eye cm ese rom 990 Return of Organization Exempt From Income Tax 9010 Under section 50(), §27, 049473) of te intamal Revenue Code (except lack hing _= ane wun or private founaton) ee > Tm xpnatnon ay hve apy team oa stoping maaan FX For the 201 calendar yon, or tar you beginning C770 707, and ending T5730,20 11 eee peace 7 Ea aon or B cverewm | THE CHILDREN'S HOSPITAL OF PHILADELPHIA 23-1352166 aT ee wien |_aerH st. civic conren suvo (215) 590-1000 pe tS [_ounaoereaia, on 19104-4300 6 Ges mage #1, 610,605,118. [i | Fiunsta ase eps SEVEN ACTSCTOLER orsaeapemn |] vo [ho 34TH ST § CIVIC CENTER BLVD. PHILADELPHIA, PA 19104 |p) recremmamncntt [_] Yes [_] no (Ceeanetaee Yonge [sng 9 cet | [eset [ear] rrermnetn me ncn) Sass p RW CHOP EDU M49 oapeanocnnase K Farm oforgancaton [X[Coporeion] [Trt] [Assonsion | [Other > Tu Yesror formation 1860] W Stato atlegat domaie PA Summary 1 Bet doscnbe the organzatorsmiston or most spnscant actos PROVIDE CHARITABLE HEALTH CARE SERVICES TO : 2 ee e | 2 Chock ins box D> [] whe organization discontnued ts operabons or posed of more than 25% of snot assets 8] 3 numberof ving members of be goveming body (Pat Vi, Ine a) tee 29 8] 4 Number of méependent votng members of the governing body (Part Vi, ine 1b) 24 §] £ eeecteaente ener nee st0 Pat. awa : 0, 160 {6 Total number ovlunoes(stmate fnecessary) Levees : 324, Ta Total gross unrelated business revenue from Part Vil, column (C), ime 12 | ee 0 Db Not unrelated business taxable ncome om Form @90-T,line34 os tts sss ise On = RECEIVED Pir ves Gan $$ g) 8 conmauons ae rants Para a : Tis, 400, 661.| 215,510,124. S| 8 Program sernce revenue Parti} ine 25). | 1,192,842, 91 268,249,991 . E}10. investment income (Part Vil lary AHIR 8 & aA * [___7,363,214.| 5,042,363. : (tna reve Pat Vi os 5,64, 858,10, [“ie, 907, 925. | 47,236, 902. = Toro ates 8 lug in ~[rapststatnto“prssetanys00: 3 ‘Grants and smiar amounts pal (Pale ea 15,844,669.| 24,313,165. j|s.sercectocmgenpmorentinenng AE : : |r elec neater we ores eer ee a 673,626, 672.| 758,576, 021. 1,289, 767,540. |i, 420,814,140. 135,747,170.| 116,033,260. Total assets (ParX, Ine 1). pee oerzovpeserevenieraaersear271 Telalliabities (Pat X, ine 28) 1,089, 410,676. i,093, 934, 928. Not assets or und balances Suva ino 1,118, 447,998. fL,243, 048,343. Signature Block ‘Unorpeaan o gana, dere Pal have ezaranad a Our a ACERT SDE SETA, aa ha Hy Meda eal, TE, rect na caplet Desgon 0 preerreher an cer Shed oa atone whch prepare hs sy owen i sin |p Liptay S/ofih Hore | DP soxkcvaracr oa 4 Thomas J. Todorow D ramrenone parser a oa os _ = Te es noun PV Pomme E> [ae a amp FRTCEHRTERROUSECOODAES CoP raven TS=A008324 pies eae ae on Phere 267-330-3000 ‘ay eT oes te rekon to proper how above? (ne maucion) Toes LxTves_ [Tne FerPapenor edocon At Notes, tre epee start rom 950 ao s4ai2y 1467 v 10-8.3 Ny PAGE 2PUBLIC DISCLOSURE COPY For 2010) 23-1352166 ae ‘Saterent of Program Service Accomplahrenis heck Schedule O cotans a response fo any question ints Patt 1 Grey describe the organization's masion PROVIDE CHARTTABLE HEALTH CARE_ SERVICES TO PEDIATRIC PATIENTS. 2 Did tre erpanizaton undertake any Significant program serwoes dunng the year whch were not ted on the prior Form 990 or 990-EZ? os... .» Coes ino "Yes," descnbe these new services on Schedule O 3 Did the organization cease conducting, or make signifcant changes in how it conducts, any program eee ee rr ee peeeveeeeceee ers Dl ves W¥es;"describe these changes on Schedule 0 44 Descnbe the exempt purpose achievements for each of the organization's three largest program sermces by expenses. Section 504(6\3) and 501(c)4) organizations and section 4847(a)) trusts are requred to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported a (ode (Expenses — sos,a20, 300. mneuding grants of § Revenue $s ais,ovesnon) ATTACHMENT “4b (Code YExpenses$ 221, s07,474, _nouding grants Of$ py 753,400, (Revenue § aaa) ‘THE HOSPYTAL AAS AN EXTENSIVE RESEARCH PROGRAM. TTS EDUCATIONAL PROGRAMS INCLUDE THE LARGEST OR SECOND LARGEST PEDIATRIC RESIDENCY PROGRAM IN THE COUNTRY. THE HOSPITAL IS ENGAGED IN NUMEROUS COMMUNITY BENEFIT ACTIVITIES AND A VARIETY OF COMMUNITY OUTREACH PROGRAMS (SEE WWW. CHOP.EDU) e (ode TExpensess neuang grants oF S ViRevenue s ) “4d Other program services. (Describe in Schedule 0) (Exponsos $ including grants of $ (Revenues ) Ze Total program service expenses 1, 068,227,613. a Ferm 890 (2010) sa3i2y 1467 Vv 10-8.3 PAGE 3PUBLIC DISCLOSURE COPY Form 990 2010) 23~1352166 Page ‘Checklist of Required Schedules: 1 Is tm orpanzaton descnbed in secton S0¥cKS) oF 4947/1) (ote than a pate fundaton)? Ye,” ‘complete Schedule A a1| x 2. Is the organzation required to complete Schedule 8, Schedule of Contnbutors? (see msiructons) 2|x« 3. Did the organizaton engage in drect or indirect politcal campaign actvtes on behalf of or in opposition to candidates for public office? If "Yes, “complete Schedule C, Part. eee es x 4 Section 601(¢){3) organizations. Did the organtaton engage in lobbying actives, or have a sechon 501(h) lection in effect during the tax year? if "Yes,"complete Schedule C, Part Il. -La] x 5 Is the organization a section 501(0)(4), 5015), or 5016) organzation thet receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-197 If “Yes,” complete Schedule C, Parti... +. +. peer eee les {6 Did the organzaion maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distibuton or investment of amounts in such funds or accounts? if "Yes," ‘complete Schodulo D, Part. . . ee «Ls x 7. Did the organization recane or hold @ conservation easement, ncuding easements to preserve open space, the environment, histone land areas, or histone structures? if "Yes, complete Schedule D, Part I. set x 8 Di the organization mamian collectons of works of art historical weasures, or other similar assets? "Yes," ‘complete Schedule D, Part ill . oe [2 x Did the organization report an amount in Part X, line 21, serve as a custodian for amounts not isted in Part X; oF provide credit counseling, debt management, credit repair, or dabt ee eee ‘complete Schedule D, Part IV «Ls x 40 Did the organzation, directly or through @ related organization, hold assets in term, permanent, or ‘quasi-endowments? if "Yes,“complete Schedule D, Part V. ea ee eee wee [0 x 11. the organization's answer to any of the flowing questions 16 “Yes. thon complete Schedule D, Pars VI, ] VII, Vill X, or X as applicable Jt '@ Did the organizaton report an amount for land, buildings, and equipment in Part X, bine a Schedule D, Part VI. ata|_ x b Did the organization report an amount for investments —othersecurties in Part X, line 12 that is 8% or more Of its total assets reported in Part X, ine 167 If "Yes,"complete Schedule D, Part Vil. 41b es ‘© Did the organization report an amount for invesiments-program related in Part X, line 13 that is §% or more ofits total assets reported in Part X, ine 167 If "Yes,"complete Schedule D, Part Vill, . [Me x 4 Did the organization report an amount for other assets n Part X, line 15 that is 5% or more ofits total assets reported in PartX, line 167 if “Yes, complete Schedule D, PartIX .. 2.0... 04. + pita ‘© Did the organization report an amount for other labiltes in PartX, line 257 if "Yes,"complete Schedule D, Part x’ [116 | x 1 Did the organzaton’s separate or consoldated financial siatoments for the tax year ncude @ footnote that addresses ‘the organization's ability for unceran tax posttons under FIN 48 (ASC 740)? If"Yes,*complele Schedule D, PertX . 0 x 12. Did the organization obtain separate, independent auelted financial statements for the tax year? If "Yas," complete Schedule D, Parts XI, XIl, and XII!. : oo [2a x bb Was the ecganzatonincosedn consoSdaed apendent ated fnenoalslatemants forthe tax year? f"Yoe*andid ‘the organzaton answored "No" tone 122, then compotng Schedule D, Parts X, XI, and Xl optonal = [fab] x. 43. Isthe organzaton a school esenbed in section 170(6\ AN? IF"¥es," compote Schedule E = [a3 x ‘14.8 Did the organization maintain an office, employees, or agents outside of the Urited States? . . . . . 14a |X 'b Did the organizaton have aggregate revenues or expenses of more than $10,000 rom grantmalong, fundrasing, business, and program service actvities outside the United States?/f “Yes, “complete Schedule F, Parts |and IV- - |44b|_X 15 Did the organization report on Part IX, column (A), ine 3, more than $5,000 of grants or assistance to any ‘organization or entity located outside the United States? f “Yes, complete Schedule F, Parts Nand /V.......| 18 |_X 46 Did tho organization report on PartX, column (A), ine 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? if "Yes, “complete Schedule F, Parts liend IV - +» [46 x 17 Dd the organization report a total of more than $15,000 of expenses for professional fundraising. services fon Part ix, column (A), ines 6 and 116? if "Yes,"complete Schedule G, Part! (see structions) - ++ [a7 x 18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part Vill, nes t¢ and 8a If "Yes, "completo Schedule G,Part Il. . . . 18 x 49 Did the organzaton report mere than $15,000 of gross income from gaming actives on Part Vil ine 8a? WfYes,*complete Schedule G, Part ll. 19 x 20a Did the organzation operate one or more hospitals? if "Yes,"comploto Schedule»... . ss s +++ [peal x 'b It"¥es"to line 208, dd the organization attach its audited financial statements to this retum? Note, Some Form, 990 fiers that operate one or more hospitals must attach audited financial statements (see structions) = =» = - 20] x a Ferm 990 (2010) sa3i2y 1467 v 10-8.3 PRGE 4PUBLIC DISCLOSURE COPY Form a0 2301352166 ‘Ghackist of Required Schedules (continued) a 2 ma a » 30 4 Fr 7 Fy Page Did the organuzation report more than $5,000 of grants and other assistance to govemments and organizations inthe United States on Part IX, column (A), line 17 "¥es,"complote Schedule | Parts andl. . Did the organization report more than $5,000 of grants and other assistance to individuals inthe United States ‘on Part IX, column (A), line 2? If"Yes," complete Schedule |, Parts! and Il! id the organization answer "Yes" to Part Vil, Section A, line 3, 4, or § about compensaton of the forganizaton's. current and former officers, directors, trustees, key employees, and highest compensated ‘employees? if "Yes, complete Schedule J.» . eee Did the organzaton have a taxexempt bond issue with an oulsianding prnapal ‘amount of more than’ {$100,000 as of the last day of the year, that was issued after December 31, 20027 If "Yas,"answor ines 24b through 240 and complete Schodule K If ‘No,"g0 to line 25 . : Did the organzzation invest any proceeds of tax-exempt bonds beyond a temporary period exception? .. +. . Did the organization maintain an escrow account other then a refunding escrow at any time during the year to defease any tax-exempt bonds? . ‘i Di the organzation act as anon behal of issuer for bonds outstanding at anytime during the year? ‘Section 601(c)(3) and 501(¢)(4) organizations. Did the organization engage in an excess beneft transaction with a disqualified person during the year?if “Yes, complete Schedule L, Part] . . ts the organization aware that it engaged in an excess benefit transaction with @ oIsqualiied person in a prior ‘year, and that the transaction has not been reported on any of the organization's pnor Forms 990 or 990-627 I "Yes, "complete Schedule L, Part. tenes Was a loan to or by a current or former offcer, director, tustee, Key employee, highiy compensated employes, of disqualified person outstanding as of the end ofthe organization's tax year? if "Yes,"complole Schadule L Part Il. Did the organization provide a grant or other assistance to an officer, director, trustee, key employe substantial contnbutor, or a grant selection committee member, or to a person related to such an individual I "Yes, "complete Schedule L, Part Il! Was the organization a party to 2 business transaction with ne of the folowing partes (see Schedule Part IV instructions for applicable fling thresholds, conditons, and exceptions) ‘A current or former officer, rector, trustee, or key employee? If "Yas, complete Schedule L, Part IV : ‘A family member of @ curent or former officer, deector, trustee, or key employee? if "Yes," complete ‘Schedule L, Part V. ‘An ontty of which ‘a current or former officer, drectr, trustee, or key employee (ora family member thereof) was an offer, director, trustee, or direct or ndirect owner? If"Yes, "complete Schedule L Part IV . Did the organization receive more than $25,000. in non-cash contnbutions? if “Yes,” completo Schedule M_ Did the organization receive contnbutions of