2020-08-13T12:56:58-05:00 2019-09-30 010494526 Baker Newman & Noyes LLC 280 Fore Street Portland ME 04101 990 2018-10-01 043259647 Children's Hospital Radiology Foundation Inc CHIL 6173558347 300 Longwood Avenue Boston MA 02115 Richard Robertson MD President 6173558347 2020-08-12 0 Nicholas E Porto P01310283 8002447444 2020-08-12 208.105.168.164 2020-08-12 09:08:01 ED P 8D27C340D9F2F89D467D155AEFB91C71D643DA43 DA1D1F22D002DE74304CAE64996AD19EA354FE22 2018 2020-09-23 17:36:50Z Richard Robertson MD 300 Longwood Avenue Boston MA 02115 68072743 0 X N/A X 1995 MA The Foundation provides medical, scientific, and educational services for the (see Schedule O) patients of Boston Children's Hospital. 9 0 60 0 0 0 0 45664 36229660 35507866 3444761 2480181 316585 0 39991006 38033711 1500000 145549 0 0 27238372 28092203 0 0 0 8139715 6205984 36878087 34443736 3112919 3589975 65119611 64563823 22248632 25228382 42870979 39335441 X The Foundation was organized and operates exclusively for the benefit of Boston Children's Hospital (the Hospital) and Harvard Medical School (Harvard). The Foundation is subject to established policies, practices, and procedures of the Hospital and (see Schedule O) Harvard. The Foundation provides radiology services primarily to patients at the Hospital and at satellite locations. 0 0 33021307 145549 35507866 The Foundation provides radiology services to patients at Boston Children's Hospital. It also carries on and promotes basic and applied medical research and education in the field of pediatric radiology by teaching students and other medical and scientific personnel; by providing or supplementing income to research personnel through fellowships, research grants, and stipends; and by giving lectures and publishing information regarding problems and research results in the field of pediatric radiology in order to educate the medical profession and the general public. The Foundation may charge for patient care and other medical services, provided that any net income be used exclusively for the charitable, scientific, and educational purposes for which the Foundation was created. The Foundation (see Schedule O) provides care to patients who meet certain criteria under the Hospital's free-care policy without charge or at an amount less than its established rates. 33021307 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 60 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Stephan D Voss MD PhD 6173558347 300 Longwood Avenue Boston MA 02115 Richard Robertson MD President 55.00 5.00 X X 640291 0 81322 Stephan D Voss MD PhD Treasurer 60.00 0.00 X X 507211 0 81169 Stephen D Brown MD Secretary 36.00 0.00 X X 263987 0 78337 Sarah Bixby MD Director 60.00 0.00 X 487161 0 81169 Darren B Orbach MD PhD Director 60.00 0.00 X 611390 0 81334 Caroline D Robson MD Director 60.00 0.00 X 504856 0 81169 Kirsten Ecklund MD Director 48.00 0.00 X 401986 0 80415 Judy A Estroff MD Director 60.00 0.00 X 438874 0 82041 Sanjay Prabhu MD Director 40.00 0.00 X 400996 0 80307 Physician's Org at CH Inc Independent Board Member 2.00 0.00 X 0 0 0 Ahmad Alomari MD Radiologist 60.00 0.00 X 614028 0 81338 Horacio Padua MD Radiologist 60.00 0.00 X 495947 0 81170 Irene Paresky Employee 1.00 60.00 X 653715 0 78080 Raja Shaikh MD Radiologist 60.00 0.00 X 465341 0 78368 Victoria Michelle Silvera MD Radiologist 60.00 0.00 X 2438070 0 57038 8923853 0 1103257 42 0 1 0 AdvantEdge Healthcare Solutions PO Box 638564 Cincinnati OH 452638564 Billing Services 533069 Merrill Lynch 100 Federal Street Boston MA 02110 Investment Fees 264819 2 45664 45664 Patient Service Revenue 621300 32786403 32786403 Other revenue 621300 2001830 2001830 Education and Research 611710 719633 719633 35507866 1497861 1497861 31021352 30039032 982320 982320 982320 38033711 35507866 0 2480181 145549 145549 4832180 4832180 17356060 17238316 117744 2636151 2636151 2687458 2538961 148497 580354 571897 8457 4222 4222 34709 34709 264819 264819 578498 113357 465141 478554 162114 316440 30405 30405 49510 49510 14326 14326 542544 480144 62400 Billing services 1479237 1479237 Medical service equipme 1394909 1394909 PO dues 734231 734231 Coordinated Specialty P 343029 343029 256991 256991 34443736 33021307 1422429 0 4152202 3362646 7435008 6844864 4241828 4025970 50000 354000 302000 131571 163779 286234 198741 58752 87493 44769573 47916908 3976677 1810163 65119611 64563823 1751425 2384884 9314584 7056333 11182623 15787165 22248632 25228382 X 39130752 35645214 3740227 3690227 42870979 39335441 65119611 64563823 X 3589975 197540 -7323053 X X 0 1 X 1 0 X 45664 45664 33948405 35092122 8881173 36229660 35507866 149659226 33948405 35092122 8881173 36229660 35553530 149704890 0 0 0 149704890 1494884 1262442 679503 1331939 1497861 6266629 1494884 1262442 679503 1331939 1497861 6266629 212710 316585 529295 35655999 36354564 9560676 37878184 37051391 156500814 0.95660 0.95520 0.04000 0.04140 X Schedule A, Part III, Line 12, Explanation of Other Income: Insurance rebate - 2014 Amount: $ 212,710. 