2016-11-11T13:30:05-06:00 2015-12-31 KPMG LLP 4200 Wells Fargo Ctr 90 S 7th Minneapolis MN 55402 990 2015-01-01 453765330 Children's Clinic Network % Todd Ostendorf CHIL 6128136113 2525 Chicago Avenue South Minneapolis MN 55404 TODD OSTENDORF CFO 6087756600 2016-11-15 true ANN LAMOUREUX P00691316 6123055000 2015 2017-02-10 21:41:12Z Todd Ostendorf CFO 2525 Chicago Avenue South Minneapolis MN 55404 45376612 false X childrensmn.org X 2011 MN CHILDREN'S CLINIC NETWORK CHAMPIONS THE SPECIAL HEALTH NEEDS OF CHILDREN AND THEIR FAMILIES. 9 8 199 0 0 0 0 0 46429095 45374109 0 0 17765 2503 46446860 45376612 0 33768 0 0 10050033 9089540 0 0 0 33921096 35128364 43971129 44251672 2475731 1124940 7918740 6879618 8352318 6188256 -433578 691362 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 42865413 33768 45374109 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 214,884 clinic visits. 42865413 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 199 true false false false false false false false false false false X 9 8 false false false false true true true true true false false true true true true true true true true false MN X Todd Ostendorf 6128136113 2525 Chicago Avenue South Minneapolis MN 55404 X Robert Bonar Jr CEO, Board Member 50.0 0.0 X X 0 1002365 198384 Hayes Batson Board Chair 1.0 0.0 X X 0 0 0 Russell Becker Board Chair 1.0 1.0 X X 0 0 0 Greg Goven BOARD MEMBER 1.0 1.0 X 0 0 0 John McNamara MD BOARD MEMBER 1.0 1.0 X 0 0 0 Bruce Shay BOARD MEMBER 1.0 1.0 X 0 0 0 Leonard Snellman MD BOARD MEMBER 1.0 1.0 X 0 0 0 Tom Tefft BOARD MEMBER 1.0 1.0 X 0 0 0 Martin Bassett BOARD MEMBER 1.0 1.0 X 0 0 0 Alec Mahmood VP, Finance and CFO 50.0 1.0 X 0 578264 30757 Rebecca Woitalewicz Interim CFO 50.0 0.0 X 0 193246 30797 Jennifer Close Chief Ambulatory Officer 50.0 0.0 X 0 200360 15013 Trevor Sawallish Chief Ambulatory Officer 50.0 0.0 X 0 23489 1727 Kristin Heuermann Clinic Physician 50.0 0.0 X 148997 0 17736 Cynthia Krull Clinic Physician 50.0 0.0 X 158178 0 14351 Catherine Bedford Clinic Physician 50.0 0.0 X 155411 0 29287 Gail Casemore Clinic Physician 50.0 0.0 X 182630 0 31527 James Hocks Clinic Physician 50.0 0.0 X 248577 0 24723 Jerry Massmann Former VP of Finance and CFO 0.0 0.0 X 0 305255 0 893793 2302979 394302 8 true true false Metropolitan Pediatric Specialists 6545 France Ave South Ste 400 Edina MN 55435 Physician & staff 11047099 Partners in Pediatrics 12720 Bass Lake Road Maple Grove MN 55369 Physician & staff 9347704 Eclinicalworks LLC 2 Technology Dr Westborough MA 01581 Techonolocy maint. 242788 Trizetto Provider Services Dept CH 16897 Palatine IL 60055 IT consulting 107140 4 0 Patient Service 621400 42054594 42054594 Medicaid 621400 3215799 3215799 Pay for Performance Bonus 621400 94089 94089 Training Program 621400 9627 9627 45374109 0 0 0 2503 2503 0 2503 2503 0 0 0 0 0 45376612 45374109 2503 X 0 33768 33768 0 0 0 0 6793828 6157669 636159 312520 308260 4260 1514485 1493841 20644 468707 462318 6389 0 58105 58105 105181 105181 381 381 0 0 21772297 21503068 269229 76736 76736 418181 418181 397045 187489 209556 0 3099917 3099917 48610 48610 0 160666 160666 0 0 484566 484566 82053 82053 Medical Expenses 7275829 7275829 MN Care & Sales Tax 939251 939251 Dues & Licenses 86546 86546 Subscriptions & Books 62435 62435 60565 60565 44251672 42865413 1386259 0 0 0 0 0 0 0 4069544 3582376 0 0 0 0 0 0 903291 1066065 44529 -17329 4405218 2156712 2901376 2248506 0 0 0 0 0 0 0 0 0 0 7918740 6879618 1428446 296486 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6923872 5891770 8352318 6188256 X -433578 691362 0 0 0 0 -433578 691362 7918740 6879618 1124940 X false true X true false X Schedule 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 381 381 false Form Sch C, Part II-B, Part 1A Children's is a member of the American Academy of Pediatrics (AAP). $381 of membership dues paid to AAP relate to lobbying activities. 1850414 670159 1180255 2554804 1486553 1068251 2248506 0 MN CARE TAX 63658 PAYABLE TO CHC 5828112 5891770 X Part X, Line 2 The Internal Revenue Service (IRS) has determined that Children's and its subsidiaries are exempt organizations as described in Section 501(c)(3) of the Internal Revenue Code (IRC). Children's believes that it continues to meet the requirements of the IRC to sustain its tax-exempt status. There are no federal income tax expenses, penalties, or interest recognized in the consolidated statements of operations and no unrecognized tax benefits for the years ended December 31, 2015 and 2014. true Charity Care Assistance to Individuals 257 33768 Cost Charity care to indv X true true false false false false false false false Kristin Heuermann Clinic Physician 130373 18098 526 9421 0 8315 0 166733 0 0 0 Cynthia Krull Clinic Physician 120017 32415 5746 13137 0 1214 0 172529 0 0 0 Catherine Bedford Clinic Physician 142679 11533 1199 10267 0 19020 0 184698 0 0 0 Gail Casemore Clinic Physician 130480 41725 10425 11687 0 19840 0 214157 0 0 0 James Hocks Clinic Physician 180266 53503 14808 15235 0 9488 0 273300 0 0 0 Alec Mahmood VP, Finance and CFO 383724 169100 25440 0 14662 0 16095 0 609021 0 19151 Robert Bonar Jr CEO, Board Member 817011 185354 0 180988 0 17396 0 1200749 0 0 Rebecca Woitalewicz Interim CFO 166654 22152 4440 0 12621 0 18176 0 224043 0 0 Jennifer Close Chief Ambulatory Officer 117540 81796 1024 0 10836 0 4177 0 215373 0 0 Jerry Massmann Former VP of Finance and CFO 305255 0 0 0 0 0 305255 0 284877 Form 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, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board or compensation committee. Form Sch J, Part I, Line 4a Jerry Massmann began receiving severance pay on 8/1/2013 for two years. He received $280,388 in 2015. Form 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 2015: Alec Mahmood - $19,151 Jerry Massmann - $24,868 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 6545 France Avenue South Suite 400 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, Section A, 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, Section A, 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 Incorpation and Bylaws. Form 990, Part VI, Section B, line 11: 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, Section B, 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. Form 990, Part VI, Section B, Line 15: 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 deliveration and decision through detailed minutes of the Compensation Committee and full board meetings where executive compensation is considered. Form 990, Part VI, Section C, 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:21127999 FORM 990 PART IX LINE 11G DESCRIPTION:Consulting Fees TOTAL FEES:307015 FORM 990 PART IX LINE 11G DESCRIPTION:Data Processing TOTAL FEES:22769 FORM 990 PART IX LINE 11G DESCRIPTION:Repairs and Maintenance TOTAL FEES:193595 FORM 990 PART IX LINE 11G DESCRIPTION:Leased Equipment TOTAL FEES:113057 FORM 990 PART IX LINE 11G DESCRIPTION:Linen TOTAL FEES:7802 FORM 990 PART IX LINE 11G DESCRIPTION:Security TOTAL FEES:60 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 11A CHC false Children's Health Insurance Network Ltd Insurance CJ CHC C Corp 0 0 0.00000 false Children's Health Network 910 East 26th Street Suite 330 Minneapolis MN 55404 463226418 Medical Services MN CHC C Corp 0 0 0.00000 false false false false false false false false false false false false false true false true true true true true