2011-11-01T11:34:18-05:00 2010-12-31 WARRENAVERETTKIMBROUGH & MARINOLLC 2500 ACTON ROAD BIRMINGHAM AL 35243 990 2010-01-01 630307306 THE CHILDREN'S HOSPITAL OF ALABAMA CHIL 2059399100 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 MIKE BURGESS 2059399100 2011-09-26 1 2059794100 2010 2016-03-07 17:11:31Z WILLIAM MICHAEL WARREN 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 591856122 0 X WWW.CHSYS.ORG X 1911 AL SPECIALTY ACUTE-CARE HOSPITAL PROVIDING INPATIENT AND OUTPATIENT MEDICAL SERVICES TO PEDIATRIC PATIENTS. 34 29 4157 1036 0 0 3018119 3024950 468055752 539732200 1600269 -2500604 15370376 15240034 488044516 555496580 0 0 0 0 215917370 218730169 0 0 0 236750940 262308519 452668310 481038688 35376206 74457892 607021403 574659849 425430836 432119150 181590567 142540699 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 239597475 321282001 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 2010, CHILDREN'S HOSPITAL HAD 13,904 INPATIENT CASES AND 81,057 PATIENT DAYS. INPATIENT SURGERY CASES TOTALED 4,721 FOR 2010. THE CHILDREN'S CRITICAL CARE TRANSPORT TEAM PROVIDES HELICOPTER, JET AND GROUND TRANSPORT FOR CRITICALLY ILL AND INJURED CHILDREN. 153036012 190848308 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 2010, THESE CLINICS HAD 249,948 VISITS AND 15,890 OUTPATIENT SURGERIES WERE PERFORMED. THE HOSPITAL ALSO PROVIDES A STATEWIDE AND REGIONAL REFERRAL SITE FOR COMPLEX EMERGENCY PATIENTS. THE EMERGENCY DEPARTMENT HAD 46,700 VISITS IN 2010. 40301330 38705023 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 2010 THESE PRACTICES PROVIDED 336,246 VISITS. 432934817 1 1 0 1 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 1 1 1 0 0 1 254 0 1 4157 1 0 1 CJ 0 0 0 0 0 0 0 0 X 34 29 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DAWN WALTON 2059399073 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 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 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 RICHARD J BIELEN 0.50 X 0 0 0 GILLIAN W GOODRICH 0.50 X 0 0 0 BEVERLY P HEAD 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 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 JOHN O HUDSON III 0.50 X 0 0 0 HUGH J MORGAN JR 0.50 X 0 0 0 W JERRY OAKES 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 ROBERT S MCANNALLY 0.50 X 0 0 0 L GWALTNEY MCCOLLUM JR 0.50 X 0 0 0 WILLIAM MICHAEL WARREN JR 40.00 X 736107 0 184407 THOMAS G SHUFFLEBARGER 40.00 X 676658 0 111534 JAMES MICHAEL BURGESS 40.00 X 554420 0 103160 JACKIE STOREY 40.00 X 470650 0 96917 LORI EWOLDSEN 40.00 X 402366 0 52742 DOUGLAS DEAN 40.00 X 395620 0 78942 COKE MATTHEWS 40.00 X 375576 0 67829 AUDIE WOOLLEY 40.00 X 988867 0 100444 JIMMY SCOTT HILL 40.00 X 983725 0 100506 BRIAN WIATRAK 40.00 X 801142 0 100516 WILLIAM PEYTON SHIRLEY 40.00 X 521510 0 19977 RICHARD FELIX SMITH 40.00 X 425662 0 15485 SUPORA THOMAS 0.00 X 454852 0 804 7787155 0 1033263 221 1 1 0 HOARBE&K JOINT VENTURE TWO METROPLEX DRIVE STE 400 BIRMINGHAM AL 35209 CONSTRUCTION 46171456 UNIVERSITY OF ALABAMA HEALTH SERVICES FO 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 SUBSPECIALTY, MOONLIGHTING, AFTER HOURS, 15840171 UNIVERSITY OF ALABAMA HOSPITAL 619 19TH STREET SOUTH JEFFERSON TO BIRMINGHAM AL 35233 HOSPITAL RESIDENTS 7421194 ARAMARK PO BOX 651009 CHARLOTTE NC 282651009 CAFETERIA, CENTRAL TRANSPORT 6753180 HKS ARCHITECTS INC PO BOX 674097 DALLAS TX 752674097 ARCHITECHTURAL DESIGN CONSULTANTS 5358385 61 2282299 742651 3024950 PATIENT SERVICE 900099 530947073 530947073 MEDICAID DISPROPORTION 900099 8785127 8785127 539732200 10625008 10625008 686110 686110 2902469 2291820 610649 610649 610649 20253000 3000 34062052 5670 -13809052 -2670 -13811722 -13811722 GRADUATE MEDICAL 900099 5589773 5589773 TRANSPORT REVENUE 900099 3068812 3068812 CAFETERIA/VENDING 900099 2485290 2485290 3485510 2444547 1040963 14629385 