2020-07-14T10:47:49-05:00 2019-06-30 990 2018-07-01 463674691 CHILDRESS INSTITUTE FOR PEDIATRIC TRAUMA CHIL 3367131627 MEDICAL CENTER BOULEVARD WINSTON SALEM NC 27157 BRADLEY A CLARK TREASURER 3367131627 2020-07-08 152.11.92.106 2020-07-08 07:58:59 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 92F11F32722E8792293CAF8DF02A44B038BF976A 2018 2021-01-29 14:40:06Z JOHN D MCCONNELL MD MEDICAL CENTER BOULEVARD WINSTON SALEM NC 27157 861465 0 X WWW.SAVEINJUREDKIDS.ORG X 2013 NC TO IMPROVE THE TREATMENT FOR CRITICALLY INJURED CHILDREN IN THE UNITED STATES THROUGH RESEARCH, MEDICAL EDUCATION AND AWARENESS. 5 2 0 25 0 0 1059385 817128 0 0 0 0 -89304 -66169 970081 750959 266252 365999 0 0 316481 289161 0 0 54774 357718 366276 940451 1021436 29630 -270477 1104007 1233970 92609 172915 1011398 1061055 X TO DISCOVER AND SHARE THE BEST WAYS TO PREVENT AND TREAT SEVERE INJURIES IN CHILDREN. 0 0 869770 365999 THE ORGANIZATION STRIVES TO DISCOVER AND SHARE THE BEST WAYS TO PREVENT AND TREAT SEVERE INJURIES IN CHILDREN. ITS VISION IS TO REDUCE, BY 50%, DEATH AND DISABILITY TO SEVERELY INJURED CHILDREN NATIONWIDE BY 2020 BY:- RAISING THE LEVEL OF CARE NATIONWIDE FOR PEDIATRIC TRAUMA, LEVERAGING EXPERTISE OF LEVEL 1 PEDIATRIC TRAUMA HOSPITALS FOR THE BENEFIT OF NON-TRAUMA HOSPITALS; AND- ADDRESSING PREVENTION AND TREATMENT OF TRAUMATIC INJURY IN YOUTH (14 AND UNDER) RECREATION AND SPORTS.THE ORGANIZATION FUNDS RESEARCH, EDUCATION AND ADVOCACY TO HELP IMPROVE THE CARE AND TREATMENT INJURED KIDS RECEIVE.ITS VALUES ARE TO:- COLLABORATE: COLLABORATE ALWAYS TO CREATE THE WIN FOR ALL PARTIES.- MEASURE: PLAN AND DO WHAT CAN BE MEASURED. OUTCOMES MATTER.- LEAD: BE PRO-ACTIVE, A FAST FOLLOWER IS STILL A FOLLOWER.- CARE: VALUE AND NURTURE EVERY RELATIONSHIP.- THINK BIG: ADOPT AN EXPLORER MINDSET - BOLD, UNCHARTED, CREATIVE.- ACCENTUATE THE POSITIVE: OUR WORK IS A JOURNEY WITH DAILY PROGRESS. 869770 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 8 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 5 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 AL AK AR CA CO CT FL GA HI IL KS MD MA MI MN MS NH NJ NM NY OH OK OR PA RI SC TN UT VA WV WI X JOSEPH DOLAN 3367164445 MEDICAL CENTER BLVD WINSTON SALEM NC 27157 X RICHARD CHILDRESS DIRECTOR 0.50 X 0 0 0 JOHN D MCCONNELL MD DIRECTOR, PRESIDENT 0.10 39.90 X X 0 5552782 44771 J WAYNE MEREDITH MD DIRECTOR, VP 1.00 39.00 X X 0 828162 44693 TERRY L HALES JR DIRECTOR, SECRETARY 1.00 39.00 X X 0 579912 68917 BRADLEY A CLARK DIRECTOR, TREASURER 1.00 39.00 X X 0 0 0 ROBERT GFELLER EXEC DIR & COO (TO 12/31/18) 10.00 30.00 X 661825 0 147557 661825 6960856 305938 0 0 1 1 SQUIRE PATTON BOGGS LLP 2550 M STREET NW WASHINGTON DC 20037 HEALTHCARE CONSULTING SERVICES 128964 1 405070 412058 817128 44337 405070 110506 -66169 -66169 750959 0 0 -66169 355446 355446 10553 10553 283120 212841 42167 28112 6041 4543 899 599 25267 762 24505 97727 97727 6839 6839 98474 60869 37605 66324 64485 1839 33669 