2021-11-15T09:45:23-06:00 2020-12-31 560747981 Dixon Hughes Goodman LLP 500 Ridgefield Court Asheville NC 28806 990 2020-01-01 630307306 The Children's Hospital of Alabama CHIL 2056389100 1600 Seventh Avenue South Birmingham AL 35233 Dawn Walton CFO 2056389100 2021-11-15 1 Dawn Walton 999009999 Amy Bibby P00445891 8282542254 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Thomas G Shufflebarger 1600 Seventh Avenue South Birmingham AL 35233 783269094 0 X WWW.ChildrensAL.org X 1911 AL Specialty acute-care hospital providing inpatient and outpatient medical services to pediatric patients. 33 31 6047 619 0 0 3714382 3767445 744501813 759383887 2308714 11885896 10072638 8090668 760597547 783127896 0 0 0 0 355672573 345541361 0 0 0 362113862 355968330 717786435 701509691 42811112 81618205 786269809 830300382 471704641 490515237 314565168 339785145 X The mission of Children's of Alabama is to provide the finest pediatric health services to all children in an environment that fosters excellence in research and medical education. Children's will be an advocate for all children and work to educate the public about issues affecting children's health and well-being. 0 0 575228904 764646412 Inpatient:Children's Hospital is the one of the largest and busiest pediatric medical centers in the United States. It is the only pediatric renal care center and the largest pediatric burn center in the Southeast. Children's operates 351 beds, which include 48 NICU bassinets and 100 critical care beds in the following units: Cardiovascular, Pediatric, Neonatal, Special Care, Critical Care, Burn and Stem Cell Transplant. In 2020, Children's Hospital had 12,334 discharges and 87,741 patient days. Inpatient surgery cases totaled 5,515 for 2020. The Children's Critical Care Transport team provides helicopter, jet, and ground transport for critically ill and injured children. Outpatient:Children's Hospital operates 13 outpatient specialty clinics that handle follow-up visits for patients as well as referrals from health departments across the state. These clinics provide services in Hemodialysis, Gastroenterology, Hematology/Oncology, Orthopedics, Urology, Otorhinolaryngology, Neurology, Pulmonary Function, General Surgery, Dental, Behavioral Services, Speech and Hearing, Physical Therapy, Occupational Therapy, Heart Transplant and others. In 2020, these clinics had 232,211 visits and 16,914 outpatient surgeries were performed. The Hospital also provides a statewide and regional referral site for complex emergency patients. The Emergency Department had 40,333 visits in 2020.Pediatric Practices:The Hospital has a network of primary care practices throughout the state known as Pediatric Practice Solutions. It consists of 14 practices supporting approximately 70 general pediatricians. In 2020 these practices provided 278,286 visits. 575228904 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 367 0 1 6047 1 0 1 CJ 0 0 0 0 0 0 0 0 0 0 X 33 31 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Jenny Wakeford 2056386778 1600 Seventh Avenue South Birmingham AL 35233 Brian J Wiatrak Pediatrician 40.00 X 1034961 0 25866 Audie L Woolley Pediatrician 40.00 X 1030356 0 28763 Jimmy Scott Hill Pediatrician 40.00 X 1026309 0 28851 Thomas G Shufflebarger Chief Operating Officer & Senior EVP 40.00 X 935121 0 26661 Dawn Walton Chief Financial Officer 40.00 1.00 X 817236 0 22678 Crayton A Fargason Jr Medical Director & VP Clinical Affairs 40.00 X 791110 0 11564 Brian Kulbersh Pediatrician 40.00 X 756483 0 28763 Nicholas Smith Pediatrician 40.00 X 718584 0 28680 William Michael Warren Jr President & CEO 40.00 1.00 X X 706426 0 22629 Robert Sarnecki Chief Information Officer 40.00 X 669823 0 23580 Douglas Dean VP of Human Resources 40.00 X 588692 0 21668 Michael E McDevitt EVP of Facilities 40.00 X 497353 0 22408 Andrew Loehr VP & Chief Nursing Officer 40.00 X 460287 0 28851 Deborah M Wesley Chief Nursing Officer (through March 14, 2020) 40.00 X 374419 0 9059 Temple W Tutwiler III Chairman of the Board 1.00 X X 0 0 0 Richard J Bielen Vice Chairman of the Board 1.00 X X 0 0 0 Lee J Styslinger III Treasurer of the Board 1.00 X X 0 0 0 Beth G Dubina Secretary of the Board 1.00 X X 0 0 0 Tracey Morant Adams Director 1.00 X 0 0 0 Edward K Aldag Jr Director 1.00 X 0 0 0 J David Brown III Director 1.00 X 0 0 0 Myla E Calhoun Director 1.00 X 0 0 0 Derrol Dawkins MD Director 1.00 X 0 0 0 