2017 Amount: $ 316,585. Schedule A, Part III: The Foundation changed its year-end from June 30 to September 30 starting with the three month period ending September 30, 2017. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3740227 45664 95664 3690227 3806227 66000 3740227 3806227 3806227 3866227 60000 3806227 3951801 85574 3866227 0.00000 0.00000 1.00000 0 0 162844 121931 40913 123390 76810 46580 87493 Due to Boston Children's Hospital 2713834 Due to Physicians Organization 388285 Accrued Professional Liability 814450 Accrued Defined Benefit Plan 11728900 Due to Children's Hospital Pediatric Associates, Inc. 141696 15787165 X 38231251 197540 197540 38033711 0 38033711 41766789 7323053 7323053 34443736 0 34443736 Part V, Line 4: The endowment funds represent donations that were given for physician recruitment, a quality charge project, and a clinical initiative. The uses of these funds were restricted by the donor. Part X, Line 2: The Foundation is a tax-exempt corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code), and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. In addition, the Foundation qualifies for the charitable contribution deduction under Section 170(b)(1)(A), and has been classified as an organization that is not a private foundation under Section 509(a)(2). Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items including unrelated business income or tax status. The Foundation has evaluated the position taken on its filed tax returns. The Foundation has concluded that no uncertain income tax positions exist at September 30, 2019. The Foundation's tax years from 2016 through 2019 are potentially subject to examination. Part XII, Line 2d - Other Adjustments: Pension adjustment 7,323,053. 1 Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 501(c)(3) 145549 N/A N/A General Support 1 0 Part I, Line 2: Monitoring is provided by the Chilren's Hospital Radiology Foundation, Inc. (the Foundation) through oversight of the terms and conditions of a written grant agreement. Multiyear agreements require yearly progress and financial reports for continuation of funding. During the year ended September 30, 2019, the Foundation only provided grant donations to other 501(c)(3) organizations. X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 Richard Robertson MD President 510786 0 79017 0 50488 0 35000 0 46322 0 721613 0 0 0 Stephan D Voss MD PhD Treasurer 415590 0 36380 0 55241 0 35000 0 46169 0 588380 0 0 0 Stephen D Brown MD Secretary 203054 0 26823 0 34110 0 35000 0 43337 0 342324 0 0 0 Sarah Bixby MD Director 409094 0 39897 0 38170 0 35000 0 46169 0 568330 0 0 0 Darren B Orbach MD PhD Director 533358 0 37621 0 40411 0 35000 0 46334 0 692724 0 0 0 Caroline D Robson MD Director 415590 0 40315 0 48951 0 35000 0 46169 0 586025 0 0 0 Kirsten Ecklund MD Director 333181 0 31841 0 36964 0 35000 0 45415 0 482401 0 0 0 Judy A Estroff MD Director 345595 0 37116 0 56163 0 35000 0 47041 0 520915 0 0 0 Sanjay Prabhu MD Director 324029 0 39548 0 37419 0 35000 0 45307 0 481303 0 0 0 Ahmad Alomari MD Radiologist 534488 0 40063 0 39477 0 35000 0 46338 0 695366 0 0 0 Horacio Padua MD Radiologist 422766 0 34017 0 39164 0 35000 0 46170 0 577117 0 0 0 Irene Paresky Employee 421691 0 197461 0 34563 0 35000 0 43080 0 731795 0 0 0 Raja Shaikh MD Radiologist 387724 0 36738 0 40879 0 35000 0 43368 0 543709 0 0 0 Victoria Michelle Silvera MD Radiologist 2425845 0 0 0 12225 0 35000 0 22038 0 2495108 0 0 0 Part I, Line 1a Health club dues are reimbursed to some employees and included as taxable income on their W-2s. All individuals listed in Form 990, Part VII received this benefit and the reimbursement is included as part of taxable wages to each recipient. Part I, Line 7 Bonus compensation is based on a budgeted amount. The amount is distributed equally based on the physician's full-time equivalent. Raja Shaikh MD Radiologist Recruitment