ar, histoncal treasures, or other simiar assets, or qualified ‘conservation contributions? if "¥es, "complete Schedule M . Bee Did the organization iquidate, terminate, or dissolve and cease operations? if "Yes," complete Schedule WN, Part! , Did the organization sll, complete Schedule N, Part. Dad the exganizaon own 100% of an eny cisregarded as separate om the orgenzaton under Regulations sectons 301 7701-2 and 301 7701-3? If Yes,"complete Schedule R, Part! . .. - ‘Was the organzaton relates to any taxcexempt of taxable entity? i Yes,"complete Schedule R, Pats I, Wand V, fine 1 ; Is any related organization a contri enty wan the meaning of secton 5120)(13)? Did the organization receive any payment rom or engage in any transaction with @ controled entity withn the meaning of secion S12(b\13)? IF "Yes," complete Schedule R, Part V, line 2 pichange, dispose of, or Wanster ‘more tan 25% ofits net assets? f “Vos,” oo Clyes G4) neo| Section 601(c){3) organizations. Did the organization make any transfers to an ‘exempt non-chartable related organization? if "Yes, “completo Schedule R, Part V, ine 2. Dia the organization conduct more then 5% of ts actives through an entity that is neta related organization ‘and that 1s teated as a partnership for federal Income tax purposes? If "Yes," complole Schedule R, Part Vi. fe 1D the oTganizaton ‘complete Schedule O and provide explanations in Schedule O for Part Vi ines 11 and 497 Note. Al Form 990 flers are required to complete Schedule O. . al x 2 x as| x 2s] x. 26 x zap] x. 2e| x 30 x at x sa| x! 0 x so | x s4312y 1467 v 10-8.3 Fem 580 (270) PAGE 5PUBLIC DISCLOSURE COPY Fam 90 2090 23-135216 a ‘Statements Regarding Other IRS Fllinga and Tax Compliance Check f Schedule O contains @ response to any question in this Part V. feet 1a Enter the number reported in Box 3 of Form 1096. Enter -0-if not applicable fa 595] ® Enlar he numberof Farms W.2G ined mine ta Enter nt apoable tb q Dis the organzaton comply with backup withaling mules for reportable payments to vendors and reportable gaming (gambling) winnngs to prze winners, . see 2a Ener te number of employees reported on Form W., Transmit! of Woge and Tax Stamens, fled forthe calendar year ending with or win te year covered by is return. 2a | 20,260] | _ If atleast one 1s reported on lino 2, cd the organzaton fe al required federal employment tx returns? | 2b | Note. ithe sum of ines 10 and 2a s greater than 250, you may be requred to ofl. (cee inetuctons) I 3 Did the organization have unrelated business gross income of $1,000 or more dunng the year? wpe [OTe b if-Yes has fled a Form 960-1 for te year? IN," provdo an explanation n Schedule O. 3 4a At any time dung the calendar yer, did the organzaton have an ntrst i, ora signature of other ahoiy” ‘over, a fnancal account in fregn coun (euch as a bank account, secuntes account, or ober financial account?” al |x © Yes, err the name ofthe foregn eau." Seeinsiructon for fing requirements for Farm TDF 80221, Report of Foreign anand Financial Accounts. |_|__|_} 5 Was he organization a pry toa prombed tax sheer ransacton at anytime dng the tax year? a] Te Dia any taxable party nobly the organaton that It was or is pary to a prohibtod tax shoter vansacion?’ [6 | —[ ¢ If "¥es,"to line 5a or Sb, did the organwzation file Form 8886-T? _ oe. | Se Does te orpanczaton have annual gross receipe that are onal grsior Wan $160,000,” and aid to ‘organization soit any coninbuons that were not tax deductbe? al |x b it"¥es; dd the orgenzaton inue wah every solctaton an exprss saiinent that such connbtons” or ‘gifts were not tax deductible? . . , oe a oo eb 7 Organtzatons that may receive dedicible contributions under section 170() ‘id the organization receive & payment in excess of §75 made parly as a contibuton and party for goods |_| |_| and services provided to te payor? ma |e b If"¥es," did the ‘organization noly the donor of the value of the goods or services provided? eee e eee eee LD € Did he opinzaon se exage o oere apse of tne pan! pony i wich ws requred to fle Form 82827. rail ele, 4 eves, indcate the umber of Fors 8282 fled dung the year i foro © Did he organzaton receive any unds, dec or indrecy, to pay prnnaris ona personal benefit convact? |e |_| X f Did te organization, during the year pay premuums, drecly or indrecty, on a personal beneft contact?’ -7¥-| | x 1 116 ecancaton recived a conten of ned mlecs propery, te orgenaaton fle Ferm e098 asreaured?.. . [T 1 itt opanaatn econedacorintvion cf ca, boas, apans oer vane, de orpanzabon si aFerm s00e-c? [Th {© Sponsoring organizations maintaining donor” adviaed funds and section S09aY) supporting organizations. Ord the supporing organization, or a donor adysed fund mamtaned by @ sponsorng organization, have excess busness holdings at anytime dunng the year? Sponsoring organizations mainaining donor advised funds {Did the orpanzation make any taxable dsinbvions under secon 49067 © Did the organization make a dstrbuton to don, donor advisor, or related person? 40 Section S016)7) organizations, Enter ‘a Initiation fees and capital contributions included on Part Vill, line 12 . 10a © Gross recs, ncided on For 860, Part Vil, ine 12 for public use of ib facies” 100 11" Section 50%(6K12) organizations, Enter a Gross income from members or shareholders, , see oo see Li} Gross mcome ‘fom other sources (Oo not ni amcunis"due or paid to oiher sources aganst amounts due or recwed rom thom). 11 eel 12a Section 4847a\1) non-oxompt charlable trsts. s the organizaton ing Form $00 i iu of Form ¥O4i? [a 3 trves, enter the amount of tacexerpt interest recevedor actus during to yor 12 1 48° Section s01(2(28) qualified nonproft health Insurance Issuers ‘a Is the organization licensed to issue qualified health plans in more than one state?. . . . . a Note. Seethe nstructons for addtional nfrmaton the ergnizaton must report on Schedule b Enter the amount of reserves tho organization is equred fo mantan bythe stats in which the organzaton is lcansed to issue quaifed heath plans.» sss, 3B «Enter the amount of serves on hand 36 ‘463 id he organzaton racanve any payments for indoor tanning sences curing th tx year? patel easlene bl rveshabit fad a Form 720 to repr hese payments Ir "No,-prowde an exglanalon n Schedule ©. .“[rab coSeo Tem 880-() sa3i2y 1467 Vv 10-8.3 PAGE 6PUBLIC DISCLOSURE COPY 002010), 231382166 Poe [EEEMIM Governance, Management, and Disclosure For each "Yes" response to ines 2 through 7b below, and for a "No" response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in ‘Schedule O. See instructions. Check if Schedule O contains a response to any question in this Part VI... - fl Section A. Governing Body and Management 1a Enter the number of voting members of the governing body at the end of the tax year ee [te af bb Enterthe number of votng members includedin ine ta, above, wh ae independent... LAB 2 2 Did any ofcer, drecor, trustee, orkey employee have afamiyclatonshop ora business relationship with any other ofcer, decor, trustee, or key employee? eeceeret fet x 3._Did te organization delegate conrl over management dues customariy performed by or unde the sirect supervision of ofcers, decors or rusts, or Key employees toa management company or other person? a} tx 404 te orgnzaton make any sgnicant changes tos governg documents snca the por Fom 900wasfies? «= =| 4 {1 5 Dd the organization become aware dunng the year oa significant aversion ofthe erganzaton’s assets? .. ..| 8 |X {6 Does the organizaton have members or stockholders? vee fe hk 7a Does the organization have member, stockholder, robe persons may eect one or more members ofthe governing body? . .« « veeeefal de 'b Aroany decisions ofthe govern body subject o approve by members, stockholders or ober persons?» . (Te | 1x {8 Did he organzationcontemporaneously document the meetings held or writen actons undertaken during the yearby the folowing. 12 The governing boay?. a x 'b Each committe wth authonty to acton behalf ofthe governing body? - Mh x 8 Is there any offcer, director, tustee, or key employee sted n Par Vi, Sacton A, who cannot be reached at the organization's maiing edaress? Ios," provid th names and adresses m Szhedue O ~~ ol x Section B. Policies(This Section B requests information about polctes nol required by the Infernal Revenue Code] 40a Does te organzation have local chapters, branches, oafats? ee v + fag Tx 'b_t*¥es,” does the organization have unten poles and procadures govering he actives of such chapters afiiate, and branches to ensure ther operations are consistent with those a the organization? =.= « - [108 ‘a Haste ganization proved copy tts Fom S60 tal menses ot overing bet efor fing he x fom? - ne oe te bb Descnbe in Schedule Othe process, any, used bythe organization o review tus Form 980, ‘42a Does the organization have a wittan conic of interest policy? I"No,"go ln 13 =. «++ « - {rae | x Are officers, directors or trustees, and key employees required to escose annual interest that could give (se wo contics? - . ei +20 | x e Beste rpanzaton eq an asstnty mono and rere compan wih be pa? Wve describe in Schedule © how this 1s dane 7 - [ize | x 13. Doos te organization have awnten whistleblower pokey? ce sa [x 14 Does the organzatin have a wniten document retention and destucton policy? |. [x 15 Did tne process for determining compensation ofthe folowing person inclu arevew and approval By independent persons, comparabity data, and contemporaneous substantiation of the d 42 The organzain's CEO, Execute Drecor, or top management ofa x Other offcars or key employees ofthe organization : x It-¥es" tone 1a or 18b, desc the process in Schedule © (Seo nsbucion ) ‘16a_Did the organczaton nvestin, contribute asses to, oF paripats in ajint venture or simlar arrangement with a taxable entry curing the year? - {asa | fx bIf°¥es," has the organization adopted 8 writen poicy of procedure requing the organzaion to evaluate Is participation in joint venture arrangements under applicable federal tax law, and takon stops to safeguard the oraanizatir ents le Section C. Disclosure 17 List the states with which @ copy of this Form 990 is required to be filed — P_PA. - 18 Section 6104 requires an erganczaton to make its Fonns 1023 or 1024 applicable), 860, and 80-7 GONG)@)s ond) able for pubic nspecton. Indicate how you make these avaiable Check al thal aply ‘Owmvwabste [| Anciners website [x] Upon request 418 Desenbo:m Schesute O wher (nd if so, how), he organizaton makes fs govering documents confi of narest poly, and franca statements avaiable tote public 20. Stato ho name, physical aderss, and telephone numberof he person who possesses the books and ecards of te cnpanizaton »FHOUAS. TODOKON SEEN Ot” 'e CIVIC CENTER BLVD: PHILADELENIA, PA 19108 : 265-580-1000, = Fan B50 s4a3i2y 1467 Vv 10-8.3 PAGE 7oom 602010) PUBLIC DISCLOSURE COPY _23-1352166 Page Compensation of Officers, Directors, Trustees, Key Employees, Highest Componsated Employees, and Independent Contractors Check Schedule © contains a response to any question inthis Part Vil ‘Seslion A Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a Compete this table for al persons required to be fisted. Repor compensation for the calendar year ending with of witin the ‘xpanizaonts tx year stall of the organizaton's curent officers, drectors, wustees (whether indvisuls or organizatons), repercess of amount compensation Enter Bin columns (0, (and Ff no compersaton was pe *genzatons). ‘© Ustall of the organization's current key emplayees, I any. See structions for defintion of key employee" st the organzaton's five current highest compensated employees (other than an offer, director, trustee, or key employes who received reportable compensation (Box'5 of Form W.2 andlor Box 7 of Form 1099MISC) of more than $100,000 trom the ‘organization and any related organizabons List all of the organizaton’s former officers, key employees, and highest compensated employees who received more than {$100,000 of reportable compensation from the organizabon and ary related organizations List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $10,000 of repertale compensation from the organization and any related organizations Lust persons inthe followng order indwvidual trustees or directors, mnatiuional trustees; officers, key employees, highest ‘compensated employees, and former such persons check this box if neither the organzation nor any related organzaton compensated any current officer, director, or trustee. -f oy ® © @ ® a aa one To duress [pewmteesanacein| seme | roomie | eras "TEST | Tae | Gee | oar me EEE z iS spots | ometaaon SSE TEA!) outs, tones | “eee wee! Hi 4] | ew sHooetase) constion waze| 3]; i Sind 0 i =e ne cso e fadsTee o.oo x| |x 2,093,221 ol 2,075,900. TaN scorr TRUSTEE 1.00] _x o| 1,290,988, 133,372 TRAN con wD TRUSTEE 1.00] x of erase] as aan TasrEpiien BSUS CATR i TRUSTEE rool _x| |x ° 0 0. Ta Teistaa c comer J rool x |x ° ° 0 Te TRUSTEE 1.00] x ° 0 0 TRUSTEE 1.00] x ° ° °. Tapane FSM taustee rool x| |x ° ° o. Tabi c_GARBOSE sausti 1.00] x 0. 