Mark E Dixon Director 1.00 X 0 0 0 Ralph Frohsin Jr Director 1.00 X 0 0 0 Raymond J Harbert Director 1.00 X 0 0 0 William E Horton Director 1.00 X 0 0 0 Donald M James Director 1.00 X 0 0 0 Virginia Walker Jones Director 1.00 X 0 0 0 Philippe W Lathrop Director 1.00 X 0 0 0 James C Lee III Director 1.00 X 0 0 0 Thomas H Lowder Director 1.00 X 0 0 0 Anna M Manasco Director 1.00 X 0 0 0 W Charles Mayer Director 1.00 X 0 0 0 L Gwaltney McCollum Jr Director 1.00 X 0 0 0 Charles D McCrary Director 1.00 X 0 0 0 Ann D McMillan Director 1.00 X 0 0 0 C Phillip McWane Director 1.00 X 0 0 0 W Jerry Oakes MD Director 1.00 X 0 0 0 Craft ONeal Director 1.00 X 0 0 0 Margaret M Porter Director 1.00 X 0 0 0 Frederick W Renneker III Director 1.00 X 0 0 0 Stuart A Royal MD Director 1.00 X 0 0 0 Ben Russell Director 1.00 X 0 0 0 Mark J Tarr Director 1.00 X 0 0 0 Marc Bryant Tyson Director 1.00 X 0 0 0 10407160 0 330021 395 0 1 0 University of Alabama Health Services Fo 1600 7th Avenue South Birmingham AL 35233 Hospitalist Services, Emergency, Subspec 29171731 University of Alabama at Birmingham 19th Street South Suite 300 Birmingham AL 35249 Hospital Residents, Referred Testing 22827703 Hoar Construction Two Metroplex Drive Suite 400 Birmingham AL 35209 Construction 6842295 Westerkamp Group LLC 701 Warrenville Road Suite 120 Lisle IL 60532 Revenue Cycle Services 5748269 Allscripts Healthcare LLC 24630 Network Place Chicago IL 60673 Clinical Software 5442441 197 1022184 2745261 3767445 Patient Service 621300 686754765 686754765 CARE ACT Funding 900099 65440075 65440075 Graduate Medical Education 611430 5989391 5989391 Other Program Service 900099 1099656 1099656 Medicaid Disproportionate Share 621300 100000 100000 759383887 12027094 12027094 2828143 0 2828143 2828143 2828143 141198 -141198 -141198 -141198 Cafeteria and Vending 453000 3728785 3728785 Parking 900099 1212887 1212887 Gift Shop 900099 320853 320853 5262525 783127896 764646412 0 14714039 6029562 4763354 1266208 128994 101905 27089 276982289 218816008 58166281 8961175 7079328 1881847 33572171 26522015 7050156 19867170 15695064 4172106 12481514 9860396 2621118 267952 211682 56270 299700 236763 62937 65049572 51389161 13660411 985466 778518 206948 18764884 14824258 3940626 15652469 12365451 3287018 21738923 17173749 4565174 175562 138694 36868 7194603 5683736 1510867 56976946 45011787 11965159 8038034 6350047 1687987 Medical Supplies 52416441 52416441 Drugs 47756188 47756188 Provider Tax 38153836 30141530 8012306 Food and Dietary 5307860 4193209 1114651 4708380 3719620 988760 701509691 575228904 126280787 0 171425986 219228954 62826799 88265766 16520075 17141942 17165482 18921227 1249072440 796351239 485173678 452721201 33157789 34021292 786269809 830300382 46302024 44013288 30239456 34285943 211026325 195955351 184136836 216260655 471704641 490515237 X 314565168 339785145 314565168 339785145 786269809 830300382 X 81618205 -56398228 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 442180 442180 701067511 701509691 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 383125 389788 429262 442180 1644355 250000 250000 250000 250000 1000000 1500000 Part II-A, Line 1B The Hospital belongs to certain organizations that engage in lobbying activities on behalf of their hospital members. Since this is a nonallowable expense, these organizations inform their members the portion of their dues that should be considered applicable to lobbying expenses so that the appropriate adjustment can be made. In an effort to determine which dues include lobbying expenses, the Hospital reviewed the invoices for all dues payments in excess of $10,000 and scheduled all other payments we were made aware of through various inquiry. 8459772 8459772 870383264 481838617 388544647 10651985 8250339 2401646 353618450 306262283 47356167 5958969 5958969 452721201 Due to Affiliate 111377232 Salaries Payable 50177070 Accrued Interest Payable 690749 Professional Liability Accrual 3145054 Executive Retirement Plan 7197822 Retroactive Settlements 235292 Medicaid Adjust. Pool Liability 43437436 216260655 X Part X, Line 2: The Hospital and the Foundation are exempt from federal income taxes under Section 501(a) of the Internal Revenue Code as organizations described in Section 501(c)(3). TCH Ventures is a taxable entity under the Internal Revenue Code. At present, the Government of the Cayman Islands has imposed no taxation on income or