X 50000 50000 0 1 1 50000 Schedule L. Part II, Loans to and from Interested Persons: Children's Hospital Radiology Foundation, Inc. (the Foundation) has provided several secured and unsecured loans to employees. The loans bear interest at rates up to 2.87%. The loans were made for recruitment and retention purposes, to assist physician employees in the purchase of their primary residence. The amounts for the recruitment loans were determined by restricted donations provided by Boston Children's Hospital for use in recruitment. The loans will be forgiven over the terms of the notes if the recipients remain employed at the Foundation or its affiliates. The amount of the loan forgiveness will be included with accrued interest, if applicable, as compensation in the year forgiven. The balance of the loans outstanding are $352,000 at September 30, 2019. Future principal amounts due are as follows: $184,666 in 2020; $117,334 in 2021; and $50,000 in 2022. Loan amounts to individuals reported in Part VII have been disclosed in Schedule L, Part II, the balance of the notes receivable are with individuals who are not required to be disclosed in Schedule L per the IRS instructions. Form 990, Part VI, Section A, line 1 A majority of the Children's Hospital Radiology Foundation, Inc. (the Foundation) board members are physicians who are not independent from the Foundation. However, the Foundation participates in an integrated delivery system with Boston Children's Hospital (the Hospital) which does have a community board. The Foundation was organized in 1995. At that time, the board was composed entirely of physicians, a board structure that was approved by the Internal Revenue Service. The Foundation has since adjusted the board structure to make it more responsive to the Hospital by adding the Physicians Organization at Children's Hospital, Inc. (the PO) as a member. See Schedule O, Part VI, Questions 3, 6, 7b, and 12 for more details on the PO's rights. Form 990, Part VI, Section A, line 3 The Physicians Organization at Children's Hospital, Inc. (the PO) is the Class "C" member of Children's Hospital Radiology Foundation, Inc. (the Foundation). The PO has the power to approve the independent auditor and legal counsel of the Foundation from a list of firms mutually agreed to by the PO and the Foundation. The PO also has the right to review, but not to approve, the annual budgets and by-law changes of the Foundation. Lastly, Boston Children's Hospital has the right to review for compliance with applicable law, the general terms of and any modification to physician compensation and benefit plans for all physician employees of the Foundation. Form 990, Part VI, Section A, line 6 The Children's Hospital Radiology Foundation, Inc. (the Foundation) has three classes of members. The Chief of the Department of Radiology (the Department) of Boston Children's Hospital (the Hospital) is the Class "A" member. Any member of the Department (other than the Chief) who holds a medical staff appointment from the Hospital, has a full-time faculty appointment from Harvard University Medical School, and who has entered into a written agreement and receives compensation from the Hospital shall be a Class "B" member. Individuals engaged in clinical or research matters in the field of radiology at the Hospital may request membership and can be Class "B" members if invited by the Chief and ratified by the Class "B" members. The Physicians Organization at Children's Hospital, Inc. is the Class "C" member of the Foundation. Form 990, Part VI, Section A, line 7a According to the Articles of Organization, the Class "A" member is the Chief of the Department of Radiology (the Department) of Boston Children's Hospital (the Hospital). Any member of the Department who holds a medical staff appointment from the Hospital, has a full-time faculty appointment from Harvard Medical School, and who has entered into a written employment agreement and receives compensation from the Hospital shall be a Class "B" member. Class "A and "B" members hold their membership as long as they remain qualified for membership. Only Class "A and "B" members may vote at their annual meeting or other elections or serve on the Foundation's Board and may nominate candidates for election to the Board. Form 990, Part VI, Section A, line 7b The Physicians Organization at Children's Hospital, Inc. (the PO) is the Class "C" member of Children's Hospital