2021-05-17T12:08:26-05:00 2020-06-30 420714325 RSM US LLP 6 S PATTERSON BLVD DAYTON OH 45402 990 2019-07-01 311045247 DAYTON CHILDREN'S HOSPITAL FOUNDATION DAYT 9376413000 ONE CHILDRENS PLAZA DAYTON OH 454041873 CHRIS BERGMAN VP FINANCE AND CFO 9376413000 2021-05-16 1 KAREN O CRIM P00368385 9372980201 2021-05-14 2019 2022-09-23 18:48:47Z DEBORAH FELDMAN ONE CHILDRENS PLAZA DAYTON OH 454041873 33855600 0 X WWW.CHILDRENSDAYTON.ORG X 1982 OH DAYTON CHILDREN'S HOSPITAL FOUNDATION (THE FOUNDATION) EXISTS SOLELY TO BENEFIT DAYTON CHILDREN'S HOSPITAL (DCH), AND TO ASSIST DCH IN PERFORMING ITS CHARITABLE MISSION. 19 17 0 600 0 0 4272137 7120886 0 0 3509874 6345168 17100 -3867 7799111 13462187 5953107 8656720 0 0 0 0 0 0 0 166413 177241 6119520 8833961 1679591 4628226 125101663 130350233 0 274212 125101663 130076021 X DAYTON CHILDREN'S HOSPITAL FOUNDATION (THE FOUNDATION) EXISTS SOLELY TO BENEFIT DAYTON CHILDREN'S HOSPITAL, DAYTON, OHIO (DCH), AND TO ASSIST DCH IN PERFORMING ITS CHARITABLE MISSION. 0 0 8656720 8656720 DAYTON CHILDREN'S HOSPITAL FOUNDATION (THE FOUNDATION) EXISTS SOLELY TO BENEFIT DAYTON CHILDREN'S HOSPITAL (DCH) AND SUBSIDIARIES, AND TO ASSIST DCH IN PERFORMING ITS CHARITABLE MISSION. THE FOUNDATION IS FUNDED FROM CONTRIBUTIONS, BEQUESTS AND DEFERRED AND PLANNED GIFTS FROM OUTSIDE DONORS. THE FOUNDATION ASSIST DCH IN FULFILLING ITS CHARITABLE PURPOSE IN THE FOLLOWING FOUR WAYS:1. THE FOUNDATION ACCUMULATES THE PROCEEDS OF BEQUESTS AND DEFERRED AND PLANNED GIFTS AS AN ENDOWMENT FOR DCH'S FUTURE CAPITAL NEEDS. THE INCOME FROM THIS ENDOWMENT WILL BE USED TO SUPPORT DCH'S YEAR TO YEAR CAPITAL EQUIPMENT NEEDS IN THE FUTURE. IN ADDITION, INCOME FROM THE FOUNDATION MAY BE USED TO FUND ALL OR A PORTION OF EXTRAORDINARY CAPITAL PROJECTS SUCH AS ADDITIONS OR RENOVATIONS TO DCH'S BUILDINGS AND GROUNDS. IN THE YEAR ENDED JUNE 30, 2020, THE FOUNDATION EXPENDED $153,574 FOR CAPITAL PROJECTS.2. THE FOUNDATION MAKES CERTAIN OTHER PERIODIC GRANTS FOR CHILD ADVOCACY EFFORTS WHICH ARE RELATED TO DCH'S MISSION. IN THE YEAR ENDED JUNE 30, 2020 THE FOUNDATION EXPENDED $86,966 FOR ADVOCACY PROGRAMS. AN ENDOWMENT HAS BEEN ESTABLISHED TO PROVIDE ANNUAL SUPPORT OF DCH'S CHILD LIFE PROGRAM. THE FOUNDATION EXPENDED $26,184 FOR THE CHILD LIFE PROGRAM IN THE YEAR ENDED JUNE 30, 2020.3. THE FOUNDATION HAS ESTABLISHED ENDOWMENTS, THE INCOME FROM WHICH WILL BE USED EACH YEAR TO ASSIST DCH RECRUIT AND RETAIN THE TOP PEDIATRIC MEDICAL PROFESSIONALS. CURRENT ENDOWED CHAIRS ARE AS FOLLOWS: CHILD ABUSE, CRITICAL CARE, NEUROSURGERY, PULMONARY, DEVELOPMENT PEDIATRICS, PEDIATRIC NEUROLOGY, GENERAL PEDIATRIC SURGERY, PEDIATRIC CANCER AND BLOOD DISORDERS, ANESTHESIA, INFECTIOUS DISEASES, AND RECRUITMENT OF SUBSPECIALTY PHYSICIANS WHO WOULD OTHERWISE NOT BE AVAILABLE IN THE COMMUNITY. EXPENDITURES FOR THE ENDOWED MEDICINE CHAIRS IN THE YEAR ENDED JUNE 30, 2020 TOTALED $1,280,966.4. GRANTS ARE MADE TO DCH AS A WHOLE RATHER THAN TO SPECIFIC PHYSICIANS OR INDIVIDUALS. MAJORITY APPROVAL BY THE BOARD OF TRUSTEES DETERMINES WHETHER THE GRANT IS FUNDED BY THE FOUNDATION. THE FOUNDATION'S TREASURER'S APPROVAL IS REQUIRED PRIOR TO ALL DISBURSEMENTS OF FUNDS. 