2012-10-31T12:58:14-05:00 2011-12-31 454084437 WARREN AVERETT LLC 2500 ACTON ROAD BIRMINGHAM AL 35243 990 2011-01-01 630307306 THE CHILDREN'S HOSPITAL OF ALABAMA CHIL 2059399100 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 MIKE BURGESS 2059399100 2012-09-10 1 JC ROUSE P00081132 2059794100 2011 2016-02-24 21:20:13Z WILLIAM MICHAEL WARREN 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 587391759 0 X WWW.CHSYS.ORG X 1911 AL SPECIALTY ACUTE-CARE HOSPITAL PROVIDING INPATIENT AND OUTPATIENT MEDICAL SERVICES TO PEDIATRIC PATIENTS. 35 29 4157 1234 0 0 3024950 2774425 539732200 536126146 -2500604 -672747 15240034 10364751 555496580 548592575 0 0 0 0 218730169 224521458 0 0 0 262308519 248941893 481038688 473463351 74457892 75129224 574659849 668797176 432119150 415187509 142540699 253609667 X THE MISSION OF CHILDREN'S OF ALABAMA IS TO PROVIDE THE FINEST PEDIATRIC HEALTH SERVICES TO ALL CHILDREN IN AN ENVIRONMENT THAT FOSTERS EXCELLENCE IN RESEARCH AND MEDICAL EDUCATION. CHILDREN'S WILL BE AN ADVOCATE FOR ALL CHILDREN AND WORK TO EDUCATE THE PUBLIC ABOUT ISSUES AFFECTING CHILDREN'S HEALTH AND WELL-BEING. 0 0 247330324 315679817 CHILDREN'S HOSPITAL IS THE 14TH LARGEST AND THE 10TH BUSIEST PEDIATRIC MEDICAL CENTER IN THE UNITED STATES. IT IS THE ONLY LEVEL I PEDIATRIC TRAUMA CENTER, THE ONLY PEDIATRIC RENAL CARE CENTER, AND THE LARGEST PEDIATRIC BURN CENTER IN THE SOUTHEAST. CHILDREN'S IS LICENSED FOR 290 BEDS AND 42 NICU BASSINETS. THIS INCLUDES 101 CRITICAL CARE BEDS/BASSINETS IN THE FOLLOWING UNITS: PEDIATRIC, NEONATAL, SPECIAL CARE, BURN AND STEM CELL TRANSPLANTS. IN 2011, CHILDREN'S HOSPITAL HAD 13,365 INPATIENT CASES AND 79,689 PATIENT DAYS. INPATIENT SURGERY CASES TOTALED 5,117 FOR 2011. THE CHILDREN'S CRITICAL CARE TRANSPORT TEAM PROVIDES HELICOPTER, JET AND GROUND TRANSPORT FOR CRITICALLY ILL AND INJURED CHILDREN. 140595463 186209965 CHILDREN'S HOSPITAL OPERATES 13 OUTPATIENT SPECIALTY CLINICS THAT HANDLE FOLLOW-UP VISITS FOR PATIENTS AS WELL AS REFERRALS FROM HEALTH DEPARTMENTS ACROSS THE STATE. THESE CLINICS PROVIDE SERVICES IN HEMODIALYSIS, GASTROENTEROLOGY, HEMATOLOGY/ONCOLOGY, ORTHOPEDICS, UROLOGY, OTORINOLARYNGOLOGY, NEUROLOGY, PULMONARY FUNCTION, GENERAL SURGERY, DENTAL, BEHAVIORAL SERVICES, SPEECH AND HEARING, PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND OTHERS. IN 2011, THESE CLINICS HAD 240,293 VISITS AND 15,661 OUTPATIENT SURGERIES WERE PERFORMED. THE HOSPITAL ALSO PROVIDES A STATEWIDE AND REGIONAL REFERRAL SITE FOR COMPLEX EMERGENCY PATIENTS. THE EMERGENCY DEPARTMENT HAD 46,622 VISITS IN 2011. 38191223 41108889 THE HOSPITAL HAS A NETWORK OF PRIMARY CARE PRACTICES THROUGH OUT THE STATE KNOWN AS PEDIATRIC PRACTICE SOLUTIONS. IT CONSISTS OF 13 PRACTICES SUPPORTING 60 GENERAL PEDIATRICIANS. IN 2011 THESE PRACTICES PROVIDED 332,254 VISITS. 426117010 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 264 0 1 4157 1 0 1 CJ 0 0 0 0 0 0 0 0 X 35 29 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAWN WALTON 2056389073 1600 7TH AVENUE SOUTH BIRMINGHAM AL 35233 RAYMOND J HARBERT 0.50 X 0 0 0 C PHILLIP MCWANE 0.50 X 0 0 0 W CHARLES MAYER 0.50 X 0 0 0 SUSAN N HASKELL 0.50 X 0 0 0 RICHARD J BIELEN 0.50 X 0 0 0 J DAVID BROWN III 0.50 X 0 0 0 THOMAS N CARRUTHERS JR 0.50 X 0 0 0 GAYLE CUNNINGHAM 0.50 X 0 0 0 DERROL DAWKINS MD 0.50 X 0 0 0 DAVID E DIXON MD 0.50 X 0 0 0 BETH G DUBINA 0.50 X 0 0 0 DAVID M FIELDS 0.50 X 0 0 0 RALPH FROHSIN JR 0.50 X 0 0 0 GILLIAN W GOODRICH 0.50 X 0 0 0 OB GRAYSON HALL JR 0.50 X 0 0 0 BEVERLY P HEAD III 0.50 X 0 0 0 JOHN O HUDSON III 0.50 X 0 0 0 DONALD M JAMES 0.50 X 0 0 0 VIRGINIA WALKER JONES 0.50 X 0 0 0 PHILIPPE W LATHROP 0.50 X 0 0 0 JAMES C LEE III 0.50 X 0 0 0 THOMAS H LOWDER 0.50 X 0 0 0 ROBERT S MCANNALLY 0.50 X 0 0 0 