2020-07-02T16:53:13-05:00 2019-12-31 273605969 CBIZ MHM LLC 13577 FEATHER SOUND DR SUITE 400 CLEARWATER FL 337625539 990 2019-01-01 042121377 THE SHRINERS' HOSPITAL FOR CHILDREN SHRI 8132810300 POST OFFICE BOX 31356 TAMPA FL 336313356 JERRY GANTT PRESIDENT 8132810300 2020-07-02 1 PAUL DUNHAM P00100222 7275721400 71.41.95.34 2020-07-02 16:48:33 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 569D810AF00E888E09A326DEEE3447CABDDC35BC 2019 2020-09-23 17:36:50Z JERRY GANTT 2900 N ROCKY POINT DRIVE TAMPA FL 33607 393234250 0 X WWW.SHRINERSHOSPITALSFORCHILDREN.ORG X 1925 MA WE PROVIDE PEDIATRIC SPECIALTY CARE WITHOUT FINANCIAL OBLIGATION TO PATIENTS OR THEIR FAMILIES. 22 19 576 1000 0 0 22520527 21409722 13096226 13034456 54889073 43680325 1717252 1953149 92223078 80077652 0 0 0 0 34729086 34506212 0 0 656556 32351935 35795090 67081021 70301302 25142057 9776350 1063767940 535726862 7080953 6531265 1056686987 529195597 X SEE SCHEDULE OSHRINERS HOSPITALS FOR CHILDREN IN BOSTON AND SPRINGFIELD OFFER "CHARITY CARE" THROUGH AN INTERNATIONAL NETWORK OF PEDIATRIC HOSPITALS DEDICATED TO PROVIDING EXCELLENT PATIENT CARE, RESEARCH, AND EDUCATION FOR ORTHOPAEDIC CONDITIONS AND BURNS REGARDLESS OF THE FAMILY'S ABILITY TO PAY.SHRINERS HOSPITALS FOR CHILDREN-BOSTON SPECIALIZES IN PROVIDING COMPREHENSIVE ACUTE CARE AND RECONSTRUCTIVE AND REHABILITATIVE CARE TO CHILDREN WHO HAVE BEEN BURNED, INCLUDING ACUTE BURNS, SMOKE INHALATION INJURY, RECONSTRUCTIVE SURGERY FOR HEALED BURNS, AND OTHER RELATED CONDITIONS.SHRINERS HOSPITALS FOR CHILDREN-SPRINGFIELD SPECIALIZES IN CARING FOR CHILDREN WITH ORTHOPAEDIC CONDITIONS AND INJURIES SUCH AS SCOLIOSIS, CLUBFOOT, AND ORTHOPAEDIC CONDITIONS RELATED TO CEREBRAL PALSY AND SPINA BIFIDA. FOR MORE INFORMATION, VISIT HTTP://WWW.SHRINERSHOSPITALSFORCHILDREN.ORG/ OR CALL 1-800-241-GIFT. 0 0 59904351 13034456 STATE-OF-THE-ART MEDICAL CARE:SHRINERS HOSPITALS FOR CHILDREN, COMPRISED OF A NETWORK OF HOSPITALS (SEE SCHEDULE R), SERVES 179 COUNTRIES, TREATING MORE THAN 100,000 UNIQUE CHILDREN EACH YEAR. OUR ORGANIZATIONAL MISSION IS TO PROVIDE THE HIGHEST QUALITY OF CARE TO CHILDREN WITHIN A COMPASSIONATE, FAMILY-CENTERED AND COLLABORATIVE CARE ENVIRONMENT. OUR TEAM OF HIGHLY-SKILLED MEDICAL PROFESSIONALS ARE AMONG SOME OF THE MOST RECOGNIZED INDIVIDUALS IN THE FIELDS OF PEDIATRIC BURN CARE AND PEDIATRIC ORTHOPEDIC CARE. CONTINUED ON SCHEDULE O OUR SPECIALIZED CARE EXTENDS BEYOND THE CONVENTIONAL WALLS OF THE HOSPITAL. SHRINERS HOSPITALS FOR CHILDREN ALSO SEEKS TO DELIVER CARE TO THOSE INTERNATIONALLY THROUGH OUR TELEHEALTH PROGRAM, WHICH ALLOWS PATIENTS TO RECEIVE OUR WRAP-AROUND CARE VIA VIDEO CONFERENCING. WE ALSO STRIVE TO HELP THOSE IN NEED - ESPECIALLY WHEN DISASTER STRIKES. MOST RECENTLY, SHC SENT GO-TEAMS TO BOTH MEXICO CITY AND GUATEMALA IN THE WAKE OF DISASTER TO HELP THOSE AFFECTED BY THE TRAGEDIES. 