8656720 1 1 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 1 0 0 1 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 19 17 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 OH X CHRIS BERGMAN 9376415819 ONE CHILDRENS PLAZA DAYTON OH 45404 DEBORAH FELDMAN SYSTEM CEO 1.00 39.00 X X 0 944207 923991 CHRIS BERGMAN SYSTEM CFO 1.00 39.00 X X 0 493842 39653 SANDRA PIERCE TREASURER 1.00 X X 0 0 0 NICK COSTIDES CHAIR 1.00 X X 0 0 0 DARRICK WEEKS VICE CHAIR 1.00 X X 0 0 0 SUSAN BAKER TRUSTEE 1.00 X 0 0 0 JANEL BARNETT TRUSTEE 1.00 X 0 0 0 THE HONORABLE WILLIAM BEAGLE TRUSTEE 1.00 X 0 0 0 MIKE BEVIS TRUSTEE 1.00 X 0 0 0 PETER DUFFEY TRUSTEE 1.00 X 0 0 0 GREG EBERHART TRUSTEE 1.00 X 0 0 0 TOBY HENDERSON TRUSTEE 1.00 X 0 0 0 HEIDI HENNESSY TRUSTEE 1.00 X 0 0 0 HELEN JONES-KELLEY TRUSTEE 1.00 X 0 0 0 KEVIN MCDONALD TRUSTEE 1.00 X 0 0 0 SHARMILA RAO TRUSTEE 1.00 X 0 0 0 SARAH WORLEY TRUSTEE 1.00 X 0 0 0 MATTHEW YODER TRUSTEE (STARTED 10/31/19) 1.00 X 0 0 0 JEFF KLANK TRUSTEE (STARTED 10/31/19) 1.00 X 0 0 0 0 1438049 963644 0 0 1 0 HIRTLE CALLAGHAN 300 BARR HARBOR DR SUITE 500 WEST CONSHOHOCKEN PA 19428 INVESTMENT SERVICES 133853 1 630054 6490832 227530 7120886 1666257 1666257 24951240 20272329 4678911 4678911 4678911 117217 630054 121084 -3867 -3867 13462187 0 0 6341301 8317292 8317292 339428 339428 177241 177241 8833961 8656720 177241 0 2469162 4901238 3509450 6169255 107922825 109937290 9342450 9342450 1857776 0 125101663 130350233 0 274212 0 274212 X 123581029 124256418 1520634 5819603 125101663 130076021 125101663 130350233 X 4628226 -4103758 4449890 X 0 1 X 1 0 X X 1 DAYTON CHILDREN'S HOSPITAL 300672132 3 1 8317292 0 1 8317292 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 PART IV, SECTION B, LINE 1 ALL OF THE POWER TO SUPPORT/REMOVE THE DIRECTORS IS HELD BY DAYTON CHILDREN'S HOSPITAL (DCH). PART IV, SECTION A, LINE 1 THE FOUNDATION MAY PROVIDE CONTRIBUTIONS TO OTHER ORGANIZATIONS ASSOCIATED WITH DCH AND WHICH ARE THEMSELVES TAX EXEMPT ORGANIUZATIONS UNDER THE PROVISIONS OF SECTION 501(C)(3). PART IV, SECTION B, LINE 2 CHILDREN'S HOME CARE OF DAYTON IS A SUBSIDIARY OF DAYTON CHILDREN'S HOSPITAL (DCH) AND ASSISTS DCH IN THE COMPLETION OF ITS MISSION BY PROVIDING CONTINUITY OF CARE FOR DCH PATIENTS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1520634 76031 1444603 1601394 80760 1520634 183912987 760296 640717 3340064 180372542 1601394 167616099 106014 22473043 6271797 10372 183912987 168335550 9088944 -3634804 6153591 20000 167616099 1.00000 0 0 0 NMTC LOANS RECEIVABLE 9342450 F 9342450 INTERCOMPANY PAYABLE 230233 FIFTH THIRD GIFT ANNUITIES 43979 274212 X PART V, LINE 4: THE ENDOWMENTS ARE HELD BY DAYTON CHILDREN'S