2022-11-15T10:09:08-06:00 2021-12-31 381357951 PLANTE & MORAN PLLC 2601 CAMBRIDGE CT STE 300 AUBURN HILLS MI 48326 990 2021-01-01 030317160 CHILD DIMENSIONS INSURANCE COMPANY CHIL 3305438171 ONE PERKINS SQUARE AKRON OH 44308 ALICIA LAMANCUSA TREASURER 3305438171 2022-11-14 1 ALICIA LAMANCUSA 999009999 AMY CIMINELLO P00796388 2483757100 2022-11-14 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z CHRISTOPHER GESSNER ONE PERKINS SQUARE AKRON OH 44308 19119089 0 X N/A X 1988 VT TRANSACTS BUSINESS AS A CAPTIVE INSURANCE COMPANY. 10 2 0 2 0 0 0 0 5849355 4590005 9880434 4443304 0 0 15729789 9033309 0 0 0 0 0 0 0 0 0 1794955 -3579394 1794955 -3579394 13934834 12612703 66649418 72249275 33130753 25299642 33518665 46949633 CHILD DIMENSIONS INSURANCE COMPANY (CDIC) TRANSACTS BUSINESS AS A CAPTIVE INSURANCE COMPANY. CDIC PROVIDES PROFESSIONAL, GENERAL AND EXCESS LIABILITY COVERAGE TO CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON AND ITS SUBSIDIARIES. 0 0 -3862256 4590005 CHILD DIMENSIONS INSURANCE COMPANY IS A PURE CAPTIVE INSURANCE COMPANY PROVIDING PROFESSIONAL LIABILITY (MEDICAL MALPRACTICE), GENERAL, AND EXCESS LIABILITY INSURANCE TO CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON AND ITS SUBSIDIARIES. -3862256 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 6 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 2 0 0 0 0 1 1 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X MARSH MANAGEMENT SERVICES 8028645599 463 MOUNTAIN VIEW DR SUITE 301 COLCHESTER VT 05446 GRACE WAKULCHIK - PART YEAR DIRECTOR/OFFICER - PRESIDENT & CEO 2.00 48.00 X X 0 1439903 277587 JOHN CROW MD DIRECTOR 1.00 49.00 X 0 1095934 29334 SHAWN LYDEN DIRECTOR/ OFFICER - SECRETARY 2.00 48.00 X X 0 849992 134164 ROBERT MCGREGOR MD DIRECTOR 1.00 49.00 X 0 744105 120456 MICHAEL BIGHAM MD DIRECTOR & VP LOSS PREVENTION 1.00 49.00 X X 0 729742 116752 SPENCER KOWAL CFO/TREASURER - PART YEAR 2.00 48.00 X 0 810763 28224 LISA AURILIO DIRECTOR 1.00 49.00 X 0 733114 98925 ANTHEA DANIELS OFFICER - VP OF CLAIMS 2.00 48.00 X 0 543823 89034 MICHAEL BIRD MD - PART YEAR OFFICER - VP OF LOSS PREVENTION 2.00 48.00 X X 0 399381 28002 ALICIA LAMANCUSA DIRECTOR - TREASURER 2.00 48.00 X X 0 427371 15935 WILLIAM CONSIDINE FORMER CEO EMERITUS 1.00 49.00 X 0 269595 877 CHRISTOPHER GESSNER DIRECTOR - PRESIDENT - CEO 2.00 48.00 X X 0 207270 48032 RUSSELL YOUNG ASST. SECRETARY/ATTORNEY 2.00 0.00 X X 0 0 0 COURTNEY DOHERTY DIRECTOR - PART YEAR 1.00 0.00 X 0 0 0 LISA KANE DIRECTOR - PART YEAR 1.00 0.00 X 0 0 0 0 8250993 987322 0 1 1 0 HANNA CAMPBELL & POWELL LLP 3737 EMBASSY PARKWAY SUITE 100 AKRON OH 44333 LEGAL SERVICES 335996 1 PREMIUMS EARNED 900099 4590005 4590005 4590005 2292390 2292390 12236694 10085780 2150914 2150914 2150914 9033309 4590005 0 4443304 X 77325 77325 17385 17385 47318 47318 118999 118999 38500 38500 4387642 4387642 TAXES 21835 21835 REDUCTION IN MALPRACTIC -8288398 -8288398 -3579394 -3862256 282862 0 766612 147569 5276018 1531597 60606788 70570109 66649418 72249275 63927 47594 33066826 25252048 33130753 25299642 X 100000 100000 1600000 1600000 31818665 45249633 33518665 46949633 66649418 72249275 12612703 818265 0 X X 0 1 X 1 0 X X 1 CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON 340714357 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 PART IV, SECTION A, LINE 1 CHILD DIMENSIONS INSURANCE COMPANY (CDIC), THE FILING ORGANIZATION, IS ORGANIZED AND OPERATED FOR THE EXCLUSIVE BENEFIT OF CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON (CHMCA) AS STATED IN ITS GOVERNING DOCUMENTS. 