premiums of Holy Innocents. The Company adheres to the provisions of the Accounting Standards Codification relating to uncertainty in income taxes that requires entities to assess their uncertain tax positions for the likelihood that they would be overturned upon Internal Revenue Service (IRS) examination or upon examination by state taxing authorities. The Company has determined that it does not have any positions at December 31, 2020 and 2019, that it would be unable to substantiate. The Company has filed its tax returns through December 31, 2019. The tax returns for the years ended December 31, 2017, and thereafter are subject to audit by the taxing authorities. Holy Innocents Idemnity, LTD 0 0 Professional Insurance Coverage 829690 0 0 0 0 0 0 829690 0 829690 0 0 1 0 0 0 Part III Accounting Method: 1 1 1 X 1 X 1 0 1 1 5237507 5237507 0.00750 400218360 355110931 45107429 0.06470 28216884 33453667 0 0.00000 433672751 388564598 50344936 0.07220 8676969 1876572 6800397 0.00980 15177450 1951366 13226084 0.01900 1286233 1165188 121045 0.00020 286617 286617 0.00040 25427269 4993126 20434143 0.02940 459100020 393557724 70779079 0.10160 0 4466550 493122 1823571 1970237 -146666 X 1 1 1 1 Children's Hospital of Alabama 1600 Seventh Avenue South Birmingham AL 35233 X X X X X X Children's Hospital of Alabama 1 0 0 1 X X X X X X X 19 1 0 0 1 X www.childrensal.org 1 19 1 www.childrensal.org 0 1 X 200.000000000000 300.000000000000 X X 1 1 X X X 1 X www.childrensal.org X www.childrensal.org X www.childrensal.org X X X X X X 1 X 0 X X X X 1 X 0 0 Children's Hospital of Alabama Part V, Section B, Line 5: Children's engaged the Public Affairs Research Institute of Alabama (PARCA) in 2019 to conduct the community health needs assessment (CHNA) designed to identify statewide and local child health concerns for children across the state and how to best support efforts to address the concerns. Children's of Alabama's community health needs assessment findings were released on December 20, 2019. Prior to the pandemic in 2020, CoA's focus centered on the development of community outreach and programs to identify and address pediatric mental and behavioral health, children with medically complex conditions, nutrition, and other key items identified in the CHNA. Although the COVID-19 pandemic stymied many in-person outreach efforts, CoA realigned its efforts to address via virtual trainings, video presentations to stakeholders and the community-at-large, and technology-focused opportunities to reach our populations statewide. Targeted constituencies included parents, school nurses, administrators, pediatric/family medicine physician practices, community advocates, and youth. Children's Hospital of Alabama Part V, Section B, Line 11: Children's of Alabama continues to address the CHNA identified needs. These priorities include pediatric mental and behavioral health, children with medically complex conditions, and parent and youth education. The COVID-19 pandemic froze in-person outreach efforts for CoA and the participating collaborators. Innovative thinking provided a pathway for COA to provide more virtual-based educational opportunities to reach many local and statewide audiences. Programs were transformed and presented via virtual formats include COA's highly-respected teen driving campaigns and seminars, lessons on the proper fitting and usage of bicycle helmets through the Think First program, engaging with stakeholders with the End Child Hunger in Alabama (ECHA) initiative, and remote participation in community health fairs. Highlighted in many presentations are COA's mental health crisis Pediatric Intake Response Center (PIRC) and the Poison Control Center which have experienced significant volumes with the COVID onset. Children's of Alabama also retooled its popular Girlology / Guyology programs for virtual presentation in 2021. Efforts by the safety, outreach, and medical teams at CoA continue to increase the coordination and collaboration of messaging, educational resources, public events and other outreach opportunities both virtually and in-person - as appropriate. Children's Hospital of Alabama Part V, Section B, Line 20e: Signage is posted throughout the facility at entrances and all registration locations including the emergency department, waiting and admitting areas notifying patients and guarantors of the availability of financial assistance. Part