0 ° SRO AWTHONY A ERENT 1.00] x ° 0 ° 1.00] x ° 0 ° __ TRUSTEE 1.00] x 0. o| 0. TREN. MILLTGRN GEA TREASURER TAUSTEE rool_x| |x ° A 0. TjlgFneo N BTESECRER TRUSaEE 1.00|_x 0 ° 9 ROS 1.09] x ° ° ° rool x] |x ° o| o. = rem 890 a sa3izy 1467 v 10-8.3 PAGE 8PUBLIC DISCLOSURE COPY ronson ascassaies not ‘Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employesa(coninued) a o o ° © a wn as rewnan | nmense | eatin = or | cer | ae" nar ‘organzaton | (W-2/1088-MISC) oo ol waroo6.Misc) romaaien story = ses 6 aur __ TRUSTEE 1.00] x o 0. __tRustes 1.00] x oO 0. oO. sbi yhaosaaae'| a sesame. ¢ Total from continuation sheets to Part Vil, Section A” ATTACHMENT 2. >| 12, 196, 996 4 Of 1,091,750. 4 Total add lines 1 and te) »[14,290,028.| 2,165,097) 3,346,163. 2 Total number of individuals Gacluding but not mid fo those listed above) who received mere than $100,000 n reportable compensabon from the organization Pe 941 [Yes] No. 3 id the xpartzaton et any fomer oom, dvr or tusce, Koy employes, or hahest comand ‘employes on ine 127 if “Yes, "complete Schedule J for such indwidual « 4 For any individual listed on line 1a, 1s the sum of reportable compensation and other compensation from tha tgancaton and rlaed crpanzatons greta; than 31600007 Mf “Ys” camploe Sched J for such individual '5 Did any person listed on the 1a recciv or accrue compensation from any unrelated organzaton or individual for services rendared to the organizaton? If"Ves,"complate Schedule J for such person eu a ‘Section B. independent Contractors: 1 Complete this table for your fve highest compensated independent contactors tat received more than $100,000 of compensation trom the organization. “ © © Name and business adsross Deserpton of services ‘Compensation ATTACHMENT 3 2 Total number of independent contractors (including but not lnited to those sled above) who received ‘mare than $100,000_in compensaton from the organzaton 103, = Fam 980 010) s43i2y 1467 Vv 10-8.3 PAGE 9Fam o60 2010) PUBLIC DISCLOSURE COPY __23~1352166 Page 9 mn ‘Statement of Revenue I « wa, Sh na roan ‘cmt Domoss excuse rmx tro sia sisersie rn ] b a Federated campagne 'b_ Membership duos Fundraising vents. te Related organatons ....... [4a 20,808,37 Goverment rans (onions) « [te | ase, 650 ‘Abetnr consbutens, ots, srt, endermtar amounts noted above. Lat | 22,198,201. © Noveamcortoitons cided aes ttt Ih Total Adsinee toffee as Contributions, git, grants Sndother ainisr amounts woe Bl ns sieize Business Code 2a wer entteer seme so00ss 1.244,269,3 boson cevren necesere so008s 6.0 eer, ce meeERCE 200008 wre. |gasaze.ane ‘ ' a |proaram Service Rovenve ‘iota scram sce ve Total Ads ines 23.2 eet 3 _Invesment comeing eviende, tres ane ‘ther siitar amounts) 4 nea rom mvesiment of tak exempt bond nts 7 ome seen BS EET TY vvv “ica j | 62 Gross Rents. - =. Loss ronal expanses 4 Rental ncome or oss) « « [_s,088.6 Nat rental income or oss) “Gi Secanios | —“T Oiher 7a Gross amount tom sales of ‘ots ofverthan Inventory. | 72.571,095 Loss costo other baie and sales exponsos © Gamor(ioss) - « 4 ‘Notganordess) - oe Grose income fom Andraing ‘events (not nen ‘of contnbutons reported on tne 16) ‘See Pat IV, tne 18 oe Loss drect expenses © Netincome or (oss) fom fundrasing events ‘Gross income rom gaming aces ‘See Pariv, ne 19. . 5 Less drect expenses © Notincome or (ss) rom gaming act 10a Gross sales of ventory. less returns and allowances, Loss costot goods sold - -¢_Netincome or oss) tom sales ofiwentary . > Miseslaneous Ravenue ‘Business Cod lv Other Revenue fia ERECT rustic suProRT-EsERACK aEvEWe|_s00088 asaanerer | se,ane.a07 PaRMG GARAGE RAVENUE e100 a.esus02 851,582, Alother revenue « Cseoaes rn 4.857,90 [x2 _ Total revenue, Seo insinucions 207,so0. | 330s,neua asst Fam 990 (2010) vv sa3i2y 1467 v 10-8.3 PAGE 10PUBLIC DISCLOSURE COPY For 90 2010) 23-1352166 on 10 Statement of Functional Expenses ‘Section 601(6)(3) and 807(0(4) organizations must compete all columns. Altother organtzations must complete column (A) but are ot required fo complete columns (8), (C), and (D) ‘Do not include amounts reported on lines 6b, on a) ©, 2, 7b, 8b, 9b, and 10b of Part Vil. open tcponaea ponte "ena 11 Grants and other asssianea to governmenis and ‘organatons inthe US SeoPart.ine21 ..| _23,753,496.| 23,753,496. 2 Grants and other assittance fo indowduals in he US.SeePariv.ine 22...» 0. 13 Grants and other assistance to governments, organizatons, and iduais outsde the US SoePart IV, ines 15 and 16 559,669. 559, 669. 4 Benefits paid to or for members. 0 5 Compensaton of curent oftcers, deectors, ‘ruses, and key employees 17, 403, 602 17,403, 602. 6 companenton not wndided stove, to duquides perans (as afnnd under schon 48587) and erine dented nsacton 485864340) , 0. 7 Over salanes and wages... . 8 Penaon plan canmovtone (mide tecton 40%) 457,719,651. | 334,085, 665.| 163,633,986. ‘and sacs 40%) ampoyrcarnetons)- = 25,342,526. 16,436,017 8,906,509 Omer emetoyen benasis . 51,981,278.[ 33,712,109.| 18,268,570. 1 Payoltaxes. see nt 45,477,096.| 29, 494,908.| 15,982, 988. 11. Foes fr sonics (non-amplyees) 48 Management| o,| _ Legal 1,437, 635. 1,437, 635. © Accouning 731,760. 731,760. Lobbying eee eee 810,707. 10,707. {© Prtessenal undraang sarees See Pa tn $7 0. f lvostment management foes. 343,538. 343,938. 9 Other ae 77,129,001. | 42,988, 651.| 34,140,350. 42 Advertang and promovon 3,993,864. 3,993, 864. 13° Offce expenses 78,194,879 3, 385, 750. 9,805,129. 14 informaton tchnotony - 3,052,514 2,172,691 879,623. 18 Royale, : 1,817, 740 7,817,740. 18 Occupancy sos 28, 457,526.| 2, 713,125.| 25,744,401. 7 Travel. 3,182,323.[ 2,384,362. 737,961. 18 Payments of tavel or entertainment expenses for any federal, state, oF local puble oftoais °. 18 Conferences, conventions, and meting 3,078, 621.| 1,306,283. 772,538 20 Iiorest . T1,203,749.[ 0, 462,812.| 2,820,937. 21° Payments to ates 5 0. 22 Oeprecaon, doplebon, and anerszaian 115,119,279. | 86,339,459.| 28,779,820. 23 Mmsurane ee 23,889, 590.| 16,691,571. | 7,198,019. 24 er erences tongs expences not covered ove (Lat macalanaous exgences mine 241 tne 24 ameunt exceeds 10% of Ine 25, olen (A sxreunk at tne 24t expanses on Sees 0) ‘*RESEAI 261, 802, 424, | 261, 602, 424, SPARXENT. RELATED SUPPLIES —-__ [_136,728,906.| 136,728, 906. 56,247, 555.| 56,247, 555. 93,377,858. 2,050,849.| 7,327,009. 2,295,952.| 1,901,911. 394,041. ln 420,614,140. 1, 066,222,013. | 352,591,327. a 25 > LT sttotowns SOP 98-2 (ASC 058-720) Completa ths ine ‘only if tho organzaton roperted column ions costs rom a combined educabonal Earpatgn and fundrsing sosetavon’, coe Fenn 990 aio) saaiay 1467 v 10-8.3 PAGE 11PUBLIC DISCLOSURE COPY fms eeo 00) 23-1352166 age Balance Sheet * @ gt fer tn year 1 Gash roratarestbeaing > vusessvsseveseeeee z 2. Savings and tamporany cash nvesinants 21007 Twas asa 2 Pages and grant receivable net 73/339,505.[ 3 | 31,233,600. 4 Accounts resiaiesnet Tets2i.ee3.[4 | 160,391,403 & Recehabes trom curent aid former ‘ier, reders, Wustees’ kay employes, and righest compensated employees, Complete Pat ll of Scheduleo ee eee 5 (© race fo cr suo fu a ur wens wtp Gvotn nsson 24, sa ong woes te eng eta sion 1) vty erga ean eqranten ence) ‘ | 7 Notes ang loan recowaba at a 10,244, 600;| 7 | 9,007, 0 8 |e siresnanas ream eta eee 3.613.370, 8 | 2,907,626. 8. Prepaid expenses and deere charges’ || 3705,s78.[ 8 | i1,s11,775- {08 Land, buildings, and equpment. cost or cher tans Compete Part Vi of Schedule 9 [10a | 2587781713. b Lese-aceumulted deprecation. [iob[ 1051545462. [1,523,529,034. [toe 1,536,232,251 44 Investments publely waded secures © 21. ess > 151,610, 988.| 4 | 162,276,838 12. tnvertnons cer sountes See Part WV, ne 11 1 Gi. 625,262.[ 42 [70,217,334 13. investnens-programeaid Seo Pan Ne 3 {4 Intange assets ‘ i 45 Oterassets SeePaniv,ine 11 sss. : Ta5 656 S188 | 205, TEL ITS [18 total eset. Aad ines 1 rough 1 ust equine 3) 207,858,676. 16 f2,396,983,771. 17 Accor payable and acoved expenses => 207,936,609: 47 | 201,211,473 te Grants peyatie ra 19 Detered revenue 7a 755, 966. [18-| 25,708, 922 20. Tacererpt bond babies <2)! [ine trtotara® [ao [esasaaicai7 g] ow o cna accountng Bat Wt ‘Seba [1] Elza Payaties to curert and. fomeroficore, dvedors, tsiees, Key | employees, highest compensated employees, and disqualified persons 3} Complete Pao Schesl L nM — 2 23 Secured moigages and notes pyati to uneeie thr partes 23 24 Unsecred notes and ans payable to unread thr pares». rn 25 Otertaoites, CompietoPanK ofSchedue +++ +0... .{ 246,083, 60R:[as | 172, 083,116. 24 Total lates. Addins 17 vough25. 17088, 410,676- [ae 11/093, 394,928. Organizations tat follow SAS 117 check ure LE] and completa | __tnee 27 through 23, anne 3 ana 30, Elar Unestictegnetassels 1,080,060,973.| a7 [1, 190,039,253. ze Temporaniyrestnciod net assis : 38, 367-025-[98 | -52°209,080- 8) 25 permanent resinced nat ssts 2 2] organizations tat donot olow SFAS 117, check bre Co] and ©) Somat tins 90 tough 34 3] capt stock or trust pnt or cent nds ve 0 3) 31 Pact captal sup, oan, buldig,oreaupmeniiund at 232 Retained earangs,endowrent accumulated nome, oer nds a Ysa Total net ase or ind balances ; Aaa 407, 956 33 [2S Oa SS 34_Totl abies and et assetsund blaos ‘[pizoriasesere-[se-p ase. ses277 Fare 990. saziay 1467 v 10-8.3 Pace 12PUBLIC DISCLOSURE COPY am 550 2010) 23-1352166 vom? Raconciiaton of Notes = Caen eee re ve 4 Total revenue (must equal Part Vill, column (A), ne 12) 4 | 4,536,847, 400. 2 Total expenses (must equal Part [X, column (A), line 25) . eaten 3 Revenue less expenses. Subtract line 2 from line 1 3 116,033,260. ‘4. Net assets or fund balances at beginning of year (must equal Part X, ine 33, column (A)) 4 | 1,118,447, 998. 5 Otter changes in net assets ound blancs (expan m Schedule O) tit) Pap ise7-005: & Netassets or ind balances at end of year Combine Enos 3, 4 and (must equal Part X, io 3, column (@)) ss += ee ; . 1,243,049,343. Financial Statements and Reporting [Chock if Schedule © contains a response to any question inthis Part il 41 Accounting method used to prepare the Form 960 []cash [x] Accaat (J othe tte orgarizaton changed ts method of acouning om apr yar or checked "Other expan a Schedule O 2a Wire the organization's financial statements compied or reviewed by an independent accountant? -. fal |x Were the oranizabor'sfhancial statements audted by anindependent accountant?” °: Ge he ¢-f*¥es" tone 28 oF 2, does the organzaton have acommitee that assumes responsi for ovr ot the aud, revew, or complaton efits nancial statements and selecton ofan independent accountant? | 26 |X ite oganzaton change eter is oversight proces or slachon process dung te lax year, explain n Seneduo 0. 4. 1*¥es" tone 28 oF 2, check a box below to indicate whether he fancal statements forthe yoar were issued ona separate bans, consolidated bass, or bt (asllesuee va ceactdaind boas] 800 coneokdeted and sparse besis 23a As. resto federal ward, was the oranizaton required o undergo an eu or aud asset for a the Single Auait Act and OMB Circular A133? | a ee ae | isetlr b_ If"Yes," dd the organization undergo the required ait’ duis? it ha Grganization didi Undérgo'tie’ oqurad audit or audits, explan why in Schedule O and descnbe any steps taken to undergo such audits wl x Fem 990 (2010) Sa3izy 1467 v 10-8.3 PAGE 13PUBLIC DISCLOSURE COPY SCHEDULE A =orm 990 of 990-E Public Charity Status and Public Support aes i ee gy mene 2010 Comat it IS47(9K 1) nonexampt chantable ust. ‘ara Revenue Saves” > Atach to Form 990 or Form $8042 See separate instructions, Name ofthe organization Enployer orifetion number ‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA 23-1352166 Reason for Public Charity Status (Al orgarizatons must complete is part) See natuctons ‘The organzaton i not apvate foundation Because tis (For ines + rough 11, check oly one box) ‘church, convention f churches, o association of churches desenbed in section 7O(DKAVAND- A school described in section 470(SKAND. (Atach Schedule E) ‘Ahespial ora cooperative hosptal service argaizatondesenbed in section 170) WAN. ‘A metical research organzaton operated in conuncion wih a hospital desorbed in section ‘7O(OK{)ANIN. Enter the hospta's nam, cy, and state a 5 [1] Anompanizaton operated fr we benaft ofa coege oF unwary ned or operated by & goverment uni described ia section 170((ANANiw). (Complete Pat) {Atederal, stata ool government or governmental unt descnbed mn section ‘7O)VAN- 7 [J An organization that normally receives a substantal part of its support from a govermmental unit or from the general public osenbed in section 170(6)(}(A)(vil. (Complete Parti!) 