2022-05-16T14:40:34-05:00 2021-06-30 420714325 RSM US LLP 6 S PATTERSON BLVD DAYTON OH 45402 990 2020-07-01 311045247 DAYTON CHILDREN'S HOSPITAL FOUNDATION DAYT 9376413000 ONE CHILDRENS PLAZA DAYTON OH 454041873 CHRIS BERGMAN VP FINANCE AND CFO 9376413000 2022-05-16 1 CHRIS BERGMAN 999009999 KAREN O CRIM P00368385 9372980201 2022-05-16 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z DEBORAH FELDMAN ONE CHILDRENS PLAZA DAYTON OH 454041873 26121162 0 X WWW.CHILDRENSDAYTON.ORG X 1982 OH DAYTON CHILDREN'S HOSPITAL FOUNDATION (THE FOUNDATION) EXISTS SOLELY TO BENEFIT DAYTON CHILDREN'S HOSPITAL (DCH), AND TO ASSIST DCH IN PERFORMING ITS CHARITABLE MISSION. 18 15 0 600 0 0 7120886 6856416 0 0 6345168 5235024 -3867 -39342 13462187 12052098 8656720 12729906 0 0 0 0 0 0 0 177241 199028 8833961 12928934 4628226 -876836 130350233 163567188 274212 3248175 130076021 160319013 X DAYTON CHILDREN'S HOSPITAL FOUNDATION (THE FOUNDATION) EXISTS SOLELY TO BENEFIT DAYTON CHILDREN'S HOSPITAL, DAYTON, OHIO (DCH), AND TO ASSIST DCH IN PERFORMING ITS CHARITABLE MISSION. 0 0 12729906 12729906 DAYTON CHILDREN'S HOSPITAL FOUNDATION (THE FOUNDATION) EXISTS SOLELY TO BENEFIT DAYTON CHILDREN'S HOSPITAL (DCH) AND SUBSIDIARIES, AND TO ASSIST DCH IN PERFORMING ITS CHARITABLE MISSION. THE FOUNDATION IS FUNDED FROM CONTRIBUTIONS, BEQUESTS AND DEFERRED AND PLANNED GIFTS FROM OUTSIDE DONORS. THE FOUNDATION ASSIST DCH IN FULFILLING ITS CHARITABLE PURPOSE IN THE FOLLOWING WAYS:1. THE FOUNDATION ACCUMULATES THE PROCEEDS OF BEQUESTS, CONTRIBUTIONS AND PLANNED GIFTS FOR DCH'S CURRENT AND FUTURE CAPITAL NEEDS. THE PROCEEDS ARE USED TO SUPPORT DCH'S YEAR TO YEAR CAPITAL EQUIPMENT NEEDS OR USED TO FUND ALL OR A PORTION OF CAPITAL CONSTRUCTION PROJECTS SUCH AS ADDITIONS OR RENOVATIONS TO DCH'S BUILDINGS AND GROUNDS. IN THE YEAR ENDED JUNE 30, 2021, THE FOUNDATION EXPENDED $2,287,576 FOR CAPITAL EQUIPMENT AND CAPITAL PROJECTS.2. THE FOUNDATION HAS ESTABLISHED ENDOWMENTS, THE INCOME FROM WHICH WILL BE USED EACH YEAR TO ASSIST DCH TO RECRUIT AND RETAIN THE TOP PEDIATRIC MEDICAL PROFESSIONALS. CURRENT ENDOWED CHAIRS ARE AS FOLLOWS: CHILD ABUSE, CRITICAL CARE, NEUROSURGERY, PULMONARY, DEVELOPMENT PEDIATRICS, PEDIATRIC NEUROLOGY, GENERAL PEDIATRIC SURGERY, PEDIATRIC CANCER AND BLOOD DISORDERS, ANESTHESIA, INFECTIOUS DISEASES, AND RECRUITMENT OF SUBSPECIALTY PHYSICIANS WHO WOULD OTHERWISE NOT BE AVAILABLE IN THE COMMUNITY. EXPENDITURES FOR THE ENDOWED MEDICINE CHAIRS IN THE YEAR ENDED JUNE 30, 2021 TOTALED $1,216,918.3. GRANTS ARE MADE TO DCH AS A WHOLE RATHER THAN TO SPECIFIC PHYSICIANS OR INDIVIDUALS. MAJORITY APPROVAL BY THE BOARD OF TRUSTEES DETERMINES WHETHER THE GRANT IS FUNDED BY THE FOUNDATION. THE FOUNDATION'S TREASURER'S APPROVAL IS REQUIRED PRIOR TO ALL DISBURSEMENTS OF FUNDS. IN THE YEAR ENDED JUNE 30, 2021, THE FOUNDATION GRANTED $3,823,500 TO DCH FOR COVID-19 RELATED EXPENSES. 