0 RESERVE FOR PROFESSIONAL AND GENERAL LIABILITIES 25228977 PAYABLE TO PARENT 23071 25252048 9732576 818266 818266 8914310 118999 118999 9033309 -3698393 0 -3698393 118999 118999 -3579394 0 1 0 0 0 0 0 0 0 GRACE WAKULCHIK - PART YEAR DIRECTOR/OFFICER - PRESIDENT & CEO 0 994234 0 360000 0 85669 0 268072 0 9515 0 1717490 0 0 JOHN CROW MD DIRECTOR 0 1090390 0 0 0 5544 0 20300 0 9034 0 1125268 0 0 SHAWN LYDEN DIRECTOR/ OFFICER - SECRETARY 0 682279 0 135667 0 32046 0 116015 0 18149 0 984156 0 0 ROBERT MCGREGOR MD DIRECTOR 0 564438 0 153005 0 26662 0 102307 0 18149 0 864561 0 0 MICHAEL BIGHAM MD DIRECTOR & VP LOSS PREVENTION 0 416425 0 120724 0 192593 0 91894 0 24858 0 846494 0 190656 SPENCER KOWAL CFO/TREASURER - PART YEAR 0 555242 0 147002 0 108519 0 15803 0 12421 0 838987 0 107233 LISA AURILIO DIRECTOR 0 560396 0 150003 0 22715 0 89036 0 9889 0 832039 0 0 ANTHEA DANIELS OFFICER - VP OF CLAIMS 0 418860 0 123100 0 1863 0 87537 0 1497 0 632857 0 0 MICHAEL BIRD MD - PART YEAR OFFICER - VP OF LOSS PREVENTION 0 334050 0 59596 0 5735 0 3163 0 24839 0 427383 0 0 ALICIA LAMANCUSA DIRECTOR - TREASURER 0 371808 0 50927 0 4636 0 -1743 0 17678 0 443306 0 0 WILLIAM CONSIDINE FORMER CEO EMERITUS 0 179070 0 90386 0 139 0 231 0 646 0 270472 0 0 CHRISTOPHER GESSNER DIRECTOR - PRESIDENT - CEO 0 173077 0 0 0 34193 0 44384 0 3648 0 255302 0 0 PART I, LINE 3 CHILD DIMENSIONS INSURANCE COMPANY RELIES ON ITS MEMBER, CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON (CHMCA), TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON'S EXECUTIVE TOTAL COMPENSATION PROGRAM IS ULTIMATELY GOVERNED BY THE COMPENSATION COMMITTEE (COMMITTEE) OF THE BOARD OF DIRECTORS. AN INDEPENDENT SALARY SURVEY WAS LAST COMPLETED IN 2020 AND RECOMMENDATIONS WERE PROVIDED AND PRESENTED BY THE INDEPENDENT CONSULTANT TO THE COMMITTEE FOR APPROVAL. PART I, LINE 4B THE FOLLOWING INDIVIDUALS BECAME PARTICIPANTS IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLANS DURING 2018, WHEREBY THEY BECOME VESTED PER THE TERMS OF THEIR EMPLOYMENT AGREEMENT. CHMCA IS ACCRUING FOR THE BENEFIT THAT WILL OCCUR, THEREFORE THESE AMOUNTS ARE INCLUDED IN THEIR DEFERRED COMPENSATION. DISTRIBUTIONS WERE MADE IN 2021 IN THE FOLLOWING AMOUNTS: LISA AURILIO - $0 ROBERT MCGREGOR M.D. - $0 GRACE WAKULCHIK - $0 SHAWN LYDEN - $0 ANTHEA DANIELS - $0 CHRISTOPHER GESSNER - $0 MICHAEL BIGHAM - $190,656 SPENCER KOWAL - $107,233 FORM 990, PART VI, SECTION A, LINE 6 CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON IS THE SOLE STOCKHOLDER OF CHILD DIMENSIONS INSURANCE COMPANY. FORM 990, PART VI, SECTION A, LINE 7A CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON IS THE SOLE STOCKHOLDER OF CHILD DIMENSIONS INSURANCE COMPANY AND