2014-07-15T09:05:54-05:00 2013-12-31 273605969 CBIZ MHM LLC 13577 FEATHER SOUND DRIVE 400 CLEARWATER FL 33762 990 2013-01-01 362193608 SHRINERS HOSPITALS FOR CHILDREN SHRI 8132810300 POST OFFICE BOX 31356 TAMPA FL 336313356 DOUGLAS MAXWELL PRESIDENT 8132810300 2014-07-16 1 NATHAN SMITH P00543757 7275721400 2013 2015-11-30 17:44:51Z DOUGLAS MAXWELL 2900 ROCKY POINT DRIVE TAMPA FL 33607 3657763135 0 X HTTP://WWW.SHRINERSHQ.ORG/ X 1925 CO WE PROVIDE PEDIATRIC SPECIALTY CARE WITHOUT FINANCIAL OBLIGATION TO PATIENTS OR THEIR FAMILIES. 19 14 5779 5000 0 0 202387056 210375005 90235650 133601431 321112058 533553889 22979284 48018396 636714048 925548721 355040 46000 0 0 344874313 351498680 8778069 6549429 24382591 277342114 290528128 631349536 648622237 5364512 276926484 8301573544 8971718639 980615198 855319197 7320958346 8116399442 X SEE SCHEDULE OSHRINERS HOSPITALS FOR CHILDREN OFFERS "CHARITY CARE" THROUGH AN INTERNATIONAL NETWORK OF PEDIATRIC HOSPITALS DEDICATED TO PROVIDING EXCELLENT PATIENT CARE, RESEARCH, AND EDUCATION FOR ORTHOPAEDIC CONDITIONS, BURNS, SPINAL CORD INJURIES AND CLEFT LIP AND PALATE. OUR SPECIALIZED MEDICAL CARE, BACKED BY THE SKILLS AND KNOWLEDGE OF THE STAFF IN 18 HOSPITALS, DELIVERS EXPERT, FAMILY-FOCUSED CARE AT NO CHARGE. ...AS A 501(C)3 NON-PROFIT ORGANIZATION, SHRINERS HOSPITALS RELIES ON THE GENEROUS DONATIONS OF SHRINERS AND THE GENERAL PUBLIC TO CARRY OUT OUR MISSION AND CHANGE THE LIVES OF CHILDREN EVERY DAY. FOR MORE INFORMATION ABOUT SUPPORTING SHRINERS HOSPITALS, PLEASE VISIT WWW.SHRINERSHQ.ORG OR CALL 1-800-241-GIFT. 0 0 92736128 24134765 TREATMENT OF PEDIATRIC BURN VICTIMS ADMISSIONS: 885.OUTPATIENT CLINIC VISITS: 15,758 AT 2 BURNS HOSPITALS AND ONE HOSPITAL THAT SPECIALIZES IN BOTH BURNS AND ORTHOPAEDIC SERVICES.OUTPATIENT CLINIC SURGERIES: 2,078. 420617935 46000 109466666 TREATMENT OF ORTHOPAEDIC PATIENTS ADMISSIONS: 11,612. OUTPATIENT CLINIC VISITS: 252,812 AT 16 ORTHOPAEDIC HOSPITALS AND ONE HOSPITAL THAT SPECIALIZES IN BOTH ORTHOPAEDIC AND BURNS SERVICES.OUTPATIENT CLINIC SURGERIES: 9,544. 19577883 MEDICAL RESEARCH IS CONDUCTED AND PROVIDES A STRONG, POSITIVE IMPACT ON THE CARE AND CURE OF CHILDREN WITH ORTHOPAEDIC PROBLEMS, BURN AND SPINAL CORD INJURIES. 138 RESEARCH PROJECTS WERE FUNDED, AND 23 RESEARCH FELLOWSHIPS WERE PROVIDED. SHRINERS HOSPITALS FOR CHILDREN IS COMMITTED TO THE SUSTAINED INVESTMENT IN CLINICALLY USEFUL RESEARCH SO THAT FUNDAMENTAL KNOWLEDGE CAN BE ACQUIRED, IMPROVING THE QUALITY OF LIFE FOR CHILDREN WITH ORTHOPAEDIC PROBLEMS, BURN AND SPINAL CORD INJURIES. 