29715 2396 1558 7029 6618 411 20799 18144 2655 10148 8829 1319 1021436 869770 96892 54774 1100065 1182986 0 33776 642 17208 3300 0 1104007 1233970 20959 161415 71650 11500 92609 172915 X 994420 982811 16978 78244 1011398 1061055 1104007 1233970 X -270477 320134 X X 0 1 X 1 0 X 1234965 1387942 953930 1059385 817128 5453350 1234965 1387942 953930 1059385 817128 5453350 5453350 5453350 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 97727 0 0 97727 0 PART II-B, LINE 1: THE CHILDRESS INSTITUTE FOR PEDIATRIC TRAUMA IS AN ADVOCATE FOR RESEARCH, EDUCATION AND PREVENTION OF TRAUMATIC INJURY TO CHILDREN. THE CHILDRESS INSTITUTE FOR PEDIATRIC TRAUMA SUPPORTS THE PEDIATRIC TRAUMA CAUCUS IN CONGRESS. THE ORGANIZATION MEETS WITH MEMBERS OF CONGRESS TO DISCUSS PEDIATRIC TRAUMA NEEDS THROUGHOUT THE UNITED STATES. THE CAUCUS PROVIDES A VEHICLE FOR CONTINUING EDUCATION FOR MEMBERS OF CONGRESS AND THEIR STAFF AND HELPS ADVOCATE FOR BIPARTISAN SOLUTIONS TO SUPPORT THE TRAUMA SYSTEMS IN THE UNITED STATES AND FIGHT THE PEDIATRIC TRAUMA EPIDEMIC. 0 X PART X, LINE 2: THE COMPANY IS A TAX-EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE CODE) AND IS GENERALLY EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS MADE IN THE FINANCIAL STATEMENTS. THE COMPANY HAS EVALUATED UNCERTAIN TAX POSITIONS FOR ITS FISCAL YEARS ENDED JUNE 30, 2018 AND 2019, INCLUDING A QUANTIFICATION OF TAX RISKS IN AREAS SUCH AS UNRELATED BUSINESS INCOME AND TAXATION OF ITS FOR-PROFIT SUBSIDIARIES. THIS EVALUATION DID NOT HAVE A MATERIAL EFFECT ON THE COMPANY'S FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 2018 AND 2019. GOLF EVENT 193563 186250 7313 500 459 16278 400 22807 CELEB 3-3 147703 122616 25087 150 2003 6065 12596 3 108141 96204 11937 214 2575 13740 32719 449407 405070 44337 500 823 4578 36083 400 68122 110506 -66169 1 BOSTON MEDICAL CENTER CORPORATION ONE BOSTON MEDICAL CENTER PLACE BOSTON MA 02118 043314093 501(C)(3) 50000 RESEARCH AWARD_ADDRESSING PEDIATRIC SENTINEL EVENTS A COMPUTER BASED SIMULATION GAME FOR PEDIATRIC TRAUMA MANAGEMENT CINCINNATI CHILDREN'S HOSPITAL MEDICAL 3333 BURNET AVE MLC 2023 CINCINNATI OH 45229 310833936 501(C)(3) 34598 RESEARCH AWARD_ADDRESSING OPTICAL RESUSCITATION AMERICAN COLLEGE OF SURGEONS 633 NORTH SAINT CLAIR STREET CHICAGO IL 60611 362192800 501(C)(3) 25000 SPONSORSHIP OF CONFERENCE_TRAUMA PATIENT REPORTED OUTCOMES CONSENSUS (PROM) CONFERENCE THE MEDICAL COLLEGE OF WISCONSIN 8701 WATERTOWN PLANK RD MILWAUKEE WI 53226 390806261 501(C)(3) 49094 RESEARCH AWARD_PHASE TWO OF PEDIATRIC TRAUMA TOOLKIT DEVELOPMENT VIDANT MEDICAL CENTER FOUNDATION PO BOX 8489 GREENVILLE NC 27835 581399266 501(C)(3) 25000 EDUCATION AWARD_STOP THE BLEED CAMPAIGN AWARD KIDS AND PROS INC 3616 BOGAN SPRINGS DRIVE BUFORD GA 30519 264298822 501(C)(3) 21974 YOUTH SPORTS SAFETY CLINICS UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER 5323 HARRY HINES BLVD MC 9029 DALLAS TX 75235 756002868 501(C)(3) 5000 EDUCATION