2024-08-07T16:32:20-05:00 2023-09-30 010494526 Baker Newman & Noyes LLC 280 Fore Street Portland ME 04101 990 2022-10-01 042986097 Boston Pediatric Neurosurgical Foundation Inc BOST 6173554615 300 Longwood Avenue Hun 2 Boston MA 02115 Mark R Proctor MD President 6173554615 2024-08-05 0 0 Nicholas E Porto P01310283 8002447444 2024-08-05 2022 2024-08-08 14:25:15Z Mark R Proctor MD 300 Longwood Avenue Hun 2 Boston MA 02115 19520215 0 X N/A X 1988 MA The Foundation provides neurosurgical services primarily to patients at (see Schedule O) Boston Children's Hospital and at satellite locations. The Foundation also provides care for patients regardless of their ability to pay, as well as providing and supporting hospital and community based services that are either unavailable or limited elsewhere in the community. 9 0 10 0 3129 0 464450 303570 12923580 17084096 -67211 168030 0 0 13320819 17555696 28590 2465684 0 0 11283700 14128000 0 0 0 2778056 3330297 14090346 19923981 -769527 -2368285 21248644 21040935 7958820 9171307 13289824 11869628 X The Foundation provides neurosurgical services primarily to patients at Boston Children's Hospital and at satellite locations. The Foundation carries on and promotes basic and applied medical research and education in the field of neurosurgery by (see Schedule O) teaching students and other medical and scientific personnel. The Foundation also provides care for patients regardless of their ability to pay. 0 0 16796619 2465684 16875696 The Foundation provides neurosurgical services primarily to patients at Boston Children's Hospital, Brigham and Women's Hospital, Inc., and at satellite locations. The Foundation may charge for patient care and other medical services, provided that any net income is used for the charitable, scientific, and educational purposes for which the Foundation was created. The Foundation also provides care for patients regardless of their ability to pay, as well as providing and supporting hospital and community based services that are either unavailable or limited elsewhere in the community. 1460572 208400 The Foundation receives income from Boston Children's Hospital for providing administration, supervision, and teaching services. The Foundation carries on and promotes basic and applied medical research and education in the field of neurosurgery by teaching students and other medical and scientific personnel; by providing research grants; giving lectures; and publishing information concerning problems and research results in the field of pediatric neurosurgery in order to educate the general public and the medical profession. 18257191 1 1 0 0 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 10 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 0 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MA X Edward R Smith MD 6173554615 300 Longwood Avenue Boston MA 02115 Pok-Meng See MD Director 60.00 0.00 X 783821 0 90747 Mark R Proctor MD President 55.00 5.00 X X 1364973 0 90782 Edward R Smith MD Clerk/Treasurer 60.00 0.00 X X 1133773 0 127085 Benjamin C Warf MD Director 60.00 0.00 X 1133018 0 125658 Scellig S Stone MD Director 60.00 0.00 X 932474 0 126908 Katie P Fehnel MD Director 60.00 0.00 X 854149 0 74255 Joseph R Madsen MD Director 60.00 0.00 X 619716 0 134723 Lissa C Baird MD Director 60.00 0.00 X 1404064 0 90747 Weston Northam MD Director 60.00 0.00 X 187408 0 39095 Physicians Org at CH Inc Institutional Trustee 2.00 0.00 X 0 0 0 8413396 0 900000 9 0 1 0 0 281570 22000 303570 Patient Service Revenue 621300 15292635 15292635 Other Revenue 621990 1583061 1583061 Education & Research 611710 208400 208400 17084096 178885 3129 175756 1953664 1964519 -10855 -10855 -10855 17555696 17084096 3129 164901 2465684 2465684 10663843 10663843 2602307 1523692 1078615 606025 269595 336430 255825 252573 3252 10074 10074 35369 35369 3136 3136 160362 160362 647753 637492 10261 106622 106622 148949 148949 70884 70884 2188 2188 648767 619476 29291 PO dues 469661 469661 Coordinated Specialty P 435122 435122 Net Patient Service Rev 305853 305853 Billing services 269546 269546 16011 16011 19923981 18257191 1666790 0 4801470 2144274 1739357 4765180 2128058 2408064 200000 234000 100000 100000 141214 152935 233636 231314 4510 2322 2987596 2856272 6887078 7463438 2259361 914450 21248644 21040935 2136905 2153271 99955 2480839 5721960 4537197 7958820 9171307 X 12609910 11406286 679914 463342 13289824 11869628 21248644 21040935 -2368285 948089 0 X X 0 1 X 1 0 X 427059 634951 391305 464450 303570 2221335 11897536 11609440 14216142 12923580 17084096 67730794 12324595 12244391 14607447 13388030 17387666 69952129 0 0 0 69952129 45937 30187 10330 34686 175756 296896 45937 30187 10330 34686 175756 296896 -2915 -5595 75 -110 3129 -5416 214940 214940 12367617 12483923 14617852 13422606 17566551 70458549 0.99280 0.99170 0.00420 0.00210 X Schedule A, Part III, Line 12, Explanation of Other Income: Insurance rebate - 2019 Amount: $ 214,940. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 679914 50000 266572 463342 1088625 199350 608061 679914 1429904 89906 431185 1088625 1650376 356207 576679 1429904 2092705 113125 555454 1650376 0.00000 0.00000 1.00000 0 0 29770 27448 2322 203866 203866 0 2322 PO Pooled Investment Fund, LLC 7463438 F 7463438 Patient Deposits 6266 Due to Physicians Organization at Children's Hospital, Inc. 195944 Due to Boston Children's Hospital 970006 Due to Brigham and Women's Hospital, Inc. 5313 Deferred compensation plans 2055203 Accrued professional liability 1241927 Due to Children's Orthopaedics Surgical Foundation, Inc. 2673 Due to Children's Hospital Radiology Foundation, Inc. 20008 Due to Children's Hospital Pediatrics Associates, Inc. 38078 Due to CHMC Surgical Foundation, Inc. 1779 4537197 X 18500649 948089 948089 17552560 3136 3136 17555696 19920844 0 19920844 3136 3136 19923980 Part V, Line 4: The restricted funds represent donations that were given for physician recruitment and to support continued departmental efforts of a certain physician. The uses of these funds were restricted by the donor. Part X, Line 2: The Foundation is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the Code), and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. In addition, the Foundation qualifies for the charitable contribution deduction under Section 170(b)(1)(A), and has been classified as an organization that is not a private foundation under Section 509(a)(2). Tax-exempt organizations could be required to record an obligation for income taxes as the result of a tax position they have historically taken on various tax exposure items, including unrelated business income or tax status. Management of the Foundation has evaluated the positions taken on the Foundation's filed tax returns and has concluded that no uncertain income tax positions exist at September 30, 2023. 1 Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 501(c)(3) 2452184 0 N/A N/A General support Credit Union Kids at Heart 35 Corporate Drive Suite 300 Burlington MA 01803 814905853 501(c)(3) 12500 0 N/A N/A General support 2 0 Part I, Line 2: Monitoring is provided by Boston Pediatric Neurosurgical Foundation, Inc. (the Foundation) through oversight of the terms and conditions of a written grant agreement. Multiyear agreements require yearly progress and financial reports for continuation of the funding. During the year ended September 30, 2023, the Foundation only provided grant donations to other 501(c)(3) organizations. X X 1 1 X X X X X 0 0 0 0 0 0 0 1 0 Lissa C Baird MD Director 603269 0 681750 0 119045 0 63000 0 27747 0 1494811 0 0 0 Mark R Proctor MD President 816713 0 511566 0 36694 0 63000 0 27782 0 1455755 0 0 0 Edward R Smith MD Clerk/Treasurer 665456 0 280187 0 188130 0 63000 0 64085 0 1260858 0 0 0 Benjamin C Warf MD Director 634362 0 427040 0 71616 0 63000 0 62658 0 1258676 0 0 0 Scellig S Stone MD Director 520354 0 345638 0 66482 0 63000 0 63908 0 1059382 0 0 0 Katie P Fehnel MD Director 478897 0 279840 0 95412 0 63000 0 11255 0 928404 0 0 0 Pok-Meng See MD Director 455250 0 248481 0 80090 0 63000 0 27747 0 874568 0 0 0 Joseph R Madsen MD Director 574624 0 0 0 45092 0 63000 0 71723 0 754439 0 0 0 Weston Northam MD Director 158495 0 0 0 28913 0 26667 0 12428 0 226503 0 0 0 Part I, Line 1a Effective July 1, 1996, Boston Pediatric Neurosurgical Foundation, Inc. (the Foundation) established a tuition assistance plan to provide reimbursement of tuition-related expenses to eligible employees. Participants, selected by the Foundation's President in consultation with the full professors of the Foundation and legal counsel, must provide services to the Foundation as an employee or as a member of the Board of Directors. Amounts paid under this plan include approved school related living expenses. Employees who participated in this plan have these amounts included on their W-2's. Tuition-related expense reimbursements for the year ended September 30, 2023 were paid