I, Line 7: The costing methodology used to complete Line 7 was an overall cost-to-charge ratio computed using the IRS Form 990 Worksheet 2, ratio of patient care cost to charges. Part I, Ln 7 Col(f): The bad debt expense included on Form 990, Part IX, Line 25, column (a), but subtracted for purposes of calculating the percentage in this column is $4,466,550. Part II, Community Building Activities: In 2020 the Hospital participated in initiatives as defined under Part II, Community Building Activities. Due to COVID restrictions, CoA experienced a decrease in the cumulative hours of workforce development and training as reported in previous years. However, COA employees continued to train allied health and other students virtually through its partnership with area colleges and universities. Children's of Alabama continued participation in community and statewide coalitions including the United Way of Central Alabama, local and regional roundtables (virtual in 2020) on mental and behavioral health, statewide coalitions to address child hunger and numerous safety-related coalitions. CoA executives and staff continued serving on a variety of community boards, organizations, and professional organizations at the local, state and national levels. Part III, Line 2: Receivables from patients, insurance companies and third-party contractual agencies are stated at net realizable value. The Hospital evaluates the collectability of its patient accounts receivable based on the length of time the receivable is outstanding, historical collection experience, review of large balance accounts and trends in health care insurance programs to estimate the appropriate allowance for doubtful accounts and provision for bad debts. For receivables associated with services provided to patients with third-party insurers, the Hospital estimates contractual allowances based on the terms of third-party insured contracts and estimates an additional allowance for doubtful accounts on patient responsible balances after third-party payments. For receivables associated with self-pay patients, the hospital records a significant provision for bad debts in the period of service based on its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. These allowances are recorded on an estimated basis and adjusted as needed in future periods. Doubtful accounts are written off against the allowance after adequate collection effort is exhausted and recorded as recoveries of bad debts if subsequently collected. Part III, Line 3: Bad debts attributable to patients eligible for charity care were calculated based on the outstanding patient balance in excess of a reasonable amount the average person could pay without creating a medical hardship. For 2020 this amount is $24,600, which approximates the income limit for a family of 4 in the federal poverty guidelines. Charity care determinations are based on completing the required application and meeting defined criteria of the hospital. Many times, patients fail to complete paperwork required despite efforts to educate and inform patients of this option. However, based on socio-economic and other known factors, it is highly likely that these patients would meet established charity care criteria if the application process was completed. Part III, Line 8: Medicare cost & charges primarily relate to renal (ESRD) and SSI patients covered under Medicare. Given our small Medicare population, the costs/charges could fluctuate significantly year over year based on level of care. These would not be considered a community benefit. Part III, Line 9b: A guarantor will receive four bills before the account is turned over to a collection agency. After 120 days, if there is no attempt to pay - the account will be sent to a collection agency. Part VI, Line 2: Children's engaged the Public Affairs Research Institute of Alabama (PARCA) in 2019 to conduct the community health needs assessment (CHNA) designed to identify statewide and local child health concerns for children across the state and how to best support efforts to address the concerns. The assessment's geographic focus targeted Children's primary service area of Bibb, Blount, Chilton, Jefferson, Shelby, St. Clair, and Walker counties. The assessment focused on child health needs in Children's secondary service area which encompasses the entire state of Alabama. Stakeholders from both the primary and