CHILDRENS CLINIC NETWORK: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- CHILDRENS CLINIC NETWORK (EIN 45-3765330)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-13
- IRS object ID
- 202133179349300423
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-13T10:25:25-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 135565207 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KPMG LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4200 WELLS FARGO CTR 90 S 7TH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 453765330 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHILDREN'S CLINIC NETWORK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CHIL | BusinessNameControlTxt |
| Phone | 6128136113 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 CHICAGO AVENUE SOUTH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55404 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRENDA MCCORMICK | PersonNm |
| Person Title | SVP & CFO | PersonTitleTxt |
| Phone | 6128136113 | PhoneNum |
| Signature | 2021-11-11 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | BRENDA | PersonFirstNm |
| Person Last | MCCORMICK | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | HOLLY MOEN | PreparerPersonNm |
| PTIN | P01800653 | PTIN |
| Phone | 6123055000 | PhoneNum |
| Preparation | 2021-11-06 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | BRENDA MCCORMICK | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 CHICAGO AVENUE SOUTH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55404 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $45,391,912 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | CHILDRENSMN.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2011 | FormationYr |
| Legal Domicile State | MN | LegalDomicileStateCd |
| Activity Or Mission | CHILDREN'S CLINIC NETWORK CHAMPIONS THE SPECIAL HEALTH NEEDS OF CHILDREN AND THEIR FAMILIES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 4 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 3 | VotingMembersIndependentCnt |
| Total Employee | 167 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $8,042 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,202,700 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $49,430,062 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $44,188,324 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | -$6,836 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,169 | PYOtherRevenueAmt |
| CY Other Revenue | $888 | CYOtherRevenueAmt |
| PY Total Revenue | $49,439,273 | PYTotalRevenueAmt |
| CY Total Revenue | $45,385,076 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $17,767 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $20,443 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,027,462 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,482,430 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $38,286,835 | PYOtherExpensesAmt |
| CY Other Expenses | $35,262,425 | CYOtherExpensesAmt |
| PY Total Expenses | $48,332,064 | PYTotalExpensesAmt |
| CY Total Expenses | $44,765,298 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,107,209 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $619,778 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,471,137 | TotalAssetsBOYAmt |
| Total Assets EOY | $18,413,213 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $14,622,894 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,945,192 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,848,243 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,468,021 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CHILDREN'S CLINIC NETWORK CHAMPIONS THE SPECIAL HEALTH NEEDS OF CHILDREN AND THEIR FAMILIES. WE ARE COMMITTED TO IMPROVING CHILDREN'S HEALTH BY PROVIDING HIGH-QUALITY, FAMILY-CENTERED PEDIATRIC SERVICES AT OUR TEN CLINICS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $43,625,798 | ExpenseAmt |
