2019-08-12T09:27:43-05:00 2018-09-30 010494526 Baker Newman & Noyes LLC 280 Fore Street Portland ME 04101 990 2017-10-01 043085427 Children's Hospital Pathology Foundation Inc CHIL 6173554589 300 Longwood Avenue No Bader1 Boston MA 02115 Mark D Fleming MD President 6173554589 2019-08-08 0 Nicholas E Porto P01310283 8002447444 2019-08-08 208.105.168.164 2019-08-08 13:53:12 ED P 29CB6D99F401F8CF8E3813B5D3A230CB72F3674B 86AD5A998A217BD7885303F5109AB5202568ED7D 2017 2019-02-21 02:37:17Z Mark D Fleming MD 300 Longwood Avenue No Bader1 Boston MA 02115 17364506 0 X N/A X 1990 MA The Foundation provides pathology services primarily to patients at Boston (see Schedule O) Children's Hospital and at satellite locations. The Foundation carries on and promotes basic and applied medical research and education in the field of pathology. The Foundation also provides care for patients regardless of their ability to pay, as well as providing and subsidizing hospital and community based services that are limited in the community. 5 0 18 0 0 20650 0 0 2795117 10839128 127366 932688 0 40556 2922483 11812372 5000 80744 0 0 2094090 8533079 0 0 0 544120 2028647 2643210 10642470 279273 1169902 14584914 14582896 4987889 3831245 9597025 10751651 X The Foundation's mission is to provide pathology services primarily to patients at Boston Children's Hospital and at satellite locations. The Foundation carries on and promotes basic and applied medical research and education in the field of pathology. The (see Schedule O) Foundation also provides services for patients regardless of their ability to pay. 0 0 7507755 80744 8671302 The Foundation was organized exclusively for charitable, scientific, and educational purposes. The Foundation provides pathology services primarily to patients at Boston Children's Hospital and at satellite locations. The Foundation may charge for patient care and other medical services provided that any net income is used exclusively for the charitable, scientific, and educational purposes for which the Foundation was created. The Foundation also provides care for patients regardless of their ability to pay, as well as providing and subsidizing hospital and community based services that are either unavailable or limited elsewhere in the community. 1876939 2167826 The Foundation receives income from Boston Children's Hospital for providing administration, supervision, and teaching services. The Foundation carries on and promotes basic and applied medical research and education in the field of pathology 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 concerning problems and research results in the field of pediatric pathology in order to educate the general public and the medical profession. 9384694 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 1 18 1 1 1 0 0 0 0 0 0 0 0 0 X 5 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Antonio R Perez-Atayde MD 6173554589 300 Longwood Avenue Boston MA 02115 Mark D Fleming MD President 55.00 5.00 X X 695461 0 91525 Antonio R Perez-Atayde MD Secretary/Treasurer 60.00 0.00 X X 431221 0 91525 Harry PW Kozakewich MD Clerk/Appointed Member 60.00 0.00 X X 387682 0 121285 Theonia K Boyd MD Appointed Member 60.00 0.00 X 536359 0 91525 Lisa Anne Teot MD Appointed Member 60.00 0.00 X 391470 0 70591 Physicians Org at CH Inc Independent Board Member 2.00 0.00 X 0 0 0 Jeffrey Goldsmith MD Physician 60.00 0.00 X 440558 0 71020 Olga K Weinberg MD Physician 60.00 0.00 X 367983 0 91525 Sara O Vargas MD Physician 60.00 0.00 X 337004 0 91525 Hart GW Lidov MD Physician 60.00 0.00 X 321439 0 67531 Marian Harris MD Physician 60.00 0.00 X 272101 0 90520 4181278 0 878572 14 0 1 0 Morgan Stanley 125 High Street Boston MA 02115 Investment advisor 104518 1 Patient Service Revenue 621300 8335635 8335635 Other Revenue 621300 1512776 1512776 Education and Research Programs 611710 990717 990717 10839128 229741 229741 6255081 5552134 702947 702947 702947 Insurance Rebate 990009 40556 40556 40556 11812372 10839128 0 973244 80744 80744 2720732 2720732 4522752 3611438 911314 500291 464009 36282 587807 587807 201497 189558 11939 1899 1899 104518 104518 294354 239400 54954 303603 184345 119258 11797 11797 28417 28417 73527 59152 14375 Research Expenses 629879 629879 PO Dues 247537 247537 Bad Debt Expense 186581 186581 Coordinated Specialty P 143298 143298 3237 3237 10642470 9384694 1257776 0 1857512 1445981 577868 792000 912245 877005 170000 120000 33679 37437 444158 398911 73664 45247 10522210 10692956 437736 572270 14584914 14582896 37581 321597 3868332 2595470 1081976 914178 4987889 3831245 X 9597025 10751651 9597025 10751651 14584914 14582896 1169902 -15276 0 X X 0 1 X 1 0 X 9165718 9512850 10425773 2795117 10839128 42738586 9165718 9512850 10425773 2795117 10839128 42738586 0 0 0 42738586 272739 187044 211857 52511 229741 953892 272739 187044 211857 52511 229741 953892 26108 40556 66664 9438457 9726002 10637630 2847628 11109425 43759142 0.97670 0.97540 0.02180 0.02400 X Schedule A, Part III, Line 12, Explanation of Other Income: Insurance Rebate - 2014 Amount: $ 26,108. 