secondary service areas were invited to participate in an online survey to identify health needs for children's in Alabama. Responding parties included parents, youth leaders, school nurses, administrators, pediatricians, family practice physicians, community advocates, business leaders, and the community at large. In addition to the online survey tool, face-to-face and telephone interviews were conducted in 2019 with Alabama's public health leaders, community, and nonprofit advocates. COA's community health needs assessment findings were released on December 20, 2019. While the COVID-19 pandemic hindered some ability to deliver outreach 'in-person,' CoA's advocacy and outreach divisions successfully developed new opportunities to reach stakeholders through remote teaching, virtual trainings, and video presentations. Part VI, Line 3: Each patient that presents as a self pay patient is directed to a financial counselor. The financial counselor educates patients and their families about government and financial assistance programs and assists with related applications. If a patient is not counseled by a financial counselor on the date of service, statements are sent with the information needed to apply for financial assistance by the business office. In addition, the Financial Assistance Policy is posted on the Hospital's website and there is signage throughout the Hospital informing patients of the availability of a financial assistance program. Part VI, Line 4: The Hospital's primary service area is Birmingham / Hoover metropolitan statistical area as defined by the U.S. Office of Management and Budget. The Hospital's secondary service area is defined as the rest of the state, and we care for patients from every county in the state. demographic data including race, gender, and age is captured through the registration process. For 2020, Caucasians, African Americans, Hispanics, and other races accounted for 55%, 36%, 7%, and 2%, respectively, of the patients served while 37%, 35%, and 28% were ages 0-4, 5-12, and 13+ years, respectively. Economic demographic data is not specifically captured. Part VI, Line 5: Children's of Alabama is the primary source of pediatric healthcare and health education/training in Alabama through its affiliation with the School of Medicine at The University of Alabama at Birmingham, other four-year universities, and Alabama's two-year community colleges. In accordance with the IRS 501(3) requirements, Children's operates an open medical staff, has a board comprised of community members, and operates an open emergency department that treats all emergent patients regardless of their ability to pay. Children's operates Alabama's only Level 1 pediatric trauma center, pediatric renal care center, pediatric cardiac and transplant unit, and inpatient children's psychiatric units. In addition, the largest pediatric burn center in the southeast is located within Children's. In addition to quality care, Children's retains a strong focus and collaboration for education and research with universities and community colleges as a pathway to train and educate future healthcare professionals and allied healthcare professionals. Greater than 70% of Alabama's practicing pediatricians are trained at the Children's. X X X X 0 0 0 0 0 0 0 0 0 Brian J Wiatrak Pediatrician 641397 0 390000 0 3564 0 9750 0 16116 0 1060827 0 0 0 Audie L Woolley Pediatrician 638034 0 390000 0 2322 0 9750 0 19013 0 1059119 0 0 0 Jimmy Scott Hill Pediatrician 633987 0 390000 0 2322 0 9750 0 19101 0 1055160 0 0 0 Thomas G Shufflebarger Chief Operating Officer & Senior EVP 589906 0 321550 0 23665 0 9750 0 16911 0 961782 0 0 0 Dawn Walton Chief Financial Officer 493857 0 301110 0 22269 0 9750 0 12928 0 839914 0 0 0 Crayton A Fargason Jr Medical Director & VP Clinical Affai 494270 0 272633 0 24207 0 9750 0 1814 0 802674 0 0 0 Brian Kulbersh Pediatrician 390639 0 363135 0 2709 0 9750 0 19013 0 785246 0 0 0 Nicholas Smith Pediatrician 392016 0 323860 0 2708 0 9750 0 18930 0 747264 0 0 0 William Michael Warren Jr President & CEO 597336 0 81500 0 27590 0 9750 0 12879 0 729055 0 0 0 Robert Sarnecki Chief Information Officer 401310 0 242800 0 25713 0 9750 0 13830 0 693403 0 0 0 Douglas Dean VP of Human Resources 352400 0 207220 0 29072 0 7838 0 13830 0 610360 0 0 0 Michael E McDevitt EVP of Facilities 402768 0 72080 0 22505 0 9750 0 12658 0 519761 0 0 0 Andrew Loehr VP & Chief Nursing Officer 250444 0 187480 0 22363 0 9750 0 19101 0 489138 0 0 0 Deborah M Wesley Chief Nursing Officer (through March 77633 0 283730 0 13056 0 5573 0 3486 0 383478 0 0 0 A Special Care Facilities Financing Auth of the City of Bham-Children's Hosp 631005621 090929fz8 2012-02-24 26250000 Finance Expansion Facility 0 0 0 B Special Care Facilities Financing Auth of the City of Bham-Children's Hosp 631005621 2012-06-28 52000000 Finance Expansion Facility 0 0 0 C Special Care Facilities Financing Auth of the City of Bham-Children's Hosp 631005621 090929gj3 2015-09-12 153240000 Defease 2009 Bonds on 9/12/15 0 0 0 A 15250000 26250000 26250000 0 0 1 1 B 33800000 52000000 52000000 0 0 1 1 C 153240000 1557585 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 0 0 0 0 C 0 1 0 1 0 0 0 0 0 A 0 B 0 C 0 Buffalo Rock Entity more than 35% owned by James C. Lee III, Director 128994 Vending 0 Form 990, Part VI, Section A, line 2 Richard Bielen serves with Mr. Warren on the board of directors of a local insurance company. Form 990, Part VI, Section B, line 11b The completed Form 990 is reviewed in detail by the finance and audit committee. The Form 990 is then provided to the board of trustees, prior to the filing of the return. Form 990, Part VI, Section B, line 12c The Corporate Compliance Officer is responsible for monitoring compliance with the Conflict of Interest Policy. Annual disclosure requests are sent and followed up on to ensure that all are returned. Returned conflict of interest statements are reviewed by the Corporate Compliance Officer and compliance department staff as well as officers of the Organization for accuracy and completeness. Conflict of interest statements are maintained by the compliance department. The Compliance Officer reports activity related to any potential conflicts of interest, including changes in previously reported conflicts to administration, and the corporate compliance committee which is a subcommittee of the board of directors. Form 990, Part VI, Section B, line 15 The Hospital maintains oversight concerning all executive compensation action. This process is led by the Hospital board of trustees compensation committee, which is involved annually, and throughout the year as needed, in providing oversight of all executive compensation. Total compensation (i.e., base salary, incentive compensation, and executive benefits) of officers, key employees, and other vice-presidents is approved by the compensation committee prior to such compensation being paid. The total compensation that is presented for approval is determined by evaluation of market data comparisons on executive total compensation. This independent, objective market data is provided by the hospital's independent executive compensation consulting firm, Sullivan Cotter. All compensation committee proceedings, decisions, and actions are documented in committee minutes that are maintained by the Hospital. Form 990, Part VI, Section C, line 19 The Conflict of Interest Policy is summarized in the Corporate Code of Conduct which is available on the Hospital's website. The governing documents and financial statements are not generally available to the public, although the quarterly disclosures and audited financial statements of the Children's Hospital of Alabama are filed on the electronic municipal market access ("EMMA") section of the municipal securities rulemaking board as we maintain public debt. Audited financial statements are also filed as part of this 990. Form 990, Part XI, line 9: Intercompany transfers -288,228. Transfer to Foundation -56,110,000. Form 990, Part XII, Line 2c: The process has not changed from the prior year. TCH Ventures LLC 1600 Seventh Avenue South Birmingham AL 35233 630942442 Holding Company AL 199591 731902 The Children's Hospital of Alabama Alabama Children's Hospital Foundation 1600 Seventh Avenue South Birmingham AL 35233 630879471 Fundraising Activities AL 501(c)(3) Line 12b, II The Children's Hospital of Alabama 1 Holy Innocents Indemnity LTD PO Box 10073 APO Grand Cayman Grand Cayman CJ 980436612 Insurance CJ The Children's Hospital of Alabama C 3961223 26214829 1.00000 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 0 Alabama Children's Hospital Foundation B 56110000 Fair Market Value Alabama Children's Hospital Foundation C 711772 Fair Market Value Holy Innocents Indemnity LLC F 10000000 Fair Market Value