HOSPITAL FOUNDATION, A SUBSIDIARY OF DAYTON CHILDREN'S HOSPITAL. THE FUNDS ARE USED EXCLUSIVELY TO SUPPORT DAYTON CHILDREN'S HOSPITAL AND ITS SUBSIDIARIES. THE INTENDED USE OF THE FUNDS IS TO COVER EXPENSES FOR THE CARE & COMFORT PROGRAM. PART X, LINE 2: ALL SUBSIDIARIES OF THE HOSPITAL EXCEPT DAYTON CHILDREN'S SPECIALTY PEDIATRICS, AND SELECTED JOINT VENTURE ENTITIES ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE WHOLLY OWNED FOR-PROFIT SUBSIDIARIES DAYTON CHILDREN'S SPECIALTY PEDIATRICS HAD NO TAXABLE INCOME IN 2020 OR 2019. THE PROVISION FOR INCOME TAXES FOR THE JOINT VENTURE ENTITIES IS NOT SIGNIFICANT TO THE HOSPITAL. THE HOSPITAL COMPLETED AN ANALYSIS OF ITS TAX POSITIONS IN ACCORDANCE WITH APPLICABLE ACCOUNTING GUIDANCE, AND DETERMINED THAT NO AMOUNTS WERE REQUIRED TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS AT JUNE 30, 2020 OR 2019. CENTRAL AMERICA AND THE CARIBBEAN 0 0 INVESTMENTS 24872844 EAST ASIA AND THE PACIFIC 0 0 INVESTMENTS 16965 EUROPE (INCLUDING ICELAND & GREENLAND) 0 0 INVESTMENTS 579756 NORTH AMERICA 0 0 INVESTMENTS 402854 0 0 0 0 0 0 25872419 0 25872419 1 0 0 1 0 0 PART III ACCOUNTING METHOD: K99.1FM RADIOTHON 344165 344165 GEN CITY JAM GOLF OUTING 206175 156925 49250 11810 23044 8921 21842 3 196931 128964 67967 16477 28234 738 10018 747271 630054 117217 11810 16477 51278 9659 31860 121084 -3867 1 DAYTON CHILDREN'S HOSPITAL ONE CHILDRENS PLAZA DAYTON OH 45404 310672132 501(C)(3) 8317292 GENERAL OPERATING SUPPORT 1 0 MEDICATIONS 321 40190 MEALS/FOOD 1700 84815 TRANSPORTATION 1435 50124 RENT/UTILITIES 130 74837 SPECIAL EQUIPMENT 46 13411 OTHER 231 76051 PART I, LINE 2: AS THE FOUNDATION'S PURPOSE IS "SOLELY TO BENEFIT DAYTON CHILDREN'S HOSPITAL (DCH)," THE RELATIONSHIP BETWEEN THE 2 ENTITIES IS EXTREMELY CLOSE. WITH THE EXCEPTION OF RESEARCH GRANTS AND SPECIAL ADVOCACY GRANTS, THE FUNDS PROVIDED TO DCH COVER JUST A FRACTION OF THE COST OF THE PROGRAMS FOR WHICH THEY ARE GIVEN. AS SUCH, FUNDS ARE TRANSFERRED TO DCH BUT SPECIFIC EXPENDITURES ARE NOT TRACKED. THE FOUNDATION'S MANAGEMENT APPROVES AND MONITORS ALL GRANTS AND CHARITABLE DONATIONS. RESEARCH - EACH RESEARCH GRANT PROPOSAL FUNDED IS APPROVED BY BOTH THE FOUNDATION'S BOARD AND DCH'S INSTITUTIONAL REVIEW BOARD. RESEARCH PROJECTS ARE TRACKED INDIVIDUALLY AT DCH AND MONTHLY REPORTING IS GIVEN TO THE PROJECT DIRECTOR AND IS AVAILABLE TO THE FOUNDATION. IF THE PROJECT IS COMPLETED WITH UNSPENT FUNDS REMAINING, THEY ARE RETURNED TO THE FOUNDATION. SPECIAL GRANTS - ADDITIONAL GRANTS MAY BE ESTABLISHED FOR A SPECIFIC USE OR TO FULLY FUND A SPECIFIC CHILD ADVOCACY ONE-TIME COST OR PROGRAM. THESE FUNDS ARE TRANSFERRED TO DCH AND PLACED IN SPECIFIC ACCOUNT FOR TRACKING PURPOSES. DETAILED ACTIVITY REPORTS ARE AVAILABLE TO THE FOUNDATION. UNSPENT FUNDS ARE RETURNED TO THE FOUNDATION. CHCOD ENDOWMENT - AN ENDOWMENT WAS ESTABLISHED FOR THE CHILDREN'S HOME CARE OF DAYTON (A SUPPORTED ORGANIZATION) FOR THEIR CARE AND COMFORT PROGRAM. THIS SUPPORT DOES NOT FULLY FUND THE PROGRAM AND IS TRANSFERRED ANNUALLY. 