532931946 1 1 0 0 0 0 0 0 1 1 1 0 0 1 1 0 0 1 0 0 1 0 0 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 976 0 1 5779 1 0 1 AS AU BE BD BR BU CA CJ CI CH CO DA FI FR GM HK IN ID EI IS IT JA KS LU RM MX NL NO PM PE PL QA RS SN SF SP SW SZ TW UK UY 0 0 0 1 1 1 2 0 0 1 1 0 X 19 14 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY X X SHARON RUSSELL 8132810300 2900 ROCKY POINT DRIVE TAMPA FL 33607 JACK JONES DIRECTOR 15.00 X 0 149289 0 DOUGLAS MAXWELL PRESIDENT, TRUSTEE 35.00 X X 18000 0 0 ALAN MADSEN DIRECTOR 5.00 X 0 47500 0 JOHN CINOTTO CHAIRMAN 5.00 X X 0 71250 0 DALE STAUSS FIRST V.P. 5.00 X X 0 0 0 JERRY GANTT SECOND V.P. 5.00 X X 0 0 0 CHRIS SMITH SECRETARY 5.00 X X 0 0 0 GARY BERGENSKE ASSISTANT SECRETARY 5.00 X X 0 2700 0 JIM CAIN DIRECTOR 5.00 X 0 0 0 JEFFREY SOWDER DIRECTOR 5.00 X 0 0 0 WAYNE LACHUT DIRECTOR 5.00 X 0 0 0 JAMES SMITH DIRECTOR 5.00 X 0 0 0 GARY DUNWOODY TRUSTEE 5.00 X 0 0 0 RAOUL L FREVAL TRUSTEE 5.00 X 0 0 0 BOBBY SIMMONS TRUSTEE 5.00 X 0 0 0 ANTHONY WEST TRUSTEE 5.00 X 0 0 0 JAMES MCCONNELL TREASURER 5.00 X X 0 0 0 JOSEPH SAVAGLIO DIRECTOR 5.00 X 0 0 0 SKIP STANAWAY DIRECTOR 5.00 X 0 0 0 JOHN MCCABE EXECUTIVE VICE PRESIDENT 40.00 X 326120 0 18541 MICHAEL ALONA CHIEF OF STAFF 40.00 X 452664 0 1305417 KEVIN YAKUBOFF CHIEF OF PLASTIC SURGERY 40.00 X 354744 0 547062 DENNIS GROGAN CHIEF OF STAFF 40.00 X 326536 0 695062 PETER ARMSTRONG CHIEF OF STAFF 40.00 X 339243 0 671805 JOHN LORANT PLASTIC SURGEON, ASSOCIATE PROFESSOR 40.00 X 385444 0 384451 2202751 270739 3622338 415 0 1 0 S M WILSON AND CO 2185 HAMPTON AVE ST LOUIS MO 63139 CONSTRUCTION SERVICES 9328042 UTMB AT GALVESTON 301 UNIVERSITY BLVD GALVESTON TX 77550 MEDICAL SERVICES 8127019 JJ HEALTHCARE SYSTEMS 425 HOES LANE PISCATAWAY TOWNSHIP NJ 08854 MEDICAL SUPPLIES 7633075 CERNER CORP 2800 ROCKCREEK PKWY NORTH KANSAS CITY MO 64117 SOFTWARE MAINTENANCE 7336726 OWENS & MINOR 9120 LOCKWOOD BLVD MECHANICSVILLE VA 23116 MEDICAL SERVICES 6979870 376 1332186 3420738 205622081 210375005 PATIENT SERVICE 621110 133601431 133601431 133601431 179328253 179328253 41567 41567 14262935 0 14262935 14262935 14262935 3085962700 2731613205 123859 354349495 -123859 354225636 354225636 26707961 477350 26230611 26230611 OTHER INCOME 900099 7483283 7483283 7483283 925548721 133601431 0 581572285 X 46000 46000 362661 311888 50773 256713311 231170325 23990088 1552898 34184533 31703805 2480728 42598673 37535385 5063288 17639502 15859623 1779879 6549429 6549429 12484900 12484900 75468165 59750474 13468850 2248841 2186007 2031438 152593 1976 17000429 5933138 10724012 343279 5904958 468406 5423917 12635 20679574 16263233 4416341 5602614 3061655 2339686 201273 524817 213452 201926 109439 180655 180655 45669818 38967912 6701906 4310743 3586508 724235 MEDICAL SUPPLIES 77813334 77813334 PGA EVENT EXPENSES 10263540 10263540 PATIENT COSTS 2998179 2220119 778060 DUES AND REGISTRATIONS 1878003 1690205 174634 13164 7562392 4305046 171229 3086117 648622237 532931946 91307700 24382591 6625642 10708836 8645395 32381302 18755223 18050435 7657763 10361996 1190985368 580693790 606032608 610291578 6015404955 6520990621 241391907 257723656 1397060051 1511210215 8301573544 8971718639 314377590 