555496580 550835332 0 1636298 3611397 3250256 361141 179617256 161655531 17961725 23240584 20916526 2324058 12260932 11034839 1226093 264448 238003 26445 234762 211286 23476 32286163 29057547 3228616 6193500 5574150 619350 2291820 2062638 229182 5970837 5373753 597084 33171227 29854104 3317123 7571827 6814644 757183 MEDICAL SUPPLIES 35752602 32177342 3575260 DRUGS 31369197 28232277 3136920 TAXES AND LICENSES 28483674 25635307 2848367 BAD DEBT EXPENSE 19021304 17119174 1902130 MANAGEMENT CONTRACTS 10584966 9526469 1058497 49112192 44200971 4911221 481038688 432934817 48103871 0 42265651 41703106 207148677 112704490 54573587 32654546 6742673 7554292 10361549 10797159 694546278 353131741 251398767 341414537 34530499 27831719 607021403 574659849 33284387 45794428 6454846 332661742 326458593 59484707 53411283 425430836 432119150 X 181590567 142540699 181590567 142540699 607021403 574659849 X 74457892 -113507760 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 230070 230070 483100438 483330508 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 346173 402993 293157 230070 1272393 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 289795833 157738993 132056840 6923008 2927804 3995204 213807606 178221396 35586210 179219713 14243548 164976165 341414537 SALARIES PAYABLE 20556085 ACCRUED INTEREST PAYABLE 1518895 PROFESSIONAL LIABILITY ACCRUAL 3562802 TEBA LIABILITY 17558141 INTEREST RATE SWAP 951476 ESTIMATED THIRD PARTY PAYOR SETTLEMENT 2280918 DUE TO AFFILIATE 6982966 53411283 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, 2010, THAT IT WOULD BE UNABLE TO SUBSTANTIATE. THE COMPANY HAS FILED ITS TAX RETURNS THROUGH DECEMBER 31, 2009. THE TAX RETURNS FOR THE YEARS ENDED DECEMBER 31, 2007, AND THEREAFTER ARE SUBJECT TO AUDIT BY THE TAXING AUTHORITIES. 1 1 1 X 1 X 0 0 0 627226 0 627226 0.00140 231525551 269110607 -37585056 0.00000 14513475 15301131 -787656 0.00000 246666252 284411738 -37745486 0.00140 18 154669 5566160 1579184 3986976 0.00860 6 3391 10973947 2047121 8926826 0.01930 4 130 9845734 6062104 3783630 0.00820 1 0 451820 244122 207698 0.00040 1 600 14986 0 14986 0.00000 30 158790 26852647 9932531 16920116 0.03650 30 158790 273518899 294344269 -20825370 0.03790 0 7056904 2226076 1854811 2310864 -456053 X 0 1 1 CHILDREN'S HOSPITAL OF ALABAMA

1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233

X X X X X X NA 1 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 $19,021,304 IS EXCLUDED FROM TOTAL OPERATING EXPENSES OF $481,038,688 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 59.20% PART II: WHILE THE HOSPITAL DID NOT HAVE SYSTEMS IN PLACE TO FORMALLY TRACK COMMUNITY BUILDING ACTIVITIES FOR 2010, 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: ALLOWANCES FOR DOUBTFUL ACCOUNTS ARE ESTIMATED BASED ON HISTORICAL WRITE-OFF PERCENTAGES AND REVIEW OF LARGE BALANCE SELF-PAY ACCOUNTS. 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 2010 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. 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 CHARITY CARE 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 CHARITY CARE POLICY IS POSTED ON THE HOSPITAL'S WEBSITE AND THERE IS SIGNAGE THROUGHOUT THE HOSPITAL INFORMING PATIENTS OF THE AVAILABILITY OF A CHARITY CARE 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 2010, CAUCASIANS, AFRICAN-AMERICANS, HISPANICS, AND OTHER RACES ACCOUNTED FOR 56%, 36%, 5%, AND 3%, RESPECTIVELY, OF THE PATIENTS SERVED WHILE 42%, 22%, AND 36% WERE AGES 0-4, 5-12, AND 13+ YEARS, RESPECTIVELY. ECONOMIC DEMOGRAPHIC DATA IS NOT SPECIFICALLY CAPTURED HOWEVER, IN 2010 GREATER THAN 60% OF THE HOSPITAL'S PATIENTS QUALIFIED FOR GOVERNMENTAL MEANS-TESTED PROGRAMS SUCH AS MEDICAID AND SCHIP. PART VI, LINE 6: 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 13 DIFFERENT COLLEGES AND UNIVERSITIES DURING 2010. IN ADDITION, THE