2011-11-10T09:51:13-06:00 2010-12-31 KOLBCO SC 13400 BISHOPS LANE SUITE 300 BROOKFIELD WI 53005 990 2010-01-01 391500074 CHILDREN'S HOSPITAL AND HEALTH SYSTEM INC CHIL 4142665420 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 MARC CADIEUX 4142665420 2011-10-24 1 BRYAN L PAUTSCH CPA 2627549400 2011-10-24 2010 2016-03-07 17:11:31Z MARC CADIEUX 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 89016303 0 X WWW.CHW.ORG X 1985 WI INTEGRATED AND COORDINATED HEALTH SERVICES NETWORK FOR INFANTS, CHILDREN AND ADOLESCENTS. 25 17 621 2132 515358 0 1085227 13600714 71978921 74260183 179672 279709 561264 875430 73805084 89016036 793796 471296 0 0 43785228 47534061 0 0 0 27904998 41136912 72484022 89142269 1321062 -126233 79135568 77799339 17076322 15566603 62059246 62232736 X CHILDREN'S HOSPITAL AND HEALTH SYSTEM, INC. ("CHHS") IS COMMITTED TO ENSURING A HEALTHIER FUTURE FOR CHILDREN BY PROVIDING AN INTEGRATED AND COORDINATED HEALTH AND SOCIAL SERVICES NETWORK FOR INFANTS, CHILDREN AND ADOLESCENTS. 1 0 52808712 455185 58150307 CHHS IS THE PARENT ORGANIZATION OF AN INTEGRATED SYSTEM OF ENTITIES PROVIDING COMPREHENSIVE MEDICAL CARE AND SOCIAL SERVICES TO CHILDREN FROM WISCONSIN AND THROUGHOUT THE MIDWEST. THE SYSTEM INCLUDES WISCONSIN'S ONLY FREESTANDING HOSPITAL DEDICATED SOLELY TO THE CARE AND TREATMENT OF CHILDREN, AS WELL AS VARIOUS OTHER FACILITIES PROVIDING INPATIENT AND OUTPATIENT CARE FOR CHILDREN WITH ALL TYPES OF ILLNESSES, INJURIES, BIRTH DEFECTS AND OTHER DISORDERS. THE SYSTEM ALSO INCLUDES EXTENSIVE RESEARCH, EDUCATION AND COMMUNITY OUTREACH PROGRAMS. ON AN AGGREGATE BASIS, THE ENTITIES WITHIN THE SYSTEM PROVIDED COMMUNITY BENEFITS OF OVER $105 MILLION.CHHS OVERSEES AND COORDINATES THE ACTIVITIES OF THE VARIOUS OPERATING ENTITIES WITHIN THE INTEGRATED SYSTEM, INCLUDING THROUGH THE PROVISION OF SUPPORTIVE AND ADMINISTRATIVE SERVICES ON A CONSOLIDATED, CENTRALIZED BASIS. 11914091 732814 CHILDREN'S RESEARCH INSTITUTE ("CRI") IS A PROGRAM OF CHHS THAT CONDUCTS RESEARCH FOCUSED IN EIGHT STRATEGIC THEMES OR OBJECTIVES: GENOMICS; CANCER/IMMUNOLOGY/HOST RESPONSE; CARDIOVASCULAR BIOLOGY; DEVELOPMENTAL & CELL BIOLOGY; COMMUNITY HEALTH & PREVENTION; CLINICAL RESEARCH EFFECTIVENESS & OUTCOMES; BEHAVIORAL HEALTH; AND HEALTH SERVICES RESEARCH. ONE AREA OF FOCUS WITHIN THE CRI'S STRATEGIC OBJECTIVE OF GENOMICS IS "INDIVIDUALIZED PEDIATRICS" WHICH WOULD ENABLE PHYSICIANS TO USE EACH CHILD'S UNIQUE GENETIC SIGNATURE TO IDENTIFY DISEASES, DISEASE SUSCEPTABILITY, AND DISEASE PROGNOSIS. IN 2010, CLINICIANS AND RESEARCHERS USED GENETIC SEQUENCING OF DNA TO HELP DIAGNOSE AND TREAT A MYSTERY ILLNESS IN A DYING CHILD. THE GROUND-BREAKING RESEARCH WAS PUBLISHED IN "GENETICS IN MEDICINE" AND RECEIVED COVERAGE IN LOCAL, NATIONAL, AND INTERNATIONAL MEDIA OUTLETS. ANOTHER CRI INVESTIGATOR WAS AWARDED A GRANT FROM THE NATIONAL INSTITUTES OF HEALTH'S NATIONAL HEART, LUNG, AND BLOOD INSTITUTE TO CONTINUE STUDYING A RARE AND POTENTIALLY FATAL HEART AND LUNG CONDITION CALLED PERSISTENT PULMONARY HYPERTENSION OF THE NEWBORN. THIS RESEARCH WILL POTENTIALLY FOSTER DEVELOPMENT OF NEW TREATMENTS TO IMPROVE THE LIVES OF INFANTS IMPACTED BY THIS DEBILITATING CONDITION. 