5039108 RESEARCH:SHRINERS HOSPITALS FOR CHILDREN PRIDES ITSELF ON THE WRAP-AROUND CARE THAT IT PROVIDES TO PATIENTS AND FAMILIES. AS A HEALTH CARE SYSTEM WITH 22 LOCATIONS IN THE U.S., CANADA AND MEXICO (2 OPERATED BY THIS ORGANIZATION), OUR STAFF IS DEDICATED TO IMPROVING THE LIVES OF CHILDREN BY PROVIDING PEDIATRIC SPECIALTY CARE, CONDUCTING INNOVATIVE RESEARCH, AND OFFERING OUTSTANDING TEACHING PROGRAMS FOR MEDICAL PROFESSIONALS. CONTINUED ON SCHEDULE OOUR RESEARCH TEAM IS AMONG THE MOST HIGHLY RENOWNED, GAINING NATIONAL RECOGNITION FOR CLINICAL RESEARCH. SIX SHC LOCATIONS ARE MAJOR RESEARCH HOSPITALS (ONE OPERATED BY THIS ORGANIZATION), WORKING TO DEVELOP NEW TREATMENTS AND TECHNOLOGICAL ADVANCES WITHIN THE MEDICAL COMMUNITY. 64943459 1 1 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 110 0 1 576 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 22 19 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X X RACHEL L MEHLENBACHER 8135187845 2900 N ROCKY POINT DR TAMPA FL 336071435 GARY J BERGENSKE CHAIRMAN 5.00 0.00 X X 0 47500 0 JERRY G GANTT PRESIDENT 2.00 40.00 X X 0 18000 0 JIM CAIN VICE PRESIDENT 2.00 11.00 X X 0 47500 0 BRAD T KOEHN TREASURER 2.00 23.00 X X 0 0 0 EDWARD W GEOFFRION ASSISTANT TREASURER 2.00 0.00 X X 0 0 0 CHARLES H WEAVER CLERK 2.00 0.00 X X 0 0 0 RANDY E RUDGE ASSISTANT SECRETARY 2.00 0.00 X X 0 7200 0 PETER P DIAZ TRUSTEE 2.00 5.00 X 0 0 0 SKIP DF STANAWAY TRUSTEE 2.00 5.00 X 0 0 0 ANTHONY M WEST TRUSTEE 2.00 5.00 X 0 0 0 JAMES A DOEL TRUSTEE 2.00 5.00 X 0 0 0 W BRANDT BEDE TRUSTEE 2.00 0.00 X 0 0 0 CHUCK PITTMAN TRUSTEE 2.00 5.00 X 0 0 0 JEFFREY L SOWDER TRUSTEE 2.00 41.00 X 0 0 0 CHRIS L SMITH TRUSTEE 2.00 0.00 X 0 0 0 STEVEN E BEHE TRUSTEE 2.00 0.00 X 0 0 0 TIMOTHY J LUTTRELL TRUSTEE 2.00 0.00 X 0 0 0 BRADFORD LACHUT TRUSTEE 2.00 0.00 X 0 0 0 ROBERT L BAKER TRUSTEE 2.00 0.00 X 0 0 0 ROBERT L TURNER TRUSTEE 2.00 0.00 X 0 0 0 BARRY J GATES TRUSTEE 2.00 0.00 X 0 0 0 ROBERT J BENNETT TRUSTEE 2.00 0.00 X 0 0 0 JOHN DEWEESE ORTHOPEDIC SURGEON, ASST PROF 32.00 0.00 X 571001 0 31739 JAMES F MOONEY III CHIEF OF STAFF 40.00 0.00 X 675806 0 52590 RUBINI PATHY ORTHOPEDIC SURGEON, ASST PROF 40.00 0.00 X 396603 0 28023 H LEE KIRK JR ADMINISTRATOR 40.00 0.00 X 255693 0 41102 KERSTIN SOBUS PHYSIATRIST 40.00 0.00 X 251007 0 46470 2150110 120200 199924 59 0 1 0 THE GENERAL HOSPITAL CORPORATION 55 FRUIT ST BOSTON MA 02114 OUTSIDE PATIENT SERVICES 5812040 SPRINGFIELD