197332431 14071728 12126811 37483795 36981955 63000000 0 551682085 608878000 980615198 855319197 X 5969812253 6726358349 320177402 309908402 1030968691 1080132691 7320958346 8116399442 8301573544 8971718639 X 276926484 434122545 84392067 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 6725272450 968695800 388260817 7305707433 6340401648 830356472 445485670 6725272450 6598994424 3569133 262161909 6340401648 6299536273 696982199 397524048 6598994424 5604239809 995576563 300280099 6299536273 0.81000 0.15000 0.04000 0 0 28638234 28638234 800178917 345697120 454481797 10650879 8515719 2135160 298053303 226480951 71572352 53464035 53464035 610291578 BENEFICIAL INTERESTS IN TRUSTS 535121378 ESTATES IN PROCESS 281058276 PATIENT TRANSPORTATION FUNDS 54866573 COLLATERAL CASH AND SECURITIES 608878000 RECEIVABLES FROM INCOME TRUSTS 1635792 RELATED PARTY RECEIVABLES 29650196 1511210215 LIABILITY UNDER SEC. LENDING 608878000 608878000 1347945003 434122545 434122545 913822458 11726263 11726263 925548721 636614687 477350 477350 636137337 12484900 12484900 648622237 PART V, LINE 4: THE ENDOWMENT FUNDS (INCLUDING UNRESTRICTED FUND BALANCES) ARE THE PRIMARY SOURCE OF SUPPORT FROM WHICH SHRINERS HOSPITALS FOR CHILDREN PERFORMS ITS PROGRAM SERVICES TO ACHIEVE ITS PRIMARY EXEMPT PURPOSE. PART XI, LINE 4B - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSES RECLASSIFIED FROM EXPENSES -477,350. OTHER CHANGES -379,498. LIFE MEMBERSHIPS INCOME FROM CHANGE IN FUND BALANCE 98,211. RECLASSIFIED INVESTMENT EXPENSES 12,484,900. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENTS EXPENSES RECLASSIFIED TO NET WITH REVENUES 477,350. PART XII, LINE 4B - OTHER ADJUSTMENTS: BANK FEES RECLASSIFIED FROM REVENUES 12,484,900. FORM 990, PART XI, LINE 8 CHANGE IN MINIMUM PENSION LIABILITY : 124,173,204 TRANSFERS: SHRINERS HOSPITALS FOR CHILDREN, A MASSACHUSETTS CORPORATION = (22,336,842) SHRINERS HOSPITALS FOR CHILDREN, A CANADIAN CORPORATION = (8,140,680) SHRINERS HOSPITALS FOR CHILDREN, A MEXICAN CORPORATION = (13,683,320) SUBTOTAL TRANSFERS : (44,160,842) CHANGE IN PATIENT TRANSPORTATION FUNDS HELD BY SHRINE TEMPLES : 2,932,318 OTHER CHANGE IN FUND BALANCE : 468,277 TOTAL : 83,412,957 PART IV, LINE 2B EXPLANATION: THE AMOUNT INCLUDED ON FORM 990, PART X, LINE 21 CONSISTS OF ANNUITY LIABILITIES ASSOCIATED WITH CHARITABLE REMAINDER TRUSTS HELD BY SHRINERS HOSPITALS FOR CHILDREN, WHICH ARE DETERMINED BASED ON PRESENT VALUE OF THE ESTIMATED FUTURE PAYMENTS TO BE PAID TO THE DESIGNATED BENEFICIARIES. DEFERRED INCOME IS RECOGNIZED ON GIFTS TO SHRINERS HOSPITALS FOR CHILDREN POOLED INCOME FUNDS WHICH REPRESENT THE DISCOUNTED VALUE OF THE ASSETS FOR THE ESTIMATED TIME PERIOD UNTIL THE DONOR'S DEATH. 1 MEXICO 1 331 FUNDING TO HOSPITAL SHRINERS PARA NINOS, A RELATED NONPROFIT ORGANIZATION. 15499000 CANADA 1 252 FUNDING TO SHRINERS HOSPITALS FOR CHILDREN, A RELATED NONPROFIT ORGANIZATION. 