8 [J Acommunity rust descnbed in section 170(b)(1WAN(i). (Complete Parti!) 9] An organization that normally recewes. (1) more than 3317 % ofits support from contibutions, membership fees, and gross receipts from activites related to its exempt functions - subject to certain exceptions, and (2) no more than 330% of its ‘support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975 See section 509(a)(2). (Complete Part!) 10 [7] Anorganzaton organized and operated exclusively to test fr public safety See section 609(a)4). 11 [7] An organization organzed and operated exclusively for the benefit of, to perform the functions of, or to cay out the purposes of one or more publicly supported organizations described in section 509(a)(1) or secon 509(a)(2) ‘See section {509(a)(3). Check tho box that descnbes the type of supporting organization and complete lines 11e through 1h, (_]typet > LJ] type! © [_) Type tt- Functonally ntegrated ¢ (J type t- omer (J) By checking this box, | certify that the organizaton is not contolled directly or indrectly by one or more disqualified Persons other than foundation managers and other than one or more publicly supported organizations. described in section '509(@)(1) or secton 508(2)(2), {Ifthe organzation received a wniten determination from the IRS that it is a Type f, Type Il, or Type Il supporting organization, chock this box . pba ese @ Since August 17, 2006, has the organzabon accepted any gif or eontbtion from any ofthe {following persons? () A person who drectly or indirectly controls, exher alone or together with persons described in (i) Yeap {and (i) below, the governing body of the supported organization? . ot (i) Atamily member ofa person descnbed in () above? |... TILED [rte {ily A 35% controlled entty ofa person descnbed in () or i) above? : omn] |b Provide the felloming information about the supported organzation(e) {W Name o supported MEW — | GM Typ—ofogancaton | (Wane |MOayourcy| (Wome | (ah Amountol ‘ogencauon (orenoed nines +6" | eemorn |‘Gworpanasion | onnaston ‘suppor hove oriRc socvon |S Otamn | “went (ot [cot Meranaee (eee instructions) yeursazor |inneUs? “ © oy seven Reduction Act Netice, coe tho Instructions Yor ‘Schodle A (Fo 99 0G 2010 for 9002" s43i2y 1467 v 10-8.3 PAGE 14PUBLIC DISCLOSURE COPY ‘Schacile (Fom 00 02) 2010 23-1352166 Page 2 EERE support Schedule for Organizations Described in Sections 170(6)(1)(A)iv)_and 17O(B\ANANvi) (Complete only if you checked the box on line 5, 7, or 8 of Part! orif the organization failed to qualify under Partili.f the organization fails to qualify under the tests listed below, please complete Partlll) Section A. Public Support Calendar year or fiscal year beginning im) > [2006 |e) 2007 |e) 2008 | eh 2008 | 7070 Tear its, grants, contnbutons, and rmomershp feos “recenad "(Oo not Imalude any "unsaual grants") «ss «= Tax revenues lone for the rganzation's bene reer pa ter expended on ie bona Tho value of senices or faites fumished by 2 governmental unit the ‘rgantzaton witout charge Total, Ads ines 1 Hyoughd «sess ‘The porbon of total contnbutons by each person (ater than a goverment unt or Dubiely suppered organization) melded ‘on ine 1 tat excaods 2% of te amount ‘shown on ine #1, column ( Public support. Subtract ine Section B. Total Support Calondar your (r fiscal year beginning in) > wyz007 | (e)2008 | jay2006 [wy 00 ‘ral 7 Amount fori 4 8 Gross income from snares, diicende, payments recewed’ on secunies fons, {A ovis an income ron sat % Net income trom unelated business ewes, whether or not the busines IS regu cared on = = ie 40 Other came, Do nat neide gan oF Toss. trom te sale of capa assels (Explain Parti) ocee 41 Total support Ads ines 7 rough 10. 12. Gross receipts rom rolaed acbwbes, oc (sea nstuctons) .. ss + 50 2 12 Fie fie yer, he Fore 800 forte eranzabois et stent, He fan 0 or oth “te yur a8 toon S100) organaton, check tvs ox and stop hare ee 7 . es ef) ‘Section C. Computation of Public Support Percentage 14 Public support percentage or 2010 (line 6, column () divided By ine 19, column (0) 4 % 48 Public support percentage from 2009 Schedule A, Part! ine 14 ee 48 %. 16a 3340% support test -2010. Ifthe organization did not check the box on line 13, and line 14 is 3318 % oF more, check ttys box and stop hero. The organzaton qualifies as.a publicly supported organization -h 'b 33413 % support test - 2008. ifthe organzaton did not check @ bex on line 13 of 16a, and Ine 15 Is 3311 % or more, ‘heck this box and stop here. The organization qualifes as a publicly supported organization . OO 17a 10%facts-and-circumstances test -2010. Ifthe organization did not check a box on lino 13, 16a oF 16, and line 14 is 10% ‘or more, and if the organization meets the "facts-and-crcumstances" test, check this box and stop here. Explain in Part IV how the organization meets the “Yacts-and-crcumstances test The organization qualifies as a publicly supported organizaton . fe »O b 10%facts-and-circumstances test = 2008. Ifthe organization id not check a box on ime 19, 16a, 10b, or 172, and line 18 18 10% or more, and if the organzation meets the “facts-and-crcumstances” test, check this box and stop here. Explain in Part IV how the organzaton meets the “facts-and-cicumstancas" test. The organization qualfes as a publicly supported organization... oh 18 Private foundation. If the organization ‘id not check & box on ine 13, 169, 160, 17a, or 17>, check ths box and see instructions. ee é eee > ‘Schedule k (Form 90 oF 090-2) 2010, s4312¥ 1467 v 10-8.3 PAGE 15PUBLIC DISCLOSURE COPY Schedule Form S00 o 502) 2010 23-1352166 Pog 3 ‘Support Schedule for Organizations Described in Section 809(a)(2) (Complete only if you checked the box on line 9 of Part | or ifthe organization failed to qualify under Part I Ifthe organization fails to qualify under the tests listed below, please complete Part I.) ‘Section A. Public Support ‘Calendar your (or fiscal year begining in) ]|__(e) 2008 (2007 | (e)2008 | ~ yay2000 | (e010 Teal 1 Gita, gras, conrowters, and mame tes recaves (00 not lu any "uns ats) 2 Gres recopts om aemasons, martandae sels or sarees peorrad, of foes uae nang acy tat lated 1 ihe rpenuators tmexempt pues. , 3 Gros capt fom scones at ar no an 4 Teerevenuesteves forthe erganazaton's Dene and eter paid to or expended on 1s bohat tees pce 5 The valve of services or” fealines fumished by a governmental unt to the ‘orvanzation without charge & Total Addines 1 wrough S | : 7a Amounis Included on ines 1, 2, and 3 received tom disqualifed persons... . © prime ewe oni 2S crs that" exceed tho, groan of G00" ors ofthe amcunt Sn tne 13 fort y et © Add ines 7a and 7D. . 8 Public support (Subvact Ine 76 tom’ fino 8) eae ‘Section B. Total Support” ‘Calendar year or fiscal year begining ia) ®[ (a) 7008 | ~(ey2007_[vey2008_ | raya0e | (@ya010 (Total 9 Amounts romine 6... Ee 108 Gross come tom terest aindonds,| payrontsrecawved’ on recunbes loans, fonts, royalbee and ancame,Fom sma 1 Unrelated business taxable mcome (ass secton 511 taxes) from busmesses scqured afer June 20, 1975... © Add ines 108 and 10>. 41 Net income fom unrelated” buaness aetwies "not icuded in ine 0b, wheter or ot Se Buses regu 412 Other income Do not inchise gan or loss fom we sale of capdal astots Explanin anv)... 13 Total support (Add nes 9, 106, 1," and'12) . 14 Firat fve years. it wwe Form 600 ls for the ompanaaters Ret, wecond, Wind, Touth, oF Mth tax yoar as @ sechon SO1(e}) organuaton, chock tis box and stop here peer > Section C. Computation of Publie Support Percentage 18 Publ suppert percentage for 2010 (ine 8, colurn () évdea by ne 73, cana () : 7% % 16 _ Pubic support percentage rom 2009 Scheie A, Par Il ne 15 peel as %. Seclion 0. Computation of investment Income Pereantage {7 veeran cone prin fr 2010 Oe ie, coe () eid byl CaM [SE 1 Inwetanncone peraniage fom 2208 Sédle A Putte a ite 291m supe tw "210. be opuaten techs a ‘akon 4, en 86 now an BOSH we {7m ro mere an S010, het fa bor tnd aap tan Tm ogutnen quite set pokey peas srenian” 339% supper tnt 2000 tw epancaten det eck a box onic hw 94, to ne 16 Wmv tan 3340 nd ina 184 ro mor a 3918 % cnc thn ox ad lp hrs Th egaraaion Quer ere publ eimpeed pencaton > 20_Pinam fonton, fu eunnaen tt Goek ber on eee iy i cst Ht bor tan toca — Sscaiok am tne ETAT satay 1467 v 10-8.3 PACE 16PUBLIC DISCLOSURE COPY 23-1352166 erate (For 960 0 99062) 2010 Page ‘Supplemental Information. Complete this part to provide the explanations required by Part, line 10, Partil, ine 17a or 17b; or Partlll, ine 12. Also complete this part for any additional information, (See instructions). ” ‘Schedule A (Form 890 or B0-EZ) 2010 SOUS sq3izy 1467 v 10-8.3 PAGE 17PUBLIC DISCLOSURE COPY ‘SCHEDULE C Political Campaign and Lobbying Activities essere |p me reer cee tastes peat Completa epetin sorted nom pat, zeraniminany | patch Forn verter WEE pSeesemmiinetutons en to Fu {tthe organization answered "You to Form 990, Part, line 3, or Form 9902, Part Iie 48 (Polticl Campaign Active) on +" Secon 50163) orgenizatons Compote Paris -Aand B Dono complete Pac + Secnen 501) (oter man secon SOT.) oranzatons Compl Pars A and C beow Donat compete Part * Scion 527 arganizatons. Complete Part ery. the organization answered "Ys," to Ferm 90, Pat, ine 4 oF Form 880-2, Part ine (Lobbying Active) thn ‘ Sezion £01()9) xganaators at nave fed Form 768 (cton under scion SON) Compe Pat Ir Do not carte Pa 18 ‘ 'Secaon501|_] ifthe fling organization belongs to an affilated group. B_Check »| | ifthe fling organization checked box A and “limited conto” provisions apply Limits on Lobbying Expenditures. (The torm “expenditures” means amounts pald or incurred.) (Fang organzatorts totals (@Aiiates ‘up totals Total lobbying expenditures to nftuence public oprrion (grass rots ebbying) Total lobbying expenditures to nftuence a legisiatve body (direct lobbying) Total lobbying expenditures (add lines 1aand tb)... ... : ‘Other exempt purpose expenditures otal exempt purpose expensitures (add lines 1¢ and 14) Lobbying nontaxable amount. Enter the amount from the fellowing tabla in bath columns. it amount online 40, column (a) oF (|The lobbying nantaxable amount: Not ever $500,000, [20% of ne amount on ine 10 [Over $500,000 but not over $1,000,000 | $100,000 pus 15% of he excass over $50 0,000 Over $1,000,000 but not over $1,500,000 | $175,000 lus 10% of th oxcats over $1,000,000 Over $1,500,000 but not ver $17,000,000 |5225,000 lus 6% of the excuse over $1,500,000 [Over $17,000,000 s3,000,00. ‘9 Grassroots nontaxable amount (enter 25% of ine 1f) hh Sublractline 1g from line 1a i zero or less, enter-0- ' i Subtract ne from line 1e. zero of ess, enter -0- there is an amount otner than zero on erther line 1h oF line 1, eid the organizaion fle Form 4720 reporting _L1ves [7] ne section 4911 tax forth year? 4-Year Averaging Poriod Under Section 501(h) (Some organizations that made a section 601(h) election do not have to complete all ofthe five ‘columns below. See the instructions for ines 2a through 2f en pagk Lobbying Exponditures During &-Yoar Averaging Pariod Catena your cal your ee 1) 2008 (2000 (2010 (orTotat 2a Lobbyng nontaxable amount ' Lobbyng caling amount (450% oft 25, column) © Total lobbying expenatres 4 Grassrots nontaxable amount © Grassroois cing amount (4508 oft 26, ature () 1 Grassroots lobbying expendaures sagi2y 1467 v 10-8.3 Saha Form BD or OED ITO PAGE 36PUBLIC DISCLOSURE COPY Saoauac Fe 990 9902 2010 23-1352166 Pope ‘Complete if the organization is exempt under section 601(c)(3) and has NOT filed Form 6768 (election under section 04(h)). o w yea] No “Amount 1 Dunng the year, did the fling organization atlempt to influence foreign, natonal, state or local legislation, including any attempt to influence pubic opinion on @ legisiatve matter of foferendum, through the use of a Volunteers? x 'b Paid staff or management (inckide coniperisation in expenses repéried on ines ie'tirough 1) [x © Media advertisements? ¥ d_Malings to members, leg X ‘© Publicatons, or published or broadcast statements? x {Grants to other organizations for lobbying purposes?” x 310,707. e x 367,448. h x ‘ % 1 Total Add lines 1c through th. , 1,178,155. 