ANESTHESIA SERVICES PO BOX 1330 SPRINGFIELD MA 011011330 ANESTHESIOLOGY SERVICES 450850 DR EDWARD BITTNER 36 GARDEN ST BOSTON MA 02114 MEDICAL SERVICES 382059 UNIVERSAL PROTECTION SERVICE LP 1551 N TUSTIN AVE STE 650 SANTA ANA CA 92705 SECURITY 380669 BAYSTATE MEDICAL PRACTICES 759 CHESTNUT ST SPRINGFIELD MA 01199 MEDICAL SERVICES 276092 9 14189818 302961 6916943 468791 21409722 PATIENT SERVICE 621110 13034456 13034456 13034456 32489056 32489056 1319105 0 1319105 1319105 1319105 323871691 312672023 8399 11199668 -8399 11191269 11191269 663627 476176 187451 187451 446593 446593 446593 80077652 13034456 0 45633474 X 27613162 26528098 671850 413214 1677982 1612045 40827 25110 3254661 3126769 79188 48704 1960407 1883373 47698 29336 3040905 3040905 14826154 14793088 420 32646 331736 331736 1269267 1191009 23461 54797 22870 22870 3234289 3234289 315926 294440 14616 6870 111856 107070 4786 5518330 5518330 694489 694489 MEDICAL SUPPLIES 4975359 4953323 1647 20389 PATIENT TRAVEL COSTS 561965 561965 TAXES AND FEES RELATED 266330 266330 DUES AND REGISTRATIONS 151036 99264 49022 2750 474578 419460 32378 22740 70301302 64943459 4701287 656556 330716 239363 3863219 2938638 553726 543094 410392 365773 159344618 97313138 65664323 62031480 966953792 341223458 25991772 128385056 1063767940 535726862 5877678 6531265 1203275 0 7080953 6531265 X 1056686987 529195597 1056686987 529195597 1063767940 535726862 X 9776350 138978566 -676246306 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 964170713 179626386 803208720 340588379 1077905407 -63175030 50559664 964170713 978806802 142372461 43273856 1077905407 916304098 75583538 13080834 978806802 970144874 -15047821 38792955 916304098 1.00000 0.00000 0.00000 0 1 1 303990 303990 414179 414179 0 107811718 58782705 49029013 43780097 38116254 5663843 7034634 7034634 62031480 RECEIVABLES FROM INCOME TRUSTS 261241 LOANS TO OTHER ORGANIZATIONS - SHRINERS CO 128123815 128385056 215397233 138978566 -266330 138712236 76684997 3040905 351750 3392655 80077652 66642317 -351750 -351750 66994067 3040905 266330 3307235 70301302 PART V, LINE 4: THE ENDOWMENT FUNDS (INCLUDING UNRESTRICTED FUND BALANCES) ARE A SIGNIFICANT SOURCE OF SUPPORT FROM WHICH SHRINERS HOSPITALS FOR CHILDREN PERFORMS ITS PROGRAM SERVICES TO ACHIEVE ITS PRIMARY EXEMPT PURPOSE. IN ADDITION, AS PATIENTS OFTEN COME TO SHRINERS HOSPITALS FOR CHILDREN AS AN INFANT AND REMAIN PATIENTS THROUGHOUT THEIR CHILDHOOD, A STRONG ENDOWMENT IS REQUIRED TO ENSURE FUNDS ARE AVAILABLE TO SUPPORT THE MISSION AND HEALTH NEEDS OF THE PATIENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: TAXES AND FEES RELATED TO TPP -266,330. PART XI, LINE 4B - OTHER ADJUSTMENTS: CAFETERIA INCOME RECLASSIFIED OUT OF EXPENSES 187,451. OTHER REVENUE RECLASSIFIED OUT OF EXPENSES 164,299. PART XII, LINE 2D - OTHER ADJUSTMENTS: CAFETERIA INCOME RECLASSIFIED OUT OF EXPENSES -187,451. OTHER REVENUE RECLASSIFIED OUT OF EXPENSES -164,299. PART XII, LINE 4B - OTHER ADJUSTMENTS: TAXES AND FEES RELATED TO TPP 266,330. 