2024-05-14T09:01:46-05:00 2023-06-30 135565207 KPMG LLP 8350 BROAD STREET SUITE 900 MCLEAN VA 22102 990 2022-07-01 541278865 CHILDREN'S HEALTH FOUNDATION CHIL 7576687000 601 CHILDRENS LANE NORFOLK VA 23507 KATHERYN ABSHIRE CFO/ASST TREAS/SEC 7576687000 2024-05-13 1 KATHERYN ABSHIRE 999009999 1 SHAWN HUTCHINSON P01048557 7032868000 2024-05-10 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z AMY SAMPSON 601 CHILDRENS LANE NORFOLK VA 23507 42307778 0 X WWW.CHKD.ORG X 1984 VA SEE SCHEDULE OTHE FOUNDATION SUPPORTS CHILDREN'S HEALTH SYSTEM (CHS) AND CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS (CHKD) BY MANAGING ASSETS FOR CHKD AND PROVIDING FUNDS. SEE PART III. 13 12 0 13 0 0 4829234 8878095 0 0 -2461793 4018984 0 0 2367441 12897079 43731593 17340627 0 0 0 0 0 0 0 129496 100561 43861089 17441188 -41493648 -4544109 162572960 165753206 153902 219112 162419058 165534094 CHILDREN'S HEALTH FOUNDATION (CHF) SUPPORTS CHILDREN'S HEALTH SYSTEM (CHS) AND CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS (CHKD). CHF IS ORGANIZED AND OPERATED TO CARRY OUT THE CHARITABLE, EDUCATIONAL AND SCIENTIFIC PURPOSES OF CHS AND CHKD. 0 0 17340627 17340627 PROVIDING GRANTS TO ASSIST IN THE OVERALL MISSION OF THE ORGANIZATION'S RECIPIENTS. SUCH GRANTS FOR THE CURRENT YEAR INCLUDE THOSE THAT FURTHER THE CHARITABLE, EDUCATIONAL AND SCIENTIC PURPOSES OF CHKD. 17340627 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 NC VA X KATHRYN ABSHIRE 7576687000 601 CHILDRENS LANE NORFOLK VA 23507 JAMES D DAHLING UNTIL 62123 PRESIDENT/DIRECTOR 1.00 42.00 X X 0 1189913 40552 MICHAEL R MATACUNAS DIRECTOR 1.00 0.00 X 0 0 0 LARRY BERNERT CHAIRMAN/DIRECTOR 2.00 0.00 X X 0 0 0 DAN BOYLE DIRECTOR 1.00 0.00 X 0 0 0 TREY HUELSBERG VICE CHAIR/DIRECTOR 2.00 0.00 X X 0 0 0 KIM MCMILLAN SECRETARY/DIRECTOR 2.00 0.00 X X 0 0 0 KIMBERLY GEIGER DIRECTOR 1.00 0.00 X 0 0 0 DOUG HILLEBRANDT DIRECTOR 1.00 0.00 X 0 0 0 KELLY JOHNSON DIRECTOR 1.00 0.00 X 0 0 0 KAREN PRIEST TREASURER/DIRECTOR 2.00 0.00 X X 0 0 0 MARK COMPTON DIRECTOR 1.00 0.00 X 0 0 0 MATTHEW NUSBAUM DIRECTOR 1.00 0.00 X 0 0 0 SCOTT CARR DIRECTOR 1.00 0.00 X 0 0 0 TAYLOR PRIEST DIRECTOR 1.00 1.00 X 0 0 0 AMY SAMPSON AS OF 062123 PRESIDENT/DIRECTOR 1.00 42.00 X X 0 686334 289621 KATHRYN ABSHIRE AS OF 070822 ASSISTANT SECRETARY/TREASURER 1.00 42.00 X 0 567656 192618 DENNIS RYAN UNTIL 070822 ASSISTANT SECRETARY/TREASURER 1.00 42.00 X 0 348254 31377 0 2792157 554168 0 0 1 0 0 8878095 8878095 4988275 4988275 28441408 29410699 -969291 -969291 -969291 12897079 0 0 4018984 17340627 17340627 3657 3657 96879 96879 OTHER EXPENSE 25 25 17441188 17340627 100561 