CHILDRENS HEALTH CARE SERVICES INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CHILDRENS HEALTH CARE SERVICES INC (EIN 41-1756478)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-08
- IRS object ID
- 201333129349300618
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-08T10:49:27-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 861065772 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 SOUTH SIXTH STREET STE 2800 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 55402 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 411756478 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Children's Health Care Services Inc | BusinessNameLine1 |
| Business Name Line2 | DBA Children's - Minnetonka | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CHIL | NameControl |
| Phone | 6128136000 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 Chicago Avenue South | AddressLine1 |
| City | Minneapolis | City |
| State | MN | State |
| ZIP Code | 554040000 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ALEC MAHMOOD | Name |
| Title | CFO | Title |
| Phone | 6128136000 | Phone |
| Date Signed | 2013-10-30 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kristina Rasmussen | Name |
| PTIN | P00143920 | PTIN |
| Phone | 6123974000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Children's - Minnetonka | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Alec Mahmood | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 Chicago Avenue South | AddressLine1 |
| City | Minneapolis | City |
| State | MN | State |
| ZIP Code | 554040000 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 8834063 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | childrensmn.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1994 | YearFormation |
| State Legal Domicile | MN | StateLegalDomicile |
| Activity Or Mission Description | We serve the community's children as a superior, pediatric specialty health care center. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 60 | TotalNbrEmployees |
| Total Nbr Volunteers | 10 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2378 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 8273515 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 7780301 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 434396 | OtherRevenuePriorYear |
| Other Revenue Current Year | 392884 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 8707911 | TotalRevenuePriorYear |
| Total Revenue Current Year | 8175563 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4117181 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4480788 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 3652725 | OtherExpensePriorYear |
| Other Expenses Current Year | 3179912 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 7769906 | TotalExpensesPriorYear |
| Total Expenses Current Year | 7660700 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 938005 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 514863 | RevenuesLessExpensesCY |
| Total Assets BOY | 7062570 | TotalAssetsBOY |
| Total Assets EOY | 7471219 | TotalAssetsEOY |
| Total Liabilities BOY | 231483 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 125269 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 6831087 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 7345950 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | We serve the community's children as a specialty pediatric ambulatory surgery center and diagnostic and treatment facility. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 6492269 | Expense |
| Revenue | 7780301 | Revenue |
| Description | Children's Health Care Services, Inc. ("Children's - Minnetonka") 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. We provide a lower cost environment and option to the community we serve than what can generally be provided in a hospital setting. Children's - Minnetonka performed 3,627 outpatient surgical cases, and 5,206 radiology and special diagnostic tests. See Schedule O.We perform general and specialty surgical procedures, including dental/oral, gastroenterology, orthopaedic, ophthalmology, plastics, urology, physiatry (botox/phenol injections), ear, nose, and throat. Surgery is performed by a team of professionals who specialize in the unique needs of children. Among them is the pediatric anesthesia team, who work solely with children and understand their specific medical needs. At Children's - Minnetonka, we provide the following radiology and special diagnostic services: magnetic resonance imaging (MRI) and computerized tomography (CT) scans, ultrasound, auditory brain stem envoked responses, and general radiology and fluoroscopic procedures including diagnostic X-rays, upper gastrointestinal images, and colon exams. Nitrous sedation and anesthesia services are available. The nitrous oxide sedation program at Children's - Minnetonka is a breakthrough, award-winning program. Patients are awake but calm during its administration before and during the procedure. Nitrous oxide frees patients from the side effects typically associated with other sedatives. While other sedatives may stay in a child's system for hours, nitrous oxide quickly leaves children's systems, enabling them to resume normal activities such as school. | Description |
| Total Program Service Expense | 6492269 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 60 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Alec Mahmood | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 6128136113 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2525 Chicago Avenue South | AddressLine1 |
| City | Minneapolis | City |
| State | MN | State |
| ZIP Code | 55404 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|---|
| Phil Kibort MD | |||||||||
| President | 1.50 | 50.00 | X | X | 0 | 674587 | 52212 | ||
| Jerry Massmann | |||||||||
| Secretary / Treasurer | 1.50 | 52.00 | X | X | 0 | 646564 | 50702 | ||
| Brian Larson | |||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||||
| David Dorn | |||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||||
| Eric Simso | |||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||||
| Janet Swiecichowski | |||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||||
| Karen Laurean Walkowski | |||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||||
| Lorene Freehil MD FAAP | |||||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||||