2017 Amount: $ 40,556. 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. 104189 104189 0 339969 294722 45247 45247 Due to Boston Children's Hospital 503881 Due to Physicians Org. at CH, Inc. 94140 Deferred Compensation 251976 Accrued Professional Liability 64181 914178 X 11797096 -15276 -15276 11812372 0 11812372 10642470 0 10642470 0 10642470 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. Management of the Foundation has evaluated the positions taken on the Foundation's filed tax returns and has concluded that no uncertain income tax positions exist at September 30, 2018. The Foundation's tax years from 2015 through 2018 are potentially subject to examination. 1 Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 501(c)(3) 66488 N/A General Support Pan Mass Challenge 77 Fourth Avenue Needham MA 02494 042746912 501(c)(3) 10000 N/A General Support 2 0 Part I, Line 2: Monitoring is provided by the Chilren's Hospital Pathology 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, 2018, the Foundation only provided grant donations to other 501(c)(3) organizations. X 0 0 X X X X 0 0 0 0 0 0 0 1 0 Mark D Fleming MD President 482565 0 175457 0 37439 0 53500 0 38025 0 786986 0 0 0 Antonio R Perez-Atayde MD Secretary/Treasurer 307176 0 79520 0 44525 0 53500 0 38025 0 522746 0 0 0 Harry PW Kozakewich MD Clerk/Appointed Member 277497 0 82224 0 27961 0 53500 0 67785 0 508967 0 0 0 Theonia K Boyd MD Appointed Member 410277 0 89888 0 36194 0 53500 0 38025 0 627884 0 0 0 Lisa Anne Teot MD Appointed Member 289848 0 66910 0 34712 0 53500 0 17091 0 462061 0 0 0 Jeffrey Goldsmith MD Physician 344352 0 72500 0 23706 0 53500 0 17520 0 511578 0 0 0 Olga K Weinberg MD Physician 361653 0 0 0 6330 0 53500 0 38025 0 459508 0 0 0 Sara O Vargas MD Physician 242093 0 62788 0 32123 0 53500 0 38025 0 428529 0 0 0 Hart GW Lidov MD Physician 227603 0 56545 0 37291 0 53500 0 14031 0 388970 0 0 0 Marian Harris MD Physician 195325 0 52505 0 24271 0 52495 0 38025 0 362621 0 0 0 Part I, Line 1a The Foundation provides reimbursement for health club fees. All individuals listed in Form 990, Part VII received this benefit and the reimbursement is included as part of taxable wages to each recipient. The Foundation discontinued offering this benefit in March of 2017. Part I, Line 7 The method for calculation bonus payments is a percentage of the individual's salary. However, the Chairman can change the bonus amount based on a number of factors including but not limited to, the following: clinical workload adjustments; teaching responsibilities; academic performance; administrative responsibilities; and/or special circumstances. The bonus amounts are discretionary. Form 990, Part VI, Section A, line 1 A majority of the Children's Hospital Pathology Foundation, Inc.'s (the Foundation's) board members are physicians who are not independent of 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 1990. 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 Pathology 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. Form 990, Part VI, Section A, line 6 The Children's Hospital Pathology Foundation, Inc. (the Foundation) has three classes of members. The Chairman of the Department of Pathology (the Department) of Boston Children's Hospital (the Hospital) is the Class "A" member. Any member of the Department (other than the Chairman) 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 with and receives compensation from the Foundation shall be a Class "B" member. Individuals engaged in clinical or research matters in the field of pathology at the Hospital may request membership and can be Class "B" members if invited by the Chairman 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 Chairman of the Department of Pathology (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, serve on the Children's Hospital Pathology Foundation, Inc.'s Board, or 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 Pathology 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, Mark D. Fleming, MD and the administrator, John Baci. A copy of 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 The Physicians Organization at Children's Hospital, Inc. (the PO) and Boston Children's Hospital (the Hospital) administer an annual conflict of interest disclosure process 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 conflicts 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 Children's Hospital Pathology 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 Hospital's 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. The documents are available upon request. 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 Organization at Children's Hospital Inc 300 Longwood Avenue Boston MA 02115 043266103 Management services MA 501(c)(3) Line 12c, III-FI N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0