1 1 X 1 X 400.000000000000 0 1 1 0 1 1 32444197 3990084 28454113 0.40470 27460154 9044372 18415782 0.26200 59904351 13034456 46869895 0.66670 5039108 5039108 0.07170 5039108 5039108 0.07170 64943459 13034456 51909003 0.73840 0 0 2 1 SHRINERS HOSPITAL FOR CHILDREN-BOSTON 51 BLOSSOM STREET BOSTON MA 021142699 WWW.SHRINERSHOSPITALSFORCHILDREN.ORG 2316 X X X X A 2 SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIELD 516 CAREW STREET SPRINGFIELD MA 01104 WWW.SHRINERSHOSPITALSFORCHILDREN.ORG 2152 X X X A SHRINERS HOSPITAL FOR CHILDREN-GROUP A 0 0 1 X X X X X X X X X 18 1 1 1 1 X WWW.SHRINERSHOSPITALSFORCHILDREN.ORG 1 18 1 WWW.SHRINERSHOSPITALSFORCHILDREN.ORG 0 1 X 400.000000000000 0.000000000000 X X 1 1 X 1 X HTTP://WWW.SHRINERSHOSPITALSFORCHILDREN.ORG/EN/FINANCIAL-ASSISTANCE X HTTP://WWW.SHRINERSHOSPITALSFORCHILDREN.ORG/EN/FINANCIAL-ASSISTANCE X HTTP://WWW.SHRINERSHOSPITALSFORCHILDREN.ORG/EN/FINANCIAL-ASSISTANCE X X X X 0 0 0 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: SHRINERS HOSPITAL FOR CHILDREN-BOSTON, - FACILITY 2: SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIELD GROUP A-FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN-BOSTON PART V, SECTION B, LINE 5: THE SHRINERS HOSPITALS FOR CHILDREN TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY FOR ITS MOST RECENT CHNA THROUGH SURVEYS AND FOCUS GROUPS. GROUP A-FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN-BOSTON PART V, SECTION B, LINE 11: AFTER CONDUCTING THE 2018 CHNA, SHRINERS HOSPITALS FOR CHILDREN WILL CONTINUE ON A MULTIFACETED APPROACH THAT INCLUDES AFFILIATE AND COMMUNITY PROVIDERS IN COMMUNITY OUTREACH, COMMUNITY INVOLVEMENT, AND COMMUNITY EDUCATION TO ADDRESS IDENTIFIED HEALTH CARE NEEDS WITHIN EACH MARKET. HEALTH CARE NEEDS THAT ARE IDENTIFIED BUT NOT ADDRESSED WITHIN ANY ACTION PLAN FALL OUTSIDE OF THE SERVICE OFFERINGS PROVIDED AT SHRINERS HOSPITALS FOR CHILDREN. SOME OF THE NEEDS IDENTIFIED BUT NOT ADDRESSED ARE MENTAL HEALTH, DIABETES, OBESITY, ASTHMA, AND DRUG & ALCOHOL ABUSE. THEREFORE, PATIENTS/FAMILIES PRESENTING WITH HEALTH CARE NEEDS WHICH ARE OUTSIDE OF THE HOSPITAL SERVICE OFFERINGS WILL RECEIVE CARE COORDINATION AND BE REFERRED TO THE APPROPRIATE PROFESSIONALS WITHIN THE COMMUNITY FOR PROVISION OF SERVICES. GROUP