0 4382867 1125701 138396732 143718318 19793361 20909187 162572960 165753206 2122 151780 219112 153902 219112 X 162419058 165534094 162419058 165534094 162572960 165753206 -4544109 7655488 3657 0 X 0 1 X 1 0 X X 5 CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS 540506321 3 1 16328154 0 EASTERN VIRGINIA MEDICAL SCHOOL 546055378 2 0 800000 0 EDMARC 541092904 7 0 125000 0 RONALD MCDONALD HOUSE 362934689 7 0 75000 0 ODU EDUCATION FOUNDATION 546068198 7 0 12473 0 5 17340627 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 PART IV, SECTION A, LINE 1: CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS IS LISTED BY NAME AS A SUPPORTED ORGANIZATION AND THE OTHERS THAT ARE SUPPORTED ARE DESIGNATED BY CLASS OR PURPOSE TO FURTHER THE CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES OF CHKD. IT IS NOT CLEAR THAT THE INTENTION OF SCHEDULE R WAS TO CONSIDER SUPPORTED ORGANIZATIONS DESIGNATED BY CLASS OR PURPOSE TO BE RELATED ORGANIZATIONS OF A FILING ORGANIZATION. THESE SUPPORTED ORGANIZATIONS DESIGNATED BY CLASS OR PURPOSE ARE NOT OTHERWISE OPERATED, SUPERVISED, OR CONTROLLED BY THE FOUNDATION. THEREFORE, THEY HAVE NOT BEEN REPORTED ON SCHEDULE R. PART IV, SECTION A, LINE 2: THE FOUNDATION PROVIDED SUPPORT TO ORGANIZATIONS THAT PROMOTE THE HEALTH OF CHILDREN THAT MAY BE OPERATED, SUPERVISED OR CONTROLLED BY OR IN CONNECTION WITH THE HEALTH SYSTEM PARENT, SO LONG AS SUCH ORGANIZATIONS ARE DESCRIBED IN SECTION 501(C)(3) AND SECTION 509(A)(1) OR SECTION 509(A)(2), AND OTHER ORGANIZATIONS FOR THE BENEFIT OF ITS SUPPORTED ORGANIZATIONS TAX EXEMPT PURPOSE. THE FOUNDATION PROVIDED SUPPORT TO ONE OF ITS SUPPORTED ORGANIZATIONS DESCRIBED IN SECTION 509(A)(1) THROUGH MAKING A GRANT TO ONE OF ITS SECTION 509(A)(3) SUPPORTING ORGANIZATIONS. THIS GRANT WAS MADE FOR THE BENEFIT OF THIS SUPPORTED ORGANIZATION'S TAX EXEMPT PURPOSE. INFORMATION ABOUT THIS GRANT IS INCLUDED IN SCHEDULE I. PART IV, SECTION B, LINE 1: THE FOUNDATION'S MEMBER IS THE SYSTEM PARENT. PURSUANT TO THE HOSPITAL'S BYLAWS AND AS PERMITTED BY VIRGINIA CODE SECTION 13.1-852.1 THE HOSPITAL IS MANAGED BY ITS SOLE MEMBER, THE HEALTH SYSTEM PARENT WITH THE POWER TO APPOINT AND REMOVE A MAJORITY OF THE BOARD. THEREFORE, THE HOSPITAL BOARD EFFECTIVELY APPOINTS THE MAJORITY BOARD OF THE ORGANIZATION. PART IV, SECTION B, LINE 2: ON OCCASION, THE HOSPITAL CARRIES OUT ITS EXEMPT PURPOSE BY MAKING GRANTS TO 501(C)(3) AND OTHER ORGANIZATIONS FOR THE BENEFIT OF HOSPITAL'S CHARITABLE CLASS. IF THE HOSPITAL DIRECTS THE ORGANIZATION TO DO SO, THEN THE FOUNDATION WILL MAKE SUCH GRANTS, PROVIDED THAT THE GRANT ACCOMPLISHES THE