12729906 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 1 0 0 1 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 18 15 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 OH X CHRIS BERGMAN 9376415819 ONE CHILDRENS PLAZA DAYTON OH 45404 DEBORAH FELDMAN SYSTEM CEO 1.00 39.00 X X 0 901408 951523 CHRIS BERGMAN SYSTEM CFO 1.00 39.00 X X 0 492641 38544 NICK COSTIDES CHAIR 1.00 X X 0 0 0 DARRICK WEEKS VICE CHAIR 1.00 X X 0 0 0 JEFF KLANK TREASURER 1.00 X X 0 0 0 SANDRA PIERCE TREASURER (UNTIL 10/31/2020) 1.00 X X 0 0 0 JANEL BARNETT SECRETARY 1.00 X X 0 0 0 SUSAN BAKER TRUSTEE (UNTIL 10/31/2020) 1.00 X 0 0 0 THE HONORABLE WILLIAM BEAGLE TRUSTEE 1.00 X 0 0 0 MIKE BEVIS TRUSTEE 1.00 X 0 0 0 PETER DUFFEY TRUSTEE 1.00 X 0 0 0 GREG EBERHART TRUSTEE 1.00 X 0 0 0 JONATHAN FAULKNER TRUSTEE (AS OF 10/30/20 1.00 X 0 0 0 TOBY HENDERSON TRUSTEE 1.00 X 0 0 0 HEIDI HENNESSY TRUSTEE 1.00 X 0 0 0 HELEN JONES-KELLEY TRUSTEE (UNTIL 10/31/2020) 1.00 X 0 0 0 LAURA LEWIS TRUSTEE (AS OF 10/30/20) 1.00 X 0 0 0 KEVIN MCDONALD TRUSTEE (UNTIL 10/31/2020) 1.00 X 0 0 0 SHARMILA RAO TRUSTEE 1.00 X 0 0 0 SARAH WORLEY TRUSTEE 1.00 X 0 0 0 MATTHEW YODER TRUSTEE 1.00 X 0 0 0 JENA PADO EXECUTIVE DIRECTOR, FOUNDATION 40.00 X X 0 206020 25867 0 1600069 1015934 0 0 1 0 HIRTLE CALLAGHAN 300 BARR HARBOR DR SUITE 500 WEST CONSHOHOCKEN PA 19428 INVESTMENT SERVICES 134659 1 489651 6366765 62096 6856416 1191390 1191390 18050080 14006446 4043634 4043634 4043634 23276 489651 62618 -39342 -39342 12052098 0 0 5195682 12098652 12098652 631254 631254 199028 199028 12928934 12729906 199028 0 4901238 3084931 6169255 4784956 109937290 146354851 9342450 9342450 130350233 163567188 274212 3248175 274212 3248175 X 124256418 154773141 5819603 5545872 130076021 160319013 130350233 163567188 X -876836 31358793 -238965 X 0 1 X 1 0 X X 1 DAYTON CHILDREN'S HOSPITAL 300672132 3 1 12098652 0 1 12098652 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 PART IV, SECTION A, LINE 1 THE FOUNDATION MAY PROVIDE CONTRIBUTIONS TO OTHER ORGANIZATIONS AFFILIATED WITH DCH AND WHICH ARE THEMSELVES TAX EXEMPT ORGANIZATIONS UNDER THE PROVISIONS OF SECTION 501(C)(3). PART IV, SECTION B, LINE 1 ALL OF THE POWER TO SUPPORT/REMOVE THE DIRECTORS IS HELD BY DAYTON CHILDREN'S HOSPITAL (DCH). PART IV, SECTION B, LINE 2 CHILDREN'S HOME CARE OF DAYTON IS A SUBSIDIARY OF DAYTON CHILDREN'S HOSPITAL (DCH) AND ASSISTS DCH IN THE COMPLETION OF ITS MISSION BY PROVIDING CONTINUITY OF CARE FOR DCH PATIENTS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1444603 72231 1372372 1520634 76031 1444603 1601394 80760 1520634 183912987 760296 640717 3340064 180372542 1601394 167616099 106014 22473043 6271797 10372 183912987 1.00000 0.00000 0.00000 0 0 0 NMTC LOANS RECEIVABLE 9342450 F 9342450 INTERCOMPANY PAYABLE 3196765 FIFTH THIRD GIFT ANNUITIES 51410 3248175 X PART V, LINE 4: THE ENDOWMENTS ARE HELD BY DAYTON CHILDREN'S HOSPITAL FOUNDATION, A SUBSIDIARY