to Edward R. Smith, MD, $119,126 and Joseph R. Madsen, MD, $9,470. The Foundation also provides gross-up payments for mortgage forgiveness, long-term disability insurance, and life insurance. These payments are included as taxable wages during the year. All permanent full-time employees of the Foundation are eligible for gross-up payments. Part I, Line 7 The overall compensation package is based on the employee's academic rank for direct and indirect compensation under the Boston Children's Hospital guidelines. Bonuses are reviewed and approved by the Chief. Lissa C Baird MD Director Recruitment X 100000 67000 0 1 1 Pok-Meng See MD Director Recruitment X 100000 67000 0 1 1 Weston Northam MD Director Recruitment X 100000 100000 0 1 1 234000 Schedule L, Part II: The Foundation has provided a secured forgivable loan to an employee. In most cases, the Foundation forgives an amount equal to 33% of the principal value for each year of continued employment. The amount forgiven is included in the employee's W-2 during the year of forgiveness. At September 30, 2023, the balance of the recruitment loans to persons listed in Form 990, Part VII is $234,000. Future principal balances due are $99,000 in 2024; $101,000 in 2025; and $34,000 in 2026. Form 990, Part VI, Section A, line 1a A majority of Boston Pediatric Neurosurgical Foundation, Inc.'s (the Foundation's) board members are physicians who are not independent from the Foundation. However, the Foundation is part of an integrated delivery system with Boston Children's Hospital (the Hospital) which does have a community board. The Foundation was organized in 1988. At the time, the board was composed entirely of physicians, a board structure that was approved by the Internal Revenue Service. The Foundation has since adjusted the board structure by adding the Physicians Organization at Children's Hospital, Inc. (the PO) as a member. See Schedule O, Part VI, Questions 3, 6, 7b, and 12 for more on the PO's rights. Form 990, Part VI, Section A, line 3 The Physicians Organization at Children's Hospital, Inc. (the PO) is the Class "C" member of Boston Pediatric Neurosurgical Foundation, Inc. (the Foundation). The PO is responsible for providing management services to the Foundation. The PO has the power to approve the independent auditor and legal counsel of the Foundation from a list of firms mutually agreed to by the PO and the Foundation. The PO also has the right to review the annual budgets as well as the right to review and approve by-law changes of the Foundation. Lastly, Boston Children's Hospital has the right to review for compliance with applicable law, the general terms of and any modification to physician compensation and benefit plans for all physician employees of the Foundation. Form 990, Part VI, Section A, line 6 Boston Pediatric Neurosurgical Foundation, Inc. (the Foundation) has three classes of members. The Chief of the Department of Neurosurgery (the Department) of Boston Children's Hospital (the Hospital) is the sole Class "A" member. Any member of the Department (other than the Chief) who holds a professional staff appointment in neurosurgery at the Hospital, has a full-time faculty appointment from Harvard Medical School, and who is geographically full-time at the Hospital shall be a Class "B" member. Other physicians upon recommendation from the Chief and approval from the President of the Hospital may be permitted to be Class "B" members. The Physicians Organization at Children's Hospital, Inc. is the Class "C" member of the Foundation. Form 990, Part VI, Section A, line 7a According to the Articles of Organization, the Class "A" member is the Chief of the Department of Neurosurgery (the Department) of Boston Children's Hospital (the Hospital). Any other member of the Department who holds a professional staff appointment in neurosurgery at the Hospital, has a full-time faculty appointment from Harvard Medical School, and who is geographically full-time at the Hospital shall be a Class "B" member. A Class "A or "B" member shall hold membership as long as he/she remains qualified for membership. Only Class "A and "B" members may vote in annual meetings or other elections, serve on the Hospital's Board of Trustees, or nominate candidates for election to the Board. Form 990, Part VI, Section A, line 7b The Physicians Organization at Children's Hospital, Inc. (the PO) is the Class "C" member of Boston Pediatric Neurosurgical Foundation, Inc. (the