HOSPITAL PARTICIPATES IN AN AVERAGE OF 220 CLINICAL RESEARCH STUDIES ON AN ANNUAL BASIS. X X X X 0 1 0 0 0 0 0 0 0 WILLIAM MICHAEL WARREN JR 521292 0 0 0 214815 0 166797 0 17610 0 920514 0 214815 0 THOMAS G SHUFFLEBARGER 329024 0 248000 0 99634 0 87495 0 24039 0 788192 0 99634 0 JAMES MICHAEL BURGESS 310420 0 244000 0 0 0 81005 0 22155 0 657580 0 0 0 JACKIE STOREY 280650 0 190000 0 0 0 82115 0 14802 0 567567 0 0 0 LORI EWOLDSEN 157290 0 90000 0 155076 0 29343 0 23399 0 455108 0 155076 0 DOUGLAS DEAN 228620 0 167000 0 0 0 50245 0 28697 0 474562 0 0 0 COKE MATTHEWS 218576 0 157000 0 0 0 50974 0 16855 0 443405 0 0 0 AUDIE WOOLLEY 519179 0 469688 0 0 0 80467 0 19977 0 1089311 0 0 0 JIMMY SCOTT HILL 514037 0 469688 0 0 0 80529 0 19977 0 1084231 0 0 0 BRIAN WIATRAK 331454 0 469688 0 0 0 80539 0 19977 0 901658 0 0 0 WILLIAM PEYTON SHIRLEY 338679 0 150019 0 32812 0 0 0 19977 0 541487 0 32812 0 RICHARD FELIX SMITH 284866 0 139112 0 1684 0 0 0 15485 0 441147 0 0 0 SUPORA THOMAS 8718 0 45000 0 401134 0 0 0 804 0 455656 0 0 0 PART I, LINE 4B PART I, LINE 4B: WILLIAM MICHAEL WARREN, JR - $166,797 THOMAS G. SHUFFLEBARGER - $87,495 JAMES MICHAEL BURGESS - $81,005 JACKIE STOREY - $82,115 LORI EWOLDSEN - $29,343 DOUGLAS B. DEAN - $50,245 COKE MATTHEWS - $50,974 AUDIE WOOLLEY - $80,467 JIMMY SCOTT HILL - $80,529 BRIAN WIATRACK - $80,539 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 3746408 358832 630695 33042025 1 0 1 1 233179363 22803600 18150592 3480828 4329725 111711558 73595448 0 0 0 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 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 129577 VENDING 0 ALABAMA POWER CHARLES D. MCCRARY & DONALD JAMES ARE DIRECTORS OF THE ABOVE ENTITY 3342673 ELECTRICITY PROVIDER 0 USA READY MIX MARC TYSON IS AN OFFICER OF THE ABOVE ENTITY 3266127 CONSTRUCTION MATERIALS 0 ALABAMA GAS CORPORATION ROBERT MCANNALLY IS EMPLOYED BY THE ABOVE ENTITY 1178881 GAS UTILITY 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. KEITH GEORGESON, M.D. HAD ADMITTING PRIVILEGES TO THE HOSPITAL AND OCCUPIED THE JOE FARLEY ENDOWED CHAIR WHICH IS FUNDED BY THE FOUNDATION PRIOR TO HIS RETIREMENT FROM THE HOSPITAL DURING 2010. 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 THE PARTNERSHIP THAT IS THE LEAD CONTRACTOR ON A MAJOR EXPANSION PROJECT AT THE TIME THE PROJECT WAS BID. RAYMOND J. HARBERT OWNS AN INVESTMENT COMPANY THAT MANAGES A HEDGE FUND IN WHICH THE HOSPITAL HAS INVESTED THROUGH A FUND OF FUNDS. BEVERLY P. HEAD, III IS THE LEAD TRUSTEE OF AN ORGANIZATION THAT MAKES CONTRIBUTIONS TO THE FOUNDATION. IN ADDITION, MR. HEAD'S SPOUSE HAS AN OWNERSHIP INTEREST AND IS EMPLOYED BY A COMPANY THAT DISTRIBUTES CONSTRUCTION MATERIALS AND RELATED EQUIPMENT THAT ARE BEING UTILIZED BY THE HOSPITAL'S CONTRACTOR 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 IS 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 A 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 ELECTRICITY 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 2010. 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 2010. 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. 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 24F LAB EXPENSE: PROGRAM SERVICE EXPENSES 8,914,397. MANAGEMENT AND GENERAL EXPENSES 990,489. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,904,886. EQUIPMENT RENTAL AND MAINTENANCE: PROGRAM SERVICE EXPENSES 5,412,411. MANAGEMENT AND GENERAL EXPENSES 601,379. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,013,790. MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 4,542,591. MANAGEMENT AND GENERAL EXPENSES 504,732. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,047,323. CONSULTING FEES: PROGRAM SERVICE EXPENSES 3,782,086. MANAGEMENT AND GENERAL EXPENSES 420,232. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,202,318. EQUIPMENT RELATED SUPPLIES: PROGRAM SERVICE EXPENSES 3,414,592. MANAGEMENT AND GENERAL EXPENSES 379,399. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,793,991. MAINTENANCE: PROGRAM SERVICE EXPENSES 3,230,084. MANAGEMENT AND GENERAL EXPENSES 358,898. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,588,982. TRANSPORTATION: PROGRAM SERVICE EXPENSES 2,694,435. MANAGEMENT AND GENERAL EXPENSES 299,382. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,993,817. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,508,320. MANAGEMENT AND GENERAL EXPENSES 278,702. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,787,022. SUPPLIES: PROGRAM SERVICE EXPENSES 2,360,093. MANAGEMENT AND GENERAL EXPENSES 262,233. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,622,326. MINOR MEDICAL EQUIPMENT: PROGRAM SERVICE EXPENSES 1,941,740. MANAGEMENT AND GENERAL EXPENSES 215,749. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,157,489. TELEPHONE: PROGRAM SERVICE EXPENSES 1,288,668. MANAGEMENT AND GENERAL EXPENSES 143,185. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,431,853. PROFESSIONAL DUES: PROGRAM SERVICE EXPENSES 1,269,034. MANAGEMENT AND GENERAL EXPENSES 141,004. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,410,038. REGISTRATION FEES: PROGRAM SERVICE EXPENSES 388,478. MANAGEMENT AND GENERAL EXPENSES 43,164. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 431,642. SUBSCRIPTIONS AND PUBLICATIONS: PROGRAM SERVICE EXPENSES 384,096. MANAGEMENT AND GENERAL EXPENSES 42,677. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 426,773. PRINTING AND PUBLICATIONS: PROGRAM SERVICE EXPENSES 358,091. MANAGEMENT AND GENERAL EXPENSES 39,788. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 397,879. BANKING FEES: PROGRAM SERVICE EXPENSES 354,347. MANAGEMENT AND GENERAL EXPENSES 39,372. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 393,719. POSTAGE AND SHIPPING: PROGRAM SERVICE EXPENSES 299,535. MANAGEMENT AND GENERAL EXPENSES 33,282. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 332,817. COLLECTION FEES: PROGRAM SERVICE EXPENSES 295,520. MANAGEMENT AND GENERAL EXPENSES 32,836. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 328,356. LODGING: PROGRAM SERVICE EXPENSES 249,802. MANAGEMENT AND GENERAL EXPENSES 27,756. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 277,558. NOVELTIES: PROGRAM SERVICE EXPENSES 208,412. MANAGEMENT AND GENERAL EXPENSES 23,157. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 231,569. SPECIAL FUNCTIONS: PROGRAM SERVICE EXPENSES 149,420. MANAGEMENT AND GENERAL EXPENSES 16,602. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 166,022. MEALS: PROGRAM SERVICE EXPENSES 142,532. MANAGEMENT AND GENERAL EXPENSES 15,837. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 158,369. RECOGNITIONS: PROGRAM SERVICE EXPENSES 12,282. MANAGEMENT AND GENERAL EXPENSES 1,365. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,647. TELETHON EXPENSE: PROGRAM SERVICE EXPENSES 5. MANAGEMENT AND GENERAL EXPENSES 1. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,184,995. TRANSFER TO ALABAMA CHILDREN'S HOSPITAL FOUNDATION -120,849,830. UNREALIZED LOSS ON INTEREST RATE SWAP 8,527,065. TOTAL TO FORM 990, PART XI, LINE 5: -113,507,760. 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 N/A 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 N/A C 787 1.00000 HOLY INNOCENTS INDEMNITY LTD PO BOX 10073 APO GRAND CAYMAN GRAND CAYMAN CJ 980436612 INSURANCE CJ N/A C 4589766 21066585 1.00000 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 ALABAMA CHILDREN'S HOSPITAL FOUNDATION B 120000000 FAIR MARKET VALUE ALABAMA CHILDREN'S HOSPITAL FOUNDATION E 11036728 FAIR MARKET VALUE HOLY INNOCENTS INDEMNITY LLC E -471265 FAIR MARKET VALUE HOLY INNOCENTS INDEMNITY LLC Q 3582774 FAIR MARKET VALUE ALABAMA CHILDREN'S HOSPITAL FOUNDATION C 1138089 FAIR MARKET VALUE