2019-11-14T08:39:10-06:00 2018-12-31 KPMG LLP 4200 Wells Fargo Ctr 90 S 7th Minneapolis MN 55402 990 2018-01-01 453765330 Children's Clinic Network % BRENDA MCCORMICK VP & CFO CHIL 6128136113 2525 Chicago Avenue South Minneapolis MN 55404 BRENDA MCCORMICK VP & CFO 6087756600 2019-11-05 true Monroe J Gierl P01413237 6123055000 2019-11-05 167.68.102.5 41438720193185000000 2019-11-14 P 78E8547FA765C8D9E89905B57511D075833AD426 EA4B65EE71D42BE71D1FFD4325509DD549A18899 2018 2020-03-31 21:24:44Z TREVOR SAWALLISH COO 2525 Chicago Avenue South Minneapolis MN 55404 49009954 false X childrensmn.org X 2011 MN CHILDREN'S CLINIC NETWORK CHAMPIONS THE SPECIAL HEALTH NEEDS OF CHILDREN AND THEIR FAMILIES. 9 7 185 8 0 26632 1500 1765 49120313 49006572 1454 0 1542 1617 49124809 49009954 23726 21081 0 0 9988805 9573643 0 0 0 38103862 37372912 48116393 46967636 1008416 2042318 7160596 7095825 3409567 1302478 3751029 5793347 X 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. false false 45929675 21081 49006572 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 213,097 CLINIC VISITS. 45929675 true false false true false false false false false false true false false false true true false true false false false false false false false false false false true true false false false false false false false false false false false false false true false false false true X 0 0 true 185 true true true false false false false false false false false false false false X 9 7 false false false false true true true true true false false true true true true true true true true false MN X BRENDA MCCORMICK VP CFO 6128136000 2525 Chicago Avenue South Minneapolis MN 55404 X Bonnie McGrath Board Member 1.0 0.0 X 0 0 0 Bruce Shay Board Member 1.0 0.0 X 0 0 0 Gary Blackford Board Member 1.0 0.0 X 0 0 0 Lynn Littlejohn Board Member 1.0 0.0 X 0 0 0 Martin Bassett Board Chair 1.0 0.0 X X 0 0 0 Matt Furman Board Member 1.0 0.0 X 0 0 0 Stephen Nelson MD Staff Physician, Board Member 1.0 49.0 X 0 510677 48984 Thomas Tefft Board Member 1.0 0.0 X 0 0 0 Marc Gorelick MD President & CEO 1.0 49.0 X 0 955459 36090 Monica Schiller VP Ambulatory Services 20.0 30.0 X 86892 144140 36559 Rebecca Woitalewicz Acting VP, Finance and CFO 50.0 0.0 X 0 318258 41419 Trevor Sawallish SVP Clinical Ops & COO 49.0 1.0 X 0 523405 40953 Catherine Bedford MD Clinic Physician 50.0 0.0 X 197299 0 33898 Cynthia Krull MD Clinic Physician 50.0 0.0 X 175505 0 29213 Gail Casemore MD Clinic Physician 50.0 0.0 X 180478 0 24650 James Hocks MD Clinic Physician 50.0 0.0 X 223117 0 26790 Kristin Heuermann MD Clinic Physician 50.0 0.0 X 169094 0 20854 Robert Bonar JR Former President & CEO 0.0 0.0 X 0 656379 0 Todd Ostendorf Former VP, Finance and CFO 0.0 0.0 X 0 372847 0 1032385 3481165 339410 8 true true false Metropolitan Pediatric Specialists 6545 France Ave South Ste 400 Edina MN 55435 Physician & staff 11467956 Partners in Pediatrics 12720 Bass Lake Road Maple Grove MN 55369 Physician & staff 9272599 Eclinicalworks LLC 2 Technology Drive Westborough MA 01581 Technology maint. 212873 3 1765 1765 PATIENT SERVICE 621498 44915791 44915791 MEDICAID 621498 3880513 3880513 PAY FOR PERFORMANCE BONUS 621498 203101 203101 TRAINING PROGRAM 621498 7167 7167 49006572 0 0 0 1617 1617 0 1617 1617 0 0 0 0 0 0 0 0 0 0 0 49009954 49006572 1617 X 0 21081 21081 0 0 86892 86892 0 7023143 6594155 428988 369982 348742 21240 1592421 1501002 91419 501205 472432 28773 0 31774 31774 112387 112387 2870 2870 0 0 22185169 22185169 7393 7393 355036 355036 415234 186139 229095 0 3211359 3211359 29716 29716 0 169020 169020 0 0 568086 568086 166511 166511 Medical Expenses 8108336 8108336 MN Care & Sales Tax 1006689 1006689 Dues & Licenses 83654 83654 Subscriptions & Books 59418 59418 860260 860260 46967636 45929675 1037961 0 0 0 0 0 0 0 3317354 3648467 0 0 0 0 0 0 673822 632317 384747 559514 6183693 3928166 2784673 2255527 0 0 0 0 0 0 0 0 0 0 7160596 7095825 149858 175977 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3259709 1126501 3409567 1302478 X 3751029 5793347 0 0 0 0 3751029 5793347 7160596 7095825 2042318 X false true X true false X Form 990 Sch A, Supplemental Information 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. false false false false false false false false true 2870 2870 false Form 990 Sch C Part II-B Line 1I DUES RELATED TO LOBBYING: AMERICAN MEDICAL ASSOCIATION (AMA): $231 MINNESOTA MEDICAL ASSOCIATION (MMA): $1,471 AMERICAN ACADEMY OF PEDIATRICS (AAP): $1,168 2765403 1183551 1581852 3418290 2744615 673675 2255527 0 MNCARE TAX 65501 TENANT IMPROVEMENT 574964 PAYABLE TO CHC 486036 1126501 X Form 990 Sch D Part X Line 2 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, 2018 AND 2017. CHILDREN'S IS NOT SUBJECT TO AN INCOME TAX EXAMINATION FOR YEARS BEFORE 2015. true Charity care assistance to individuals 187 21081 Cost Charity care to indv Form 990 Sch I Part I Line 2 CHILDREN'S CLINIC NETWORK PROVIDES CHARITY CARE ASSISTANCE TO INDIVIDUALS OUTLINED IN OUR POLICY WHICH IS CLOSELY MONITORED BY MANAGEMENT. true true false false false false false false false Robert Bonar JR Former President & CEO 0 0 0 0 0 656379 0 0 0 0 0 656379 0 0 Stephen Nelson MD Staff Physician, Board Member 0 215121 0 102055 0 193501 0 25075 0 23909 0 559661 0 185739 Todd Ostendorf Former VP, Finance and CFO 0 0 0 16642 0 356205 0 0 0 0 0 372847 0 0 Marc Gorelick MD President & CEO 0 845108 0 94102 0 16249 0 16500 0 19590 0 991549 0 0 Monica Schiller VP Ambulatory Services 86892 122916 0 19874 0 1350 0 14036 0 22523 86892 180699 0 0 Rebecca Woitalewicz Acting VP, Finance and CFO 0 288080 0 24935 0 5243 0 18696 0 22723 0 359677 0 0 Trevor Sawallish SVP Clinical Ops & COO 0 419547 0 48206 0 55652 0 15558 0 25395 0 564358 0 39339 Catherine Bedford MD Clinic Physician 162966 0 33078 0 1255 0 10637 0 23261 0 231197 0 0 0 Cynthia Krull MD Clinic Physician 131959 0 36693 0 6853 0 7754 0 21459 0 204718 0 6567 0 Gail Casemore MD Clinic Physician 116606 0 58003 0 5869 0 14107 0 10543 0 205128 0 3000 0 James Hocks MD Clinic Physician 179496 0 29451 0 14170 0 15887 0 10903 0 249907 0 9190 0 Kristin Heuermann MD Clinic Physician 141977 0 26683 0 434 0 10628 0 10226 0 189948 0 0 0 Form 990 Sch J 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. Form 990 Sch J Part I Line 4a SEVERANCE PAYMENTS: ROBERT BONAR - $656,379 Paid in 2018 TODD OSTENDORF - $356,205 paid in 2018 Form 990 Sch J 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 2018: CYNTHIA KRULL - $6,567 GAIL CASEMORE - $3,000 JAMES HOCKS - $9,190 STEPHEN NELSON - $185,739 TREVOR SWALLISH - $39,339 Form 990 Part III Line 4a PROGRAM SERVICE ACCOMPLISHMENTS: LOCATIONS - ADDRESSES OF OUR TEN NETWORK CLINICS 1547 LIVINGSTON AVENUE WEST ST. PAUL, MN 55118 14701 VICTOR HUGO BLVD N HUGO, MN 55038 6517 DREW AVENUE EDINA, MN 55435 14050 NICOLLET AVENUE, SUITE 300 BURNSVILLE, MN 55337 1515 ST. FRANCIS AVENUE, SUITE 100 SHAKOPEE, MN 55379 EDINBURGH MEDICAL AND DENTAL PLAZA 8500 EDINBROOK PARKWAY BROOKLYN PARK, MN 55443 3910 EXCELSIOR BOULEVARD ST. LOUIS PARK, MN 55416 BASS LAKE CENTER 12720 BASS LAKE ROAD MAPLE GROVE, MN 55369 WEST HEALTH CAMPUS 2855 CAMPUS DRIVE, SUITE 350 PLYMOUTH, MN 55441 13980 NORTHDALE BOULEVARD ROGERS, MN 55374 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 Line 6 CHILDREN'S CLINIC NETWORK HAS A SOLE MEMBER, CHILDREN'S HEALTH CARE, A MINNESOTA NONPROFIT CORPORATION. Form 990 Part VI 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 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 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 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. matter. Form 990 Part VI Line 15a 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 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 DESCRIPTION:Purchased Lab & Medical Svcs TOTAL FEES:21656970 FORM 990 PART IX LINE 11G DESCRIPTION:Consulting Fees TOTAL FEES:73556 FORM 990 PART IX LINE 11G DESCRIPTION:Data Processing TOTAL FEES:27048 FORM 990 PART IX LINE 11G DESCRIPTION:Repairs and Maintenance TOTAL FEES:303387 FORM 990 PART IX LINE 11G DESCRIPTION:Leased Equipment TOTAL FEES:118295 FORM 990 PART IX LINE 11G DESCRIPTION:Linen TOTAL FEES:5913 Children's Health Care Inc 2525 Chicago Avenue South Minneapolis MN 55404 411754276 Healthcare MN 501(c)(3) Line 3 NA false Children's Health Care Foundation 2525 Chicago Avenue South Minneapolis MN 55404 411814223 Healthcare MN 501(c)(3) Line 7 CHC false Children's Health Care Services Inc 2525 Chicago Avenue South Minneapolis MN 55404 411756478 Healthcare MN 501(c)(3) Line 3 CHC false Mother Baby Facility LLC 2525 Chicago Avenue South Minneapolis MN 55404 454078371 Healthcare MN 501(c)(3) Line 12A CHC false Children's Health Insurance Network Ltd PO Box 30600 Grand Cayman CJ Insurance CJ CHC C Corp 0 0 false Children's Health Network 910 East 26th Street Suite 330 Minneapolis MN 55404 463226418 Medical Services MN CHC C Corp 0 0 false false false true false false false false false false true false false true false true true true true true