OF DAYTON CHILDREN'S HOSPITAL. THE FUNDS ARE USED EXCLUSIVELY TO SUPPORT DAYTON CHILDREN'S HOSPITAL AND ITS SUBSIDIARIES. THE INTENDED USE OF THE FUNDS IS TO COVER EXPENSES FOR THE CHILDREN'S CARE AND COMFORT PROGRAM. PART X, LINE 2: ALL SUBSIDIARIES OF THE HOSPITAL EXCEPT DCSP, ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE WHOLLY OWNED FOR-PROFIT SUBSIDIARY, DCSP, HAD NO TAXABLE INCOME IN 2021 OR 2020. THE PROVISION FOR INCOME TAXES FOR THE JOINT VENTURE ENTITIES IS NOT SIGNIFICANT TO THE HOSPITAL. THE HOSPITAL COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE, AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2021 OR 2020. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 28185925 EAST ASIA AND THE PACIFIC 0 0 INVESTMENTS 16639 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 INVESTMENTS 459151 NORTH AMERICA 0 0 INVESTMENTS 352760 0 0 0 0 0 0 29014475 0 29014475 1 0 0 1 0 0 PART III ACCOUNTING METHOD: K99.1FM RADIOTHON 260724 260724 10000 GEM CITY JAM GOLF OUTING 161164 141364 19800 11275 15523 1180 21164 1 91039 87563 3476 3476 512927 489651 23276 11275 15523 1180 34640 62618 -39342 1 DAYTON CHILDREN'S HOSPITAL ONE CHILDRENS PLAZA DAYTON OH 45404 310672132 501(C)(3) 12098652 GENERAL OPERATING SUPPORT 1 0 MEDICATIONS 269 30116 MEALS/FOOD 3910 215410 TRANSPORTATION 2072 69512 RENT/UTILITIES 200 221576 SPECIAL EQUIPMENT 338 31744 OTHER 281 62896 PART I, LINE 2: AS THE FOUNDATION'S PURPOSE IS "SOLELY TO BENEFIT DAYTON CHILDREN'S HOSPITAL (DCH)," THE RELATIONSHIP BETWEEN THE 2 ENTITIES IS EXTREMELY CLOSE. WITH THE EXCEPTION OF RESEARCH GRANTS AND SPECIAL ADVOCACY GRANTS, THE FUNDS PROVIDED TO DCH COVER JUST A FRACTION OF THE COST OF THE PROGRAMS FOR WHICH THEY ARE GIVEN. AS SUCH, FUNDS ARE TRANSFERRED TO DCH BUT SPECIFIC EXPENDITURES ARE NOT TRACKED. THE FOUNDATION'S MANAGEMENT APPROVES AND MONITORS ALL GRANTS AND CHARITABLE DONATIONS. RESEARCH - EACH RESEARCH GRANT PROPOSAL FUNDED IS APPROVED BY BOTH THE FOUNDATION'S BOARD AND DCH'S INSTITUTIONAL REVIEW BOARD. RESEARCH PROJECTS ARE TRACKED INDIVIDUALLY AT DCH AND MONTHLY REPORTING IS GIVEN TO THE PROJECT DIRECTOR AND IS AVAILABLE TO THE FOUNDATION. IF THE PROJECT IS COMPLETED WITH UNSPENT FUNDS REMAINING, THEY ARE RETURNED TO THE FOUNDATION. SPECIAL GRANTS - ADDITIONAL GRANTS MAY BE ESTABLISHED FOR A SPECIFIC USE OR TO FULLY FUND A SPECIFIC CHILD ADVOCACY ONE-TIME COST OR PROGRAM. THESE FUNDS ARE TRANSFERRED TO DCH AND PLACED IN A SPECIFIC ACCOUNT FOR TRACKING PURPOSES. DETAILED ACTIVITY REPORTS ARE AVAILABLE TO THE FOUNDATION. UNSPENT FUNDS ARE RETURNED TO THE FOUNDATION. CHCOD ENDOWMENT - AN ENDOWMENT WAS ESTABLISHED FOR THE CHILDREN'S HOME CARE OF DAYTON (A SUPPORTED ORGANIZATION) FOR THEIR CARE AND COMFORT PROGRAM. THIS SUPPORT DOES NOT FULLY FUND THE PROGRAM AND IS TRANSFERRED ANNUALLY. 0 1 0 0 0 0 0 0 0 DEBORAH FELDMAN SYSTEM CEO 0 861151 0 0 0 40257 0 943793 0 7730 0 1852931 0 0 CHRIS BERGMAN SYSTEM CFO 0 481641 0 0 0 11000 0 16120 0 22424 0 531185 0 0 JENA PADO EXECUTIVE DIRECTOR, FOUNDATION 0 187478 0 17413 0 1129 0 24691 0 1176 0 231887 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUAL PARTICIPATES IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND THE FOLLOWING IS THE INCREASE IN THE ACTURIAL VALUE DURING THE YEAR: DEBORAH FELDMAN - $929,643 THE FOLLOWING INDIVIDUALS RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: DEBORAH FELDMAN - $23,193 CHRIS BERGMAN - $2,936 X 4 62096 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): IS THE NUMBER OF CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 6 DAYTON CHILDREN'S HOSPITAL (DCH) IS THE SOLE MEMBER OF DAYTON CHILDREN'S HOSPITAL FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A DCH IS THE SOLE MEMBER OF THE FOUNDATION. THE BOARD OF DCH APPOINTS THE FOUNDATION BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWS KEY DISCLOSURES WITH APPROPRIATE COMMITTEES OF THE BOARD OF TRUSTEES. THEN PRIOR TO FILING, THE FORM 990 IS ELECTRONICALLY LOADED TO A SECURE HOSPITAL WEBSITE FOR THE ENTIRE BOARD OF TRUSTEES TO REVIEW. AN EMAIL IS SENT TO ALL MEMBERS NOTIFYING THEM THAT THE FORM IS AVAILABLE FOR THEIR REVIEW AND THAT IT WILL BE FILED ON OR BEFORE THE EXTENDED DUE DATE. FORM 990, PART VI, SECTION B, LINE 12C AT THE BEGINNING OF EACH MEETING, THE CHAIRMAN OF THE BOARD ASKS EACH MEMBER TO IDENTIFY AND DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST BASED ON THE AGENDA OR ANY CHANGES IN THEIR BUSINESS PRACTICE THAT MIGHT BE RELEVANT. IF THERE ARE ANY CONFLICTS, THE MEMBER(S) EXCUSE THEMSELVES AND DO NOT PARTICIPATE IN THE DISCUSSION AND DO NO VOTE ON THE ITEM. THIS THEN IS NOTED IN THE MINUTES OF THAT MEETING. BOARD MEMBERS ANNUALLY AGREE TO ABIDE BY WRITTEN CONFLICT OF INTEREST AND CONFIDENTIALITY POLICIES. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS, ORGANIZING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE GENERAL PUBLIC UPON WRITTEN OR VERBAL REQUEST TO DAYTON CHILDREN'S HOSPITAL, FOR THE SAME PERIOD OF TIME AS SET FORTH IN THE INTERNAL REVENUE CODE SECTION 6104(D). FORM 990, PART XI, LINE 9: NET ASSET TRANSFER TO RELATED ORGANIZATION -2,212. CONTRIBUTIONS RELEASED FROM RESTRICTIONS -236,753. DAYTON CHILDREN'S HOSPITAL ONE CHILDRENS PLAZA DAYTON OH 45404 310672132 HEALTH CARE OH 501(C)(3) LINE 3 N/A 0 CHILDREN'S HOME CARE OF DAYTON 18 CHILDRENS PLAZA DAYTON OH 45404 311356037 HOME HEALTH CARE OH 501(C)(3) LINE 10 DAYTON CHILDREN'S HOSPITAL 1 DAYTON CHILDREN'S SPECIALTY PHYSICIANS INC ONE CHILDRENS PLAZA DAYTON OH 45404 311411364 SPECIALTY PHYSICIANS GROUP OH N/A C 1 PEDIATRIC ASSURANCE COMPANY LTD BUTTERFIELD BANK BLDG 6TH FL 65 FRO HAMILTON HM BD 980478183 SELF-INSURANCE BD N/A 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 CHILDREN'S HOME CARE OF DAYTON B 72230 CASH DAYTON CHILDREN'S SPECIALTY PHYSICIANS O 44919 CASH