AWARD_HEAD INJURY EDUCATION FOR EMS WORLDWIDE SPORTS SAFETY 6118 LINCOLNSHIRE COURT ROCKWALL TX 70587 812001671 501(C)(3) 5000 EDUCATION AWARD_TEAMSAFE SPORTS WAKE FOREST UNIVERSITY HEALTH SCIENCES MEDICAL CENTER BLVD WINSTONSALEM NC 27157 223849199 501(C)(3) 105000 RESEARCH PROJECTS AND STUDIES RELATED TO ITAKL (FOOTBALL AND SOCCER) NORTH CAROLINA BAPTIST HOSPITAL MEDICAL CENTER BLVD WINSTONSALEM NC 27157 560552787 501(C)(3) 10000 SAFE KIDS PROGRAM DAYTON CHILDREN'S HOSPITAL ONE CHILDRENS PLAZA DAYTON OH 454041815 310672132 501(C)(3) 24780 RESEARCH AWARD_USE OF NIRS IN DIAGNOSIS OF INTRACRANIAL HEMORRHAGE 11 0 PEDIATRIC TRAUMA ADVOCACY & EMS SEMINARS 6 10553 0 PART I, LINE 2: GRANT RECIPIENTS ARE SELECTED BASED ON SEVERAL FACTORS AND CRITERIA WITH THE OVERARCHING GOAL TO ENHANCE STANDARD PRACTICES IN PEDIATRIC TRAUMA MANAGEMENT. SUCH CRITERIA INCLUDE: THE SIGNIFICANCE OF THE PROPOSED RESEARCH TO PEDIATRIC TRAUMA AND THE IMPACT ON NATIONAL HEALTH; THE QUALIFICATION(S) OF INVESTIGATOR(S), THE STRENGTH OF LEADERSHIP PLAN AND/OR THE RESEARCH INNOVATION AND FEASIBILITY; AND THE INFRASTRUCTURE/RESOURCES TO SUPPORT THE PROJECT. AN EXTERNAL REVIEW COMMITTEE REVIEWS THE GRANT PROPOSALS AND PROVIDES RECOMMENDATIONS TO THE ORGANIZATION'S EXECUTIVE DIRECTOR AND BOARD. 0 1 0 0 0 0 0 0 0 JOHN D MCCONNELL MD DIRECTOR, PRESIDENT 0 1038531 0 0 0 4514251 0 23648 0 21123 0 5597553 0 3858352 J WAYNE MEREDITH MD DIRECTOR, VP 0 747397 0 59979 0 20786 0 23648 0 21045 0 872855 0 0 TERRY L HALES JR DIRECTOR, SECRETARY 0 407550 0 112287 0 60075 0 44824 0 24093 0 648829 0 0 ROBERT GFELLER EXEC DIR & COO (TO 12/31/18) 495090 0 163123 0 3612 0 129925 0 17632 0 809382 0 0 0 PART I, LINE 4B CERTAIN OFFICERS AND DIRECTORS OF THE FILING ORGANIZATION PARTICIPATED IN SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS (SERP) AND EXECUTIVE INCENTIVE COMPENSATION PLANS (ALL OF WHICH WAS PAID BY A RELATED ORGANIZATION, WAKE FOREST UNIVERSITY HEALTH SCIENCES, AS PART OF THE INDIVIDUALS' COMPENSATION FROM THE RELATED ORGANIZATION). THE FOLLOWING OFFICERS AND DIRECTORS RECEIVED A SERP PAYMENT DURING CALENDAR YEAR 2018: JOHN D. MCCONNELL, M.D. - $4,477,272 TERRY L. HALES, JR. - $58,815 PART VII, LINE 5: COMPENSATION FROM UNRELATED ORGANIZATION THE FOLLOWING CURRENT OFFICER WAS COMPENSATED BY WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER FOR SERVICES PERFORMED FOR THE ORGANIZATION. SEE PART VII AND SCHEDULE J, PART II FOR HIS 2018 COMPENSATION: ROBERT GFELLER FORM 990, PART VI, SECTION A, LINE 6 AS STATED IN THE FILING ORGANIZATION'S BY-LAWS, THE ORGANIZATION HAS TWO CATEGORIES OF MEMBERS; MANAGING MEMBERS WITH VOTING RIGHTS AND SUPPORTING MEMBERS WITH NO VOTING RIGHTS. THE SOLE INITIAL MANAGING MEMBER IS WAKE FOREST UNIVERSITY HEALTH SCIENCES. FORM 990, PART VI, SECTION A, LINE 7A MANAGING MEMBERS HAVE THE RIGHT TO VOTE ON THE ADMISSION OF MEMBERS, ON THE ELECTION OF DIRECTORS AND ON OTHER MATTERS FOR WHICH MEMBERS ARE ENTITLED TO VOTE