L GWALTNEY MCCOLLUM JR 0.50 X 0 0 0 CHARLES D MCCRARY 0.50 X 0 0 0 ANN D MCMILLAN 0.50 X 0 0 0 BEVERLY MCNEIL 0.50 X 0 0 0 HUGH J MORGAN JR 0.50 X 0 0 0 W JERRY OAKS MD 0.50 X 0 0 0 CRAFT O'NEAL 0.50 X 0 0 0 MARGARET M PORTER 0.50 X 0 0 0 FREDERICK W RENNEKER III 0.50 X 0 0 0 STUART A ROYAL MD 0.50 X 0 0 0 BEN RUSSELL 0.50 X 0 0 0 SERGIO B STAGNO MD 0.50 X 0 0 0 LEE J STYSLINGER III 0.50 X 0 0 0 TEMPLE W TUTWILER III 0.50 X 0 0 0 MARC BRYANT TYSON 0.50 X 0 0 0 WILLIAM MICHAEL WARREN JR 40.00 X 539645 0 187173 THOMAS G SHUFFLEBARGER 40.00 X 820050 0 117804 JAMES MICHAEL BURGESS 40.00 X 1006289 0 106893 JACKIE STOREY 40.00 X 402147 0 96948 MIKE MCDEVITT 40.00 X 423233 0 144367 DOUGLAS DEAN 40.00 X 326788 0 77530 COKE MATTHEWS 40.00 X 311738 0 70312 AUDIE WOOLLEY 40.00 X 971421 0 98719 JIMMY SCOTT HILL 40.00 X 1893514 0 98719 BRIAN WIATRAK 40.00 X 764357 0 262297 WILLIAM PEYTON SHIRLEY 40.00 X 433727 0 19969 JOSEPH L HAMM 40.00 X 393176 0 19877 8286085 0 1300608 222 0 1 0 HOARBE&K JOINT VENTURE TWO METROPLEX DRIVE STE 400 BIRMINGHAM AL 35209 CONSTRUCTION 91983592 UNIVERSITY OF ALABAMA HEALTH SERVICES FO 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 SUBSPECIALTY, MOONLIGHTING, AFTER HOURS, 16178147 ARAMARK PO BOX 651009 CHARLOTTE NC 282651009 CAFETERIA, CENTRAL TRANSPORT 6449375 THE OUTSOURCE GROUP INC PO BOX 504542 ST LOUIS MO 631504542 PATIENT ACCOUNTING, MANAGEMENT 5246132 UNIVERSITY OF ALABAMA HOSPITAL 619 19TH STREET SOUTH JEFFERSON TO BIRMINGHAM AL 35233 HOSPITAL RESIDENTS 4820852 53 2002149 772276 2774425 PATIENT SERVICE 900099 529671300 529671300 MEDICAID DISPROPORTION 900099 6454846 6454846 536126146 878591 878591 418993 418993 2852101 2993953 -141852 -141852 -141852 33829000 5900 35805231 0 -1976231 5900 -1970331 -1970331 GRADUATE MEDICAL 900099 4115827 4115827 CAFETERIA/VENDING 900099 2586093 2586093 PARKING 900099 949539 949539 2855144 2756698 98446 10506603 548592575 542998671 0 2819479 X 3829889 3446900 382989 184251290 165826161 18425129 23774409 21396968 2377441 12665870 11399283 1266587 404530 364077 40453 202194 181975 20219 32412714 29171443 3241271 7011679 6310511 701168 2993953 2694558 299395 4234462 3811016 423446 31845963 28661367 3184596 4488685 4039816 448869 MEDICAL SUPPLIES 36818538 33136684 3681854 DRUGS 30997280 27897552 3099728 TAXES AND LICENSES 27318096 24586286 2731810 MANAGEMENT CONTRACTS 11450368 10305331 1145037 58763431 52887082 5876349 473463351 426117010 47346341 0 41703106 15680465 112704490 36736664 32654546 37278069 7554292 7524546 10797159 10879861 881107968 383797311 341414537 497310657 27831719 63386914 574659849 668797176 45794428 43921857 6454846 326458593 304903715 53411283 66361937 432119150 415187509 X 142540699 253609667 142540699 253609667 574659849 668797176 X 75129224 35939744 X X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 249541 249541 476207763 476457304 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 402993 293157 230070 249541 1175761 250000 250000 250000 250000 1000000 1500000 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: CHS BELONGS TO CERTAIN ORGANIZATIONS THAT ENGAGE IN LOBBYING ACTIVITIES ON BEHALF OF THEIR HOSPITAL MEMBERS. SINCE THIS IS A NONALLOWABLE EXPENSE, THESE ORGANIZATIONS INFORM THEIR MEMBERS THE PORTION OF THEIR DUES THAT SHOULD BE CONSIDERED APPLICABLE TO LOBBYING EXPENSES SO THAT THE APPROPRIATE ADJUSTMENT CAN BE MADE. IN AN EFFORT TO DETERMINE WHICH DUES INCLUDE LOBBYING EXPENSES, WE REVIEWED THE INVOICES FOR ALL DUES PAYMENTS IN EXCESS OF $10,000 AND SCHEDULED ALL OTHER PAYMENTS WE WERE MADE AWARE OF THROUGH VARIOUS INQUIRY. 