| Gloria Drake | |||||||||
| Sr Dir Clinical Svc Peri | 6.00 | 50.00 | 28457 | 177844 | 46003 | X | |||
| Julianne Wagner | |||||||||
| Nurse Manager | 50.00 | 123001 | 0 | 11669 | X | ||||
| Barbara Kleven | |||||||||
| Nurse Anesthetist | 40.00 | 114521 | 0 | 4605 | X | ||||
| Janice Anderson | |||||||||
| Nurse Anesthetist | 40.00 | 161240 | 0 | 21011 | X | ||||
| Judy Holasek-Fritz | |||||||||
| Nurse Anesthetist | 40.00 | 155610 | 0 | 23390 | X | ||||
| Mary Lovejoy | |||||||||
| Nurse Anesthetist | 40.00 | 150195 | 0 | 23473 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 733024 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1498995 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 233065 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Metro Anesthesia Network | |||||
| Suite 20 14700 28th Avenue North | Plymouth | MN | 55441 | Anesthesia | 384912 |
| GE Healthcare | |||||
| PO Box 96483 | Chicago | IL | 60693 | MRI Service Agreement | 105745 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Related Organizations | 2378 | RelatedOrganizations |
| Total Contributions | 2378 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| Patient Service | 621400 | 6646075 | 6646075 | |
| Medicare / Medicaid Pa | 621400 | 1129679 | 1129679 | |
| Commission Machines Re | 722210 | 2303 | $2,303 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2244 | TotalRevenueColumn |
| Related Or Exempt Function Income | 2244 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 7780301 | TotalProgramServiceRevenue |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1051384 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 658500 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 392884 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 392884 | TotalRevenueColumn |
| Exclusion | $392,884 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 8175563 | TotalRevenueColumn |
| Related Or Exempt Function Income | 7777998 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $395,187 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 34800 | Total |
| Management And General | 34800 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3502921 | Total |
| Program Services | 3157485 | ProgramServices |
| Management And General | 345436 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 222845 | Total |
| Program Services | 190575 | ProgramServices |
| Management And General | 32270 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 511955 | Total |
| Program Services | 440368 | ProgramServices |
| Management And General | 71587 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 208267 | Total |
| Program Services | 182284 | ProgramServices |
| Management And General | 25983 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44800 | Total |
| Management And General | 44800 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 982654 | Total |
| Program Services | 808324 | ProgramServices |
| Management And General | 174330 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 73008 | Total |
| Program Services | 48071 | ProgramServices |
| Management And General | 24937 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 110916 | Total |
| Program Services | 102036 | ProgramServices |
| Management And General | 8880 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 119412 | Total |
| Program Services | 119412 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7704 | Total |
| Program Services | 6669 | ProgramServices |
| Management And General | 1035 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7564 | Total |
| Program Services | 6814 | ProgramServices |
| Management And General | 750 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59781 | Total |
| Program Services | 59781 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 829410 | Total |
| Program Services | 431571 | ProgramServices |
| Management And General | 397839 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4572 | Total |
| Program Services | 4572 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Medical Supplies | 744267 | 744267 |
| MN Care Tax | 146660 | 146660 |
| Bad Debt | 43380 | 43380 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5784 | Total |
| Management And General | 5784 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7660700 | Total |
| Program Services | 6492269 | ProgramServices |
| Management And General | 1168431 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 796908 | BOY |
| EOY | 795676 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 80333 | BOY |
| EOY | 1258269 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 22581229 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 17163955 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6185329 | BOY |
| EOY | 5417274 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7062570 | BOY |
| EOY | 7471219 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 141578 | BOY |
| EOY | 93115 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 89905 | BOY |
| EOY | 32154 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 231483 | BOY |
| EOY | 125269 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6831087 | BOY |
| EOY | 7345950 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6831087 | BOY |
| EOY | 7345950 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7062570 | BOY |
| EOY | 7471219 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 514863 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 675764 | OtherCostOrOtherBasis |
| Book Value | 675764 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14795577 | OtherCostOrOtherBasis |
| Depreciation | 10933649 | Depreciation |
| Book Value | 3861928 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 0 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7109888 | OtherCostOrOtherBasis |
| Depreciation | 6230306 | Depreciation |
| Book Value | 879582 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5417274 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MN CARE TAX RESERVE | Description |
| Amount | $32,154 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 32154 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 8785145 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 609582 | OtherRevenues |
| Revenue Not Rptd F990 | 609582 | RevenueNotRptdF990 |