23961000 2 583 0 0 2 583 39460000 0 39460000 0 0 0 0 0 0 PART I, LINE 2: THE FOREIGN ORGANIZATIONS RECEIVING FUNDING ARE ENTIRELY CONTROLLED BY THIS ORGANIZATION'S OFFICERS. THE SAME PROTOCOLS FOR THIS ORGANIZATION'S PROGRAM SERVICE INITIATIVES APPLY TO THE FOREIGN ORGANIZATIONS. X X X X X X 1 EDGE DIRECT 3030 WATERVIEW AVE BALTIMORE MD 21230 DIRECT MAIL SOLICITATION 0 9146639 3272577 5874062 LEO BURNETT 35 WEST WACKER DRIVE CHICAGO IL 60601 DIRECT MAIL SOLICITATION 0 2166794 664339 1502455 11313433 3936916 7376517 AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY PAPER CRUSADE 8875391 8875391 158629 FOOTBALL GAME 4209707 4209707 75240 30 13622863 13622863 243481 26707961 26707961 477350 477350 26230611 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 511209085 133601431 377607654 0.58220 511209085 133601431 377607654 0.58220 20743753 20743753 0.03200 20743753 20743753 0.03200 531952838 133601431 398351407 0.61420 0 0 18 1 SHRINERS HOSPITAL FOR CHILDREN-CHICAGO 2211 NORTH OAK PARK AVENUE CHICAGO IL 607073392 X X X X A 2 SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT 3229 BURNET AVENUE CINCINNATI OH 452293095 X X X X A 3 SHRINERS HOSPITAL FOR CHILDREN-ERIE 1645 WEST 8TH STREET ERIE PA 16505 X OUTPATIENT AMBULATORY SURGICAL CENTER & CLINIC A 4 SHRINERS HOSPITAL FOR CHILDREN-GALVESTON 815 MARKET STREET GALVESTON TX 77550 X X X X A 5 SHRINERS HOSPITAL FOR CHILDREN-GREENV 950 WEST FARIS ROAD GREENVILLE SC 29605 X X X X A 6 SHRINERS HOSPITAL FOR CHILDREN-HONOLULU 1310 PUNAHOU STREET HONOLULU HI 968261099 X X X X A 7 SHRINERS HOSPITAL FOR CHILDREN-HOUSTON 6977 MAIN STREET HOUSTON TX 770303701 X X X X A 8 SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON 1900 RICHMOND ROAD LEXINGTON KY 40502 X X X X A 9 SHRINERS HOSPITAL FOR CHILDREN-LA 3160 GENEVA STREET LOS ANGELES CA 90020 X X X X A 10 SHRINERS HOSPITAL FOR CHILDREN-PHILADELP 3551 NORTH BROAD STREET PHILADELPHIA PA 191404131 X X X X A 11 SHRINERS HOSPITAL FOR CHILDREN-PORTLAND 3101 SW SAM JACKSON PARK RD PORTLAND OR 972393095 X X X X A 12 SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE FAIRFAX ROAD AT VIRGINIA STREET SALT LAKE CITY UT 84103 X X X X A 13 SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR 3100 SAMFORD AVENUE SHREVEPORT LA 71103 X X X X A 14 SHRINERS HOSPITAL FOR CHILDREN-SPOKANE 911 WEST 5TH AVENUE SPOKANE WA 99204 X X X X A 15 SHRINERS HOSPITAL FOR CHILDREN-ST LOUIS 2001 S LINDBERGH BOULEVARD ST LOUIS MO 631313597 X X X X A 16 SHRINERS HOSPITAL FOR CHILDREN-TAMPA 12502 USF PINE DRIVE TAMPA FL 336129499 X X X X A 17 SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY 2025 EAST RIVER PARKWAY MINNEAPOLIS MN 55414 X X X X A 18 SHRINERS HOSPITAL FOR CHILDREN-N CALI 2425 STOCKTON BOULEVARD SACRAMENTO CA 95817 X X X X A SHRINERS HOSPITAL FOR CHILDREN-GROUP A 1 X X X X X X X X 12 1 1 1 X