4800118 4800118 321381824 189131914 132249910 7018280 3632288 3385992 240970312 191033109 49937203 306937434 306937434 497310657 UNAMORTIZED BOND ISSUE COSTS 9119521 OTHER ASSETS 92346 TEBA ASSET 16741919 INVESTMENT IN AFFILIATE 250000 RESTRICTED CASH 36906684 DUE FROM AFFILIATE 276444 63386914 SALARIES PAYABLE 22645373 ACCRUED INTEREST PAYABLE 1427920 PROFESSIONAL LIABILITY ACCRUAL 3698214 TEBA LIABILITY 16741919 INTEREST RATE SWAP 908227 ESTIMATED THIRD PARTY PAYOR SETTLEMENT 10253185 DUE TO AFFILIATE 10687099 66361937 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL AND THE FOUNDATION ARE EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(A) OF THE INTERNAL REVENUE CODE AS ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3). THE COMPANY ADHERES TO THE PROVISION OF THE ACCOUNTING STANDARDS CODIFICATION RELATING TO UNCERTAINTY IN INCOME TAXES THAT REQUIRES ENTITIES TO ASSESS THEIR UNCERTAIN TAX POSITIONS FOR THE LIKELIHOOD THAT THEY WOULD BE OVERTURNED UPON INTERNAL REVENUE SERVICE (IRS) EXAMINATION OR UPON EXAMINATION BY STATE TAXING AUTHORITIES. THE COMPANY HAS DETERMINED THAT IT DOES NOT HAVE ANY POSITIONS AT DECEMBER 31, 2011, THAT IT WOULD BE UNABLE TO SUBSTANTIATE. THE COMPANY HAS FILED ITS TAX RETURNS THROUGH DECEMBER 31, 2010. THE TAX RETURNS FOR THE YEARS ENDED DECEMBER 31, 2008, AND THEREAFTER ARE SUBJECT TO AUDIT BY THE TAXING AUTHORITIES. 1 1 1 X 1 X 0 0 0 701808 0 701808 0.00150 226134515 258247641 -32113126 0.00000 17401542 19976578 -2575036 0.00000 244237865 278224219 -33986354 0.00150 20 164462 5626868 652371 4974497 0.01070 4 95616 11417088 1696395 9720693 0.02090 3 50 2069470 888355 1181115 0.00250 1 0 253210 0 253210 0.00050 1 878 3574 0 3574 0.00000 29 261006 19370210 3237121 16133089 0.03460 29 261006 263608075 281461340 -17853265 0.03610 0 3036236 2168645 1524800 1915072 -390272 X 0 1 1 CHILDREN'S HOSPITAL OF ALABAMA

1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233

X X X X X X THE CHILDREN'S HOPSTIAL OF ALABAMA 1 0 1 1 250.000000000000 1 400.000000000000 1 X X X X X 1 1 X X X 1 X 1 X X X X 1 X 0 0 PART I, LINE 7: THE COSTING METHODOLOGY USED TO COMPLETE LINE 7 WAS AN OVERALL COST-TO-CHARGE RATIO COMPUTED USING THE IRS FORM 990 WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. PART I, L7 COL(F): TOTAL BAD DEBT EXPENSE OF $8,385,075 IS EXCLUDED FROM TOTAL OPERATING EXPENSES OF $473,463,351 IN CALCULATING THE PERCENTAGES SHOWN. SEE DETAIL OF EXPENSES ON FORM 990, PART IX, LINE 25, COLUMN A. NOTE THAT TOTAL COMMUNITY BENEFIT EXPENSES REPORTED IN COLUMN C AS A PERCENTAGE OF OPERATING EXPENSES NET OF BAD DEBT EXPENSE ARE 56.68% PART II: WHILE THE HOSPITAL DID NOT HAVE SYSTEMS IN PLACE TO FORMALLY TRACK COMMUNITY BUILDING ACTIVITIES FOR 2011, HOSPITAL EXECUTIVES AND VICE PRESIDENTS SERVED ON A VARIETY OF COMMUNITY BOARDS INCLUDING MAGIC MOMENTS AND RONALD MCDONALD HOUSE. IN ADDITION, APPROXIMATELY 50 ADMINISTRATIVE INTERNS AND AIDES WERE EDUCATED BY HOSPITAL EMPLOYEES DURING THE YEAR. PART III, LINE 4: RECEIVABLES FROM PATIENTS, INSURANCE COMPANIES AND THIRD-PARTY CONTRACTUAL AGENCIES ARE STATED AT NET REALIZABLE VALUE. THE HOSPITAL EVALUATES THE COLLECTABILITY OF ITS PATIENT ACCOUNTS RECEIVABLE BASED ON THE LENGTH OF TIME THE RECEIVABLE IS OUTSTANDING, HISTORICAL COLLECTION EXPERIENCE, REVIEW OF LARGE BALANCE ACCOUNTS AND TRENDS IN HEALTH CARE INSURANCE PROGRAMS TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WITH THIRD-PARTY INSURERS, THE HOSPITAL ESTIMATES CONTRACTUAL ALLOWANCES BASED ON THE TERMS OF THIRD-PARTY INSURED CONTRACTS AND ESTIMATES AN ADDITIONAL ALLOWANCE FOR DOUBTFUL ACCOUNTS ON PATIENT RESPONSIBLE BALANCES AFTER THIRD-PARTY PAYMENTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THESE ALLOWANCES ARE RECORDED ON AN ESTIMATED BASIS AND ADJUSTED AS NEEDED IN FUTURE PERIODS. DOUBTFUL ACCOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE AFTER ADEQUATE COLLECTION