2a Did the actwvites in ine 1 cause the organ x b_ I"¥es,"enter the amount of any tax incurred under section 4912.0... © 1f"Yes,"enter the amount of any tax ncured by organization managers under section 4912 44_itne tng ecarzaton neurel a secion ab? tax dst Fom 4720 for tne yeu, [Pas nc erm esi eperenrpemepettey err weeny cra pepe Soros) Yes [No 1 Were substantally all (90% or more) dues recewed nondeductbla by members? 2 2 Did the organization make only in-house lobbying expencitures of $2,000 or lass?’ 3 bid t ‘organization agree to carryover lobbying and politcal expenditures fom tha pier yar? > ‘Complete if the organization is exempt under section 501(c)(4), section 501(c)(6), or section {501(c)(6) if BOTH Part IIA, lines 1 and 2 are answered "No" OR if Part I-A, line 3 is answered "Yes. ‘1 Dues, assessments and similar amounts fom members .,............+..s0.s000s000]4 Secton 162() nondeducibe lobbying and poltca ex expenses for which the section §27() tax was pad) 2 Curent yoar © Camyover rom lst year © Tota AS 3) Aaoregste amount reportd'n schon 853340\ca) noose of nondeicbia secon taa(e) ues’ |” || 4 if notees wore sent and the amount on ine 2e exceeds te amount on ine 2, what porton of tie excess doos tho organzaton agree to canyover tothe reasonable estmate of nondeductble fobbying and potteal expenditure next year? Taxable amount of btying and pic scares (ds vse)” ‘Supplemental information Complete ths part t provide the descnptons requred for Part FA, ine 1, Pan FB,ine 4, Part. i ‘Als, complete tis pat for any adétonl infomation 5, and Part II-B, tine 1 ‘SEE PAGE G say 1467 v 10-8.3 PAGE 37PUBLIC DISCLOSURE COPY 23-1352166 Schwioc(Fom 90 602) 2010 Page 4 FEMI Suppiemental information (continued) SCHEDULE C, PART TT-B, LINE 1 DURING THE YEAR ENDING JUNE 30, 2011, CHOP CONDUCTED VARIOUS LOBBYING ACTIVITIES THROUGH THE USE OF ITS EMPLOYEES, VOLUNTEERS, INDEPENDENT CONTRACTORS, AND OTHER ORGANIZATIONS. THESE LOBBYING ACTIVITIES WERE ON BOTH A FEDERAL AND A STATE LEVEL IN SUPPORT OF VARIOUS CAUSES, ISSUES AND REFORM REGARDING HEALTHCARE. THE AMOUNTS RELATING TO THESE ACTIVITIES ARE REPORTED ON LINE 1. ~ Sehodal Form 90 or OZ) 2 sazi2y 1467 v 10-8.3 PAGE 38Pusu pisciosuRe coPY Supplemental Financial Statements > Complate ithe organization SCHEDULE D (Form 990) iswered "Yes," to Form 99 owratnent tt te Partial §,7,8,8,10, 1, 0r12. Creer ferme > Attach to Form 990,_b See separate instructions. events iaeaieoseunee sapere ‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA 23-1352166 Organizations Maintaining Donor Advised Funds or Other Similar Funds or AccountsComplete if the ‘organization answered "Yes" to Form 980, Part IV, line 8. (a) Donor ade fade (Funds and oer accours 1 Total number at end of year... « 2 Agoregate contributions to (during year) 3 Aggregate grants from (during year) 4 Aggregate value at end of year CT 5 Dia the organization inform all donors and donor advisor in wring thatthe assets held in donor advised funds are the organization's property, subject tothe organization's exclusive lagal contro? ee - Oves Tne 5 Did the organization inform all grantaes, donors, and donor advisors in wring that grant funds can be ‘sed only for chantable purposes and not forthe benefit ofthe donor or donor advisor, or for any other = Dyer FI no. ‘Conservation Easements. Complete ifthe organization answered "Yes" to Form 880, PartlV-line 7. At Pulbsel) of concoateressorun hell ay he opanetortreokal Saran). Preservation of and for public use (e.g, recreaton or education) Preservation of an histoncaly important land area Protection of natural habitat Preservation ofa certified historic structure Preservation of open space 2 Complete lines 2a through 2d if the organizaton held a qualified conservation cantnbubon inthe form ofa conservaton ‘easement onthe last day of the tx year. fd atthe End of the Tax Your Total numberof conservation easements... Total acreage resticted by conserva eavorants Number of sonservatoneusementa an acaried ats srocure nis Number of conseratoneutements used) acute ater 8/76, an ton histone stuce fled the Nena Repser 2 Nambe' of consratoneecerens modhed, tasters, lated aringhed, x omanaied byte aranizton dung a mre 4 Number of ss wera propa sje to consrvatoneatement i oated > ——— violations, and enforcement of the conservation easements t holds? -». Cves Die Saf andveunteer nous ceote to monte, inspecin, ane enforcing consrvatoncasrens dunn hs yar > 1 oun expanses nara m nontong.iapecing, and enone conservation easements daring the year » 8 Does cach consowatn (ana r7OMVANENO? Clr One © InPatXIv, send novo ainzaton oper ancevaion ese wl ove and epee tore and balance shee andra, appiable te fect of reo tote erpunzbos ance uerans el Sesatoes he ergerizoorsascounng fr caesrason earn [REUIN Organisations Maintaining Colections of An, Historical Teasares, or Other Similar Asai Gomplet te organization anawered Yes" 1 Form 960, Parte ine 8 T= We expanaion sec, at ported wey SEAS 16 SC ES), rl to pet Bure sateen as pace sh, ‘an, histoncal ‘easurae, or other similar Bic ‘exhbion, education, or research lm fureranca of Buble Sennes, prove, in Part XV; te text of Bs footnote to ts fnancll statements Mat cescibes these tems bf to organzation lected, as permitted under SFAS 116 (ASC 958), to roport in Its revenue statement and balance sheet Works of art, historical treasures, or other simiar assets held for public exhibition, education, or research in furtherance of Public service, provide the folowing amounts relating to these toms (Revenues inciuded in Form 990, Part Vill ine 1. (i) Assets included in Form 980,PatX 2... 5 - 2° it the organzation received or hold works of ar, historcal treasures, or alher simlar assets for fnancial gan, provide the ‘ong sours requed lo ba repre under SFAS 8 (ASCE) ring to theve tee Jement reported online 2(4) above satisfy the requirements of section 170(%)(4XB) Revenues included in Form 990, Part Vil ine 1 oe hse. bb _Assets included in Form 990, Part X ere pera For Paponeork Reduction Act Notes, eo the ratte fr Form #0 ‘Schedule D (Form 890) 2070 S4312y 1467 Vv 10-8.3 PAGE 39PUBLIC DISCLOSURE COPY Scbeal 0 arm 60) 010, 23-1352166 Page ‘Organizations Maintaining Collections of Ar, Historical Treasures, or Other Similar Assets(coniinued) Using the organization's acquistion, accession, and other records, check any of the folowing that are a significant uso of its collection items (check all that apply) [7] Punic exniton ‘ Loan or exchange programs Scholarly research ° Otner Preservation for future generations = Provide a descripton of the organation’s collections and explan how they further the organizaton's exempt purpose in Part XIV. During the year, did the organzation solat or receive donations of art, histoncal treasures, or other similar ‘assets to be sold to raise funds rather than to be mantained as pat of the organzation’s collecton? ~- [yes [7] No Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 980, Part lV, 1” » 4 t 2a b 4 line 9, or reported an amount on Form 990, Part X, ine 21 's the organization an agent, trustee, custo dian or other inter Included on Form 900, Part X? . Yes," explain the arrangement in Part XIV and complete the folowing table ay for contributions or other assets not -» Dyes (no Bogining balance Additions dunng the year Distnbutons during the year Ending balance . . - - : Die the organization inchide an amount on Form 860, Part X, li lt-Yes,* explain the arrangement in Part XIV. RA Endowment Funds. Complete if organization answered "Yas" to Form 990, Part IV, ne 70, (a) curertyaar |) Preryesr | () Two yeurs back "| _(€)Tve yours neck (o) Four yoo baa Beginning of year balance Provide the estimated percentage ofthey ear end balance Fel as Board designated or quasi-endowment > % Permanent endowment Pe Term endowment ‘Are there endowment finds natin the pos. session ofthe organization that are held and administered forthe corganizabon by (0 unrelated organizations (i celated organizations. Sno It¥es" to Bali), are the related organizations isted as required on Schedule R? |. Doscnbo in Part XIV the intended uses oft he organizaton's endowment funds ‘Land, Buildings, and EquipmentSee Form 990, Part X, line 10. Doserpon of evestment (a) Coste omerbase | (9) Coste oberbaas | (e)Acamaaied (Bookie ‘eve (cow ‘eprcaoon Ta Land 23,711, 073,| 29,711, 079 tb Buildings =... +++ + [T768, 216, 67. 625,225, 7981 1,142, 980,919. © Leasehold improvements «=.=. @ Equpment .-. esses 83,626, 467 426,325, 104 257, 302, 763. Other. 106,227, 490., 106,227,490. Total. Add ines fa ough Ya. (Colum (| must equal Form 990, Part X-cotui (BT TOW) Bl 1,536,232, 251. ‘Schedule O (Form 90) 2010 4312y 1467 v 10-8.3 PAGE 40PUBLIC DISCLOSURE COPY 4a 0 For 290) 2010 23-1352166 Paoe’3 Investments - Other Securities. See Form 990, Part X, line 12. (@) Descrpton of sacuny or eategory () Book value {e) Method of vaiaton. (atuing name of security. Coster end-oyear market vale (1) Financial denvatves (2) Closely-held equity interests | @ oa Coon Oneal om 0 aK al Wim) Investments - Program Related. See Form 680, PanX. Ine 7 (a) Desenpion ofivestnent ype (0) Book vate {)Metied of valaton Coste end-otyaar mare! vale a) 2) @ ) ®) (8) 7) (8) (9) G0) os Conn moa om Pei at ew] (Other Assets. Ses Form 990, Pat ine 15, ‘siDesetion Baie GY BUS_FRON_THERD PARTIES 24,443,717. (@) DUS_FROW AFFILIATES 340,075,831 (@)_INTERCOMPANY AECETVABIES 3,826,069; (@) DEFERRED COSTS FESR (@) MISCELLANEOUS RECETVABEES TasT74 320. (6) ac} Le) (8) 00) tat ian monn 9 Pot ib =" el 705.3645. ‘Other Liabilis. See Form 890, Part tine 25 l. (a) Desenption of habity (b) Amount | ( Foderlncone ares (@USELF INSURANCE LIRBTEDY LEE | (3) ACCRUED PENSION COST-MIN LIABILITY 64, 030,953. | (g) INTEREST RATE SWAP 14266171. (5) DEFERRED _CONPENSATTON 8,439,263 | {e) DUE. 70. AFFYLTATES Teoh 1a | m : @) | 9) : (10) | co | | ‘etal Cotunn (2) must equal Form 090, Pan X, col (@)ine 76) | 172,083,116. 2. FIN 48 (ASC 740) Footnote In Part XIV provide the text ofthe footnote tothe organization's franca statements that reports the ‘organization's lability for uncertain tax positons under FIN 48 (ASC 740) ceBon Sehedu O Form 90) 210 sa312y 1467 v 10-8.3 PAGE 41PUBLIC DISCLOSURE COPY ‘Seno (Form 8602010, 23-1352166 Reconciliation of Change in Net Assets from Form 990 to Audited Financial Statements aan 1 Total revenue (Form 990, Part Vil, column (A), line 12) 2 Total expenses (Form 990, Part IX, column (A), ne 25) 3. Excess or (defi forthe year. Subtract ine 2 from ine 1 4 Netunreaized gains (losses) on investments 5 Donated services and use of facilities 6 Investment expenses , 7. Prior period adjustments) 8 Other (Describe m Part xiv) | ||| 9 Total adjustments (net) Add lines 4 trough 8 0 Excess oF (defct) forthe year per audited financial siioments Combine ines 3 and 9" 4 10 Reconciliation of Revenue per Audifed Financial Statements With Revenu pat Return ‘Total revenue, gains, and other support per audted financial statements 2 Amour ned os rat avon Peon 9 pov ae Net unrealized gains on investments Donated services and use of facities Recoveries of prior year grants , , ‘Other (Describe in Part XIV). | ‘Add lines 2a through 2d 20 3 Subtract ine 2e from tine 4 [on 3 4 Amounts included on Form 960, Part Vl. ine 12, bul nat on tine 4 Investment expenses not included on Form 990, Part Vil tine 7b Other (Describe in Part XIV)... fee © Add lines 4a and 4b fe. etn rovere- ads ins 3 and 4c. (This must equal Form 990, Par |, ine 12) 5 Reconciliation of Expenses per Audited Financial Statements With Expenses per Return Toul eperses nd overs oad noe ames eT 1 ‘2 Donated services and use of facities 2a bb Prior year adjustments 2b © Other losses. 