9855406 14611031 CHHS PROVIDES VARIOUS OUTPATIENT HEALTH CARE SERVICES. IN 2010, THERE WERE 20,749 VISITS TO THE ORGANIZATION'S URGENT CARE CLINICS, AND 6,278 OUTPATIENT SURGICAL CASES PERFORMED AT THE ORGANIZATION'S OUTPATIENT AMBULATORY SURGICAL CENTER, THE SURGICENTER OF GREATER MILWAUKEE, LLC (A DISREGARDED ENTITY FOR FEDERAL TAX PURPOSES). 3213889 16111 766031 OTHER PROGRAMS OF CHHS INCLUDE THE OUTCOMES ANALYSIS SERVICES AT NATIONAL OUTCOMES CENTER ("NOC") AND HEALTH EDUCATION SERVICES AT CHILDREN'S HEALTH EDUCATION CENTER ("CHEC"). NOC PROVIDES PROFESSIONAL SERVICES ON A CONTRACTUAL BASIS FOR DATA MANAGEMENT AND ANALYSIS SERVICES AND REVIEWS OF CLINICAL OUTCOMES PURSUANT TO HEALTH RELATED STUDIES FOCUSED ON ENHANCING MORE EFFECTIVE AND EFFICIENT DELIVERY OF HEALTH CARE.CHEC OFFERS FREE AND INEXPENSIVE HEALTH EDUCATION PROGRAMS AND RESOURCES TO TEACHERS, CHILDREN AND PARENTS. PROGRAMS OFFERED INCLUDE IN CLASSROOM PROGRAMS ON HEALTHY EATING AND EXERCISE, BULLYING AND TEEN DEPRESSION, IN ADDITION TO FIELD TRIPS AT OUR BRIGHT AND ENGAGING FACILITY. CHEC ALSO HAS INJURY PREVENTION PROGRAMS WHICH FOCUS ON CAR SEAT AND BIKE HELMET FITTINGS, TO KEEP CHILDREN SAFE AND HEALTHY. ADDITIONALLY, CHEC OFFERS HEALTH-BASED E-LEARNING PROGRAMS THROUGH BLUEKIDS.ORG WHICH HELPS STUDENTS MAKE MORE POSITIVE HEALTH CHOICES. OVERALL, OUR PROGRAMS REACHED MORE THAN 142,000 FAMILIES IN 2010. 3213889 16111 766031 77792098 1 1 0 1 0 0 0 1 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 X 47 0 621 1 1 1 0 0 0 0 0 0 0 0 0 X 25 17 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 WI X MR JASON PELSIS 4142665997 9000 W WISCONSIN AVENUE MILWAUKEE WI 53201 WILLIAM J ABRAHAM JR 1.00 X 0 0 0 MICHAEL W ALTSCHAEFL 1.00 X 0 0 0 THOMAS M BOLGER 1.00 X 0 0 0 ELIZABETH BRENNER 1.00 X 0 0 0 CURT S CULVER 1.00 X 0 0 0 DAVID J DRURY 1.00 X X 0 0 0 DAVID H GILBERT 1.00 X 0 0 0 SUSAN HERMA 1.00 X 0 0 0 MARK R HOGAN 1.00 X 0 0 0 PAUL W JONES 1.00 X 0 0 0 JOSEPH KERSCHNER MD 1.00 X 0 0 0 ROBERT M KLIEGMAN MD 1.00 X 0 0 0 MARLENE MELZER LANGE MD 1.00 X 0 35000 0 C DAVID MYERS 1.00 X 0 0 0 KEITH T OLDHAM MD 1.00 X 0 0 0 ALBERT S ORR III 1.00 X 0 0 0 MICHAEL T PEPKE 1.00 X 0 0 0 J JOEL QUADRACCI 1.00 X 0 0 0 LARRY A RAMBO 1.00 X 0 0 0 JAY O ROTHMAN 1.00 X 0 0 0 JOHN E SCHLIFSKE 1.00 X 0 0 0 JOHN S SHIELY 1.00 X 0 0 0 PETER M SOMMERHAUSER 1.00 X X 0 0 0 OWEN J SULLIVAN 1.00 X 0 0 0 TIMOTHY W SULLIVAN 1.00 X 0 0 0 MARK