A-FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN-BOSTON PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. GROUP A-FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIE PART V, SECTION B, LINE 5: THE SHRINERS HOSPITALS FOR CHILDREN TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY FOR ITS MOST RECENT CHNA THROUGH SURVEYS AND FOCUS GROUPS. GROUP A-FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIE PART V, SECTION B, LINE 6B: BAYSTATE MEDICAL CENTER, BAYSTATE FRANKLIN MEDICAL CENTER, BAYSTATE MARY LANE HOSPITAL, BAYSTATE NOBLE HOSPITAL, BAYSTATE WING HOSPITAL, COOLEY DICKINSON HOSPITAL, HOLYOKE MEDICAL CENTER, MERCY MEDICAL CENTER, HEALTH NEW ENGLAND GROUP A-FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIE PART V, SECTION B, LINE 11: AFTER CONDUCTING THE 2018 CHNA, SHRINERS HOSPITALS FOR CHILDREN WILL CONTINUE ON A MULTIFACETED APPROACH THAT INCLUDES AFFILIATE AND COMMUNITY PROVIDERS IN COMMUNITY OUTREACH, COMMUNITY INVOLVEMENT, AND COMMUNITY EDUCATION TO ADDRESS IDENTIFIED HEALTH CARE NEEDS WITHIN EACH MARKET. HEALTH CARE NEEDS THAT ARE IDENTIFIED BUT NOT ADDRESSED WITHIN ANY ACTION PLAN FALL OUTSIDE OF THE SERVICE OFFERINGS PROVIDED AT SHRINERS HOSPITALS FOR CHILDREN. SOME OF THE NEEDS IDENTIFIED BUT NOT ADDRESSED ARE MENTAL HEALTH, DIABETES, OBESITY, ASTHMA, AND DRUG & ALCOHOL ABUSE. THEREFORE, PATIENTS/FAMILIES PRESENTING WITH HEALTH CARE NEEDS WHICH ARE OUTSIDE OF THE HOSPITAL SERVICE OFFERINGS WILL RECEIVE CARE COORDINATION AND BE REFERRED TO THE APPROPRIATE PROFESSIONALS WITHIN THE COMMUNITY FOR PROVISION OF SERVICES. GROUP A-FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-SPRINGFIE PART V, SECTION B, LINE 15E: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. PART I, LINE 3C: SHRINERS HOSPITALS FOR CHILDREN OFFERS SPECIALIZED MEDICAL SERVICES PERTAINING TO ORTHOPAEDIC CONDITIONS, BURNS, SPINAL CORD INJURIES AND CLEFT LIP AND PALATE. UPON PATIENT ADMITTANCE FOR ONE OF THESE CONDITIONS, SHRINERS HOSPITALS FOR CHILDREN REVIEWS THE PATIENT'S "ABILITY TO PAY" USING FEDERAL POVERTY GUIDELINES SPECIFIED IN SCHEDULE H, PART I, LINE 3A, AND PROVIDES FREE OR DISCOUNTED CARE PURSUANT TO THESE GUIDELINES. NEVERTHELESS, SHRINERS HOSPITALS FOR CHILDREN WILL ALWAYS SERVE THESE SPECIALIZED NEEDS FOR ALL OF ITS PATIENTS, REGARDLESS OF THEIR "ABILITY TO PAY." AS SUCH, SHRINERS HOSPITALS FOR CHILDREN DID NOT APPLY ANY INCOME-BASED CRITERIA, ASSET TEST, OR OTHER MEANS TEST OR THRESHOLD FOR PROVIDING FREE CARE TO PATIENTS IN 2019. PART I, LINE 7: A GENERAL LEDGER ACCOUNTING SYSTEM WAS USED TO CALCULATE THE AMOUNTS REPORTED IN PART I, LINE 7. THE SYSTEM ADDRESSES ALL PATIENT SEGMENTS (INPATIENT AND