EFFORT IS EXHAUSTED AND RECORDED AS RECOVERIES OF BAD DEBTS IF SUBSEQUENTLY COLLECTED. THE COST OF BAD DEBT WRITE-OFFS AND THE RELATED COSTS ON LINE 3 WERE CALCULATED BY APPLYING THE OVERALL COST TO CHARGE RATIO OF THE ORGANIZATION TO THE CHARGES WRITTEN OFF. BAD DEBTS ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE WERE CALCULATED BASED ON THE OUTSTANDING PATIENT BALANCE IN EXCESS OF A REASONABLE AMOUNT THE AVERAGE PERSON COULD PAY WITHOUT CREATING A MEDICAL HARDSHIP. FOR 2011 THIS AMOUNT IS $20,000, WHICH APPROXIMATES THE INCOME LIMIT FOR A FAMILY OF 4 IN THE FEDERAL POVERTY GUIDELINES. CHARITY CARE DETERMINATIONS ARE BASED ON COMPLETING THE REQUIRED APPLICATION AND MEETING DEFINED CRITERIA OF THE ORGANIZATION. MANY TIMES PATIENTS FAIL TO COMPLETE PAPERWORK REQUIRED DESPITE EFFORTS TO EDUCATE AND INFORM PATIENTS OF THIS OPTION. HOWEVER BASED ON SOCIO-ECONOMIC AND OTHER KNOWN FACTORS, IT IS HIGHLY LIKELY THAT THESE PATIENTS WOULD MEET ESTABLISHED CHARITY CARE CRITERIA IF THE APPLICATION PROCESS WAS COMPLETED. PART III, LINE 8: MEDICARE SHORTFALL SHOULD BE INCLUDED AS A COMPONENT OF COMMUNITY BENEFIT BECAUSE THE REIMBURSEMENT IS NOT NEGOTIABLE AND DOES NOT COVER COST TO PROVIDE SERVICES. ADDITIONALLY, THE MAJORITY OF THE HOSPITAL'S MEDICARE PATIENTS WOULD BE COVERED BY MEDICAID IF THEY DID NOT FALL UNDER THE MEDICARE COVERAGE OPTION. THE COST RELATED TO PROVIDING MEDICARE SERVICES WAS CALCULATED BY APPLYING THE OVERALL COST TO CHARGE RATIO OF THE ORGANIZATION TO MEDICARE CHARGES. THE CHILDREN'S HOPSTIAL OF ALABAMA PART V, SECTION B, LINE 13G: THE DETAIL FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON THE HOSPITALS WEBSITE AS WELL AS UPON REQUEST. SIGNAGE REFERENCING THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED IN THE EMERGENCY DEPARTMENT AND WAITING AND ADMITTING AREAS. IN ADDITION, THERE IS LANGUAGE INCLUDED ON ALL BILLING INVOICES INFORMING THE GUARANTOR OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. THE CHILDREN'S HOPSTIAL OF ALABAMA PART V, SECTION B, LINE 17E: SIGNAGE IS POSTED IN THE EMERGENCY DEPARTMENT AND WAITING AND ADMITTING AREAS NOTIFYING PATIENTS AND GUARANTORS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. PART VI, LINE 2: THE ORGANIZATION ASSESSES THE HEALTHCARE NEEDS OF THE COMMUNITIES IT SERVES BY EVALUATING DISEASE AND INJURY DATA OF PATIENTS THAT ARE SERVED IN THE HOSPITAL AND CLINICS AND THAT PRESENT IN THE EMERGENCY DEPARTMENT, PARTICULARLY AROUND INJURY CARE. IN ADDITION, THE ORGANIZATION CONSIDERS INFORMATION PROVIDED BY LOCAL PEDIATRICIANS, THE CENTER FOR DISEASE CONTROL, AND OTHER NATIONAL, STATE, AND LOCAL HEALTHCARE GROUPS. PART VI, LINE 3: EACH PATIENT THAT PRESENTS AS A SELF PAY PATIENT IS DIRECTED TO A FINANCIAL COUNSELOR. THE FINANCIAL COUNSELOR EDUCATES PATIENTS AND THEIR FAMILIES ABOUT GOVERNMENT AND FINANCIAL ASSISTANCE PROGRAMS AND ASSISTS WITH RELATED APPLICATIONS. IF A PATIENT IS NOT COUNSELED BY A FINANCIAL COUNSELOR ON THE DATE OF SERVICE, FOLLOW UP ATTEMPTS ARE MADE BY THE FINANCIAL COUNSELORS AND THE BUSINESS OFFICE TO CONTINUE TO INFORM AND EDUCATE PATIENTS RELATED TO AVAILABLE PROGRAMS. IN ADDITION, THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE AND THERE IS SIGNAGE THROUGHOUT THE HOSPITAL INFORMING PATIENTS OF THE AVAILABILITY OF A FINANCIAL ASSISTANCE PROGRAM. PART VI, LINE 4: CHILDREN'S PRIMARY SERVICE AREA IS BIRMINGHAM-HOOVER METROPOLITAN STATISTICAL AREA AS DEFINED BY THE U.S. OFFICE OF MANAGEMENT AND BUDGET. THE HOSPITAL'S SECONDARY SERVICE AREA IS DEFINED AS THE REST OF THE STATE, AND WE CARE FOR PATIENTS FROM EVERY COUNTY IN THE STATE. DEMOGRAPHIC DATA INCLUDING RACE, GENDER, AND AGE IS CAPTURED THROUGH THE REGISTRATION PROCESS. FOR 2011, CAUCASIANS, AFRICAN-AMERICANS, HISPANICS, AND