C WITT 1.00 X 0 0 0 MARGARET TROY 40.00 X X 997755 0 247005 TIMOTHY L BIRKENSTOCK 40.00 X 596957 0 81491 MICHELLE METTNER 40.00 X 216862 0 29957 MICHAEL NAUMAN 40.00 X 354337 0 61437 MARGARET NIEMER 40.00 X 338003 0 62047 SHEILA REYNOLDS 40.00 X 353276 0 64317 RAMESH SACHDEVA MD 40.00 X 378816 0 58468 ROBERT SANDERS 40.00 X 217980 0 50065 ROBERT DUNCAN 40.00 X 189626 0 30641 JULIET KERSTEN 40.00 X 201424 0 57975 LAWRENCE DUNCAN 40.00 X 217359 0 12389 THOMAS GAZZANA 40.00 X 322305 0 31340 CINTHIA S CHRISTENSEN 40.00 X 0 516425 82730 DENISE AUGUSTIN 40.00 X 172267 0 31587 BARBARA JOERS 40.00 X 103870 0 15700 JAMES MILLER 40.00 X 412872 0 58996 THOMAS DUNIGAN MD 40.00 X 380553 0 61097 DAVID FRIEDBERG MD 40.00 X 359874 0 27215 MARK ANDERSON 40.00 X 208511 0 45117 MARTIN VOGEL 40.00 X 201375 0 57847 JON E VICE - FORMER 0.00 X 5795708 0 39648 KENNETH MUNSON - FORMER 0.00 X 293183 0 26908 12209043 551425 1218277 73 1 1 0 MEDICAL COLLEGE OF WISCONSIN 8701 WATERTOWN PLANK RD MILWAUKEE WI 53226 RESEARCH SERVICES/ MEDICAL LEADERSHIP 9468789 MICROSOFT LICENSING GP 1401 ELM ST 5TH FLR DEPT 842467 DALLAS TX 75202 SOFTWARE LICENSING AND MAINTENANCE FEES 1608469 ECLIPSYS SOLUTIONS CORP LOCKBOX 077133 PO BOX 8538-0133 PHILADELPHIA PA 19171 SOFTWARE LICENSING AND MAINTENANCE FEES 1584258 KURT SALMON ASSC INC PO BOX 930916 ATLANTA GA 311930916 CONSULTING AND MANAGEMENT FEES 701295 CHARTIS GROUP LLC DEPT 5925 CAROL STREAM IL 601225925 CONSULTING AND MANAGEMENT FEES 568161 50 13088432 391133 121149 13600714 OPER SUPPORT SERVICES 541900 58150307 56378397 515358 1256552 OUTPATIENT HEALTH CARE 621400 14611031 14611031 RESEARCH ADMIN FEE 900099 732814 732814 DATA MGMT & ANALYSIS 541900 656036 656036 CHEC FEES 900099 109995 109995 74260183 279976 279976 267 -267 -267 -267 EDUCATIONAL SERVICES 611430 265718 265718 609712 608264 1448 875430 89016036 73361988 515358 1537976 385776 385776 85520 85520 7189137 6147050 1042087 30728827 26088267 4640560 1373716 1174690 199026 5711273 4850778 860495 2531108 2135229 395879 38191 178 38013 260537 229846 30691 298141 250532 47609 208179 184164 24015 5723018 4789086 933932 903230 854479 48751 875442 675609 199833 9122266 8016123 1106143 3476860 2998391 478469 752971 659244 93727 128418 106864 21554 4601637 4072961 528676 551588 374847 176741 RESEARCH 5685913 5685913 MEDICAL SUPPLIES 2184172 2144369 39803 SUBSCRIPTION & DUES 826589 724846 101743 ASC ASSESSMENT TAX 436276 436276 PROVISION FOR UNCOLLECT 291202 291202 4772282 4429858 342424 89142269 77792098 11350171 0 3677236 7713704 361142 357989 3624349 1658235 21000 444539 467897 3462865 3973287 72835630 18066457 58574040 54769173 8991397 8838054 79135568 77799339 10071662 10075345 15812 4001 109656 86837 6879192 5400420 17076322 15566603 X 60444682 60318449 1322763 1490112 291801 424175 62059246 