ACCORDING TO THE NORTH CAROLINA NONPROFIT CORPORATION ACT. FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS THAT ARE RESERVED TO PERSONS OTHER THAN THE GOVERNING BODY OF THE FILING ORGANIZATION INCLUDE: AMENDMENT OF THE BYLAWS OF THE ORGANIZATION, WHICH MAY BE ACCOMPLISHED ONLY BY THE MAJORITY VOTE OF THE MANAGING MEMBERS OF THE ORGANIZATION, AND EFFECTIVE ONLY AFTER THE WRITTEN APPROVAL OF THE CEO OF WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER IS GIVEN; AND THE ELECTION AND REMOVAL OF DIRECTORS, WHICH IS ACCOMPLISHED ONLY BY THE ACTION OF THE MANAGING MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B THE FILING ORGANIZATION'S BOARD OF DIRECTORS RECEIVES A COPY OF THE FORM 990 WITH SUFFICIENT TIME TO PERMIT REVIEW, COMMENT AND QUESTIONS PRIOR TO ITS FILING. IF MODIFICATIONS ARE REQUIRED FOLLOWING SUCH REVIEW AND COMMENT, THE REVISED FORM 990 IS REDISTRIBUTED PRIOR TO ITS FILING WITH THE IRS, ALONG WITH A REPORT NOTING THE MODIFICATIONS. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ITS OFFICERS AND DIRECTORS TO DISCLOSE CONFLICTS OF INTEREST ANNUALLY, AND AS THEY ARISE. ANY ITEMS DISCLOSED ARE REVIEWED AND MANAGED IN ACCORDANCE WITH THE ORGANIZATION'S POLICY ON CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION PAYS NO COMPENSATION TO OFFICERS OR DIRECTORS; AS THE ORGANIZATION HAS NO EMPLOYEES, ALL COMPENSATION PAID TO OFFICERS AND DIRECTORS WAS PAID BY A RELATED ORGANIZATION. THE RELATED ORGANIZATION'S EXECUTIVE COMMITTEE OR COMPENSATION COMMITTEE OF ITS BOARD OF DIRECTORS, OR THE GOVERNANCE & COMPENSATION COMMITTEE OF THE WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER BOARD (THROUGH AUTHORITY DELEGATED TO IT BY WAKE FOREST UNIVERSITY HEALTH SCIENCES - THE PARENT OF THE FILING ORGANIZATION) IS RESPONSIBLE FOR REVIEWING AND APPROVING MOST OFFICERS AND DIRECTORS' COMPENSATION. THE COMMITTEE UTILIZES INDEPENDENT COMPENSATION CONSULTANTS, COMPENSATION SURVEYS AND STUDIES TO DETERMINE THE APPROPRIATENESS OF EACH SUCH OFFICERS' COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION ARE AVAILABLE TO THE PUBLIC ON REQUEST AND ARE AVAILABLE ON THE WEBSITE OF THE NORTH CAROLINA SECRETARY OF STATE. THE ORGANIZATION'S BYLAWS ARE NOT PUBLISHED, BUT PROVISIONS FROM THE BYLAWS ARE INCLUDED AS NECESSARY IN THE ORGANIZATION'S POLICIES, AND ARE ATTACHED TO THE FORM 1023 FILED FOR THE ORGANIZATION WITH THE IRS, WHICH IS PUBLICLY AVAILABLE. THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON REQUEST. PART VII, SECTION A, COLUMN B, HOURS JOHN D. MCCONNELL, MD FILING ORG 0.1 UNRELATED ORG 39.9 J. WAYNE MEREDITH, MD FILING ORG 1.0 RELATED ORG 39.0 TERRY L. HALES, JR FILING ORG 1.0 RELATED ORG 39.0 ROBERT GFELLER FILING ORG 10.0 RELATED ORG 5.0 UNRELATED ORG 25.0 BRADLEY A. CLARK FILING ORG 1.0 RELATED ORG 6.6 UNRELATED ORG 32.4 NORTH CAROLINA BAPTIST HOSPITAL ("NCBH") AND WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER ("WFUBMC") ARE UNRELATED ORGANIZATIONS TO