HTTP://WWW.SHRINERSHOSPITALFORCHILDREN.OR X X X 0 0 1 1 300.000000000000 1 400.000000000000 1 X X 1 0 0 0 0 X X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: SHRINERS HOSPITAL FOR CHILDREN-CHICAGO, - FACILITY 2: SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT, - FACILITY 3: SHRINERS HOSPITAL FOR CHILDREN-ERIE, - FACILITY 4: SHRINERS HOSPITAL FOR CHILDREN-GALVESTON, - FACILITY 5: SHRINERS HOSPITAL FOR CHILDREN-GREENV, - FACILITY 6: SHRINERS HOSPITAL FOR CHILDREN-HONOLULU, - FACILITY 7: SHRINERS HOSPITAL FOR CHILDREN-HOUSTON, - FACILITY 8: SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON, - FACILITY 9: SHRINERS HOSPITAL FOR CHILDREN-L.A., - FACILITY 10: SHRINERS HOSPITAL FOR CHILDREN-PHILADELP, - FACILITY 11: SHRINERS HOSPITAL FOR CHILDREN-PORTLAND, - FACILITY 12: SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE, - FACILITY 13: SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR, - FACILITY 14: SHRINERS HOSPITAL FOR CHILDREN-SPOKANE, - FACILITY 15: SHRINERS HOSPITAL FOR CHILDREN-ST. LOUIS, - FACILITY 16: SHRINERS HOSPITAL FOR CHILDREN-TAMPA, - FACILITY 17: SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY, - FACILITY 18: SHRINERS HOSPITAL FOR CHILDREN-N. CALI FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN - CHICAGO PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 1 -- SHRINERS HOSPITAL FOR CHILDREN - CHICAGO PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 2 -- SHRINERS HOSPITAL FOR CHILDREN-CINCINNAT PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 3 -- SHRINERS HOSPITAL FOR CHILDREN-ERIE PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 3 -- SHRINERS HOSPITAL FOR CHILDREN-ERIE PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 4 -- SHRINERS HOSPITAL FOR CHILDREN-GALVESTON PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 4 -- SHRINERS HOSPITAL FOR CHILDREN-GALVESTON PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 5 -- SHRINERS HOSPITAL FOR CHILDREN-GREENV PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 5 -- SHRINERS HOSPITAL FOR CHILDREN-GREENV PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 6 -- SHRINERS HOSPITAL FOR CHILDREN-HONOLULU PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 6 -- SHRINERS HOSPITAL FOR CHILDREN-HONOLULU PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 7 -- SHRINERS HOSPITAL FOR CHILDREN-HOUSTON PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 7 -- SHRINERS HOSPITAL FOR CHILDREN-HOUSTON PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 8 -- SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 8 -- SHRINERS HOSPITAL FOR CHILDREN-LEXINGTON PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 9 -- SHRINERS HOSPITAL FOR CHILDREN-L.A. PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 9 -- SHRINERS HOSPITAL FOR CHILDREN-L.A. PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 