OTHER RACES ACCOUNTED FOR 56%, 36%, 5%, AND 3%, RESPECTIVELY, OF THE PATIENTS SERVED WHILE 42%, 36%, AND 22% WERE AGES 0-4, 5-12, AND 13+ YEARS, RESPECTIVELY. ECONOMIC DEMOGRAPHIC DATA IS NOT SPECIFICALLY CAPTURED HOWEVER, IN 2011 GREATER THAN 60% OF THE HOSPITAL'S PATIENTS QUALIFIED FOR GOVERNMENTAL MEANS-TESTED PROGRAMS SUCH AS MEDICAID AND SCHIP. PART VI, LINE 5: CHILDREN'S HOSPITAL IS THE PRIMARY SOURCE OF PEDIATRIC HEALTHCARE AND PEDIATRIC HEALTH EDUCATION IN THE STATE OF ALABAMA THROUGH ITS AFFILIATION WITH THE SCHOOL OF MEDICINE AT THE UNIVERSITY OF ALABAMA AT BIRMINGHAM. THE HOSPITAL OPERATES AN OPEN MEDICAL STAFF, HAS A BOARD COMPRISED OF COMMUNITY MEMBERS, AND OPERATES AN OPEN EMERGENCY DEPARTMENT THAT TREATS ALL EMERGENT PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL OPERATES THE ONLY LEVEL 1 PEDIATRIC TRAUMA CENTER, THE ONLY PEDIATRIC RENAL CARE CENTER, AND THE ONLY INPATIENT CHILDREN'S PSYCHIATRIC UNIT IN THE STATE. IN ADDITION, THE HOSPITAL OPERATES THE LARGEST PEDIATRIC BURN CENTER IN THE SOUTHEAST. THE HOSPITAL IS EDUCATION AND RESEARCH FOCUSED AND COLLABORATES WITH LOCAL UNIVERSITIES, AS WELL AS THOSE THROUGHOUT THE STATE, TO TRAIN AND EDUCATE FUTURE HEALTHCARE PROFESSIONALS. THIS IS REFLECTED BY THE FACT THAT APPROXIMATELY 50-60% OF THE PEDIATRICIANS PRACTICING IN THE STATE OF ALABAMA TRAINED AT CHILDREN'S HOSPITAL AND THAT THE HOSPITAL TRAINED NURSING STUDENTS FROM 14 DIFFERENT COLLEGES AND UNIVERSITIES DURING 2011. IN ADDITION, THE HOSPITAL PARTICIPATES APPROXIMATELY 225 CLINICAL RESEARCH STUDIES ON AN ANNUAL BASIS. X X X X 0 1 0 0 0 0 0 0 0 WILLIAM MICHAEL WARREN JR 538220 0 0 0 1425 0 172583 0 14590 0 726818 0 0 0 THOMAS G SHUFFLEBARGER 337180 0 137000 0 345870 0 91434 0 26370 0 937854 0 344430 0 JAMES MICHAEL BURGESS 317577 0 153000 0 535712 0 83732 0 23161 0 1113182 0 534244 0 JACKIE STOREY 290705 0 110000 0 1442 0 85223 0 11725 0 499095 0 0 0 MIKE MCDEVITT 271761 0 150000 0 1472 0 123961 0 20406 0 567600 0 0 0 DOUGLAS DEAN 231788 0 95000 0 0 0 53532 0 23998 0 404318 0 0 0 COKE MATTHEWS 223323 0 87000 0 1415 0 57357 0 12955 0 382050 0 0 0 AUDIE WOOLLEY 517552 0 408946 0 44923 0 78750 0 19969 0 1070140 0 43390 0 JIMMY SCOTT HILL 512280 0 408946 0 972288 0 78750 0 19969 0 1992233 0 970851 0 BRIAN WIATRAK 353974 0 408946 0 1437 0 242328 0 19969 0 1026654 0 0 0 WILLIAM PEYTON SHIRLEY 332777 0 99490 0 1460 0 0 0 19969 0 453696 0 0 0 JOSEPH L HAMM 246288 0 145463 0 1425 0 0 0 19877 0 413053 0 0 0 PART I, LINE 4B PART I, LINE 4B: WILLIAM MICHAEL WARREN, JR - $172,583 THOMAS G. SHUFFLEBARGER - $91,434 JAMES MICHAEL BURGESS - $83,732 JACKIE STOREY - $85,223 DOUGLAS B. DEAN - $53,532 COKE MATTHEWS - $57,357 AUDIE WOOLLEY - $78,750 JIMMY SCOTT HILL - $78,750 BRIAN WIATRACK - $242,328 MIKE MCDEVITT - $123,961 SPECIAL CARE FACILITIES FINANCING AUTH OF THE CTY OF BHAM - CHILDREN'S HOSP 631005621 090929FF2 2003-04-16 34031552 DEFEASE 1993-B REVENUE BONDS 0 0 0 SPECIAL CARE FACILITIES FINANCING AUTH OF THE CTY OF BHAM - CHILDREN'S HOSP 631005621 090929FV7 2009-09-01 233179363 CONSTRUCT AND EQUIP FACILITY 0 0 0 34031552 3746407 358832 630695 33042025 1 0 1 1 233179363 22803600 25538118 3480828 4329725 176300761 726331 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 1 BAYERISCHE LANDESBANK 0.043200000000 1 0 0 0 0 0 0 0 0 BUFFALO ROCK ENTITY MORE THAN 35% OWNED BY JAMES C. LEE, III, DIRECTOR 164890 VENDING 0 ALABAMA POWER CHARLES D. MCCRARY & DONALD JAMES ARE DIRECTORS OF THE ABOVE ENTITY 4109637 ELECTRICITY PROVIDER 0 ALABAMA GAS CORPORATION ROBERT MCANNALLY IS EMPLOYED BY THE ABOVE ENTITY 1406557 GAS UTILITY 0 REGIONS BANK CHARLES D. MCCRARY & LEE STYSLINGER ARE DIRECTORS OF THE ABOVE ENTITY 217080 BANKING SERVICES 0 REGIONS BANK O.B. GRAYSON HALL, JR. IS