TAX-EXEMPT PURPOSES OF THE HOSPITAL. FOR ADMINISTRATIVE CONVENIENCE, THE FOUNDATION MAY MAKE GRANTS DIRECTLY TO 501(C)(3) AND OTHER ORGANIZATIONS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 PRIVATE EQUITY FUNDS 20909187 F 20909187 INTERCOMPANY LIABILITIES 219112 219112 X PART X, LINE 2: FIN 48 FOOTNOTE FROM CONSOLIDATED AUDIT REPORT CHS RECOGNIZES ANY BENEFITS FROM AN UNCERTAIN TAX POSITION ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITION WILL BE SUSTAINED UPON EXAMINATION BY THE TAXING AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. IF APPLICABLE, THE TAX BENEFITS RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS FROM SUCH A POSITION WOULD BE MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE RESOLUTION. CHS DOES NOT BELIEVE ANY UNCERTAIN TAX PROVISIONS REQUIRE RECORDING IN ITS CONSOLIDATED FINANCIAL STATEMENTS. 1 CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS 601 CHILDRENS LANE NORFOLK VA 23507 540506321 501(C)(3) 16328154 0 GRANT FUNDING OLD DOMINION UNIVERSITY RESEARCH FOUNDATION PO BOX 6369 NORFOLK VA 23508 546068198 501(C)(3) 12473 0 SCOLIOSIS SURGERY PLANNING EASTERN VIRGINIA MEDICAL SCHOOL PO BOX 1980 NORFOLK VA 23507 546055378 501(C)(3) 800000 0 PERINATOLOGY GRANT EDMARC 516 LONDON ST PORTSMOUTH VA 23507 541092904 501(C)(3) 125000 0 CHILDREN'S HOSPICE GRANT RONALD MCDONALD HOUSE 404 COLLEY AVE NORFOLK VA 23507 362934689 501(C)(3) 75000 0 TEMP LODGING/SUPPORT 5 PART I, LINE 2: AWARDS MADE BY CHILDREN'S HEALTH FOUNDATION, INC. (CHF) ARE FOR SPECIFIC PROJECT OR RESEARCH ENDEAVORS. FUNDING REQUESTS ARE COMPLETED AND SUBMITTED WHERE THEY ARE REVIEWED BY THE FINANCE DEPARTMENT, THE CEO AND THE APPLICABLE BOARD. AFTER AN AWARD IS MADE, THE AWARDEE MUST FILE QUARTERLY REIMBURSEMENT REQUSTS TO THE FINANCE DEPARTMENT. FINAL REPORTS MUST BE SUBMITTED TO FINANCE SUMMARIZING PROGRAMMTIC AND FINANCIAL RESULTS WITHIN 60 DAYS OF GRANT END DATE. 0 1 0 0 0 0 0 0 0 JAMES D DAHLING UNTIL 62123 PRESIDENT/DIRECTOR 0 1078156 0 0 0 111757 0 12200 0 28352 0 1230465 0 0 AMY SAMPSON AS OF 062123 PRESIDENT/DIRECTOR 0 405847 0 19125 0 261362 0 270031 0 19590 0 975955 0 247211 KATHRYN ABSHIRE AS OF 070822 ASSISTANT SECRETARY/TREASURER 0 477698 0 0 0 89958 0 156267 0 36351 0 760274 0 76184 DENNIS RYAN UNTIL 070822 ASSISTANT SECRETARY/TREASURER 0 296651 0 0 0 51603 0 12179 0 19198 0 379631 0 35452 PART I, LINE 3 THE FOUNDATION RELIES ON A RELATED ORGANIZATION, CHILDREN'S HEALTH SYSTEM, TO ESTABLISH THE COMPENSATION OF ITS OFFICERS. PART III, LINE 4B: CHILDREN'S HEALTH SYSTEM SPONSORS A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN ("THE PLAN"). THE