OUTPATIENT). A COST-TO-CHARGE RATIO IS NOT PART OF THE SYSTEM AND IS NOT APPLICABLE TO SHRINERS HOSPITALS FOR CHILDREN. PART III, LINE 4: BAD DEBT EXPENSE IS NOT APPLICABLE TO SHRINERS HOSPITALS FOR CHILDREN, AND AS SUCH, IS NOT PART OF THE FOOTNOTES IN ITS FINANCIAL STATEMENTS. SHRINERS HOSPITALS FOR CHILDREN PROVIDES PATIENT CARE REGARDLESS OF THEIR ABILITY TO PAY. AS SUCH, THERE ARE NO REVENUES AGAINST WHICH A BAD DEBT COULD ARISE. PART III, LINE 9B: SHRINERS HOSPITALS FOR CHILDREN PROVIDES PATIENT CARE REGARDLESS OF THEIR ABILITY TO PAY. AS SUCH, THERE IS NO DEBT COLLECTION POLICY. PART VI, LINE 2: SHRINERS HOSPITALS FOR CHILDREN PROVIDES PEDIATRIC, ORTHOPAEDIC, AND BURN CARE REGARDLESS OF THEIR ABILITY TO PAY. PART VI, LINE 3: SHRINERS HOSPITALS FOR CHILDREN POSTS ITS CHARITY CARE POLICY IN ADMISSION AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF FACILITIES WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT, AND PROVIDES A COPY OF ITS POLICY TO PATIENTS AS PART OF THE INTAKE PROCESS AND WITH DISCHARGE MATERIALS. PART VI, LINE 4: SHRINERS HOSPITALS FOR CHILDREN (THROUGH THIS ENTITY AND ITS RELATED ENTITY) SERVE CHILDREN IN NEED OF SPECIALIZED ORTHOPAEDIC AND BURN CARE ACROSS THE UNITED STATES AND WORLD-WIDE. X X X 1 1 X X X X 0 1 0 0 0 0 0 0 0 JOHN DEWEESE ORTHOPEDIC SURGEON, ASST PROF 414755 0 0 0 156246 0 8400 0 23339 0 602740 0 0 0 JAMES F MOONEY III CHIEF OF STAFF 653555 0 0 0 22251 0 16800 0 35790 0 728396 0 0 0 RUBINI PATHY ORTHOPEDIC SURGEON, ASST PROF 377160 0 0 0 19443 0 16357 0 11666 0 424626 0 0 0 H LEE KIRK JR ADMINISTRATOR 239814 0 0 0 15879 0 15672 0 25430 0 296795 0 0 0 KERSTIN SOBUS PHYSIATRIST 249934 0 0 0 1073 0 10102 0 36368 0 297477 0 0 0 PART I, LINE 1A FIRST CLASS TRAVEL IS AVAILABLE ONLY TO BOARD MEMBERS AND EXECUTIVE STAFF AND ONLY IF THE FLIGHT IS LONGER THAN TWO AND A HALF HOURS. A COMPANION ONLY QUALIFIES FOR TRAVEL IF HE OR SHE IS A COMPANION OF A BOARD MEMBER AND IS ACTIVIELY PARTICIPATING IN SHRINE BUSINESS DURING THE TRIP. FOR SOME KEY EMPLOYEES, IF RELOCATION IS REQUIRED, A TEMPORARY HOUSING ALLOWANCE MAY BE PROVIDED AS A MEANS TO RECRUIT TOP INDIVIDUALS. PART I, LINE 4B EMPLOYEE PARTICIPATING IN SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP): JOHN DEWEESE $153,354 X LIFE INSURANCE 1 468791 FAIR MARKET VALUE 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS ORGANIZED AS A NONPROFIT CORPORATION WITH MEMBERS. MEMBERS HAVE THE RIGHT TO ELECT PERSONS BELONGING TO THE GOVERNING BODY, AND TO APPROVE SIGNIFICANT DECISIONS OF THE GOVERNING BODY. COMPENSATION IS NOT PROVIDED FOR BEING A MEMBER. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS APPROXIMATELY 1,400 MEMBERS WHOM ARE APPOINTED FROM THE TOTAL MEMBERSHIP OF SHRINERS INTERNATIONAL (A RELATED ORGANIZATION). MEMBERS MAY ELECT PERSONS ON THE ORGANIZATION'S GOVERNING BODY, AND MAY APPROVE SIGNIFICANT DECISIONS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B UNDER THE BYLAWS OF THE ORGANIZATION, SIGNIFICANT DECISIONS OF THE GOVERNING BODY REQUIRE APPROVAL BY THE ORGANIZATION'S 1,400 MEMBERS (SUCH AS CHANGES TO THE BYLAWS, OR SIGNIFICANT RESTRUCTURING OR EXTRAORDINARY EVENTS). THE ORGANIZATION'S MEMBERS ALSO MAY ELECT PERSONS TO SERVE ON THE ORGANIZATION'S GOVERNING BODY. THE ORGANIZATION'S MEMBERS DO NOT HAVE CONTROL OVER THE GENERAL OPERATIONS OR FINANCIAL MATTERS OF THE ORGANIZATION. ELECTIONS ARE HELD ANNUALLY BY THE MEMBERS AT VARYING LOCATIONS IN THE U.S. VOTING IS DECIDED WITH SIMPLE MAJORITY, WHERE EACH MEMBER'S VOTE IS EQUAL WEIGHTED. ELECTED PERSONS SERVE A THREE-YEAR TERM ON THE BOARD OF TRUSTEES, A ONE-YEAR TERM ON THE BOARD OF DIRECTORS, A ONE-YEAR TERM FOR THE ORGANIZATION'S PRESIDENT, AND A ONE-YEAR TERM FOR THE ORGANIZATION'S TREASURER. THE ORGANIZATION'S OFFICERS ARE NOT ELECTED, AND INSTEAD ARE HIRED BY COMMITTEE. FORM 990, PART VI, SECTION B, LINE 11B A COMPLETE COPY OF FORM 990 IS REVIEWED BY THE AUDIT AND FINANCE COMMITTEE. SUBSEQUENTLY, A COMPLETE COPY OF FORM 990 IS PROVIDED TO THE FULL BOARD. MANAGEMENT REVIEWS THE FORM WITH THE BOARD PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY AND ALL MEMBERS ARE REQUIRED TO DISCLOSE ANY CONFLICTING INTERESTS OR STATE "NONE" ON THE ANNUAL CONFLICT OF INTEREST FORM. POTENTIAL CONFLICTS ARE DETERMINED BY THE BOARD OF DIRECTORS. THE PERSON(S) HAVING A POTENTIAL CONFLICT OF INTEREST ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS/DECISIONS IN THE TRANSACTION. FORM 990, PART VI, SECTION B, LINE 15 A SALARY AND PERSONNEL COMMITTEE IS INVOLVED WITH ALL COMPENSATION AND APPROVES WAGES FOR MANAGEMENT AND COMPARES THESE SALARIES TO VARIOUS MARKET INDICATORS. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATION'S FORM 990 CAN BE FOUND ONLINE AT HTTPS://LOVETOTHERESCUE.ORG/FINANCIALS-2/#FIN-DOCS. THIS SITE CAN BE ACCESSED FROM THE MAIN WEBSITE HTTP://WWW.SHRINERSHOSPITALSFORCHILDREN.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS (INCLUDING ITS CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS) ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 12,425,569. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,425,569. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,865,691. MANAGEMENT AND GENERAL EXPENSES 420. FUNDRAISING EXPENSES 11,068. TOTAL EXPENSES 1,877,179. AGENCY PERSONNEL: PROGRAM SERVICE EXPENSES 501,828. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 21,578. TOTAL EXPENSES 523,406. FORM 990, PART XI, LINE 9: INTERCOMPANY SETTLEMENT (SEE EXPLANATION BELOW) -676,246,306. FORM 990, PART XII, LINE 2C EXPLANATION: THE ORGANIZATION HAS AN AUDIT AND FINANCE COMMITTEE RESPONSIBLE FOR OVERSIGHT OF THE FINANCIAL STATEMENT AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THE COMMITTEE MEETS THREE TIMES A YEAR AND COORDINATES THE AUDIT WITH THE INDEPENDENT AUDITORS. ANY FINANCIAL CONCERN ENCOUNTERED IN THE SYSTEM IS ROUTED TO THIS COMMITTEE FOR REVIEW. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEARS. FORM 990, PART XI, LINE 9, EXPLANATION OF CHANGES IN NET ASSETS: OTHER CHANGES IN NET ASSETS INCLUDES AN INTERCOMPANY SETTLEMENT WITH SHRINERS HOSPITALS FOR CHILDREN (CO CORPORATION), A RELATED TAX-EXEMPT ORGANIZATION (SEE SCHEDULE R). THE SETTLEMENT TRANSACTION REPRESENTED SEVERAL PAST YEARS OF EXPENSES PAID BY THE CO CORPORATION FOR THE TWO (2) MASSACHUSETTS HOSPITALS OWNED BY THIS ORGANIZATION. $676,246,306 WAS TRANSFERRED FROM THE ORGANIZATION'S ENDOWMENT TO THE CO CORPORATION'S ENDOWMENT IN REFUND OF THOSE EXPENSES PREVIOUSLY PAID. A TRUE UP OF EXPENSES WILL OCCUR ANNUALLY MOVING FORWARD. SHRINERS HOSPITALS FOR CHILDREN EMPLOYEE DISASTER RELIEF FUND 2900 ROCKY POINT DRIVE TAMPA FL 33607 263733381 DISASTER RELIEF DC 501(C)(3) LINE 7 SHRINERS HOSPITALS FOR CHILDREN 0 SHRINERS HOSPITALS FOR CHILDREN POST OFFICE BOX 31356 TAMPA FL 336313356 362193608 HOSPITAL SYSTEM CO 501(C)(3) LINE 3 SHRINERS INTERNATIONAL 0 SHRINERS INTERNATIONAL POST OFFICE BOX 31356 TAMPA FL 336313356 362158164 FOUNDED SHRINERS HOSPITALS FOR CHILDREN IA 501(C)(10) N/A N/A 0 SHRINERS HOSPITALS FOR CHILDREN A CANADIAN CORPORATION 1529 CEDAR AVE MONTREAL QUEBEC CA H36 1A6 HOSPITAL SYSTEM CA 501(C)(3) EQUIVALENT LINE 3 SHRINERS HOSPITALS FOR CHILDREN 0 SHRINERS HOSPITALS FOR CHILDREN (QUEBEC) INC 1529 CEDAR AVE MONTREAL QUEBEC CA H36 1A6 HOSPITAL SYSTEM CA 501(C)(3) EQUIVALENT LINE 3 SHRINERS HOSPITALS FOR CHILDREN 0 SHRINERS HOSPITALS FOR CHILDREN A MEXICAN ASSOCIATION MX AV DEL IMAN NO 257 MEXICO CITY MX 04600 HOSPITAL SYSTEM MX 501(C)(3) EQUIVALENT LINE 3 SHRINERS HOSPITALS FOR CHILDREN 0 SHRINERS INTERNATIONAL EDUCATION FOUNDATION POST OFFICE BOX 25251 TAMPA FL 33622 813788196 EDUCATION AND LEADERSHIP TRAINING TX 501(C)(3) LINE 7 SHRINERS INTERNATIONAL 0 SHRINERS HOSPITALS FOR CHILDREN AMBULATORY CLINIC AT HIC AC BOSQUE DE DURAZNOS NO 61 PISO 4 BOSQUE DE LAS LOMAS MEXICO CITY MX 11700 HOSPITAL SYSTEM MX 501(C)(3) EQUIVALENT LINE 3 SHRINERS HOSPITALS FOR CHILDREN 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1