10 -- SHRINERS HOSPITAL FOR CHILDREN-PHILADELP PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 10 -- SHRINERS HOSPITAL FOR CHILDREN-PHILADELP PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 11 -- SHRINERS HOSPITAL FOR CHILDREN-PORTLAND PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 11 -- SHRINERS HOSPITAL FOR CHILDREN-PORTLAND PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 12 -- SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 12 -- SHRINERS HOSPITAL FOR CHILDREN-SALT LAKE PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 13 -- SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 13 -- SHRINERS HOSPITAL FOR CHILDREN-SHREVEPOR PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 14 -- SHRINERS HOSPITAL FOR CHILDREN-SPOKANE PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 14 -- SHRINERS HOSPITAL FOR CHILDREN-SPOKANE PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 15 -- SHRINERS HOSPITAL FOR CHILDREN-ST. LOUIS PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 15 -- SHRINERS HOSPITAL FOR CHILDREN-ST. LOUIS PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 16 -- SHRINERS HOSPITAL FOR CHILDREN-TAMPA PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 16 -- SHRINERS HOSPITAL FOR CHILDREN-TAMPA PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 17 -- SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 17 -- SHRINERS HOSPITAL FOR CHILDREN-TWIN CITY PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. FACILITY 18 -- SHRINERS HOSPITAL FOR CHILDREN-N. CALI PART V, SECTION B, LINE 12I: PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED UPON THEIR INCOME LEVEL COMPARED TO THE FEDERAL POVERTY GUIDELINES AND INTERNAL POLICY. FACILITY 18 -- SHRINERS HOSPITAL FOR CHILDREN-N. CALI PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED IS CONSISTENT FOR ALL PAYER CLASSES, PATIENTS QUALIFY FOR FINANCIAL ASSISTANCE BASED ON THEIR INCOME LEVEL AND FEDERAL POVERTY GUIDELINES. 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 THE FEDERAL POVERTY GUIDELINES SPECIFIED IN SCHEDULE H, PART I, LINES 3A AND 3B, 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 2013. 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. 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 ENTIRE UNITED STATES. 1 AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS 6300 NORTH RIVER ROAD ROSEMONT IL 60018 362110592 501(C)(3) 46000 SPONSORSHIP GRANT 1 PART I, LINE 2: SHRINERS HOSPITALS FOR CHILDREN IS ACTIVELY INVOLVED WITH ALL GRANT RECIPIENTS. THROUGH THIS ACTIVE INVOLVEMENT, THE ORGANIZATIONS ARE MONITORED TO ENSURE THEIR GRANT PROCEEDS ARE BEING USED APPROPRIATELY. X X 1 1 X X 0 1 0 0 0 0 0 0 0 JOHN MCCABE EXECUTIVE VICE PRESIDENT 326120 0 0 0 0 0 17000 0 1541 0 344661 0 0 0 MICHAEL ALONA CHIEF OF STAFF 452664 0 0 0 0 0 1300531 0 4886 0 1758081 0 0 0 KEVIN YAKUBOFF