2e Other (Describe in Pari nv) * 2d ‘© Add lines 2a through 24 | | 3 Subtract ine 26 from fine 1 : “4 Amounts included on Form 990, PartX, line 25, but naton tine 1 ‘2 Investment expenses not included on Form 990, Part Vill, ine 75 b Other (Desenbe in PartXIV) © Add ines 4a and 4 AA ene Rie eee 5 Total expenses. Add ines'3‘ahd de. (This nisi dquél Fenn 960, Pat's, ne 10) * ‘Supplemental information ‘Complete this part to provide the descnptions required for Parti ines 3, 6, and 9, Part Il, ines 4 PartV, ine 4; PartX, tine 2, Part, ine 8, Part Xl ines 24 and 4b, and PartXil, ines 24 and 4b, Also complete this pat to provide any adelvonal information sa312y 1467 v 10-8.3 “Schedle 8 fom 990 PAGE 42Scauo 0 om 90) 2010 PUBLIC DISCLOSURE COPY 23-1352166 a0 FETE Supplemental information (continued) ‘ehedl Dorm 90) 2010 sa3n2y 1467 v 10-8.3 PAGE 43PUBLIC DISCLOSURE COPY CHEE Statement of Activities Outside the United States on eel > Complete it the organization answered "Yes to Form 990, Party ine 40, 15,0 16. Depart oft Teasry > Attach to Form S80. See soparat instructions Open to Public ‘tama’ evens Sana Inspection Nave e srnaston TEmpayraenterton ramber THE CHILDREN'S HOSPITAL OF PHILADELPHIA 23-1352166 General information on Activities Outside the United States. Complete i the organization answered "Yes" to Form 980, Part IV, ine 146, 1 For grantmakers. Does the organizaton maintain records (© subsiantate the amount of the granis or assistance, the grantees’ eligiblty for te grants or assistance, and the selecton enteia used to award the lrants or assistance? . eves Eyes [no 2 For grantmakers. Descnbe in Part V the organization's procedures for monitoring the use of grant funds outside the Untied States 3_Acthites per Region. (The following Part ne 3 table can be duplicated if additonal space 1s needed ) (9 Renon (ymeberot | (e)Runrct | (Actes conduandn raat “agen | "ogo | Skane maven Smlinresiens Saracen serwcatehnregen| inven ind aap) 11 von nse seawnanine naam —2_nanoee seaman roess0s (8)_suv-sannsas aenica coawmauave 14.20 4) ras asia mo oe ercreL coawmouave 124,200 (8) wears went 2. | pocnas senvncrs smacuine ¢ sesrascy 10,106 (@)_sxs0 asin wo se onertse 3._|rnocovas services | oeacune ¢ nestance sua (P)_wsoour east ano woare armica 2 | ocaas senvsces sencive ¢ meseasce pass £8) wnoee 415,_| moc senvrers senciine ¢ seseance 2,490. (9) sours weeazcn 2. | enocue senvices encima ¢ esseasce ssn. (10) on re 3 wa, ws) 8, on Saou ete seeee erect a 88 b Total from’ continuation sheets to Paths... ¢_Totals (add ines 3a and 3b) sa Perry For Paperwork Reduction Act Nate, 06 the Instructions for Form 800 ‘Schedule F (Form 980) 2010 sa3izy 1467 v 10-8.3 PAGE 44sh sova creo A = 7 a 3 ovate og eu ppp nee ydwexe-xe) se pezuBo28 “Aqunoo uBre10; ey) Aq SequEys sG008, a8 YY @AOQE peysi| SUONEE Tow wa WH we a = a ssc orn om cafe — sa cone om am corer fer om co Se seas ar | ares} ra re w a] =u SR eae] ——orosernTe ee oxs|ore come] ames = SER ER [Se | em [atte | ewe A ‘apeou | @oede [eUOR (000's$ Ue\) @10u panjaoes uaidioas euo ou ! x09 SIMA HDEYD “OOO'SS UPL) e/0W PenrBOeI OWN IU palemsue voneZiveb10 Oty e12/dWOD “SAIEIS PAHLUN OWN EPISINO SeAAUA 10 suOHEZIUEBIO o> 99TZSET-Ez payeoidnp eq UES Ti ved d00 aunso7osia annecorr xzters mine 9» aowa er8-0T A 1 (oss ws ommeuss wT wr wr veomce "aM 1200) coun oo ve8 wee 0100) Biome, | scone eney patente) rman) outa) ;Pepeeu s} e0eds jeuonIppe jt PareDidnp eq UeD II wed rm 9} out ‘AI Hed ‘066 ‘99TZsCI-E2 Ado aunsovasia anand . PaJeMSUE UOHeZIUEELO eLp J! e}eIdWOD “SAPEAS PeTIUN OWN SPISINO SIENPIAIPU 0} BDUE SISSY J01RO PUP SIUEI To swPUBLIC DISCLOSURE COPY Scream s60) 2010 Foreign Forms Was the organzaton a US. tanstorr of propery to @ foreign corporation dung the tax year? Yes,* the organczeton may be equved to fle Farm 826, Retum by @ US Transfer of Property to @ Foran Corporation (seoinsiuctons fer Form 926). Did the organization have an interest @ fregn tust dunng the tax year? I "Yes." the orpenzation ‘may be required to fle Fm 3520, Annual Retum to Report Transactons wih Foregn Tris and Recept of Certan Forvan Gite, ander Farm 3520-A, Annual inomaton Ratum of Forwgn Tat Wah @ US. Owner soeinsiuctons for Forms 2620 and 2520-4) ‘id the organzation have an ownership interest ina fragn corperaton during the tax year? I "Yas," the orgenzaton may be requred to fie Foon 5471, Infomaton Relum of US Persons wih respect 10 Cortan Foreign Corporations (see instruction for Form 5471) Was the organization a dict or ndrct shareholder of @ passive foregn investment company or @ ‘ualfed electing fund dunng the tax year?f"Ys,*the organzaton may be requred to fle Form 8621, Retum by 8 Sharoholier of a Passve Foreign Investment Company or Quaifed Electing Fund. (s00 Intructons for Form 8621) Dic the erganzaton have en owershp interest a foreign partnership dunng the tax year? I "Yas." the arganzaton mey be requrad to fio Form 8865, Retum of US Persons wah respect fo Cortan Freya Parinerships (se Instuctone fer Form 8865), id the organzation have any operations in or related to any boyeting countnes ng the tax year? *Yes,"theargancaton may be requred fo fle Form 5713, Inwmatenal Boycott Report (se Instone forFom 8759)... os OO ves OO ves Yes OD ve O. Bw Bw sa3izy 1467 v 10-8.3 ‘Scheie F Form 00) 2010 PAGE 47THE CHILDREN'S HOSPITAL OF PHILADELPHI?PUBLC DISCLOSURE COPY 23-135216 senda em 09 2010 2301352166 Poo ‘Supplemental information Complete this pat o provide the formation required by Par ine 2(montonng af funds); Par ine 9, column (9 {accounting method): Part, ne 1 (accountng method, Part il (accountng method): and Parl column () estimated numberof epens), as epplcable Also compete is pat o provide any addonaiformaton (see msrucons) MONITORING PROCEDURES SCHEDULE F, PART I, LINE 2 ‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA HAS ESTABLISHED CONTROLS IN PLACE TO MONITOR THE USE OF GRANT FUNDS BOTH OUTSIDE AND WITHIN THE UNITED STATES. EXPENDITURES ARE MONITORED BASED ON THE GUIDELINES OUTLINED BY 4SCER PART 74 APPENDIX B (OASC~3). IT IS OUR POLICY TO FOLLOW THE FEDERAL GOVERNMENT-ESTABLISHED PRINCIPLES FOR DETERMINING COSTS APPLICABLE TO GRANTS, CONTRACTS, AND OTHER AGREEMENTS. THE HOSPITAL GENERALLY APPLIES THESE SANE COST PRINCIPLES TO NON-FEDERAL FUNDING. ALL COSTS POSTED TO SPONSORED PROJECTS MUST COMPLY WITH GOVERNMENT AND SPONSOR RULES AND REGULATIONS. COSTS MUST MEET SEVERAL CRITERIA: (1) COSTS BEING CHARGED TO A GRANT MUST BE REASONABLE AND NECESSARY FOR MEETING THE OBJECTIVES OF THE GRANT/PROJECT, (2) COSTS MUST BE ALLOWABLE IN ACCOROANCE WITH THE SPONSOR RULES AND REGULATIONS, (3) COSTS MUST BE ALLOCABLE BASED ON THE BENEFIT DERIVED, CAUSE AND EFFECT, OR OTHER EQUITABLE RELATIONSHIP, AND (4) COSTS MUST BE CONSISTENT WITH COSTS CHARGED IN SIMILAR CIRCUMSTANCES TO OTHER SPONSORED PROJECTS. = ‘ehodaleF Form 8) 2070 54312y 1467 Vv 10-8.3 PAGE 48PUBLIC DISCLOSURE coPY SCHEDULE H Hospitals (orm 990) >> complats he orenizationannared Yes" fo Form 90, Pat V, gestion 2 ee D> Atach io Fom a8,” Sen spare netetons Perr ‘eearmcatnae reer fearon eae near THE CHILOREN'S HOSPITAL OF PHILADELPHIA 23-1352166 Financial Assistance and Certain Other Community Bonoff at Cost Res] Ro 1a Did the organization have a financial assistance Lesa ‘during the tax year? If "No," skip to question 6a x x If*Yes,"was ta written policy? « : 2 Ifthe organzaton had multple hosptal facittes, indicate which of the folowing best descabes application of the financial assistance policy to ts various hosptl faites dunng the tax year | Applied uniformly to allhosptal aciives ‘Applied uniformly to most hospital facies | Generally taiored to individual hospital faci 3 Answer the following based on the financial assistance eligbilty critena that applied to the largest number of the organtzation's patents during the tax year { ‘2 Did the organuaton use Federal Poverty Guldlnes (FPG) to delemine eigiitty for prong free care 10 low income | Se eae cee ee emia alee a 100% 150% 200% ‘Other % | SE ier ro ern eign ie elocpe pede edegery Broewg hed tg) alk a ele esa ep ee Fy aa eee fatlan revo! of ear coae pe ne ncomlaarcn ee | ee ey a open ib Sree recon entender | Gy cu oa cesaccrl area ein fas aa perl wae ee eee Bee een erie cantons one ieee eerste le f Stmmegrmmnnaptenne trimer aunna apt wcrttannnasiin tobi fl Cit cies ans Heed eoemctsees cee taEarmon eee - ¢ If "Yes" to hne 5b, as a result of budget considerations, was the ee unable to provide free or discounted |_| |X Le asnve tan ceas tone ae ees : t. Dernegraanprpat antes inatapsiometemert 12 tte 3 teecanteagearin nant sears OISSET ne eI LLLe She Complete the following table using the worksheets provided in the Schedule H instuctons. Do not submit ‘hese worksheets yal the Schedule H | 7 _ Financial Assistance and Certain Other Community Benefits at Cost cee ee a eT om esac | eae | coe reese 30,465,972. 18,496,972. 11,969,001. 83 Youmans 440,645,670.| 324, 931,855.| 115,724,015. 8.06 3,255,648. 3,255,668 23 ‘ 28,104, 646. 6,644,444.| 21,540,202. 1.50 7 102, 475,046. 94, 666,178. 7,808, 868 54 ® 208,182, 002.| 28, 655,263.| 179,526,719. 12.51 117,458. 117, 458. on il 342,214, 800.| 128, 965,505.| 21,248,695. 14.79 hentai "762, 860,670.| 454,897, 760.| 327, 962, 910. 22.65 For Poparwor Reucton Act Neon, so the vrata for Form #0, ‘SehwauaHFom 90) 2010 saaizy 1467 v 10-8.3 PAGE 49PUBLIC DISCLOSURE COPY Schaauou Fo 990 2010 23-1352166 Pago 2 ‘Community Building Activities Complete this table i the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it Serves. inneera] @Penon] ioscan | wbatemeew | onaommna | Greene aace | “awa | “Wemmowae ne Uso | Sime meee | corey = i hetecmmeioen 1 comma nae 7 cote sn 7 conn etapa wooo re donee er Toa Gad Debt, Medicare, & Collection Practices ‘ection A Bad Debt Expnse ve 1 Does the organization report bad debt expense in accordance wih Healhcare Financia! Management Association Statement No 157. oe voeeL at] x | 2 Enter the amount ofthe organization's bad debt expense (at cost) 49, 648/532. 3 Entr the estmatod amount ofthe orpanizalon's bad dbl expense (aco stutble to palons olgble under the organzators tance assistance poy. 3 4 Provide in Part VI th toxtof fhe footnote tothe erganzators finan ‘sairects that dovarbes bad dob expense In adéion, desenbe te coting ‘abedslogy used i deterring the amounts reported on ines 2 and 3, and ratonale fr including a poron of bad debt amounts in conmunty benef section B Medicare Ener total revenue received ttm Medare (cluding DSH and IME) s| 1,507,095. {Enter Medicare alowable cost of care relating to payments on ine 5 | 5,989,802. 1 Subtract ine 6 fom ine 6. Ths the surplus (or short) 7 —=4401,907: {Deserve in Pan Vth extent to which any short repaid in ne 7 shoud be Veated as corimuniy bene Also deserbo m Par VI the cosing methodology or source used to determine te amount reported on ine 6 Check the box tat deschbes the method used Cost accounting system LX] costo charge ratio] other secon olcton Pracices ‘Does the organzation havea wen dob colcton poy during the taxyoor? see eax 1 Yanna onus atin pny hl appa ee abe pt mg bt yu Can pan x be ctu ps ote prs vo wenn © gua teal mesma PY cee seee eee ww lx Management Companies and Joint Ventures, (onane ty (Opin agony ee re ayaa omen | Moser | reas, Cmte’ | acpipeeet | "Smachose Ricotta 7 2 3 4 § ¢ 7 @ 3 w i @ Fa x ‘Schedule Horm 09) 210 ease 5.2 1467 v 10-8.3 PAGE 50PUBLIC DISCLOSURE COPY 23-1352166 ‘Section A, Hospital Facil (Ustin order of size, measured by total revenue per facility, from largest to smallest) ay How many hospital facibes did the organization operate during the tax year? _1 wefine = eapou mmueo Name and address '4_THE CHILDREN’S HOSPITAL OF PATLADELPATI 34TH STREET & CIVIC CENTER BOULEVARD PHILADELPHIA PA_19104 2 ‘ehedute Horm 090) 2010 sa3i2y 1467 Vv 10-8.3 PAGE 51PUBLIC DISCLOSURE COPY scm Fam 20 2010 Facility Information (continued) ‘Section B. Facility Policies. Practices (Complete a separate Section B for each ofthe hospital facies listed in Part V, Secton A) Namo of Hospital Facility: THE CHILDREN'S HOSPITAL OF PHILADELPAIA ‘Line Number of Hospital Facility (fom Schedule H, Part V, Section A): __1 Pam ‘Community Health Needs Assessment (Lines 1 through 7 are opbonal for 2070) 7 During the tax year or any pror tax year, did the hospital facility conduct a community health needs assessment (Needs Assessment)7If "No," skip to line 8 . If "Yes,"indicate what the Needs Assessment describes (check al that apply) ‘A definiuon of the community served by the hospital facilty Demographics of the community Existng health care facies and resources within the community that are avaliable to respond to the | health needs of the community [1 How data was obtained [| The heatth needs of the communty LJ Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, ‘and minonty groups 1 the process for identiying and pnodizing community heath needs and services to mest the |, community health needs [| The process for consulting with persons representing the community's interests [1 information gaps that limt the hospital facity’sabilty to assess all of the community's health needs. (] other (describe in Part vi) Indicate the tax year the hospital facility last conducted a Needs Assessment 200 _ |In conductng its most recent Needs Assessment, did the hospital facily take into account input from Persons who represent the community served by the hospital faclty? If "Yes," desenbe in Part VI how the hhosprtal facility took into account input from persons who represent the communty, and identify the persons ‘the hospital facility consulted : ‘Was the hospital facitys Needs Assessment conducted with one or more other hospital facies? If Yes," list the other hospital faciites in PartVI.. . . . oo Did the hospital facity make is Needs Assessment widely avallatie tothe public? h*¥es," indicate how the Needs Assessment was made widely available (check all that apply Hospital facily’s webste ‘Avaliable upon request rom the hospital factity [1 other (describe in Part vi tthe hospital feciety addressod needs identified in its most recenty conducted Neads Assessment, indicate how (check all that apply). ‘Adoption of an implementation strategy to address the health needs ofthe hespta facity’s community Execution of the implementation strategy Participation n the development ofa community-wide community benefit plan Partcipaton m the execution of a community-wide community benefit plan Inclusion ofa community beneft section in operational plans ‘Adoption of a budget for provision of services that address the needs entified in the Needs Assessment Proritzaton of health needs in ts community Prioritzaton of services that the hospital facility wil undertake to meet health n Other (describe mn Part Vi) Did the hospital facity address all ofthe needs dented in its most recently conducted Needs Assessment? I¥°No.