PLAN IS DESIGNED TO RETAIN EXECUTIVES IN POSITIONS ESSENTIAL TO THE SUCCESS OF CHILDREN'S HEALTH SYSTEM. DURING THE YEAR, THE FOLLOWING INDIVIDUALS WERE PARTICIPANTS IN A SPONSORED SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN AND RECEIVED THE FOLLOWING ACTUARIAL INCREASE OR DEFERRED CONTRIBUTION (INCLUDED IN SCHEDULE J, PART II, COLUMN (C)) AND/OR PAYMENT (INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III)). AMOUNTS REPORTED IN SCHEDULE J, PART II, COLUMN (B) III MAY DIFFER FROM AMOUNTS PAID DUE TO TIMING DIFFERENCES IN VESTING AND PAYMENTS. NAME: KATHRYN ABSHIRE ACT. INC.: $121,446 AMT. PAID: $32,987 NAME: AMY SAMPSON ACT. INC.: $230,294 AMT. PAID: $101,131 FORM 990, PART VI, SECTION A, LINE 6 CHILDREN'S HEALTH FOUNDATION, INC. IS A VIRGINIA NON-STOCK CORPORATION AND HAS A SOLE MEMBER. THE SOLE MEMBER OF CHILDREN'S HEALTH FOUNDATION, INC. IS CHILDREN'S HEALTH SYSTEM, INC., A VIRGINIA NON-STOCK NOT-FOR-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A CHILDREN'S HEALTH SYSTEM, INC., THE SOLE MEMBER OF CHILDREN'S HEALTH FOUNDATION, INC., ELECTS THE DIRECTORS WHO SERVE ON THE BOARD OF DIRECTORS OF CHILDREN'S HEALTH FOUNDATION, INC. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING DECISIONS OF THE BOARD OF DIRECTORS OF CHILDREN'S HEALTH FOUNDATION, INC. ARE SUBJECT TO APPROVAL BY ITS SOLE MEMBER, CHILDREN'S HEALTH SYSTEM, INC.: 1) AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE CORPORATION; 2) ANNUAL CAPITAL AND OPERATING BUDGETS; 3) THE UNDERTAKING OF UNBUDGETED OPERATING EXPENDITURES, CAPITAL EXPENDITURES, BORROWING OF FUNDS, LENDING OF FUNDS, AND REAL PROPERTY LEASES IN EXCESS OF CERTAIN AMOUNTS, 4) CREATING ANY LIEN, MORTGAGE, OR OTHER SECURITY INTEREST IN REAL PROPERTY BELONGING TO THE CORPORATION; 5) CREATION, REORGANIZATION OR DISSOLUTION OF A SUBSIDIARY CORPORATION; 6) CERTAIN GIFTS, DONATIONS, OR OTHER TRANSFERS OF ASSETS OR FUNDS; 7) THE SELECTION OF INDEPENDENT AUDITORS AND LEGAL COUNSEL; 8) GENERAL INVESTMENT POLICIES OF THE CORPORATION; AND 9) THE ADOPTION, ALTERATION, AMENDMENT, OR REPEAL OF A CAPITAL PLAN, STRATEGIC PLAN OR LONG-RANGE PLAN. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED USING THE ANNUAL FINANCIAL STATEMENTS THAT ARE REVIEWED BY THE BOARD AND AUDITED ANNUALLY AS A PART OF THE CONSOLIDATED FINANCIAL STATEMENTS OF CHILDREN'S HEALTH SYSTEM, INC. UPON COMPLETION OF THE DRAFT OF THE RETURN, A DETAIL REVIEW IS PERFORMED BY SEVERAL MEMBERS OF STAFF AND MANAGEMENT. PRIOR TO FILING WITH THE IRS, THE BOARD IS PROVIDED A COPY TO REVIEW. FORM 990, PART VI, SECTION B, LINE 12C CONFLICT POLICY CONSIDERATIONS CHF