| Grant | $20,443 | GrantAmt |
| Revenue | $44,188,324 | RevenueAmt |
| Desc | CHILDREN'S CLINIC NETWORK 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. OUR TEN NETWORK CLINICS, AT THEIR LOCATIONS (SEE SCHEDULE O FOR LOCATIONS) PROVIDED 161,393 CLINIC VISITS.PROGRAM SERVICE ACCOMPLISHMENTS:LOCATIONS - ADDRESSES OF OUR TEN NETWORK CLINICS963 S. ROBERTS ST.WEST ST. PAUL, MN 5511814701 VICTOR HUGO BLVD NHUGO, MN XXX-XX-XXXX DREW AVENUEEDINA, MN 5543514050 NICOLLET AVENUE, SUITE 300BURNSVILLE, MN XXX-XX-XXXX ST. FRANCIS AVENUE, SUITE 100SHAKOPEE, MN 55379EDINBURGH MEDICAL AND DENTAL PLAZA8500 EDINBROOK PARKWAYBROOKLYN PARK, MN XXX-XX-XXXX EXCELSIOR BOULEVARDST. LOUIS PARK, MN 55416BASS LAKE CENTER12720 BASS LAKE ROADMAPLE GROVE, MN 55369WEST HEALTH CAMPUS2855 CAMPUS DRIVE, SUITE 350PLYMOUTH, MN 5544113980 NORTHDALE BOULEVARDROGERS, MN 55374 | Desc |
| Total Program Service Expenses | $43,625,798 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 167 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 4 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 3 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BRENDA MCCORMICK SVP & CFO | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6128136000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 CHICAGO AVENUE SOUTH | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55404 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd |
|---|---|---|---|---|---|---|---|---|---|
| MARC GORELICK MD | |||||||||
| PRESIDENT & CEO | 1.00 | 49.00 | Yes (X) | Yes (X) | $0 | $1,447,496 | $40,586 | ||
| GARY BLACKFORD | |||||||||
| BOARD CHAIR | 1.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| MARTIN BASSETT | |||||||||
| VICE CHAIR | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| HENRY CHANG | |||||||||
| TREASURER | 1.00 | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| BRENDA MCCORMICK | |||||||||
| SVP AND CFO | 1.00 | 49.00 | Yes (X) | $0 | $565,657 | $43,294 | |||
| TREVOR SAWALLISH | |||||||||
| SVP CLINICAL OPS & COO | 1.00 | 49.00 | Yes (X) | $0 | $696,819 | $43,203 | |||
| MONICA SCHILLER | |||||||||
| VP AMBULATORY SERVICES | 10.00 | 40.00 | Yes (X) | $55,812 | $302,953 | $88,432 | |||
| PAMELA GIGI CHAWLA MD | |||||||||
| VP CHIEF OF GENERAL PEDIATRICS | 10.00 | 40.00 | Yes (X) | $101,007 | $438,704 | $24,419 | |||
| JENNIFER OLSON MARKET | |||||||||
| SVP SYS OPS & CHIEF STRTGY OFF | 1.00 | 49.00 | Yes (X) | $0 | $694,925 | $39,937 | |||
| KRISTIN HEUERMANN MD | |||||||||
| CLINIC PHYSICIAN | 50.00 | 0.00 | $182,258 | $0 | $182,258 | Yes (X) | |||
| CYNTHIA KRULL MD | |||||||||
| CLINIC PHYSICIAN | 50.00 | 0.00 | $179,198 | $0 | $179,198 | Yes (X) | |||
| CATHERINE BEDFORD MD | |||||||||
| MEDICAL DIRECTOR | 50.00 | 0.00 | $202,009 | $0 | $202,009 | Yes (X) | |||
| GAIL CASEMORE MD | |||||||||
| CLINIC PHYSICIAN | 50.00 | 0.00 | $148,175 | $0 | $148,175 | Yes (X) | |||
| PAMELA NIKSICH MD | |||||||||
| STAFF PHYSICIAN | 50.00 | 0.00 | $210,833 | $0 | $210,833 | Yes (X) | |||
| REBECCA WOITALEWICZ | |||||||||
| VP PAYER STRATEGY & ANALYTICS | 0.00 | 50.00 | $0 | $357,436 | $18,782 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,079,292 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $4,503,990 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $1,221,126 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | Yes (1) | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| METROPOLITAN PEDIATRIC SPECIALISTS | |||||
| 6545 FRANCE AVE SOUTH STE 400 | EDINA | MN | 55435 | PHYSICIAN & STAFF | $10,202,506 |