ITS GOVERNING BODY HAS THE RIGHT TO ELECT OR APPOINT MEMBERS OF THE ORGANIZATION'S GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PROVIDED TO THE AUDIT COMMITTEE OF CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON (MEMBER) FOR REVIEW AND DISCUSSION PRIOR TO FILING THE RETURN WITH THE INTERNAL REVENUE SERVICE. THE AUDIT COMMITTEE IS A COMMITTEE OF THE BOARD OF DIRECTORS AND EMPOWERED TO COMPLETE THE REVIEW ON BEHALF OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C IT IS THE POLICY OF CDIC TO FOLLOW THE POLICIES OF CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON (CHMCA). ALL OFFICERS, DIRECTORS, AND EMPLOYEES DISCLOSE REAL OR APPARENT CONFLICTS OF INTEREST AS A CONDITION OF BOARD MEMBERSHIP WITH CDIC. SINCE CDIC HAS NO EMPLOYEES, ONLY OFFICERS AND DIRECTORS DISCLOSE, IN WRITING, ON AN ANNUAL BASIS, A LIST OF ALL BUSINESSES OR OTHER ORGANIZATIONS IN WHICH HE/SHE (OR AN IMMEDIATE FAMILY MEMBER) IS AN OFFICER, MEMBER, OWNER, SHAREHOLDER, TRUSTEE OR EMPLOYEE FOR WHICH HE/SHE ACTS AS AN AGENT OR MIGHT REASONABLY IN THE NEAR FUTURE ENTER INTO A RELATIONSHIP OR TRANSACTION IN WHICH HE/SHE COULD HAVE A DUALITY OF INTEREST. IF A SITUATION ARISES IN WHICH THERE IS A DUALITY OF INTEREST AND AS SUCH, POTENTIAL FOR A CONFLICT OF INTEREST, IT IS THE PRIMARY RESPONSIBILITY OF SUCH INDIVIDUAL DIRECTLY INVOLVED TO MAKE IMMEDIATE AND COMPLETE DISCLOSURE TO THE APPROPRIATE SUPERVISOR. THE CHIEF HUMAN RESOURCES OFFICER SHALL REVIEW ALL DISCLOSURE STATEMENTS AND FORWARD THOSE WITH RECOMMENDATIONS TO THE CHIEF LEGAL OFFICER. THE CHIEF LEGAL OFFICER REFERS SELECTED ISSUES OR MATTERS FOR CONSULTATION TO THE AUDIT COMMITTEE OF THE BOARD. ANNUALLY, ALL DIRECTORS AND OFFICERS OF CDIC MUST DISCLOSE THIER CONFLICTS ON THE CONFLICT OF INTEREST/DUAL INTEREST DISCLOSURE STATEMENT IN ACCORDANCE WITH THE EMPLOYEE CONFLICT OF INTEREST POLICY WHICH POLICY APPLIES TO ALL EMPLOYEES OF CHMCA. FORM 990, PART VI, SECTION B, LINE 15 CDIC RELIES ON THE RELATED ORGANIZATION, CHILDREN'S HOSPITAL MEDICAL CENTER OF AKRON, TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES - CONSULTING FEES: PROGRAM SERVICE EXPENSES 38,500. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 38,500. PART XII, LINE 2C CDIC THROUGH ITS PARENT COMPANY CHILDREN'S HOSPITAL CENTER OF AKRON HAS AN AUDIT COMMITTEE THAT ASSUMES THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT, REVIEW, OR COMPILATION OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM PRIOR YEAR. CHILDREN'S HOSPITAL MED CENTER OF AKRON ONE PERKINS SQUARE AKRON OH 44308 340714357 HOSPITAL OH 501(C)(3) LINE 3 N/A 0 AKRON CHILDREN'S HOSPITAL FOUNDATION ONE PERKINS SQUARE AKRON OH 44308 237114013 FOUNDATION OH 501(C)(3) LINE 7 CHILDREN'S HOSPITAL MED CENTER OF AKRON 1 CHILDREN'S HOME CARE GROUP ONE PERKINS SQUARE AKRON OH 44308 341575266 HOME CARE OH 501(C)(3) LINE 12A, I CHILDREN'S HOSPITAL MED CENTER OF AKRON 1 AKRON CHILDREN'S HEALTH COLLABORATIVE ONE PERKINS SQUARE AKRON OH 44308 870853487 ACCOUNTABLE CARE ORGANIZATION OH 501(C)(4) LINE 12A, I CHILDREN'S HOSPITAL MED CENTER OF AKRON 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0