THE FILING ORGANIZATION. PURSUANT TO THE TERMS OF THE "MEDICAL CENTER INTEGRATION AGREEMENT" (AN AGREEMENT ENTERED INTO IN 2010 AMONG FOUR PARTIES: WAKE FOREST UNIVERSITY, WAKE FOREST UNIVERSITY HEALTH SCIENCES (BOTH RELATED ORGANIZATIONS OF THE FILING ORGANIZATION), WAKE FOREST UNIVERSITY BAPTIST MEDICAL CENTER AND NORTH CAROLINA BAPTIST HOSPITAL (BOTH UNRELATED TO THE FILING ORGANIZATION), UNDER WHICH AGREEMENT THE OPERATION OF WFUHS AND NCBH, AND ALL OF THE RESPECTIVE SUBSIDIARIES OF EACH, WAS DELEGATED TO WFUBMC), THE CORPORATE OFFICERS OF WFUBMC GENERALLY SERVE ALSO AS THE CORPORATE OFFICERS OF WFUHS AND NCBH. THUS, CERTAIN OFFICERS OF THE FILING ORGANIZATION ALSO DEVOTE HOURS TO THE RELATED ORGANIZATIONS, AS WELL AS TO THE UNRELATED ORGANIZATIONS (WFUBMC AND NCBH), AS SHOWN IN THE BREAKDOWN OF HOURS ABOVE. FORM 990, PART XI, LINE 9: RELATED ORGANIZATION TRANSFERS 320,134. FORM 990, PART IX, LINE 2A THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. WAKE FOREST EMERGENCY PROVIDERS MEDICAL CENTER BLVD WINSTON SALEM NC 27157 561903275 HEALTHCARE NC 501(C)(3) LINE 3 WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 WAKE FOREST UNIVERSITY HEALTH SCIENCES MEDICAL CENTER BLVD WINSTON SALEM NC 27157 223849199 HEALTHCARE - CLINICAL SERVICES, RESEARCH, EDUCATION NC 501(C)(3) LINE 2 WAKE FOREST UNIVERSITY 0 WAKE FOREST UNIVERSITY BOX 7201 WINSTON SALEM NC 27109 560532138 LIBERAL ARTS, GRADUATE AND PROFESSIONAL EDUCATION NC 501(C)(3) LINE 2 N/A 0 WAKE FOREST INNOVATION QUARTER MGMT CO MEDICAL CENTER BLVD WINSTON SALEM NC 27157 061818498 RESEARCH PARK DEVELOPMENT NC 501(C)(3) LINE 12A, I WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 WAKE FOREST INNOVATION QUARTER - CDC MEDICAL CENTER BLVD WINSTON SALEM NC 27157 200177581 RESEARCH PARK DEVELOPMENT NC 501(C)(3) LINE 12A, I WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 WAKE FOREST INNOVATION QUARTER DEV CO MEDICAL CENTER BLVD WINSTON SALEM NC 27157 562094067 RESEARCH PARK DEVELOPMENT NC 501(C)(6) WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 WAKE FOREST UNIVERSITY HEALTH SCIENCES GROUP RT MEDICAL CENTER BLVD WINSTON SALEM NC 27157 900222618 PROVIDE DIALYSIS TREATMENTS TO PATIENTS NC 501(C)(3) LINE 12A, I WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 REGENMED DEVELOPMENT ORGANIZATION MEDICAL CENTER BLVD WINSTON SALEM NC 27157 202710571 ACCELERATE DEVELOPMENT OF REGENERATIVE MEDICINE THERAPY NC 501(C)(3) LINE 12A, I WAKE FOREST UNIVERSITY HEALTH SCIENCES 0 VERGER FUND II LLC PO BOX 7201 WINSTON SALEM NC 27109 352514227 INVESTMENT NC N/A WAKE FOREST TECHNOLOGY DEVELOPMENT PROGRAM LP 2520 MERIDIAN PARKWAY DURHAM NC 27713 475437596 INVESTMENT NC N/A WAKE FOREST AMBULATORY VENTURES LLC MEDICAL CENTER BOULEVARD WINSTON SALEM NC 27157 820777206 HEALTHCARE NC N/A NORTH DISTRICT OWNERS ASSOCIATION MEDICAL CENTER BLVD WINSTONSALEM NC 27157 411128865 PROPERTY OWNERS ASSOCIATION NC N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0