| PARTNERS IN PEDIATRICS | |||||
| 12720 BASS LAKE ROAD | MAPLE GROVE | MN | 55369 | PHYSICIAN & STAFF | $7,522,544 |
| ECLINICALWORKS LLC | |||||
| 2 TECHNOLOGY DRIVE | WESTBOROUGH | MA | 01581 | TECHNOLOGY MAINT. | $223,437 |
| PEAK IT GROUP | |||||
| 8918 SPANISH RIDGE AVE SUITE 100 | LAS VEGAS | NV | 89148 | TECHNOLOGY MAINT. | $166,814 |
| MTS MINNESOTA | |||||
| 2800 CAMPUS DR STE 150 | PLYMOUTH | MN | 55441 | TECHNOLOGY MAINT. | $131,755 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,202,700 | GovernmentGrantsAmt |
| Total Contributions | $1,202,700 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE | 621498 | $40,421,753 | $40,421,753 |
| MEDICAID | 621498 | $3,546,910 | $3,546,910 |
| PAY FOR PERFORMANCE BONUS | 621498 | $219,661 | $219,661 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $44,188,324 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $888 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $888 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $888 | TotalRevenueColumnAmt |
| Exclusion | $888 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $6,836 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$6,836 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$6,836 | TotalRevenueColumnAmt |
| Exclusion | -$6,836 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,385,076 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44,188,324 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$5,948 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,443 | TotalAmt |
| Program Services | $20,443 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $235,118 | TotalAmt |
| Management And General | $235,118 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,680,935 | TotalAmt |
| Program Services | $6,364,905 | ProgramServicesAmt |
| Management And General | $316,030 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $331,669 | TotalAmt |
| Program Services | $305,238 | ProgramServicesAmt |
| Management And General | $26,431 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,449,550 | TotalAmt |
| Program Services | $1,334,034 | ProgramServicesAmt |
| Management And General | $115,516 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $785,158 | TotalAmt |
| Program Services | $722,588 | ProgramServicesAmt |
| Management And General | $62,570 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,012 | TotalAmt |
| Management And General | $24,012 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $131,064 | TotalAmt |
| Management And General | $131,064 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,050 | TotalAmt |
| Program Services | $2,050 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,288,885 | TotalAmt |
| Program Services | $19,288,885 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,430 | TotalAmt |
| Management And General | $5,430 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $343,083 | TotalAmt |
| Program Services | $343,083 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $458,713 | TotalAmt |
| Program Services | $235,384 | ProgramServicesAmt |
| Management And General | $223,329 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,355,095 | TotalAmt |
| Program Services | $3,355,095 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,236 | TotalAmt |
| Program Services | $20,236 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $160,807 | TotalAmt |
| Program Services | $160,807 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $906,003 | TotalAmt |
| Program Services | $906,003 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $103,495 | TotalAmt |
| Program Services | $103,495 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| MEDICAL EXPENSES | $8,515,421 | $8,515,421 |
| MN CARE & SALES TAX | $878,184 | $878,184 |
| BAD DEBT EXPENSE | $692,120 | $692,120 |
| MISCELLANEOUS EXPENSES | $220,645 | $220,645 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $157,182 | TotalAmt |
| Program Services | $157,182 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,765,298 | TotalAmt |
| Program Services | $43,625,798 | ProgramServicesAmt |
| Management And General | $1,139,500 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,905,849 | BOYAmt |
| EOY | $3,463,975 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $687,664 | BOYAmt |
| EOY | $648,746 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,398,986 | BOYAmt |
| EOY | $120,989 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,976,465 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,444,692 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,117,494 | BOYAmt |
| EOY | $4,531,773 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,361,144 | BOYAmt |
| EOY | $9,647,730 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,471,137 | BOYAmt |
| EOY | $18,413,213 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200,484 | BOYAmt |
| EOY | $610,936 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,422,410 | BOYAmt |
| EOY | $10,334,256 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,622,894 | BOYAmt |
| EOY | $10,945,192 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,848,243 | BOYAmt |
| EOY | $7,468,021 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,848,243 | BOYAmt |
| EOY | $7,468,021 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,471,137 | BOYAmt |
| EOY | $18,413,213 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $619,778 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990 SCH A, SUPPLEMENTAL INFORMATION | FormAndLineReferenceDesc |
| Explanation | CHILDREN'S CLINIC NETWORK HAS OBTAINED TAX-EXEMPT STATUS AS AN ORGANIZATION WHOSE MAIN PURPOSE IS TO PROVIDE MEDICAL CARE. HOWEVER, CHILDREN'S CLINIC NETWORK 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. | ExplanationTxt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $2,050 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,050 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, SCHEDULE C, PART II-B, LINE 1I | FormAndLineReferenceDesc |
| Explanation | AMERICAN ACADEMY OF PEDIATRICS (AAP): $120 MINNESOTA MEDICAL ASSOCIATION (MMA): $1,930 | ExplanationTxt |
Schedule D IRS990ScheduleD
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,466,426 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,992,996 | DepreciationAmt |
| Book Value | $3,473,430 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,510,039 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,451,696 | DepreciationAmt |
| Book Value | $1,058,343 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,531,773 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ROU BASE OPERATING ASSET | $8,668,247 |
| INTERCOMPANY RECEIVABLE | $979,483 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $9,647,730 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| LEASE LIABILITY | $10,202,016 |
| MN CARE TAX | $132,240 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $10,334,256 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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 JUDGMENT OCCURS. MANAGEMENT DETERMINED THERE ARE NO MATERIAL INCOME POSITIONS FOR THE YEARS ENDED DECEMBER 31, 2020 AND 2019. CHILDREN'S IS NOT SUBJECT TO AN INCOME TAX EXAMINATION FOR YEARS BEFORE 2016. | ExplanationTxt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | CHARITY CARE ASSISTANCE TO INDIVIDUALS | GrantTypeTxt |
| Recipient | 84 | RecipientCnt |
| Non Cash Assistance | $20,443 | NonCashAssistanceAmt |
| Valuation Method Used | COST | ValuationMethodUsedDesc |
| Non Cash Assistance | CHARITY CARE TO INDIVIDUALS | NonCashAssistanceDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | CHILDREN'S CLINIC NETWORK PROVIDES CHARITY CARE ASSISTANCE TO INDIVIDUALS OUTLINED IN OUR POLICY WHICH IS CLOSELY MONITORED BY MANAGEMENT. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARC GORELICK MD | ||||||||||||||
| PRESIDENT & CEO | $0 | $988,943 | $0 | $325,001 | $0 | $133,552 | $0 | $17,100 | $0 | $23,486 | $0 | $1,488,082 | $0 | $120,910 |
| TREVOR SAWALLISH | ||||||||||||||
| SVP CLINICAL OPS & COO | $0 | $497,716 | $0 | $143,570 | $0 | $55,533 | $0 | $17,100 | $0 | $26,103 | $0 | $740,022 | $0 | $52,751 |
| JENNIFER OLSON MARKET | ||||||||||||||
| SVP SYS OPS & CHIEF STRTGY OFF | $0 | $463,600 | $0 | $176,632 | $0 | $54,693 | $0 | $17,100 | $0 | $22,837 | $0 | $734,862 | $0 | $52,019 |
| BRENDA MCCORMICK | ||||||||||||||
| SVP AND CFO | $0 | $514,005 | $0 | $47,251 | $0 | $4,401 | $0 | $17,100 | $0 | $26,194 | $0 | $608,951 | $0 | $0 |
| PAMELA GIGI CHAWLA MD | ||||||||||||||
| VP CHIEF OF GENERAL PEDIATRICS | $101,007 | $339,946 | $0 | $75,250 | $0 | $23,508 | $0 | $20,089 | $0 | $4,330 | $101,007 | $463,123 | $0 | $20,748 |
| MONICA SCHILLER | ||||||||||||||
| VP AMBULATORY SERVICES | $55,812 | $248,271 | $0 | $53,296 | $0 | $1,386 | $0 | $13,001 | $0 | $19,619 | $55,812 | $335,573 | $0 | $0 |
| REBECCA WOITALEWICZ | ||||||||||||||
| VP PAYER STRATEGY & ANALYTICS | $0 | $282,176 | $0 | $71,964 | $0 | $3,296 | $0 | $17,100 | $0 | $1,682 | $0 | $376,218 | $0 | $0 |
| CATHERINE BEDFORD MD | ||||||||||||||
| MEDICAL DIRECTOR | $143,316 | $0 | $56,319 | $0 | $2,374 | $0 | $10,953 | $0 | $24,487 | $0 | $237,449 | $0 | $0 | $0 |
| PAMELA NIKSICH MD | ||||||||||||||
| STAFF PHYSICIAN | $209,334 | $0 | $0 | $0 | $1,499 | $0 | $12,673 | $0 | $10,177 | $0 | $233,683 | $0 | $0 | $0 |
| CYNTHIA KRULL MD | ||||||||||||||
| CLINIC PHYSICIAN | $121,964 | $0 | $49,548 | $0 | $7,686 | $0 | $10,882 | $0 | $26,358 | $0 | $216,438 | $0 | $7,241 | $0 |
| KRISTIN HEUERMANN MD | ||||||||||||||
| CLINIC PHYSICIAN | $135,086 | $0 | $46,492 | $0 | $680 | $0 | $10,984 | $0 | $8,596 | $0 | $201,838 | $0 | $0 | $0 |
| GAIL CASEMORE MD | ||||||||||||||
| CLINIC PHYSICIAN | $111,481 | $0 | $30,880 | $0 | $5,814 | $0 | $14,685 | $0 | $8,391 | $0 | $171,251 | $0 | $3,000 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3 | CHILDREN'S CLINIC NETWORK RELIES ON CHILDREN'S HEALTH CARE, THE PARENT OF CHILDREN'S CLINIC NETWORK, TO ESTABLISH THE COMPENSATION OF THE CEO: COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| 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 2020: CYNTHIA KRULL - $7,241 GAIL CASEMORE - $3,000 MARC GORELICK - $120,910 TREVOR SAWALLISH - $52,751 PAMELA CHAWLA - $20,748 JENNIFER OLSON MARKET - $52,079 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 CLINIC NETWORK. 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 CLINIC NETWORK ARE REPORTED TO THE IRS. |
| FORM 990, PART VI, SECTION A, LINE 6 | CHILDREN'S CLINIC NETWORK HAS A SOLE MEMBER, CHILDREN'S HEALTH CARE, A MINNESOTA NONPROFIT CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | CHILDREN'S CLINIC NETWORK'S SOLE MEMBER, CHILDREN'S HEALTH CARE, IS AUTHORIZED UNDER CHILDREN'S CLINIC NETWORK'S BYLAWS TO ELECT DIRECTORS OF CHILDREN'S CLINIC NETWORK, AFTER APPROVAL BY THE BOARD OF DIRECTORS OF CHILDREN'S CLINIC NETWORK. |