THE CEO OF THE ABOVE ENTITY 217080 BANKING SERVICES 0 FORM 990, PART VI, SECTION A, LINE 2 THOMAS N. CARRUTHERS, JR. IS A PARTNER IN A FIRM WHICH ACTS AS GENERAL COUNSEL FOR THE HOSPITAL AS WELL AS COUNSEL TO THE OBLIGATED GROUP AND BOND COUNSEL. DERROL DAWKINS, M.D. HAS ADMITTING PRIVILEGES TO THE HOSPITAL. GILLIAN W. GOODRICH'S DAUGHTER IS A MEMBER OF THE UAB MEDICAL STAFF AND PROVIDES SERVICES AT THE HOSPITAL. IN ADDITION, MS. GOODRICH'S SPOUSE WAS AN OWNER OF A CONSTRUCTION COMPANY THAT WAS A PARTNER IN THE LEAD CONTRACTOR PARTNERSHIP ON A MAJOR EXPANSION PROJECT AT THE TIME THE PROJECT WAS BID. O.B. GRAYSON HALL, JR. IS THE CEO OF A BANK THAT PROVIDES THE MAJORITY OF THE BANKING SERVICES TO THE HOSPITAL. RAYMOND J. HARBERT OWNS AN INVESTMENT COMPANY THAT MANAGES A HEDGE FUND IN WHICH THE HOSPITAL HAS INVESTED THROUGH A FUND OF FUNDS. PRIOR TO PASSING AWAY DURING 2011, BEVERLY P. HEAD, III WAS THE LEAD TRUSTEE OF AN ORGANIZATION THAT MAKES CONTRIBUTIONS TO THE FOUNDATION. IN ADDITION, MR. HEAD'S SPOUSE HAS AN OWNERSHIP INTEREST IN AND IS EMPLOYED BY A COMPANY THAT DISTRIBUTES CONSTRUCTION MATERIALS AND RELATED EQUIPMENT THAT ARE BEING UTILIZED BY THE HOSPITAL'S CONTRACTORS ON A MAJOR EXPANSION PROJECT. DONALD M. JAMES IS A DIRECTOR OF A BANK WHICH WAS AN UNDERWRITER FOR THE HOSPITAL BONDS. MR. JAMES IS ALSO A DIRECTOR FOR THE PARENT COMPANY OF AN ELECTRIC UTILITY THAT PROVIDES UTILITY SERVICES TO THE HOSPITAL. IN ADDITION, MR. JAMES IS A TRUSTEE FOR UAB HEALTH SYSTEM AND UAB HEALTH SERVICES FOUNDATION BOTH OF WHICH HAVE AN AFFILIATION AGREEMENT TO PROVIDE MEDICAL SERVICES TO THE HOSPITAL. VIRGINA WALKER JONES IS EMPLOYED BY A COMPANY THAT PROVIDES CERTAIN VENDING SERVICES TO THE HOSPITAL. IN ADDITION, MARGARET M. PORTER AND THE SPOUSE OF MS. JONES ARE MEMBERS OF AN ADVISORY BOARD FOR A BANK THAT WAS AN UNDERWRITER AND THAT CURRENTLY PROVIDES THE MAJORITY OF THE BANKING SERVICES TO THE HOSPITAL. MARGARET M. PORTER'S SPOUSE HOLDS A MINORITY OWNERSHIP IN A REAL ESTATE CONSULTING FIRM THAT PROVIDES SERVICES TO THE HOSPITAL. JAMES C. LEE, III IS THE OWNER OF A COMPANY THAT PROVIDES VENDING SERVICES TO THE HOSPITAL. THOMAS H. LOWDER SERVES ON THE BOARD OF TWO ORGANIZATIONS THAT MAKE CONTRIBUTIONS TO THE FOUNDATION. ROBERT S. MCANNALLY IS EMPLOYED BY THE PARENT COMPANY OF AN GAS UTILITY THAT PROVIDES UTILITY SERVICES TO THE HOSPITAL. L. GWALTNEY MCCOLLUM, JR IS EMPLOYED BY AN ORGANIZATION THAT SERVES AS CUSTODIAN TO THE INVESTMENT PORTFOLIO FOR THE HOSPITAL AND FOUNDATION. CHARLES D. MCCRARY IS THE CEO OF AN ELECTRIC UTILITY WHICH PROVIDES UTILITY SERVICES TO THE HOSPITAL AS WELL AS SERVES AS A BOARD MEMBER FOR A BANK THAT WAS AN UNDERWRITER AND THAT CURRENTLY PROVIDES THE MAJORITY OF THE BANKING SERVICES TO THE HOSPITAL. W. JERRY OAKES, M.D. OCCUPIED THE DAN HENDLEY ENDOWED CHAIR, WHICH IS FUNDED BY THE FOUNDATION, DURING 2011. STUART A. ROYAL, M.D. IS EMPLOYED BY AN ORGANIZATION THAT PROVIDES SERVICES TO THE HOSPITAL AND SERVES ON AN ADVISORY COMMITTEE FOR A COMPANY THAT PROVIDES SOFTWARE SYSTEMS AND RELATED CONSULTING TO THE HOSPITAL. IN ADDITON, THE FOUNDATION FUNDS THE HARRY BURNS ENDOWED CHAIR WHICH WAS OCCUPIED BY DR. ROYAL DURING 2011. BEN RUSSELL IS THE FOUNDER AND CHAIRMAN OF THE BOARD OF A NON-PROFIT ORGANIZATION THAT LEASES SPACE FROM THE HOSPITAL TO PROVIDE FAMILY SERVICE ACTIVITIES TO PATIENTS AND THEIR FAMILIES. SERGIO B. STAGNO, M.D. IS THE CHAIRMAN OF THE UAB DEPARTMENT OF PEDIATRICS WHICH HAS AN AFFILIATION AGREEMENT WITH THE HOSPITAL TO PROVIDE CERTAIN MEDICAL SERVICES. LEE J. STYSLINGER, III SERVES AS A BOARD MEMBER FOR A BANK THAT IS AN UNDERWRITER AND THAT CURRENTLY PROVIDES THE MAJORITY OF THE BANKING SERVICES TO THE HOSPITAL. MARC TYSON IS THE CEO OF A