0 1 0 0 0 0 0 0 0 DEBORAH FELDMAN SYSTEM CEO 0 921953 0 0 0 22254 0 923991 0 0 0 1868198 0 5190 CHRIS BERGMAN SYSTEM CFO 0 485778 0 0 0 8064 0 15808 0 23845 0 533495 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUAL PARTICIPATES IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND THE FOLLOWING IS THE INCREASE IN THE ACTURIAL VALUE DURING THE YEAR: DEBORAH FELDMAN - $910,091 THE FOLLOWING INDIVIDUAL RECEIVED A PAYMENT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: DEBORAH FELDMAN - $5,190 X 5 227530 FAIR MARKET VALUE 0 0 1 0 PART I, COLUMN (B): IS THE NUMBER OF CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 6 DAYTON CHILDREN'S HOSPITAL (DCH) IS THE SOLE MEMBER OF DAYTON CHILDREN'S HOSPITAL FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A DCH IS THE SOLE MEMBER OF THE FOUNDATION. THE BOARD OF DCH APPOINTS THE FOUNDATION BOARD MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE CFO REVIEWS KEY DISCLOSURES WITH APPOPRIATE COMMITTEES OF THE BOARD OF TRUSTEES. THEN PRIOR TO FILING, THE FORM 990 IS ELECTRONICALLY LOADED TO A SECURE HOSPITAL WEBSITE FOR THE ENTIRE BOARD OF TRUSTEES TO REVIEW. AN EMAIL IS SENT TO ALL MEMBERS NOTIFYING THEM THAT THE FORM IS AVAILABLE FOR THEIR REVIEW AND THAT IT WILL BE FILED ON OR BEFORE THE EXTENDED DUE DATE. FORM 990, PART VI, SECTION B, LINE 12C AT THE BEGINNING OF EACH MEETING, THE CHAIRMAN OF THE BOARD ASKS EACH MEMBER TO IDENTIFY AND DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST BASED ON THE AGENDA OR ANY CHANGES IN THEIR BUSINESS PRACTICE THAT MIGHT BE RELEVANT. IF THERE ARE ANY CONFLICTS, THE MEMBER(S) EXCUSE THEMSELVES AND DO NOT PARTICIPATE IN THE DISCUSSION AND DO NO VOTE ON THE ITEM. THIS THEN IS NOTED IN THE MINUTES OF THAT MEETING. BOARD MEMBERS ANNUALLY AGREE TO ABIDE BY WRITTEN CONFLICT OF INTEREST AND CONFIDENTIALITY POLICIES. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS, ORGANIZING DOCUMENTS, AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE GENERAL PUBLIC UPON WRITTEN OR VERBAL REQUEST TO DAYTON CHILDREN'S HOSPITAL, FOR THE SAME PERIOD OF TIME AS SET FORTH IN THE INTERNAL REVENUE CODE SECTION 6104(D). FORM 990, PART XI, LINE 9: TRANSFER FROM DAYTON CHILDREN'S HOSPITAL -1,142. CONTRIBUTIONS AND INVESTMENT INCOME 4,451,032. DAYTON CHILDREN'S HOSPITAL ONE CHILDRENS PLAZA DAYTON OH 45404 310672132 HEALTH CARE OH 501(C)(3) LINE 3 N/A 0 CHILDREN'S HOME CARE ONE CHILDRENS PLAZA DAYTON OH 45404 311356037 HOME HEALTH CARE OH 501(C)(3) LINE 10 DCH 1 DAYTON CHILDREN'S SPECIALTY PEDIATRICS ONE CHILDRENS PLAZA DAYTON OH 45404 311411364 SPEC PHYS GROUP OH N/A C 1 PEDIATRIC ASSURANCE COMPANY LTD ONE CHILDRENS PLAZA DAYTON OH 45404 980478183 SELF-INSURANCE OH N/A 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 DAYTON CHILDREN'S SPECIALTY PEDIATRICS O 155696 CASH