Foundation). The PO is responsible for providing management services to the Foundation. The PO has the power to approve the independent auditor and legal counsel of the Foundation from a list of firms mutually agreed to by the PO and the Foundation. The PO also has the right to review the annual budgets as well as the right to review and approve by-law changes of the Foundation. Lastly, Boston Children's Hospital has the right to review for compliance with applicable laws, the general terms of any modification to the physician compensation and benefit plans for all physician employees of the Foundation. As the Class "C" member of the Foundation, the PO attends the Foundation's annual meeting. Form 990, Part VI, Section B, line 11b The detailed review will be conducted by the President of the Foundation, Mark R. Proctor, MD; the treasurer of the Foundation, Edward R. Smith, MD; and the Executive Director, Kevin Wolfe. A copy of the Form 990 will be provided to the Board prior to filing. The detailed review will be conducted before filing the return with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c In conjunction with Boston Children's Hospital, the Physicians Organization at Children's Hospital, Inc. (the PO) administers an annual conflict of interest disclosure process to all of its member Foundations which asks physicians (officers, top management, and highly compensated employees) and selected Foundation staff to disclose potential conflicts. A disclosure statement will be circulated annually to members of the PO. The audit committee shall determine those individuals (including medical staff members) who shall be required to complete the disclosure statement. The audit committee, at its discretion, may either: 1) refer any or all disclosure statements to the Board of Directors; 2) appoint an ad hoc committee to review and resolve any conflict of interest issues; or 3) review and resolve any conflict of interest personally or through a designee(s). Any person not receiving a disclosure statement has an affirmative obligation to disclose to the PO President, PO General Counsel, or his/her supervisor whenever he/she believes he/she has or may have a conflict of interest. Similarly, each person completing a disclosure statement has an affirmative obligation to update the statement any time circumstances change and/or he/she believes that a conflict of interest may exist. In the event a conflict of interest is found to exist, the Foundation prohibits the member from voting on any matter to which the conflict relates or otherwise influence the voting on such matter. Form 990, Part VI, Section B, line 15 Faculty compensation must comply with the Boston Children's Hospital (the Hospital) Physician Compensation Guidelines. These guidelines are developed in consultation with an independent external compensation consulting firm and are approved by independent Compensation Committee of the Board of Children's Medical Center Corporation and the Hospital. The guidelines set the maximum compensation limits based on a peer group analysis for the Foundation. The maximum compensation limits are based on pediatric specialty, sub-specialty, academic rank and include productivity adjustments. Any proposed compensation that exceeds the limits must be prospectively approved by the independent Compensation Committee of the Board of the Hospital. Annual compensation for individual faculty members is set by the President of Boston Pediatric Neurosurgical Foundation, Inc. (the Foundation), reviewed and approved by the Foundation in accordance with the Foundation's compensation policies and procedures. The Foundation's President's compensation is reviewed and approved annually on a prospective basis by the Boston Children's Hospital President/Chief Executive Officer. Form 990, Part VI, Section C, line 19 The Foundation maintains all financial records, conflict of interest policies, and governing documents at its main office at 300 Longwood Avenue, Boston, MA, 02115. The documents are available upon request. Form 990, Part XII, Line 2c: The audit process and scope has not changed from the prior year. Boston Children's Hospital 300 Longwood Avenue Boston MA 02115 042774441 Hospital MA 501(c)(3) Line 3 N/A 0 Physicians Organization at Children's Hospital Inc 300 Longwood Avenue Boston MA 02115 043266103 Physician Organization MA 501(c)(3) Line 12c, III-FI N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0