COMPANY, WHICH IS PROVIDING CONCRETE FOR THE EXPANSION. THE HOSPITAL BELIEVES THAT ALL BUSINESS WITH SUCH FIRMS AND BUSINESSES IS CONDUCTED ON TERMS AND CONDITIONS NO LESS FAVORABLE TO THE HOSPITAL THAN THAT WITH UNRELATED THIRD PARTIES. FORM 990, PART VI, SECTION B, LINE 11 THE COMPLETED FORM 990 IS REVIEWED IN DETAIL BY THE FINANCE AND AUDIT COMMITTEE, AS WELL AS THE BOARD OF TRUSTEES, PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE CORPORATE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. ANNUAL DISCLOSURE REQUESTS ARE SENT AND FOLLOWED UP ON TO ENSURE THAT ALL ARE RETURNED. RETURNED CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AND COMPLIANCE DEPARTMENT STAFF AS WELL AS OFFICERS OF THE ORGANIZATION FOR ACCURACY AND COMPLETENESS. CONFLICT OF INTEREST STATEMENTS ARE MAINTAINED BY THE COMPLIANCE DEPARTMENT. THE COMPLIANCE OFFICER REPORTS ACTIVITY RELATED TO ANY POTENTIAL CONFLICTS OF INTEREST, INCLUDING CHANGES IN PREVIOUSLY REPORTED CONFLICTS, TO ADMINISTRATION, THE COMPLIANCE COMMITTEE, THE FINANCE & AUDIT COMMITTEE, AND THE BOARD OF TRUSTEES ON A REGULAR BASIS. FORM 990, PART VI, SECTION B, LINE 15 CHS MAINTAINS OVERSIGHT CONCERNING ALL EXECUTIVE COMPENSATION ACTION. THIS PROCESS IS LED BY THE CHS BOARD OF TRUSTEES COMPENSATION COMMITTEE, WHICH IS INVOLVED ANNUALLY, AND THROUGHOUT THE YEAR AS NEEDED, IN PROVIDING OVERSIGHT OF ALL EXECUTIVE COMPENSATION. TOTAL COMPENSATION (I.E. BASE SALARY, INCENTIVE COMPENSATION, AND EXECUTIVE BENEFITS) OF OFFICERS, KEY EMPLOYEES, AND OTHER VICE-PRESIDENTS IS APPROVED BY THE COMPENSATION COMMITTEE PRIOR TO SUCH COMPENSATION BEING PAID. THE TOTAL COMPENSATION THAT IS PRESENTED FOR APPROVAL IS DETERMINED BY EVALUATION OF MARKET DATA COMPARISONS ON EXECUTIVE TOTAL COMPENSATION. THIS INDEPENDENT, OBJECTIVE MARKET DATA IS PROVIDED BY THE HOSPITAL'S INDEPENDENT EXECUTIVE COMPENSATION CONSULTING FIRM, MERCER. ALL COMPENSATION COMMITTEE PROCEEDINGS, DECISIONS, AND ACTIONS ARE DOCUMENTED IN COMMITTEE MINUTES THAT ARE MAINTAINED BY THE HOSPITAL. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY IS SUMMARIZED IN THE CORPORATE CODE OF CONDUCT WHICH IS AVAILABLE ON THE HOSPITAL'S WEBSITE. THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT GENERALLY AVAILABLE TO THE PUBLIC. ALL OTHER FUNCTIONAL EXPENSES FORM 990, PART X, LINE 24E LAB EXPENSE: PROGRAM SERVICE EXPENSES 9,310,733. MANAGEMENT AND GENERAL EXPENSES 1,034,526. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,345,259. BAD DEBT EXPENSE: PROGRAM SERVICE EXPENSES 7,546,568. MANAGEMENT AND GENERAL EXPENSES 838,508. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,385,076. EQUIPMENT RENTAL AND MAINTENANCE: PROGRAM SERVICE EXPENSES 5,598,502. MANAGEMENT AND GENERAL EXPENSES 622,056. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,220,558. MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 4,241,862. MANAGEMENT AND GENERAL EXPENSES 471,323. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,713,185. EQUIPMENT RELATED SUPPLIES: PROGRAM SERVICE EXPENSES 3,742,182. MANAGEMENT AND GENERAL EXPENSES 415,798. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,157,980. CONSULTING FEES: PROGRAM SERVICE EXPENSES 3,646,705. MANAGEMENT AND GENERAL EXPENSES 405,189. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,051,894. MAINTENANCE: PROGRAM SERVICE EXPENSES 3,099,235. MANAGEMENT AND GENERAL EXPENSES 344,359. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,443,594. MINOR MEDICAL EQUIPMENT: PROGRAM SERVICE EXPENSES 2,673,311. MANAGEMENT AND GENERAL EXPENSES 297,035. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,970,346. TRANSPORTATION: PROGRAM SERVICE EXPENSES 2,484,509. MANAGEMENT AND GENERAL EXPENSES 276,057. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,760,566. SUPPLIES: PROGRAM SERVICE EXPENSES 2,447,966. MANAGEMENT AND GENERAL EXPENSES 271,996. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,719,962. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,188,046. MANAGEMENT AND GENERAL EXPENSES 243,116. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,431,162. TELEPHONE: PROGRAM SERVICE EXPENSES 1,449,953. MANAGEMENT AND GENERAL EXPENSES 161,106. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,611,059. PROFESSIONAL DUES: PROGRAM SERVICE EXPENSES 1,277,844. MANAGEMENT AND GENERAL EXPENSES 141,983. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,419,827. REGISTRATION FEES: PROGRAM SERVICE EXPENSES 530,533. MANAGEMENT AND GENERAL EXPENSES 58,948. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 589,481. SUBSCRIPTIONS AND PUBLICATIONS: PROGRAM SERVICE EXPENSES 459,091. MANAGEMENT AND GENERAL EXPENSES 51,010. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 510,101. BANKING FEES: PROGRAM SERVICE EXPENSES 431,707. MANAGEMENT AND GENERAL EXPENSES 47,967. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 479,674. PRINTING AND PUBLICATIONS: PROGRAM SERVICE EXPENSES 311,000. MANAGEMENT AND GENERAL EXPENSES 34,556. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 345,556. POSTAGE AND SHIPPING: PROGRAM SERVICE EXPENSES 310,672. MANAGEMENT AND GENERAL EXPENSES 34,519. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 345,191. COLLECTION FEES: PROGRAM SERVICE EXPENSES 297,296. MANAGEMENT AND GENERAL EXPENSES 33,033. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 330,329. LODGING: PROGRAM SERVICE EXPENSES 275,171. MANAGEMENT AND GENERAL EXPENSES 30,575. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 305,746. NOVELTIES: PROGRAM SERVICE EXPENSES 219,677. MANAGEMENT AND GENERAL EXPENSES 24,409. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 244,086. MEALS: PROGRAM SERVICE EXPENSES 184,989. MANAGEMENT AND GENERAL EXPENSES 20,554. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 205,543. SPECIAL FUNCTIONS: PROGRAM SERVICE EXPENSES 152,547. MANAGEMENT AND GENERAL EXPENSES 16,950. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 169,497. RECOGNITIONS: PROGRAM SERVICE EXPENSES 6,974. MANAGEMENT AND GENERAL EXPENSES 775. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,749. TELETHON EXPENSE: PROGRAM SERVICE EXPENSES 9. MANAGEMENT AND GENERAL EXPENSES 1. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,798,580. TRANSFER FROM ALABAMA CHILDREN'S HOSPITAL FOUNDATION 34,141,164. TOTAL TO FORM 990, PART XI, LINE 5: 35,939,744. FORM 990, PART XI, LINE 2C: THE ORGANIZATION MADE NO CHANGES TO ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. ALABAMA CHILDREN'S HOSPITAL FOUNDATION 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 630879471 FUNDRAISING ACTIVITIES AL 501(C)(3) SUPPORTING ORG I THE CHILDREN'S HOSPITAL OF ALABAMA 1 THE CHILDREN'S HOSPITAL AUXILIARY 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 630774930 FUNDRAISING ACTIVITIES AL 501(C)(3) SUPPORTING ORG III N/A 0 TCH VENTURES 1600 7TH AVENUE SOUTH BIRMINGHAM AL 35233 630942442 HOLDING COMPANY AL THE CHILDREN'S HOSPITAL OF ALABAMA C 276883 1.00000 HOLY INNOCENTS INDEMNITY LTD PO BOX 10073 APO GRAND CAYMAN GRAND CAYMAN CJ 980436612 INSURANCE CJ THE CHILDREN'S HOSPITAL OF ALABAMA C 3834336 22546136 1.00000 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 1 0 ALABAMA CHILDREN'S HOSPITAL FOUNDATION B 23058100 FAIR MARKET VALUE ALABAMA CHILDREN'S HOSPITAL FOUNDATION E 3317223 FAIR MARKET VALUE HOLY INNOCENTS INDEMNITY LLC E 386910 FAIR MARKET VALUE HOLY INNOCENTS INDEMNITY LLC Q 3343836 FAIR MARKET VALUE ALABAMA CHILDREN'S HOSPITAL FOUNDATION C 57199264 FAIR MARKET VALUE TCH VENTURES D 276444 FAIR MARKET VALUE