62232736 79135568 77799339 X -126233 299723 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 282225 282225 77073597 77355822 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 445960 592525 374061 282225 1694771 250000 250000 250000 250000 1000000 1500000 1 155512 708619 705137 158994 0 1614564 1249343 30138 978936 822 1914287 1614564 1614564 0.00000 0.22200 0.77800 0 1 1 1457978 1457978 49679328 7771152 41908176 2259723 1861776 397947 19267996 8362102 10905894 170605 71427 99178 54769173 DUE FROM AFFILIATES 3583443 DEFERRED COMPENSATION PLAN ASSETS 2256514 BENEFICIAL INTEREST IN NET ASSETS OF CHILDREN'S HOSP. & HEALTH SYSTEM FOUND. 1914287 INVESTMENT IN VIRTUAL PICU SYSTEMS, LLC 525865 INVESTMENT IN NORTH SHORE SURGERY CENTER 548945 INVESTMENT IN MED-HEALTH FINANCIAL SERVICES, INC. 9000 8838054 DEFERRED COMPENSATION 2256514 RETIREMENT PLAN LIABILITY 3143906 5400420 PART IV, LINE 1B: CERTAIN EMPLOYEES OF THE ORGANIZATION HAVE SIGNING AUTHORITY FOR THE CHECKING ACCOUNT OF THE CENTER FOR INTERNATIONAL HEALTH, INC. ("CIH"). THE ORGANIZATION ALSO PROVIDES PAYROLL FUNCTIONS FOR CIH. ADDITIONALLY, CERTAIN EMPLOYEES OF THE ORGANIZATION HAVE SIGNING AUTHORITY FOR THE CHECKING ACCOUNT OF THE WELFARE AUXILIARY OF CHILDREN'S HOSPITAL OF WISCONSIN, INC. ("WA"). THE ORGANIZATION ALSO PROVIDES ACCOUNTING FUNCTIONS FOR WA. THE AMOUNTS IN PART IV ARE THE COMBINED TOTALS FOR THESE TWO INDIVIDUAL ACCOUNTS. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: CHILDREN'S HOSPITAL AND HEALTH SYSTEM FOUNDATION, INC., A RELATED ENTITY, HOLDS ENDOWMENT FUNDS ON BEHALF OF CHHS. INTENDED USES OF THE ENDOWMENT FUNDS INCLUDE VARIOUS HEALTH-EDUCATION RELATED PROJECTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: FOOTNOTE 2 INCOME TAXES: CHHS EVALUATES ITS UNCERTAIN TAX POSITIONS ON AN ANNUAL BASIS AND THERE HAVE BEEN NO UNCERTAIN TAX POSITIONS RECORDED IN 2010 OR 2009. 1 EXCHANGE CTR FOR THE PREV OF CHILD ABUSE 2120 FORDEM AVE MADISON WI 53704 390821148 501(C)(3) 50183 ANNUAL GRANT FOR A CHILD ABUSE PREVENTION PROGRAM CHILDREN'S SERVICE SOCIETY OF WISCONSIN PO BOX 1997 MILWAUKEE WI 53201 390806380 501(C)(3) 16707 ANNUAL GRANT FOR A CHILD ABUSE PREVENTION PROGRAM FAMILY RESOURCE CENTER OF SHEBOYGAN 1209A EASTERN AVENUE PLYMOUTH WI 53073 391857835 501(C)(3) 48000 ANNUAL GRANT FOR A CHILD ABUSE PREVENTION PROGRAM FAMILY RESOURCES OF NORTHEAST WISCONSIN PO BOX 22308 GREEN BAY WI 54305 390827320 501(C)(3) 64930 ANNUAL GRANT FOR A CHILD ABUSE PREVENTION PROGRAM LACAUSA 136 W GREENFIELD AVENUE MILWAUKEE WI 53204 391247667 501(C)(3) 42000 ANNUAL GRANT FOR A CHILD ABUSE PREVENTION PROGRAM LAKESHORE COMMUNITY ACTION PROG 540 N 8TH ST PO BOX 2315 MANITOWOC WI 54221 391214392 501(C)(3) 42850 ANNUAL GRANT FOR A CHILD ABUSE PREVENTION PROGRAM META HOUSE PO BOX 11564 MILWAUKEE WI 53211 