* explain in Part Vi which needs it has not addressed and the reasons why it has not addressed such needs peeeeeeeee inte community Financlal Assistance Polley ‘Did the hospital factty have in place dung the tax year a wnen fhancal assistance polcy that Explained oligibity cnteria for francil assistance, and whether such assistance nchides free or discounted care? Used federal ‘poverty guideines (FPG) to ‘delamine’ eligbity for providing’ fee care to iow income Individuals? . . "Yes," indicate the FPG family came lit fre bit ortree care | ‘Shoda H Form 99) 240 s4a312y 1467 v 10-8.3 PAGE 52" 2 a PUBLIC DISCLOSURE COPY Information (continued) THE CHTLDREN’S HOSPITAL OF PHILADELPHIA Used FPG to determine elblty for providing discounted care to low income individuals? Utes," indicate the FPG family income limit for eligibility for discounted care, ___% Explained the basis for calculating amounts charged to patients? 11¥95," indicate the factors used in determining such amounts (check al tat appt). Income tevel ‘Asset evel Medical indigency Insurance status Uninsured discount MocicaidIMedicara ‘State regulation ‘Other (descnbe mn Part VI) Explained the method for applying for financial assistance? Pecrer Included measures to publeaze the policy within the community Served by the hospital fac I1"¥0s," indicate how the hospital facility publicized the policy (check all that apply) “The policy was posted onthe hospital facility's website ‘The policy was attached tiling invoices ‘The polcy was posted inthe hospital faciiy’s emergency rooms or wating rooms “The policy was posted inthe hospital fcity’s admissions offces ‘The policy was provided, in wnting, to patents on admission to the hospital facity ‘The policy was avaliable on request Other (describe in Part i) 13 Billing and Collections: 4 6 6 7 ‘Did the hospital faciiy have in place dunng the tax year a separate bling and collecbons policy, ora wniten financial assistance policy that explamed actons the hospital facity may take upon non-payment? ‘Check al ofthe folowing collection actons against a patient that were permitted under the hospital faciy’s polices at any time dunng the tax year Reporting to credit agency Lawsuits Lens on residences Body attachments (Other actions (descnbe n Part Vi) Did the hospital facilty engage in or authorize a third party to perform any of the following collection actions ddunng the tax year? "Yes," check all cliction actions in which the hospital feciity Gratis party engaged (check all that app Reporting to ereit agency Lawsuts Lens on residences Body attachments (Other actions (descnbe n Part Vi) Indicate which actons the hospital fact took before inating any ofthe collecton actions checked in ne 16 (check all that app). [_] Notified patents of the francial assistance policy on admission [=] Notiied patents of the fhancil assistance policy prior to discharge [[] Notified patients of the fnancial assistance policy in communications with the patents regarding the ppabents’ bls (1 Documented its determination of whether a patient who applied for nancial assistance under the oO financial assistance polcy qualifed for financial assistance Other (describ in Part VI) 14 I T assesses 16 ‘Sehedute Worm 09) 2050 sa3izy 1467 v 10-8.3 PAGE 53PUBLIC DISCLOSURE COPY serosa 2010 se Facility Information continued) THE CHTEOREN’S-HOSPTIAL OF PUTTAGELPATA Policy Relating to Emergency Medical Care [Yea] No 18 Did the hospital facity have in place dunng the tax year a written policy relating to emergency medical care that requres the hospital facilly to provide, without dliscamination, care for emergency medical conditons to Individuals regardiess of their eligbilty under the hosptal facity's financial assistance policy? . . If'No," indicate the reasons why (check al that apply) 2 [) Tre nospital racity ait not provide care for any emergency medical condtons. b [| Tre hospital fact did not have a policy relating to emergency medical care © CA) Trenospital tacity imited who was elgble to receive care for emergency medical conditions (describe in Pat) & _[] Other (descnbe in Part VI) | ‘Charges for Modieal Care 19 Indicate how the hospital facity determmned the amounts biled to indwviduals who did not have insurance | Coverng emmgency of oer medaly necersary eae ceck al app), CA The nouptaltacty used the lowest nepotted commerce! Inauance rate for se services atte fosola ity » C1 Tre posal tacity used te average of the tee lowest negoeied commer surance raas fr trove serosa th hose fey ¢ F2 Tre nospital fcity uses the Medicare rate for those services ¢ CJ Ober deserve nPart 0) J 20° Did the hospi acy charge any ots pabents vo were ele fer atsstance under the hotpalfacis fnanciaattisance okey, end to\ whim" howplal feck povided emergency er ohar mosey recestar/ serene, more than he emounie grey bled to dbus wo hes irs covers cat. "en a \F-¥es," explain in Part VL (J 21 De ine spi fly cage any of ts paris an amount emul 10 the goss chage fer any sence Provided to that patient? . .. =. a 10Yes," expan in Part Vi ‘Sehedae H Form 90) 2070 4312 1467 v 10-8.3 PAGE 54PUBLIC DISCLOSURE COPY Serato H (For 0) 2010 Faclity information (contnced] Pao Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (lst in order of size, measured by total revenue per fact, trom largest to smallest) How many nor-hospta facites did the organtzation operate dunng the tax year? Name and aadress 4 CHOP CARE NETWAK PED @ ADOL SPECIAL CARE 1012 LAUREL OAK RD LAUREL OAK CORP CTR. VOORHEES NJ_08043) 2 CHOP CARE NETWAK PED @ ADOL SPECIAL CARE 211 MALL BLVD KING OF PRUSSIA PA 19406 Z_CHOP CARE NETWRX PED & ADOL SPECIAL CARE 950 PULASKI DRIVE KING OF PRUSSIA PA 15406 ‘4 CHOP CARE NETWRK PED @ ADOL SPECIAL CARE 500 BUTLER AVENUE (CHALFONT PR 16514 CHOP CARE NETWRK PED @ ADOL SPECIAL CARE 481 JOHN YOUNG WAY OAKEANDS CORP CTR EXTON PA 19341 (CHOP CARE NETWORK PEDIAT ADOLES CARE 3819-33 CHESTNUT ST ST LEON CT STE 21 PHILADELPHIA PA 1910 "7_CHOP_CARE NETWORK PEDIAT « ADOLES CARE. 1830 SO BROAD ST 2ND FL UNIT 5 PEILADELDHTA, PA 19145 @ CHOP CARE NETWRK PED 4 ADOL SPECIAL CARE 4009 BLACK HORSE PIKE. MAYS LANDING. WI_08350 ‘@ CHOP CARE NETWORK PEDIAT « ADOLES CARE. 225 COBBS CREEK PARKWAY PHILADELPHIA, BA _15135) 40 CHOP CARE NETWORK PEOIAT © ADOLES CARE 3550 MARKET STREET, 4TH @ STA ELS PHILADELPHIA PA 19104 Type of Facity (describe) PEDIATRIC © ADOLESCENT SPECIAL CARE ASF PEDIATRIC & ADOLESCENT SPECIAL CARE PEDIATRIC & ADOLESCENT SPECIAL CARE PEDIATRIC & ADOLESCENT SPECIAL CARE ASF PEDIATRIC & ADOLESCENT SPECIAL CARE ASF PEDIATRIC & ADOLESCENT CARE BEDINTRIC & ADOLESCENT SPECIAL CARE PHYSICIAN PRACTICE PEDIATRIC & ADOLESCENT CARE PEDIATRIC & ADOLESCENT CARE caer aeeeaaaanid v 10-8.3 ahd Warm 62D PAGE 55PUBLIC DISCLOSURE COPY sta fem 02010 Pee Facility Information (coninoed) ‘Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility {istin order of size, measured by foal revenue per facily, rom largest o sales) How many non-hosptalfaciives did the organzabon operate dunng the tax year? Name and adsress Type of Facity(sescrive) 7 CHOP CARE NETWORK PHYSICIAN PRACTICE 600 HAVERFORD ROAD STE 100 HAVERFORD ba 1907 CHOP CARE NETWORK PHYSICIAN PRACTICE 7700 GERMANTORN_AVENDE PHILADELPHIA FRIST CHOP CARE NETWORK PAYSICIAN PRACTICE “108 SHADY RETREAT ROAD DOYLESTOWN Pa _1a90r CHOP CARE_ NETWORK PAYSTCTAN PRACTICE 440 -E MARSHALL ST JAD FL_NO STE 300 WEST CHESTER pa 19380 @_CHOP_CARE_NETWORK PHYSICIAN PRACTICE 3201 WARNE HIGHWAY Mt, LAUREL NG_OB0Se CHOP CARE NETWORK PHYSICIAN PRACTICE 2006 SALEM ROAD BURLINGTON TWP wa 08016 [CHOP CARE NETWORK PHYSICIAN PRACTICE 196 W SPROUL RD STE05 ‘SPRINGFIELD Pa 15084 @CHOP_CARE_NETRORE PHYSICIAN PRACTICE 250 W, LANCASTER AVE STE 340 PAOLE Pa_1S300 @ CHOP CARE NETWORK PHYSICIAN PRACTICE FLOURTOWN COM 1811 BETHLBNEM PK STE_AIOG FLOURTOM Pa 13031 7o_CHOP_CARE NETWORK PHYSICIAN PRACTICE 1700-HORIZON DR SUITE 200 CHALFONT PA 185: ag Sm aay 1467 v 10-8.3 PAGE 56PUBLIC DISCLOSURE COPY scream 900 200 "Facility information (coninaed) Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (ist inorder of size, measured by total revenue per facity, fom largest to smallest) How many non-hespital facittes did the organization operate dunng the tax year? Page Name and address ‘Type of Facity (describe) 4 CHOP CARE NETWORK, PHYSICIAN PRACTICE ‘SKY VIEW MED CTR 3456 BETHLEHEM PK FLD ‘SOUDERTON PA 18964 2 CHOP CARE NETWORK PHYSICIAN PRACTICE NEWTOWN PAV 6 PENNS TRATL STE 105 NEWTOWN, PA_18940 ‘3_CHOP_CARE NETWORK PHYSICIAN PRACTICE 2100 KEYSTONE AVE STE 404 DREXEL HILL PA 19026 “4 CHOP CARE NETWORK PHYSICIAN PRACTICE "795 E MARSHALL ST STE 301-307 WEST CHESTER PA 19380 ‘CHOP CARE NETWORK PAYSICIAN PRACTICE 390 VINEYARD WAY HOOD BLDG 500 STE 501 WEST GROVE PA_19390 (CHOP CARE NETWORK PHYSICIAN PRACTICE 5003 UMBRIA STREET Seerrapenpura SSCS OSOSC~—~SCS ‘7 CHOP CARE NETWRK PED @ ADOL SPECIAL CARE "707 ALEXANDER ROAD ‘PRINCETON NS_08540 PEDIATRIC & ADOLESCENT SPECIAL CARE (CHOP CARE NETWORK PHYSICIAN PRACTICE ‘505 BAYSIDE AVENUE BAYSIDE COMMONS ‘SOMERS POINT NI_002aa @ CHOP CARE NETWORK PHYSICIAN PRACTICE 495 HIGHLANDS BLVD STE 100 COATESVILLE PA 19320 40_CHOP CARE NETWORK 200 SPROUL RD STE 206 ‘BROOMALL PR 15008 sere hi 2v 1467 v 10-8.3 BHYSTCIAN PRACTICE ‘hada W Form 90) 7H PAGE 57PUBLIC DISCLOSURE COPY Schon 0 02010 EERIE Fociity tnformation coninoes) ‘Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (ist order of size, measured by foal revenue pe facity, from largest o smallest) How many nor-hesptal facibes did the organation operate during the tax year? Name and address Type of Facity (sescnbe) 1 SHOP CARE_NETWORK PHYSICIAN PRACTICE E91 EAST BALTIMORE PIKE KENNETT SQUARE PA S548 2 CHOP CARE_NET#ORK PHYSICIAN PRACTICE 1766 WILMINGTON PIKE GLENN MILLS Ba IS5az 3 CHOP CARE NETWORK PHYSICIAN PRACEICE 176 § NEW MIDDLETON RD STE 202 MEDIA PA_15065 @cHOP_CARE_NETARK FED « ADOL SPECIAL CARE PEDIATRIC & ADOLESCENT 100 WEST SPROUL RD PAV II SUITE 221 SPECIAL CARE SPRINGFIELD. PA 13064 = CHOP CARE_NETWORK PAYSTCIAN PRACTICE 1315 ROUTE 9 SOUTH ‘CAPE NAY COURTHOUSE Wa OBsTO CHOP_CARE NETWORK PHYSICIAN PRACTICE 4850 NEW YORK RD (ROUTE 3) SMITAVILLE Na_0820T 7 CHOP CARE NETWAK PED @ ADOL SPECIAL CARE PEDIATRIC & ADOLESCENT 1766 WILMINGTON PIKE SPECIAL CARE ‘GLENN MILLS ba 19347 CHOP CARE NETWAR PED ¢ ADDL SPECIAL CARE PEDIATRIC & ADOLESCENT 1245 HIGHLAND AVE SUITE 204 SPECIAL CARE ‘ABINGTON PR 19001 @_CHOP_CARE NETWORK PAYSICIAN PRACTICE 1590_MEDIGAL DR SUITE E POTTSTOWN PA 19868 ‘THE CARDIAC CENTER @ CHOP PEDIATRIC « ADOLESCENT ST PETERS UNIV HOSP 254 EASTON V WOB-FLE SPECIAL CARE NEW BRUNSWICK NJ_08901 ‘Rea Foes BT es eazy 1467 v 10-8.3 PAGE 58PUBLIC DISCLOSURE COPY Sets em 802010 Pao ‘Supplemental Information Complete ts part to provide the following information 1 Required descriptions. Provide the descriptons required for Part |, nes 3c, 6a, and 7, Part ll; Past Il, ines 4, 8, and 9b; and Part, Section B, lines 1j, 3, 4, 5, 6,7, 11h, 13g, 15e, 16e, 17e, 184, 18d, 20, and 21 2 Needs assessmont. Descnbe how the organization assesses the health care needs of the communities it serves, in addition to ‘any needs assessments reported in Part V, Secton 8. tiont education of eligibility for assistance. Descnbe how the organzation informs and educates patients and persons who may be billed for patent care about their elgiblty for assistance under federal, state, or local goverment programs of under the organizaton’s financial assistance policy. 