CONFLICT OF INTEREST POLICY INCLUDES OFFICERS, MEMBERS OF THE BOARD OF DIRECTORS AND BOARD COMMITTEES, KEY EMPLOYEES, ALL OTHER EMPLOYEES, PROFESSIONAL STAFF AND SUBSTANTIAL DONORS. ANNUALLY, A QUESTIONNAIRE IS DISTRIBUTED AND COLLECTED FROM OFFICERS, MEMBERS OF THE BOARD OF DIRECTORS AND BOARD COMMITTEES AND KEY EMPLOYEES. RESPONSES TO THE QUESTIONNAIRES ARE REVIEWED BY THE LEGAL AND FINANCE DEPARTMENTS. FOR KNOWN CONFLICTS, THE PERSON INVOLVED RECUSES HIMSELF OR HERSELF FROM DELIBERATIONS REGARDING THE TRANSACTION. VIOLATIONS OF THE CONFLICTS OF INTEREST POLICY ARE REPORTED TO THE CHF BOARD CHAIR OR THE CHF COMPLIANCE OFFICER, AS APPLICABLE, AND MAY REQUIRE CORRECTIVE ACTION UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION PROCESS CONSIDERATIONS AN INDEPENDENT COMPENSATION CONSULTANT APPROVED AND RETAINED BY THE COMPENSATION COMMITTEE OF THE BOARD ANNUALLY, USUALLY IN APRIL, PROVIDES EDUCATION AND PRESENTS TO THE FULL BOARD COMPARATIVE SALARIES AND SALARY RANGES FROM A DATA BASE COMPRISED OF CHILDREN'S HOSPITALS AND OTHER APPLICABLE HOSPITALS FOR OFFICERS & EXECUTIVES FOR THE BOARD TO REVIEW. THE COMPENSATION COMMITTEE WITH THE AID OF THE CONSULTANT REVIEWS AND MAKES DECISIONS AS TO EXECUTIVE SALARIES OF CHS AND ITS SUBSIDIARIES. THOSE SALARY CHANGES AND APPROVALS ARE DOCUMENTED BY MINUTES MAINTAINED BY THE COMPENSATION COMMITTEE AND SIGNED BY THE CHAIRMAN OF THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS (PART OF THE CONSOLIDATED FINANCIAL STATEMENTS OF CHILDREN'S HEALTH SYSTEM, INC.) ALONG WITH GOVERNING DOCUMENTS OF THE ORGANIZATION INCLUDING THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC THROUGH DIRECT INQUIRY AND REQUEST. CHILDREN'S HEALTH SYSTEM INC 601 CHILDRENS LANE NORFOLK VA 23507 541278830 HEALTHCARE VA 501(C)(3) 12B N/A 0 CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS 601 CHILDRENS LANE NORFOLK VA 23507 540506321 HEALTHCARE VA 501(C)(3) 3 N/A 0 FORTIFY CHILDREN'S HEALTH LLC 1330 JEFFERSON PARK AVENUE CHARLOTTESVILLE VA 22903 831442745 HEALTHCARE VA N/A 0 0 0 REALTA HOLDINGS LLC 601 CHILDRENS LANE NORFOLK VA 23507 823954346 RESEARCH VA N/A 0 0 0 CHILDREN'S SURGICAL SPECIALTY GROUP INC 601 CHILDRENS LANE NORFOLK VA 23507 311610834 HEALTHCARE VA N/A C 0 CHILDREN'S MEDICAL GROUP INC 601 CHILDRENS LANE NORFOLK VA 23507 541778786 HEALTHCARE VA N/A C 0 CMG OF NORTH CAROLINA INC 601 CHILDRENS LANE NORFOLK VA 23507 561960102 HEALTHCARE NC N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS B 16328154 BOOK CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS C 8878095 BOOK CHILDREN'S HOSPITAL OF THE KING'S DAUGHTERS Q 219112 BOOK