| FORM 990, PART VI, SECTION A, LINE 7B | CHILDREN'S CLINIC NETWORK'S SOLE MEMBER, CHILDREN'S HEALTH CARE, MAINTAINS A NUMBER OF RESERVED POWERS INCLUDING BUT NOT LIMITED TO ELECTION OF DIRECTORS, APPROVAL OF ANNUAL BUDGETS, 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, THE PARENT OF CHILDREN'S CLINIC NETWORK, REVIEWS THE DRAFT OF FORM 990 WITH THE AUDIT AND COMPLIANCE COMMITTEE OF CHILDREN'S HEALTH CARE GOVERNING BODY PRIOR TO THE FILING OF THE FORM. THIS REVIEW INCLUDES AN OVERVIEW OF THE FORM AND DISCUSSION RELATED TO KEY SECTIONS. COPIES OF THE FINAL FORM 990 ARE MADE AVAILABLE TO MEMBERS OF THE COMMITTEE AND ALL DIRECTORS PRIOR TO THE FORM BEING FILED. THE AUDIT AND COMPLIANCE COMMITTEE HAS BEEN DELEGATED THE 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. |
| FORM 990, PART VI, SECTION B, LINE 12C | MANAGEMENT OF CHILDREN'S HEALTH CARE, THE PARENT OF CHILDREN'S CLINIC NETWORK, ENSURE 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., REVIEW 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 CEO OF CHILDREN'S CLINIC NETWORK IS ESTABLISHED BY CHILDREN'S HEALTH CARE AS PART OF ITS EXECUTIVE COMPENSATION PROCESS. CHILDREN'S HEALTH CARE, INC. FOLLOWS THE REQUIREMENTS SET FORTH IN THE IRS REBUTTABLE PRESUMPTION OF REASONABLENESS IS DETERMINING COMPENSATION FOR THE CEO AND OTHER OFFICERS AND EXECUTIVE LEADERS OF CHILDREN'S CLINIC NETWORK. THIS FUNCTION IS PERFORMED BY THE COMPENSATION COMMITTEE OF THE GOVERNING BOARD OF CHILDREN'S HEALTH CARE, 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, THE PARENT OF CHILDREN'S CLINIC NETWORK, 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 MAKE THIS INFORMATION PUBLICLY AVAILABLE. CHILDREN'S CLINIC NETWORK RELIES ON THE CONFLICT OF INTEREST POLICY OF CHILDREN'S HEALTH CARE, THE PARENT OF CHILDREN'S CLINIC NETWORK CHILDREN'S HEALTH CARE DOES NOT MAKE THE CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. THE GOVERNING DOCUMENTS OF CHILDREN'S CLINIC NETWORK ARE NOT AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | PURCHASED LAB & MEDICAL SVCS: PROGRAM SERVICE EXPENSES 18,812,482. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 18,812,482. CONSULTING FEES: PROGRAM SERVICE EXPENSES 74,771. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 74,771. DATA PROCESSING: PROGRAM SERVICE EXPENSES 22,396. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,396. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 346,347. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 346,347. LEASED EQUIPMENT: PROGRAM SERVICE EXPENSES 22,073. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,073. LINEN: PROGRAM SERVICE EXPENSES 10,816. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,816. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | CHC | |
| CHILDREN'S HEALTH CARE SERVICES INC | |||||||||||
| 2525 CHICAGO AVENUE SOUTH | MINNEAPOLIS | MN | 55404 | 411756478 | HEALTHCARE | MN | 501(C)(3) | LINE 3 | 0 | CHC | |
| MOTHER BABY FACILITY LLC | |||||||||||
| 2525 CHICAGO AVENUE SOUTH | MINNEAPOLIS | MN | 55404 | 454078371 | HEALTHCARE | MN | 501(C)(3) | LINE 12A | 0 | CHC | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1ForeignAddress/AddressLine1Txt | CityForeignAddress/CityNm | CountryForeignAddress/CountryCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile Foreign CountryLegalDomicileForeignCountryCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Legal Domicile StateLegalDomicileStateCd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CHILDREN'S HEALTH INSURANCE NETWORK LTD | |||||||||||||
| PO BOX 30600 | GRAND CAYMAN | CJ | INSURANCE | CJ | CHC | C | 0 | ||||||
| CHILDREN'S HEALTH NETWORK | |||||||||||||
| MEDICAL SERVICES | CHC | C | 0 | 910 EAST 26TH STREET SUITE 330 | MINNEAPOLIS | MN | 55404 | 463226418 | MN | ||||
| CHILDREN'S MN HOME MEDICAL EQUIPMENT | |||||||||||||
| MED. EQ. SERVICES | CHC | C | 0 | 2525 CHICAGO AVENUE | MINNNEAPOLIS | MN | 55404 | 842915398 | MN | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |