2022-08-12T07:22:03-05:00 2021-09-30 010494526 Baker Newman & Noyes LLC 280 Fore Street Portland ME 04101 990 2020-10-01 042702169 CHMC Anesthesia Foundation Inc CHMC 6173556457 300 Longwood Avenue No Bader3 Boston MA 02115 Joseph P Cravero MD President/Treasurer 6173556457 2022-08-09 0 Joseph Cravero MD 999009999 Nicholas E Porto P01310283 8002447444 2022-08-09 3 AAL1 IAL1 2020 2022-09-23 18:48:47Z Joseph P Cravero MD 300 Longwood Avenue No Bader3 Boston MA 02115 169274917 0 X N/A X 1980 MA The Foundation provides medical research and educational services to Boston (see Schedule O) Children's Hospital and Harvard Medical School. The Foundation also provides care for patients in Massachusetts regardless of their ability to pay, as well as providing and supporting hospital and community based services that are either unavailable or limited elsewhere in the community. 13 0 160 0 59997 0 6016896 11900967 104004368 119477701 1918777 10814152 -2923911 14407835 109016130 156600655 1461002 1135007 0 0 100781716 118674120 0 0 0 12353097 12975625 114595815 132784752 -5579685 23815903 198916474 242134032 103057128 104160903 95859346 137973129 X The Foundation operates the Department of Anesthesia at Boston Children's Hospital and in communities throughout greater Boston. The physicians and CRNAs of the Foundation provide anesthesia services to patients at the Hospital and perform anesthesia (see Schedule O) research activities as well as lectures and publish related articles. The Foundation also provides care for patients in need of anesthesiology services regardless of their ability to pay. 0 0 124885790 1135007 117358876 The CHMC Anesthesia Foundation, Inc. (the Foundation) provides anesthesia and intensive care services to the patients of Boston Children's Hospital and at satellite locations. The Foundation may charge for patient care and other medical services, where any net income generated is used exclusively for the charitable, scientific, and educational purposes for which the Foundation was created. The Foundation also provides care for patients in need of anesthesia and intensive care services, regardless of their ability to pay, as well as providing and supporting hospital and community based services that are either unavailable or limited elsewhere in the community. 2548690 2118825 The Foundation receives income from Boston Children's Hospital (the Hospital) for providing administration, supervision, and teaching services. The physicians employed by the Foundation perform medical research and teaching activities, give lectures, publish related educational articles, and pioneer many developments in the field. All of these activities play a critical role in the treatment and recovery of patients at the Hospital and makes possible the surgical advances for which the Hospital is renowned. 127434480 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 1 160 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 13 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Joseph P Cravero MD 6173556457 300 Longwood Avenue Bader 3 Boston MA 02115 Joseph P Cravero MD President/Treasurer 54.00 6.00 X X 921874 0 128202 Jeffrey Burns MD Director 59.00 1.00 X X 828588 0 152816 Sulpicio G Soriano MD Clerk (10/20-3/21) 60.00 0.00 X X 615067 0 101317 John Fiadjoe MD Clerk (4/21-9/21) 60.00 0.00 X X 0 0 0 Lynne R Ferrari MD Director 59.00 1.00 X 710883 0 101362 Jue Wang MD Director (12/20-9/21) 60.00 0.00 X 371616 0 101650 Anjali Koka MD Director (12/20-9/21) 60.00 0.00 X 338176 0 116543 Kirsten C Odegard MD Director 60.00 0.00 X 526007 0 185916 Sally Vitali MD Director (12/20-9/21) 60.00 0.00 X 402897 0 175822 Mary Landrigan-Ossar MD Director (12/20-9/21) 60.00 0.00 X 463725 0 192423 James A DiNardo MD Director 59.00 1.00 X 930240 0 101362 Christine Greco MD Director (12/20-9/21) 60.00 0.00 X 506801 0 180117 Michael L McManus MD Director 60.00 0.00 X 513504 0 81846 John H Arnold MD Director (10/20-11/20) 60.00 0.00 X 495600 0 101317 Carlos Munoz-Sanjulian MD Director (10/20-11/20) 60.00 0.00 X 426371 0 100477 Steven Zgleszewski MD Director (10/20-11/20) 60.00 0.00 X 418757 0 180550 Cynthia Tung MD Director 60.00 0.00 X 407651 0 88776 Physicians Org at CH Inc Institutional Trustee 2.00 0.00 X 0 0 0 Barry Kussman MD Physician 60.00 0.00 X 642682 0 196696 Pete Kovatsis MD Physician 60.00 0.00 X 742347 0 175942 David Waisel MD Physician 60.00 0.00 X 714520 0 167646 Robert Truog MD Physician 60.00 0.00 X 686669 0 100323 Charles Berde MD Physician 60.00 0.00 X 640211 0 104197 Paul R Hickey MD Former Officer 60.00 0.00 X 1041250 0 100495 Mark A Rockoff MD Former Officer 60.00 0.00 X 557369 0 100495 13902805 0 3036290 154 1 1 0 3Edge Asset Management 100 Oliver Street Boston MA 02110 Investment Advisor 715399 The Wagner Law Group 99 Summer Street Boston NH 02110 Legal services 419534 BNY Mellon 201 Washington Street Boston MA 02108 Investment Advisor 194730 Sarah Zack Hewitt 44 Hewitt Street North Pomfret VT 05053 CRNA services 135111 William Clarke 87 Halls Hill Road Gilmanton Iron Works NH 03837 Physician services 125000 5 335000 11565967 11900967 Patient Service Revenue 621300 106613889 106613889 Contract & miscellaneous revenue 621300 10744987 10744987 Admin, supervision, & teaching 611710 1081068 1081068 Research revenue 621300 1037757 1037757 119477701 2188414 732 2187682 21300000 12674262 8625738 8625738 8625738 Non-Operating revenue 900099 12740480 12740480 Non-Operating pension gains 900099 1608090 1608090 CMS Administration 541200 59265 59265 14407835 156600655 119477701 59997 25161990 1135007 1135007 10877557 10877557 61826731 58635931 3190800 21426097 20783314 642783 22232007 22232007 2311728 2258518 53210 203284 175513 27771 249534 249534 943118 943118 1496361 1496361 805431 628684 176747 231569 231569 15442 15442 190018 190018 820644 754335 66309 Coordinated Specialty P 2132186 2132186 PO management services 2017647 2017647 Billing expenses 1993022 1993022 Research and education 1714019 1714019 163350 163350 132784752 127434480 5350272 0 379339 521242 31571596 36124626 10729547 11901976 800000 2255758 2173868 232943 329462 1818600 1356537 599645 462063 123084226 148218404 19239460 18966626 10823960 22635765 198916474 242134032 20149340 24136930 7481395 4777852 17500 508788 75408893 74737333 103057128 104160903 X 95680528 137660311 178818 312818 95859346 137973129 198916474 242134032 X 23815903 3064881 15232999 X X 0 1 X 1 1 1 X 518133 6016896 11900967 18435996 27847406 119188702 117715167 104004368 119477701 488233344 27847406 119188702 118233300 110021264 131378668 506669340 0 0 0 506669340 506535 2595548 3107961 1951988 2188414 10350446 46813 14322 -7432 59997 113700 506535 2642361 3122283 1944556 2248411 10464146 455225 -2972491 1608090 -909176 28353941 122286288 121355583 108993329 135235169 516224310 0.98150 0.98350 0.02030 0.02160 X Schedule A, Part III, Line 12, Explanation of Other Income: Insurance rebate - 2017 Amount: $ 455,225. 2019 Amount: $ 399,250. Non-operating pension losses gains - 2019 Amount: $ -3,371,741. 2020 Amount: $ 1,608,090. Schedule A, Part III: The Foundation changed its year end from June 30 to September 30 starting with the three month period ending September 30, 2017. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 178818 14005776 13871776 312818 111817 2575063 2508062 178818 518133 406316 111817 11316 11316 274537 263217 11316 0.00000 0.00000 1.00000 0 0 1818600 1356537 462063 462063 PO Pooled Investment Fund, LLP 18966626 F 18966626 Due from Boston Children's Hospital 371767 Other receivable 416099 Malpractice insurance receivable 3916433 Due from Boston Children's Heart Foundation, Inc. 146622 Due from Boston Pediatric Neurosurgical Foundation, Inc. 3000 Due from Children's Hospital Pediatric Association, Inc. 15071 Due from Crosby Benefits 102500 Due from Physicians Organization at CH, Inc. 3845058 Prepaid defined benefit plan 13819215 22635765 Due to Harvard - Anesthesia Med Education 1506892 Due to Physicians Organization at Children's Hospital, Inc. 644736 Due to Boston Children's Hospital 5490232 Accrued education plan obligation 25901013 Accrued SERP obligation 23726379 Accrued deferred compensation 457(b) plan 6263599 Accrued professional liability 5127109 Accrued money purchase plan 5773959 FICA Tax Liability 286990 Due to Children's Hospital Pediatric Association, Inc. 16224 Due to Boston Children's Heart Foundation, Inc. 200 74737333 X Part V, Line 4: The restricted funds represent donations that were given for physician recruitment and retirement. The use of these funds was restricted by the donor. 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, 2021. 1 Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 501(c)(3) 1079107 N/A N/A General support CurePSP Inc 1216 Broadway Fl 2 New York NY 10001 521704978 501(c)(3) 10000 N/A N/A General support Greater Boston Food Bank 70 S Bay Ave Boston MA 02118 042717782 501(c)(3) 5000 N/A N/A General support 3 0 Part I, Line 2: Monitoring is provided by CHMC Anesthesia Foundation, Inc. (the Foundation) through oversight of their 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, 2021, the Foundation 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 Paul R Hickey MD Former Officer 698421 0 109250 0 233579 0 57000 0 43495 0 1141745 0 45378 0 Joseph P Cravero MD President/Treasurer 583078 0 65100 0 273696 0 83000 0 45202 0 1050076 0 0 0 James A DiNardo MD Director 525585 0 87350 0 317305 0 57000 0 44362 0 1031602 0 0 0 Jeffrey Burns MD Director 659585 0 50000 0 119003 0 108499 0 44317 0 981404 0 0 0 Pete Kovatsis MD Physician 295065 0 176425 0 270857 0 131625 0 44317 0 918289 0 0 0 David Waisel MD Physician 223490 0 24150 0 466880 0 137620 0 30026 0 882166 0 112596 0 Barry Kussman MD Physician 328025 0 111850 0 202807 0 149499 0 47197 0 839378 0 0 0 Lynne R Ferrari MD Director 477375 0 50000 0 183508 0 57000 0 44362 0 812245 0 0 0 Robert Truog MD Physician 406085 0 49000 0 231584 0 57000 0 43323 0 786992 0 0 0 Charles Berde MD Physician 509850 0 50000 0 80361 0 57000 0 47197 0 744408 0 0 0 Sulpicio G Soriano MD Clerk (10/20-3/21) 449635 0 60550 0 104882 0 57000 0 44317 0 716384 0 10084 0 Kirsten C Odegard MD Director 319855 0 122250 0 83902 0 141599 0 44317 0 711923 0 0 0 Christine Greco MD Director (12/20-9/21) 350397 0 71400 0 85004 0 135800 0 44317 0 686918 0 0 0 Mark A Rockoff MD Former Officer 308160 0 0 0 249209 0 57000 0 43495 0 657864 0 0 0 Mary Landrigan-Ossar MD Director (12/20-9/21) 297125 0 54000 0 112600 0 149282 0 43141 0 656148 0 0 0 Steven Zgleszewski MD Director (10/20-11/20) 305685 0 51000 0 62072 0 137396 0 43154 0 599307 0 0 0 John H Arnold MD Director (10/20-11/20) 374585 0 50000 0 71015 0 57000 0 44317 0 596917 0 0 0 Michael L McManus MD Director 376585 0 50000 0 86919 0 37529 0 44317 0 595350 0 10349 0 Sally Vitali MD Director (12/20-9/21) 264085 0 86500 0 52312 0 132724 0 43098 0 578719 0 0 0 Carlos Munoz-Sanjulian MD Director (10/20-11/20) 290493 0 86200 0 49678 0 76200 0 24277 0 526848 0 0 0 Cynthia Tung MD Director 283225 0 52850 0 71576 0 76500 0 12276 0 496427 0 0 0 Jue Wang MD Director (12/20-9/21) 199087 0 130850 0 41679 0 76500 0 25150 0 473266 0 0 0 Anjali Koka MD Director (12/20-9/21) 212705 0 75800 0 49671 0 72700 0 43843 0 454719 0 0 0 Part I, Line 1a The Foundation provides gross-up payments for mortgage forgiveness, tuition payments, 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 The Foundation established the CHMC Anesthesia Foundation, Inc. 2005 Supplemental Executive Retirement Plan (SERP), effective as of January 1, 2005 to reward licensed physician employees with a benefit based on services. The plan was restated on January 1, 2016 to the CHMC Anesthesia Foundation, Inc. 2016 After-Tax Plan (the Plan). Each participant employed on June 30 is allocated 6% of base salary, excluding bonuses and clinical incentive payments, during the Plan year. For the Plan year in which an eligible employee becomes a participant, they will receive an additional contribution equal to 6% of their Plan compensation for each year of service prior to becoming a participant. The Foundation's contributions under the Plan are taxable to the participant as they are made and are not subject to forfeiture if the participant leaves before retiring. Contributions to the Plan will be included as part of taxable wages in the W-2 of each individual. During 2020, the following participants received a contribution that is recorded on the W-2: John H. Arnold, MD, $24,300; Joseph P. Cravero, MD, $174,469; Lynne R. Ferrari, MD, $30,467; Michael L. McManus, MD, $24,420; Kirsten C. Odegard, MD, $22,186; Sulpicio G. Soriano, MD, $29,973; Cynthia Tung, MD, $17,860; Steven Zgleszewski, MD, $19,776; James Dinardo, MD, $31,392; Jeffrey Burns, MD, $41,400; Jue Wang, MD, $13,225; Anjali Koka, MD, $14,797; Sally Vitali, MD, $17,280; Mary Landrigan-Ossar, MD, $19,652; Christine Greco, MD, $22,837; and Carlos Munoz-Sanjulian, MD, $17,929. In addition to the regular annual contribution, the Foundation makes a one-time contribution on behalf of participants first employed by the Foundation after December 21, 2008 after completing seven years of service. The amount of the contribution is $20,000 for each of the seven years in which the participant was a full-time employee (at least 32 hours per week), and $20,000 prorated, based on the participant's full-time equivalent percentage (FTE), for each year in which the participant worked part-time. Any pre-2016 account contributions are fully vested for each participant. The vesting schedule is 50% of post-2016 earnings account amounts vest after ten years of service, 75% vest after fifteen years of service, and amounts are fully invested after twenty years of service. During 2020, a distribution from the After-Tax plan accounts was made to Sulpicio G. Soriano, MD, $10,084 and Michael L. McManus, MD, $10,349. These amounts have been reported in Schedule J, Part II, Column F. Furthermore, as these amounts were reported on previous 990s as part of total compensation earned, they are being disclosed in Schedule J, Part II, Column F. Part I, Line 7 The Foundation provides an annual bonus to their anesthesiologist-employees. The amounts are discretionary based on the financial performance of the Foundation and on individual job performance. John Fiadjoe MD Clerk (4/21-9/21) Physician recruitment X 800000 800000 0 1 1 800000 Schedule L, Part II, Loans to and from Interested Persons: CHMC Anesthesia Foundation, Inc. (the Foundation) has provided several secured and unsecured loans to employees. The loans bear interest at rates up to 2.4%. 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 $2,973,867 at September 30, 2021. Future principal amounts due are as follows: $698,112 in 2022; $487,394 in 2023; $336,836 in 2024; $137,410 in 2025; and $1,314,115 thereafter. Form 990, Part VI, Section A, line 1 A majority of CHMC Anesthesia 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 1980. 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 on 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 Anesthesia 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, but not to approve, the annual budgets and 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 Anesthesia Foundation, Inc. (the Foundation) has three classes of members. The Chief of the Department of Anesthesiology (the Department) of Boston Children's Hospital (the Hospital) is the Class "A" member. Each member (other than the Chief) who holds a medical staff appointment from the Hospital and a full-time faculty appointment under the auspices of the Anesthesiologist-in-Chief from Harvard Medical School (Harvard) is a Class "B" member of the Foundation. The Physicians Organization at Children's Hospital, Inc. (the PO) 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 Anesthesiology (the Department) of Boston Children's Hospital (the Hospital) is the Class "A" member of CHMC Anesthesia Foundation, Inc. (the Foundation). Each person who holds a medical staff appointment from the Hospital and a full-time faculty appointment under the auspices of the Anesthesiologist-in-Chief from Harvard Medical School (Harvard) is a Class "B" member. The Class "A and "B" members of the Foundation elect the Board of Directors presented by the Executive Committee at their annual meeting. Each member is entitled to one vote per 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 Anesthesia 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, but not to approve, the annual budgets and 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/Treasurer of the Foundation, Joseph P. Cravero, MD; the Senior Director of Foundation Financial Operations & Strategy Planning, Stacey Conrad; and the Director of Finance, Jaronid Jimenez. A copy of the Form 990 will be provided to the board prior to filing. The Physicians Organization at Children's Hospital, Inc. will review the Form 990 with the board members. 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 its 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 influence 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 CHMC Anesthesia 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 statements, 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 15,232,999. 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 Org 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 CHMC Anesthesia Foundation Inc Retiree Medical Benefit Trust 300 Longwood Avenue Boston MA 02115 260538595 Employee Benefit Trust MA 501(c)(9) N/A 0 CHMC Anesthesia Foundation Inc Charitable Trust 300 Longwood Avenue Boston MA 02115 306692912 Employee Benefit Trust MA 501(c)(3) Line 12a, I N/A 0 0 1 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 0 0