Radiology Foundation, Inc. (the Foundation). The PO is responsible for providing management services to the Foundation. The PO has the power to approve the independent auditor and legal counsel of the Foundation from a list of firms mutually agreed to by the PO and the Foundation. The PO also has the right to review, but not to approve, the annual budgets and by-law changes of the Foundation. Lastly, Boston Children's Hospital has the right to review for compliance with applicable laws, the general terms of and any modification to physician compensation, and benefit plans for all physician employees of the Foundation. As the Class "C" member of the Foundation, the PO attends the Foundation's annual meeting. Form 990, Part VI, Section B, line 11b The detailed review will be conducted by the President of the Foundation, Richard Robertson, MD and the Financial Director, Paul Cochran. A copy of the Form 990 will be provided to the governing board prior to filing. The detailed review will be conducted before filing the return with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c In conjunction with Boston Children's Hospital (the Hospital), the Physicians Organization at Children's Hospital, Inc. (the PO) administers an annual conflict of interest disclosure to all of their member Foundations, which asks physicians (officers, top management, and highly compensated employees) and selected Foundation staff to disclose potential conflicts. A disclosure statement will be circulated annually to members of the PO. The audit committee shall determine those individuals (including medical staff members) who shall be required to complete the disclosure statement. The audit committee, at its discretion, may either: 1) refer any or all statements to the Board of Directors; 2) appoint an ad hoc committee to review and resolve any conflict of interest issues; or 3) review and resolve any conflict of interest personally or through a designee(s). Any person not receiving a disclosure statement has an affirmative obligation to disclose to the PO President, PO General Counsel, or his/her supervisor whenever he/she believes he/she has or may have a conflict of interest. Similarly, each person completing a disclosure statement has an affirmative obligation to update the statement any time circumstances change and/or he/she believes that a conflict of interest may exist. In the event a conflict of interest is found to exist, the Foundation prohibits the member from voting on any matter to which the conflict relates or otherwise influence the voting on such matter. Form 990, Part VI, Section B, line 15 Faculty compensation must comply with the Boston Children's Hospital (the Hospital) Physician Compensation Guidelines. These guidelines are developed in consultation with an independent external compensation consulting firm and are approved by the independent Compensation Committee of the Board of Children's Medical Center Corporation and the Hospital. The guidelines set the maximum compensation limits based on a peer group analysis for the Foundation. The maximum compensation limits are based on pediatric specialty, sub-specialty, academic rank and include productivity adjustments. Any proposed compensation that exceeds the limits must be prospectively approved by the independent compensation committee of the Board of the Hospital. Annual compensation for individual faculty members is set by the President of the Children's Hospital Radiology Foundation, Inc. (the Foundation), reviewed and approved by the Foundation in accordance with the Foundation's compensation policies and procedures. The Foundation's President's compensation is reviewed and approved annually on a prospective basis by the Boston Children's Hospital Chief Executive Officer and President/Chief Operating Officer. Form 990, Part VI, Section C, line 19 The Foundation maintains all financial records, conflict of interest policies, and governing documents at its main office at 300 Longwood Avenue, Boston, MA 02115. Form 990, Part XI, line 9: Pension adjustment -7,323,053. Form 990, Part XII, Line 2c: The audit process and scope has not changed from the prior year. Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 Hospital MA 501(c)(3) Line 3 N/A 0 Physicians Org at Children's Hospital 300 Longwood Avenue Boston MA 02115 043266103 Physician Organization MA 501(c)(3) Line 12c, III-FI N/A 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0