| Revenue Subtotal | 8175563 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 8175563 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 8270282 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 609582 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 609582 | ExpensesNotRptdF990 |
| Expenses Subtotal | 7660700 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 7660700 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Description of Uncertain Tax Positions Under FIN 48: | 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, 2012 and 2011. |
| Part XI, Line 2d - Other Adjustments: | Rental Expenses Included in Income 609,582. | |
| Part XII, Line 2d - Other Adjustments: | Rental Expenses Included in Income 609,582. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Phil Kibort MD | ||||||||||||||
| President | 0 | 454271 | 0 | 203112 | 0 | 17204 | 0 | 30600 | 0 | 21612 | 0 | 726799 | 0 | 0 |
| Jerry Massmann | ||||||||||||||
| Secretary / Treasurer | 0 | 431668 | 0 | 191985 | 0 | 22911 | 0 | 34180 | 0 | 16522 | 0 | 697266 | 0 | 0 |
| Gloria Drake | ||||||||||||||
| Sr Dir Clinical Svc Peri | 24666 | 154195 | 3791 | 23649 | 0 | 0 | 4111 | 25704 | 2232 | 13956 | 34800 | 217504 | 0 | 0 |
| Janice Anderson | ||||||||||||||
| Nurse Anesthetist | 156564 | 0 | 4676 | 0 | 0 | 0 | 4915 | 0 | 16096 | 0 | 182251 | 0 | 0 | 0 |
| Judy Holasek-Fritz | ||||||||||||||
| Nurse Anesthetist | 151068 | 0 | 4542 | 0 | 0 | 0 | 4092 | 0 | 19298 | 0 | 179000 | 0 | 0 | 0 |
| Mary Lovejoy | ||||||||||||||
| Nurse Anesthetist | 145519 | 0 | 4676 | 0 | 0 | 0 | 4640 | 0 | 18833 | 0 | 173668 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part I, Line 4b | Certain employees of Children's Health Care,Inc., parent of Children's - Minnetonka, are provided the opportunity to participate in the Capital Accumulation Plan ("the Capital Plan"). The Capital 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 Capital Plan. Payments from the Capital Plan occur at vesting and are based on percentage of salary. The following amounts represent the amount paid under the Capital Plan in 2012. Phil Kibort $65,874 Jerry Massmann $47,826 Certain employees of Children's Health Care, Inc., parent of Children's - Minnetonka, are provided the opportunity to participate in the Deferral Account Pay 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. There were no amounts paid under the Deferral Plan in 2012. | |
| Part III | Part I, Line 3: Children's - Minnetonka relies on Children's Health Care, Inc., the parent of Children's - Minnetonka, to establish the compensation of the organization's CEO. Children's Health Care, Inc. uses the following methods to establish compensation of the CEO: compensation committee, independent compensation consultant, written employment contract, compensation survey or study, and approval by the board or compensation committee. | Supplemental Information |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 2 | The following people have a business relationship: Phil Kibort, Jerry Massmann, Gloria Drake. | |
| Form 990, Part VI, Section A, line 6 | Children's - Minnetonka has a sole member, Children's Health Care, Inc., a Minnesota nonprofit corporation. | |
| Form 990, Part VI, Section A, line 7a | Children's - Minnetonka's sole member, Children's Health Care, Inc., is authorized under Children's - Minnetonka's bylaws to elect directors of Children's - Minnetonka, after approval by the board of directors of Children's - Minnetonka. | |
| Form 990, Part VI, Section A, line 7b | Children's - Minnetonka's sole member, Children's Health Care, Inc., 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, Section B, line 11 | The senior management of Children's Health Care, Inc., the parent of Children's - Minnetonka, reviews the draft of Form 990 with the Audit and Compliance Committee of Children's Health Care's 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, Inc., the parent of Children's - Minnetonka, 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, 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 President of Children's - Minnetonka is established by Children's Health Care, Inc. 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 President and other officers and executive leaders of Children's - Minnetonka. This function is performed by the Compensation Committee of the governing board of Children's Health Care, Inc., 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, Section C, line 19 | Children's Health Care, Inc., the parent of Children's - Minnetonka, makes financial statement information public through a summary of financial performance in its annual report. In addition, financial statements are provided to Children's Health Care's bond trustees, who thereafter make this information publicly available. Children's - Minnetonka relies on the Conflict of Interest Policy of Children's Health Care, the parent of Children's - Minnetonka, Children's Health Care, Inc. does not make the Conflict of Interest Policy available to the public. The governing documents of Children's - Minnetonka are not available to the public. | |
| Form 990, Part IX, line 11g | Medical Director Contracts: Program service expenses 20,000. Management and general expenses 0. Fundraising expenses 0. Total expenses 20,000. Purchased Services: Program service expenses 627,100. Management and general expenses 86,364. Fundraising expenses 0. Total expenses 713,464. Equipment lease, repair and service: Program service expenses 161,224. Management and general expenses 87,966. Fundraising expenses 0. Total expenses 249,190. | Other Fees |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| Children's Health Care Inc | ||||||||||
| 2525 Chicago Avenue South | Minneapolis | MN | 554041844 | 411754276 | Healthcare | MN | 501(c)(3) | Line 3: 170(b)(1)(a) | N/A | 0 |
| Children's Health Care Foundation | ||||||||||
| 2525 Chicago Avenue South | Minneapolis | MN | 554021844 | 411814223 | Healthcare | MN | 501(c)(3) | Line 7: 170(b)(1)(a) | N/A | 1 |
| Children's Clinic Network | ||||||||||
| 2525 Chicago Avenue South | Minneapolis | MN | 554041844 | 453765330 | Healthcare | MN | 501(c)(3) | Line 7: 170(b)(1)(a) | N/A | 1 |
| Mother Baby Facility LLC | ||||||||||
| 2525 Chicago Avenue South | Minneapolis | MN | 554041844 | 454078371 | Healthcare | MN | 501(c)(3) | Line 11: 509(a)(3) | N/A | 1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 1 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |