDA MCCORMICK - $70,901 JENNIFER OLSON MARKET - $257,514 TIMOTHY LANDER - $21,311 WILLIAM MIZE - $34,594 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 18,705. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,705. SECURITY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 4,930. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,930. LINEN: PROGRAM SERVICE EXPENSES 24,847. MANAGEMENT AND GENERAL EXPENSES 566. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,413. PURCHASED MED SERVICES: PROGRAM SERVICE EXPENSES 407,827. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 407,827. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 42,491. MANAGEMENT AND GENERAL EXPENSES 8,280. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,771. PURCH SERVICES TO/FROM AFFILIATE: PROGRAM SERVICE EXPENSES 584,728. MANAGEMENT AND GENERAL EXPENSES 18,751. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 603,479. LEASED EQUIPMENT: PROGRAM SERVICE EXPENSES 31,632. MANAGEMENT AND GENERAL EXPENSES 507. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,139. MAINTENANCE SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 149,493. MANAGEMENT AND GENERAL EXPENSES 157,640. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 307,133. EQUIPMENT REPAIR & MAINTENANCE: PROGRAM SERVICE EXPENSES 3,818. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,818. 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