391017822 501(C)(3) 10000 ANNUAL GRANT FOR A CHILD ABUSE PREVENTION PROGRAM PARENTS PLUS INC 660 E MASON ST 100 MILWAUKEE WI 53202 202077792 501(C)(3) 10593 TECHNICAL ASSISTANCE FOR HOME VISITATION PROGRAM SEXUAL ASSAULT CRISIS CTR 35 PARK PLACE SUITE 100 APPLETON WI 54914 391309331 501(C)(3) 40000 ANNUAL GRANT FOR A CHILD ABUSE PREVENTION PROGRAM THE PARENTING NETWORK 7516 W BURLEIGH STREET MILWAUKEE WI 53210 391312225 501(C)(3) 50000 ANNUAL GRANT FOR A CHILD ABUSE PREVENTION PROGRAM UW EXTENSION 432 N LAKE STREET MADISON WI 53706 391805963 501(C)(3) 6000 ANNUAL GRANT FOR A CHILD ABUSE PREVENTION PROGRAM 11 0 TECHNICAL ASSISTANCE FOR HOME VISITATION GRANTS 4 69409 N/A SCHOLARSHIPS 19 16111 N/A PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: MONITORING PROCEDURES - THE CHILD ABUSE PREVENTION FUND IS COMMITTED TO ENSURING A SAFE ENVIRONMENT FOR CHILDREN THROUGH FINANCIAL SUPPORT OF PRIMARY PREVENTION ACTIVITIES THROUGHOUT WISCONSIN, AS WELL AS EDUCATING PROFESSIONALS AND THE PUBLIC ABOUT THE ROLE OF PREVENTION IN ELIMINATING CHILD ABUSE. THE CHILD ABUSE PREVENTION FUND IS A SPECIAL FUNDRAISING INITIATIVE OF CHHS. THE FUND'S FOCUS IS ON OUTCOMES OR RESULTS FOR FAMILIES, CHILDREN AND COMMUNITIES. AGENCIES THAT RECEIVE FUNDING MEET CRITERIA FOR EFFECTIVENESS AND ACCOUNTABILITY. EACH ORGANIZATION FUNDED IS EXPECTED TO DEMONSTRATE POSITIVE OUTCOMES THROUGH SIX-MONTH AND ANNUAL PROGRESS REPORTS. IN MANY CASES, CHHS STAFF OVERSEE AND PLAY A ROLE IN HELPING ORGANIZATIONS DEMONSTRATE POSITIVE OUTCOMES. CHHS STAFF ALSO PERFORM SITE VISITS. SCHEDULE I, PART III: SCHOLARSHIPS AWARDED TO RECIPIENTS ARE PAID DIRECTLY TO THE EDUCATIONAL INSTITUTIONS. X X 0 1 X X X X X X 1 1 0 0 0 0 0 1 0 MARGARET TROY 696337 0 238920 0 62498 0 213436 0 33569 0 1244760 0 0 0 TIMOTHY L BIRKENSTOCK 413954 0 124887 0 58116 0 52773 0 28718 0 678448 0 20063 0 MICHELLE METTNER 172557 0 43893 0 412 0 7650 0 22307 0 246819 0 0 0 MICHAEL NAUMAN 325491 0 0 0 28846 0 32400 0 29037 0 415774 0 0 0 MARGARET NIEMER 211304 0 61992 0 64707 0 36995 0 25052 0 400050 0 16348 0 SHEILA REYNOLDS 234291 0 80785 0 38200 0 35168 0 29149 0 417593 0 9703 0 RAMESH SACHDEVA MD 285632 0 86213 0 6971 0 29577 0 28891 0 437284 0 5274 0 ROBERT SANDERS 190351 0 26600 0 1029 0 21828 0 28237 0 268045 0 0 0 ROBERT DUNCAN 149326 0 35000 0 5300 0 18341 0 12300 0 220267 0 0 0 JULIET KERSTEN 152005 0 39319 0 10100 0 26735 0 31240 0 259399 0 7380 0 LAWRENCE DUNCAN 105794 0 52668 0 58897 0 0 0 12389 0 229748 0 9361 0 THOMAS GAZZANA 135534 0 82349 0 104422 0 19600 0 11740 0 353645 0 0 0 CINTHIA S CHRISTENSEN 0 350953 0 111248 0 54224 0 48174 0 34556 0 599155 0 31657 DENISE AUGUSTIN 142185 0 30082 0 0 0 14090 0 17497 0 203854 0 0 0 JAMES MILLER 308562 0 64000 0 40310 0 32760 0 26236 0 471868 0 0 0 THOMAS DUNIGAN MD 278815 0 62235 0 39503 