CHIEF OF PLASTIC SURGERY 354744 0 0 0 0 0 547062 0 0 0 901806 0 0 0 DENNIS GROGAN CHIEF OF STAFF 326536 0 0 0 0 0 9423 0 685639 0 1021598 0 0 0 PETER ARMSTRONG CHIEF OF STAFF 339243 0 0 0 0 0 149450 0 522355 0 1011048 0 0 0 JOHN LORANT PLASTIC SURGEON, ASSOCIATE PROFESSOR 385444 0 0 0 0 0 372842 0 11609 0 769895 0 0 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 APPOVE 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 11 A FULL VERSION OF FORM 990 AS FILED WITH THE IRS IS MADE AVAILABLE TO EACH VOTING MEMBER OF THE GOVERNING BODY AND/OR DESIGNATED COMMITTEE RESPONSIBLE FOR PERFORMING A REVIEW PROCESS 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 & 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 19 THESE DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. FORM 990, PART IX, LINE 11G PUBLIC RELATIONS & OTHER: PROGRAM SERVICE EXPENSES 24,544,517. MANAGEMENT AND GENERAL EXPENSES 5,532,783. FUNDRAISING EXPENSES 923,787. TOTAL EXPENSES 31,001,087. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 34,229,718. MANAGEMENT AND GENERAL EXPENSES 7,716,005. FUNDRAISING EXPENSES 1,288,311. TOTAL EXPENSES 43,234,034. AGENCY PERSONNEL SERVICES: PROGRAM SERVICE EXPENSES 976,239. MANAGEMENT AND GENERAL EXPENSES 220,062. FUNDRAISING EXPENSES 36,743. TOTAL EXPENSES 1,233,044. FORM 990, PART XI, LINE 9: CHANGE IN PENSION FUNDING OBLIGATION 124,173,204. TRANSFERS TO RELATED ENTITIES -44,160,842. CHANGE IN PATIENT TRANSPORTATION FUNDS HELD BY SHRINE TEMPLES 2,932,318. OTHER CHANGES IN FUND BALANCE 1,447,387. FORM 990, PART XI, LINE 2C, AUDIT COMMITTEE OVERSIGHT PROCESS: THE ORGANIZATION HAS NOT CHANGED (DURING THE CURRENT YEAR) ITS OVERSIGHT PROCESS OR ITS SELECTION PROCESS REGARDING THE COMMITTEE RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. PEDIATRIC ORTHOPEDIC & PROSTHETIC SERVICES - NORTHN CALIFORNIA LLC 2425 STOCKTON BLVD SACRAMENTO CA 95817 272210763 ORTHOPEDICS & PROSTHETICS DE 414707 229942 NO PEDIATRIC ORTHOPEDIC & PROSTHETIC SERVICES - TAMPA LLC 12502 USF PINE DRIVE TAMPA FL 336129499 452723185 ORTHOPEDICS & PROSTHETICS DE 861896 222821 NO PEDIATRIC ORTHOPEDIC & PROSTHETIC SERVICES - GREENVILLE LLC 950 W FARIS RD GREENVILLE SC 29605 453940485 ORTHOPEDICS & PROSTHETICS DE 188263 140991 NO THE SHRINERS' HOSPITAL FOR CHILDREN POST OFFICE BOX 31356 TAMPA FL 336313356 042121377 HOSPITAL SYSTEM MA 501(C)(3) 3 NO 0 SHRINERS INTERNATIONAL POST OFFICE BOX 31356 TAMPA FL 336313356 362158164 FOUNDED SHRINERS HOSPITALS FOR CHILDREN IA 501(C)(10) N/A NO 0 SHRINERS HOSPITALS FOR CHILDREN EMPLOYEE DISASTER RELIEF FUND 2900 ROCKY POINT DRIVE TAMPA FL 33607 263733381 DISASTER RELIEF DC 501(C)(3) 9 NO 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 THE SHRINERS' HOSPITAL FOR CHILDREN D 12868015 SHRINERS INTERNATIONAL J 3003386 THE SHRINERS' HOSPITAL FOR CHILDREN B 22336842 SHRINERS INTERNATIONAL D 1994441