0 42421 0 18676 0 441650 0 19805 0 DAVID FRIEDBERG MD 252662 0 100000 0 7212 0 17150 0 10065 0 387089 0 0 0 MARK ANDERSON 162979 0 0 0 45532 0 26377 0 18740 0 253628 0 9876 0 MARTIN VOGEL 190761 0 0 0 10614 0 29485 0 28362 0 259222 0 0 0 JON E VICE - FORMER 647628 0 0 0 5148080 0 0 0 39648 0 5835356 0 4895003 0 KENNETH MUNSON - FORMER 275237 0 0 0 17946 0 0 0 26908 0 320091 0 0 0 PART I, LINE 1A THE ORGANIZATION CONTINUED ITS PAST PRACTICE OF PAYING DUES FOR FOUR EXECUTIVES AT LOCAL SOCIAL CLUBS. BASED UPON PAST DISCUSSIONS WITH THE IRS REGARDING THE TAXABILITY OF SUCH AMOUNTS TO THE EXECUTIVES, THE ORGANIZATION'S PRACTICE IS TO TREAT THE ENTIRE AMOUNT OF THE DUES AND THE CORRESPONDING TAX GROSS-UP PAYMENT AS TAXABLE INCOME. SUCH AMOUNTS, INCLUDING THE ANNUAL GROSS-UP, WERE PRESENTED TO THE COMPENSATION COMMITTEE OF THE ORGANIZATION'S SOLE CORPORATE MEMBER AS PART OF THE OVERALL COMPENSATION PACKAGE FOR THE EXECUTIVES. EFFECTIVE JANUARY 1, 2011, THE ORGANIZATION HAS ELIMINATED ALL OF THE MEMBERSHIPS (AND THE CORRESPONDING TAX GROSS-UPS). PART I, LINE 1B THE ORGANIZATION HAS WRITTEN POLICIES AND PROCEDURES RELATED TO SUBSTANTIATION FOR REIMBURSEMENT OF ALL EXPENSES. THE SOCIAL CLUB DUES WERE SUBJECT TO, AND PAID IN COMPLIANCE WITH, THE WRITTEN POLICIES AND PROCEDURES; BOTH THE DUES AND THE RELATED TAX GROSS-UPS WERE INCLUDED IN AMOUNTS PRESENTED TO THE COMPENSATION COMMITTEE. PART I, LINES 4A-B PART I, LINE 4A: CHHS PAID SEVERANCE AMOUNTS TO KENNETH MUNSON, WHO SERVED AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF CHILDREN'S SERVICE SOCIETY OF WISCONSIN THROUGH 2009. PURSUANT TO A WRITTEN SEVERANCE AGREEMENT, MR. MUNSON RECEIVED SEVERANCE PAYMENTS FOR 2010. THE SEVERANCE PAYMENTS MADE IN 2010 WERE $274,985. CHHS PAID CERTAIN AMOUNTS AS SEVERANCE OR EARLY RETIREMENT INCOME TO JON VICE, WHO SERVED AS PRESIDENT/CEO THROUGH JANUARY 2009. THESE AMOUNTS WERE PAID PURSUANT TO A WRITTEN AGREEMENT ENTERED INTO IN MAY 2008. CASH PAYMENTS MADE TO MR. VICE IN 2010 TOTALED $650,638. HOWEVER, BECAUSE AMOUNTS PAYABLE UNDER THE ARRANGEMENT WERE DEEMED TO HAVE VESTED IN 2010, THE PRESENT VALUE OF PAYMENTS TO BE MADE IN FUTURE YEARS (BASED ON ACTUARIAL ESTIMATES) WAS REPORTED AS TAXABLE INCOME FOR 2010 ACCORDINGLY. PART I, LINE 4B: IN 2010, THERE WAS A CHHS FLEXIBLE BENEFIT PLAN IN PLACE WHICH WAS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN (457(F)). THE ORGANIZATION CONTRIBUTES 7% OF EACH PARTICIPATING EXECUTIVE'S SALARY. THE AMOUNTS OF EMPLOYER CONTRIBUTIONS TO THIS PLAN FOR PARTICIPATING EXECUTIVES IN 2010 WERE AS FOLLOWS: T. BIRKENSTOCK $30,723; T. DUNIGAN $20,371; J. MILLER $22,960; M. NAUMAN $24,150; M. NIEMER $17,395; S. REYNOLDS $18,018; R. SANDERS $13,578; M. TROY $50,820; M. VOGEL $13,610; R. SACHDEVA $20,251; C. CHRISTENSEN $26,124; M. ANDERSON $12,641; R. DUNCAN $15,741; J. KERSTEN $11,028. AFTER A VESTING PERIOD, PARTICIPANTS MAY ELECT TO WITHDRAW AMOUNTS PREVIOUSLY CONTRIBUTED AND REPORTED. AMOUNTS WITHDRAWN BY PARTICIPANTS IN 2010 WERE: T. BIRKENSTOCK $20,063; L. DUNCAN $9,361; T. DUNIGAN $19,805; M. NIEMER $16,348; S. REYNOLDS $9,703; R. SACHDEVA $5,274; C. CHRISTENSEN $31,657; M. ANDERSON $9,876; J. KERSTEN $7,380. CHHS HAS REPORTED ADDITIONAL AMOUNTS SET ASIDE FOR A NONQUALIFIED RETIREMENT PLAN ON BEHALF OF ITS PRESIDENT AND CEO. THE AMOUNT SET ASIDE IN 2010 WAS $152,816. PART I, LINE 7 CERTAIN EXECUTIVES PARTICIPATE IN AN ANNUAL BONUS PLAN THAT PROVIDES COMPENSATION BASED ON ACHIEVING SPECIFIC PRE-DEFINED GOALS. BONUS CRITERIA ARE ESTABLISHED ON AN EXECUTIVE-BY-EXECUTIVE BASIS. SUCH CRITERIA PERTAIN TO MATTERS WITHIN THE EXECUTIVE'S AREA OF RESPONSIBILITY, AS WELL AS ACHIEVEMENT OF OVERALL STRATEGIC OBJECTIVES OF THE ORGANIZATION AND ITS AFFILIATES. SUPPLEMENTAL INFORMATION PART III FORM 990, PART VII, COLUMN E AND SCHEDULE J, PART II: SALARIES PAID BY RELATED ORGANIZATIONS: CINTHIA CHRISTENSEN, EXECUTIVE VICE PRESIDENT OF CHILDREN'S HOSPITAL OF WISCONSIN, INC. ("CHW") - REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS AND OTHER COMPENSATION LISTED IN PART VII AND SCHEDULE J WERE PAID FOR SUPERVISORY SERVICES PROVIDED (40 HOURS PER WEEK) TO CHW AND THE SURGICENTER OF GREATER MILWAUKEE, LLC. THESE AMOUNTS WERE PAID BY CHW. HUMANA DIRECTOR (L. RAMBO) 141090 MR. RAMBO IS THE REGIONAL CHIEF EXECUTIVE OFFICER OF HUMANA, INC. THE ORGANIZATION PAID HUMANA FOR TPA SERVICES FOR ITS SELF-INSURED HEALTH PLAN IN THE AMOUNT OF $141,090. 0 HUMANA DIRECTOR (L. RAMBO) 1125620 MR. RAMBO IS THE REGIONAL CHIEF EXECUTIVE OFFICER OF HUMANA, INC. THE ORGANIZATION RECEIVED APPROXIMATELY $1,125,620 FROM HUMANA FOR HEALTH CARE SERVICES PROVIDED TO HUMANA ENROLLEES. 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 CHILDREN'S RESEARCH INSTITUTE, INC., CHILDREN'S HEALTH EDUCATION CENTER, INC., AND NATIONAL OUTCOMES CENTER, INC. ALL MERGED INTO CHHS EFFECTIVE AS OF 12/31/09. IN 2010, CHHS CONTINUED TO PROVIDE THE PROGRAMS OFFERED BY THESE ORGANIZATIONS, AND HAS DESCRIBED RESEARCH AS AN EXEMPT PURPOSE ACHIEVEMENT IN PART III LINE 4B, AND OUTCOMES AND HEALTH EDUCATION IN PART III LINE 4D. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS RELATIONSHIPS EXIST BETWEEN THE FOLLOWING BOARD MEMBERS: ABRAHAM AND ROTHMAN; BRENNER AND DRURY; BRENNER AND O. SULLIVAN; DRURY AND SOMMERHAUSER; DRURY AND SCHLIFSKE; DRURY AND O. SULLIVAN; SCHLIFSKE AND SOMMERHAUSER; SOMMERHAUSER AND HERMA; AND O. SULLIVAN AND KLIEGMAN. FORM 990, PART VI, SECTION A, LINE 4 CHHS IS THE SOLE CORPORATE MEMBER OF CHILDREN'S HOSPITAL OF WISCONSIN, INC. ("CHW"), WHICH IS A NOT-FOR-PROFIT PEDIATRIC HOSPITAL FURTHER DESCRIBED IN SCHEDULE R. THE ARTICLES OF INCORPORATION AND BYLAWS OF CHHS WERE AMENDED IN 2010 AS PART OF A SYSTEM-WIDE RESTRUCTURING. THE COMPOSITION OF THE BOARD OF DIRECTORS WAS CHANGED TO CREATE A SHARED BOARD OF DIRECTORS WITH CHW. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WAS REVIEWED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE CHHS BOARD OF DIRECTORS, AND PRIOR TO FILING, A COPY WAS PROVIDED TO ALL DIRECTORS OF CHHS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, ALL MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO SUBMIT A CONFLICT OF INTEREST DISCLOSURE TO THE CORPORATE VICE PRESIDENT AND GENERAL COUNSEL. A LIST OF POTENTIAL CONFLICTS IS PREPARED AND IS AVAILABLE AT EACH BOARD AND COMMITTEE MEETING. THE COMPLIANCE DEPARTMENT MONITORS AND PERIODICALLY REVIEWS TRANSACTIONS BETWEEN THE ORGANIZATION AND BOARD MEMBERS OR ENTITIES WITH WHICH THEY ARE AFFILIATED. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE ORGANIZATION'S CEO, SENIOR OFFICERS, AND KEY EMPLOYEES, WITH THE EXCEPTION OF THE VP OF GOVERNMENT RELATIONS, THE VP OF REGIONAL SERVICES (KERSTEN), AND THE SURGICENTER EXECUTIVE DIRECTOR, WAS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE ORGANIZATION'S BOARD OF DIRECTORS. WITH THE ASSISTANCE OF AN INDEPENDENT COMPENSATION CONSULTANT AND INFORMATION FROM A VARIETY OF EXTERNAL SOURCES (AS INDICATED ON SCHEDULE J), THE COMMITTEE CONFIRMED THAT TOTAL COMPENSATION AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGANIZATIONS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES WAS SET BY SUPERVISORY EXECUTIVES IN CONSULTATION WITH CHHS HUMAN RESOURCES LEADERS. THE PROCESS INVOLVED REVIEW BY INDEPENDENT PERSONS WHO CONFIRMED THAT TOTAL COMPENSATION AMOUNTS TO BE PAID WERE REASONABLE AND COMPARABLE TO AMOUNTS PAID BY SIMILARLY SITUATED ORGAINZATIONS. THE PROCESS AND DATA RELIED ON WERE THOROUGHLY AND TIMELY DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION OF CHHS ARE AVAILABLE TO THE PUBLIC UPON REQUEST TO THE CHHS PUBLIC RELATIONS DEPARTMENT. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: INCREASE IN BENEF. INTEREST IN NET ASSETS OF CHILDREN'S HOSPITAL FOUNDATION 299,723. TOTAL TO FORM 990, PART XI, LINE 5: 299,723. FORM 990, PART V, LINE 1A THE ORGANIZATION DID NOT FILE ANY 1099 FORMS DURING THE TAXABLE YEAR. ALTHOUGH THE ORGANIZATION DID RETAIN INDEPENDENT CONTRACTORS, THE COMPENSATION AMOUNTS OWED TO SUCH CONTRACTORS WERE PROCESSED AND PAID BY A RELATED ENTITY, CHW, WITH APPROPRIATE INTERCOMPANY ARRANGEMENTS BETWEEN THE ORGANIZATION AND CHW. THE 1099 FORMS FOR SUCH PAYMENTS WERE ISSUED BY CHW, AS THE ENTITY THAT PROCESSED AND MADE THE PAYMENTS TO THE INDEPENDENT CONTRACTORS. THE 1099 FORMS LISTED IN PART V ARE THE FORMS FILED BY THE ORGANIZATION'S DISREGARDED ENTITY. 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