4 Community information. Describe the community the organization’ serves, takng into account the geographic area and demographic constituents it serves. 5 Promotion of community health. 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VOTRULOIUT oy BpIAOIT O} HET Sip BjeisuOD WoREMIE;U) TEWNEUIO|TaNS Tm meant nna | oon mow | wa a 7 eeqoe ween uo vowing WP rediommnsnmn(a)| “eanearin) | senmouvie) | yobecarvia) emieee ouns ote) ‘Dapeeu S| e2eds [euOTIppE H PaIeDidnp 6a Uk 22 @UI ‘Ai Ved ‘066 UO. Uo ,$0,, Pa/eMSUE UONeZIUeBLO aU) J! }eIdWOD ‘SALES PAIIUN OLN UI SLENPIALPUI 6} EQUEISISSY 4010 PU eee 99 test d09 aunsOTOSIG OnnaPUBLIC DISCLOSURE COPY SCHEDULE J Compensation Information freon 290) For corain Gers Dstos,Trutn ay eplyes, nd Mat cmponied Empyaes > Compson anwar es" Fom 0, sneer > rach to Form 90. See separate instructions. THE CHILDREN'S HOSPITAL OF PHILADELPHIA 23-1352166 ‘Questions Regarding Compensation Ye [ve ‘14 Check he appropiate boxes) the ganization pronded any ofthe flowng tor fora person sted n Fom 990, Par Vil, Secon A, ine 1a. Complete Par Ito provide ay relevant nfomation regaring these ems First-class or charter travel ousng alowance or resdence for personal use Travel for companions Payments for business use of personal eidence 3) Taxindemnicaton and gross-up payments Health or socal cub dues oration fos DOscresonary spending account, Personal services (eg, mai, chau, chat) If any ofthe boxes on line 1a are checked dit the organizalon flow a wnten policy regarding payment fc fembusement or provison ef al of te expenses desenbed ‘above? it "Nor tonete Pat Mo Samenernent w |x 2 Did the organization ‘requre substanbston prot io’ raiursin’ or lowing ‘expenses incired by ai ctcars, directors, rusts, and the CEOMExecutve Dreco, regarding the tems checked mine fa?. aix 3 Indicate whic, i any, of he fotownng the organzaton uses to etablsh the compensation of the corgaizaton's CEO/Exeoutwe Drectr. Check alta! app 3] Compensaton committee [| writen employment contact 3) independent compensation consutant | Compansaton surveyor study [-x) Fon 890 of ater organizatons 5] Approval by the board or compensation commites 4 urate yu. any gran td m Frm 50, Pa, Secten A, nwt, wh spect oth fing 4 Recave a severnce payment or changef-convol paymant rom the orgarizaton or a related orgarizaton? a| |x _Partpate in, or recewe payment rom. a supplemental nonquaifd etement plan? ae © Partcipate in, or receve payment rom, an equiy-based compensation rangement? [ae fe IW"Yee"to any of ines 4c st the persons and provide te apptcable amounts foreach em in Pas fi nly section S013) and 601(c\.) organizations must complet lines 6-9. 5 Fer persons listed in Form S60, Part VI Seton line Te the organzation pay or accrue any compensation contingent onthe revenues of a Theogengaton? sevens s| | x bb Any rated organization? |?” | se [Px If*Yes" tone a or 8b, dascibe in Patil 6 Foc prsonaisndn Form 960, Part VI Secon A, ne ta, dd the erganzation pay o accrue any compensation contingent on tenet earings of a Theerganzaton? a |x Any relied organization? u {Tx Uf Yee" tolne 6 or 6b, descibe in Patil 7 For persons fisted in Form 980, Part Vil, Sacion A, ine 1a, dd the organzaton promde any nonfixed payments not desonbed m ines 6 and 6914"Yes; descnbomPartll... ms rx 8 Were any amounts reported m1 Form 990, Part Vi, pad or accrusd ‘pursuant to's contac tht was subject to the imtal contact exception described in Reguatons secton 5349S8-4(9\9)? lf "Yes" descnbe inpatin ® x 9 rer ine i grain ow ee engin poses deni Reguiatons secton 53.4958-06)7 : Peralta ork Reduction Act Noo, ue th Tsvcln e Form 00 Scheie For 0) 30 saaizy 1467 v 10-8.3 PAGE 102cor sowa ereot A capt xzte ve 10 (oes wou rompeure fo SENTGH WIHUNKD 1087983 (082616 GW NGHOS NVI Git HOTZOW EI005 NW WERHDD HOLe NOSNTTHOE AUWAET OOOH S SaTHVHO TT WERIOS NETTHRN OF Flow Wexwe © ROSNHOD Arana © NOISUIV UIaGSOON F 0666 WONONOGSA NHOE ® Sacra Peecrort 0 0 SENOD W EaEWOERA F Tae SNTTEGUH > TAO 0 AGSETEE © WOROUOE F_SWROHE OW WHTOHOSTIW W NENSIS € ea Bea raemwes ones ‘Soom wes onsen senodes ond pads lorena ruewea pam ae aaotm) weneeneieg(y | swmoromorta) | enemnen a) | sue eounniey uw 066 uo Uo Sunowe Iuved ‘06g ue vo pay 219 upoauotep ‘suogeavebi0 pales wy pue () Mol Uo LowemuRtio ig soy uogesuabunes uoee Tr PeNRS Poi! 9 TapGOU 5 S58US RUOTPHE I 601005 BOI VsTINONOTAUy PaIFSTETUIOD VOTH PUE SHOTOTGWG Noy "SOTERA "SIOTOONG SOHO EEE eee ‘O9TZSET-E2 (0102 (068 WE F emPRES doo 3unsorosia onanyor aova ere-ot a, L9bT ReTeRe ee ot loss wa) rmpenag OKOTT FTSHOIN WaONWKSTW TANT WHNOUD TaaaOH wxDONd J SWTOHSIN E FoLa7e55 =o 0 WWATTIOS GHWGES 70 eSB 807 seus pods (ore) Cal) ee ee IIA Wed ‘086 wo Uo pay You ase YEW sTeNpuIpul AUP is OU (i) Mod UO ‘suopoNASUL ‘mo! 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Seo separate Instructions. nies ame of onion Eoyr nestor amber ‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA 23-1352166 Excess Benefit Transactions{secton 501(c){3) and secton 501(0)(4) organzatons only) ‘Complete ifthe organvzation answored "Yes" on Form 990, Part IV, ine 25a or 25b, or Form 990-E2, Part V, line 40D. (©) Desenpbon of ransacton 1 () Name of asquatiied person (Q) ROOSEVELT HATRSTON @) @) @) iB 6 '2- Enter the amount of tax imposed on the organization managers or cisqualfed persone during the year ‘under section 4858, a 3 Enter the amount of tax, any, online 2, above, reimbursed by the organization SEE SCHEDULE © Loans to andlor From Interested Persons, Complete ifthe organizaton answered "Yes" on Form 980, Part IV, line 26, or Form 990-£7, Par V, ne 38a. {@) Namo of terested person and purpose aucem | ()Ongnat_ | (a) Batance due [oyin omar} Sse | pmepal amount Te [Fron| Yes [Ne o, @) a) a) (5) 16) m, (8) (9) po) Total Part BS Grants or Assistance Benefiting Interested Persons. ‘Complete i the organization answered "Yes" on Form 990, PartIV, tine 27 (a) Name ofirteresed person (©) Retstonaip between staresad pon andthe (e)Amount and ype of assistance ‘ehedale Farm B80 or DE 2010 s43i2y 1467 Vv 10-8.3 PAGE 110‘Samo Form 5000 S507) 2019 Business Transactions Involving Interested Person: PUBLIC DISCLOSURE COPY 23-1352166 Page ‘Complete if the organization answered "Yes" on Form 990, Part IV, Ine 289, 28b, or 26¢ (a) Name of terested parson ‘Ba Raasontp between Irestod person ana the (Amount of ‘ansacion (2) Dosiptonafeansacton |i) same ‘oganzaon ‘mane Yeo [ Wo (se nonce ese soot o FEORNGIAL SeRviCES x (2) sense wim see scazooxe 0 ‘44.014, | povoes oF ior * (3) sanaasa wzoce, wo sue scapooxs 0 15,302. [ enptores oF * (4) czzn so0ono EDU 204038, meeovee oF cioe * 8 a8 @ @) (9) 0) ‘Supplemental information. Complete ths part to provide addtional information for responses to questons on Schedule L (see instuctions) s4312v 1467 v 10-8.3 ‘Scheate Form 0 or W90-ED) 2010 PAGE 111PUBLIC DISCLOSURE COPY scHEoULE © | Supplemental information to Form 990 or 990-EZ Comite provid nfrmaton for sponses to apace uation on em Tom 080 cr 802 orn provide any ana inconon, pers momen taste Fom abr Sane rein a eo THE CHILDREN'S HOSPYnAL oF SHILADELHIA 2acis2i6 FORM 990, PART IV, LINE 12 AN AUDIT IS PERFORMED ON AN OBLIGATED GROUP WHICH COMPRISES THE CHILDREN'S HOSPITAL OF PHILADELPHIA, THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION, AND FIRST MEDICAL INSURANCE COMPANY. AN AUDIT. IS ALSO PERFORMED ON A CONSOLIDATED BASIS WHICH INCLUDES THE OBLIGATED GROUP, PGH DEVELOPMENT CORPORATION, CHILDREN'S ANESTHESIOLOGY ASSOCIATES, LID, CHILDREN'S ANESTHESIOLOGY ASSOCIATES OF NJ, INC., CHILOREN'S HEALTH CARE ASSOCIATES, INC., CHILDREN'S HEALTH CARE ASSOCIATES OF NJ, CHILDREN'S SURGICAL ASSOCIATES L7D., CHILDREN'S SURGICAL ASSOCIATES OF NJ, INC., SURGICAL RESEARCH AND EDUCATION FOUNDATION AND RADIOLOGY ASSOCIATES OF CHILDREN'S HOSPITAL, INC. FORM 990, PART VI, LINE 5 SEE SCHEDULE L, PART T FORM 990, PART VI, LINE 118 A COPY OF THIS RETURN WAS REVIEWED BY THE BOARD AUDIT 6 COMPLTANCE COMMITTEE BEFORE THE RETURN WAS FILED. BEFORE THE RETURN WAS FILED, THE FORM 990 WAS ALSO MADE AVATLABLE TO THE ENTIRE GOVERNING BODY OF THE ORGANIZATION THROUGH AN ACCESSIBLE SHARED COMPUTER NETWORK DRIVE MAINTAINED BY THE CHILDREN'S HOSPITAL OF PHILADELPHIA, FORM 990, PART VI, LINE 12 THE CHILDREN'S HOSPITAL OF PHILADELPHIA MAINTAINS A WRITTEN CONFLICTS OF ForPivacy Act and Paperwork Reduction Act Notice, vo he ietruclona for Form 690 or UE ‘Schedule 0 (Fon 090 or OED 10) sa3i2y 1467 v 10-8.3 PAGE 112PUBLIC DISCLOSURE COPY ‘Schau 0 (Fm 060 or 90.22 2010 Nene afte pinaaton| Cpyer entation br THE CHILDREN'S HOSPITAL OF PHILADELPHIA 231352166 INTEREST POLICY THAT APPLIES TO, INTER ALIA, ALL OF ITS TRUSTEES, OFFICERS, EMPLOYEES, MEMBERS OF THE MEDICAL STAFF AND RESEARCHERS OF THE CHILDREN'S HOSPITAL OF PHILADELPHIA AND ITS AFFILIATES. THE POLICY REQUIRES ANNUAL CONFLICTS OF INTEREST STATEMENTS FROM: TRUSTEES AND OFFICERS OF THE HOSPITAL AND ITS AFFILIATES: THE PRESIDENT AND OTHERS IN SENIOR MANAGEMENT; ADMINISTRATIVE PERSONNEL SERVING AT THE LEVEL OF MANAGER AND ABOVE AND CERTAIN OTHER CATEGORIES OF EMPLOYEES DEFINED IN THE CONFLICTS OF INTEREST POLICY (SUCH AS PERSONS KNOWN TO PLACE ORDERS WITH VENDORS) ; DEPARTMENT CHAIRS, DIVISION CHIEFS AND OTHER MEMBERS OF THE MEDICAL STAFF (EXCEPT THAT MEMBERS OF THE MEDICAL STAFF WHO ARE NOT BASED AT THE HOSPITAL ARE ONLY REQUIRED TO SUBMIT STATEMENTS BI-ANNUALLY) ; MEMBERS OF THE HOSPITAL RESEARCH STAFF; DESIGNATED EMPLOYEES OF PRACTICE PLANS AFFILIATED WITH THE HOSPITAL; AND OTHER PERSONS DESIGNATED BY MANAGEMENT. THE STATEMENT TRACKS THE CONFLICTS OF INTEREST POLICY, REQUIRING EACH PERSON TO DISCLOSE INFORMATION FOR THE REPORTING PERIOD REGARDING THE EXISTENCE AND NATURE OF GIFTS, OUTSIDE INTERESTS, OUTSIDE ACTIVITIES AND OTHER MATTERS CONSTITUTING A POTENTIAL, PERCEIVED OR ACTUAL CONFLICT OF INTEREST, AND TO CERTIFY THAT THEY HAVE READ THE POLICY AND ANSWERED FULLY, ACCURATELY AND TO THE BEST OF THEIR. KNOWLEDGE. APTER CONFIRMATION THAT ALL QUESTIONS HAVE BEEN ANSWERED, THE STATEMENTS ARE REVIEWED BY THE RELEVANT VICE PRESIDENT, DEPARTMENT CHAIR OR OTHER EXECUTIVE (OR THEIR DESIGNEE), TRACKED BY THE OFFICE OF COMPLIANCE AND PRIVACY (OC&P), AND ALL STATEMENTS DISCLOSING POTENTIAL, PERCEIVED OR ACTUAL CONFLICTS ARE FORWARDED TO THE OC6P AS WELL AS THE OFFICE OF GENERAL COUNSEL (OGC) FOR FURTHER REVIEW AND FOLLOW-UP AS a “Schedule 0 (For 800 or OED) THO sa3i2y 1467 v 10-8.3 PAGE 113PUBLIC DISCLOSURE COPY ‘Sepeae 0 Fo 99 0 090-22) 2010 age2 ae oe oranzton Trpiyar aoicnton mama ‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA 23-1352166 NEEDED. THE CONFLICTS STATEMENTS SUBMITTED BY TRUSTEES OF THE HOSPITAL AND FOUNDATION, AND MEMBERS OF SENIOR MANAGEMENT, ARE REVIEWED BY THE OGC AND OCEP AND THE DISCLOSURES ARE SUMMARIZED IN MEMORANDA DISTRIBUTED TO AND REVIEWED BY THE MEMBERS OF THE AUDIT AND COMPLIANCE COMMITTEE OF THE HOSPITAL AND FOUNDATION BOARDS. THE REMAINING CONFLICTS STATEMENTS CONTAINING AFFIRMATIVE DISCLOSURES ARE REVIEWED BY STAFF IN THE OGC AND OCkP. IN REVIEWING ANNUAL STATEMENTS WHERE AN ACTUAL, PERCEIVED OR POTENTIAL CONFLICT IS DISCLOSED, WHERE PROBLEMS ARE IDENTIFIED THAT NEED TO BE ADDRESSED, THE GOAL IS TO ELIMINATE OR MANAGE THE CONFLICT GOING FORWARD AND ENSURE THAT, AS TO EMPLOYEES OR OTHERS ON THE MEDICAL OR RESEARCH STAFF, THE RELEVANT SUPERVISOR IS AWARE OF THE ISSUE. SUMMARY INFORMATION ABOUT COMPLIANCE WITH THE POLICY'S REQUIREMENT TO SUBMIT ANNUAL STATEMENTS AND DISCLOSURES CONTAINED THEREIN IS PROVIDED IN MEMORANDA TO THE AUDIT AND COMPLIANCE COMMITTEE OF THE BOARDS. IN ADDITION, IF ANY MATTER INVOLVING A POTENTIAL VIOLATION OF THE CONFLICT OF INTEREST POLICY IS BROUGHT TO THE ATTENTION OF MANAGEMENT DURING THE COURSE OF THE YEAR, A REVIEW IS CONDUCTED BY EITHER THE RELEVANT DEPARTMENT'S MANAGEMENT, OGC OR OC4P, AS APPROPRIATE. FORM 990, PART VI, LINE 15 THE COMPENSATION OF EXECUTIVES AND PHYSICIANS/SCIENTISTS 1S REVIEWED AND APPROVED BY AN INDEPENDENT COMPENSATION COMMITTEE OF THE BOARD OF ‘TRUSTEES. THE CONMITTEE REVIEWS AND APPROVES IN ADVANCE THE COMPENSATION 0 BE PROVIDED TO THE CEO, ALL VICE PRESIDENTS (INCLUDING EXECUTIVE AND SENIOR VP LEVELS), CLINICAL DEPARTMENT CHAIRS, AND ALL FACULTY PHYSICIANS fa ‘Schedule 0 (Form 000 or OEE) 210 s4azu2y 1467 v 10-8.3 PAGE 114PUBLIC DISCLOSURE COPY ‘Seheaule 0 (For 680 99052 2010, Page 2 iam fe orpinenion ‘Epa aeration aber ‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA 23-1352166 AND SCIENTISTS. FOR EACH SUCH PERSON, THIS PROCESS WAS LAST PERFORMED IN 2010. IN MAKING TTS DETERMINATIONS, THE COMMITTEE CONSIDERS THE PERFORMANCE OF THE ORGANIZATION AND THAT OF THE COVERED INDIVIDUALS AS WELL AS RELATED BUSINESS JUDGMENT FACTORS. IT ALSO CONSIDERS MARKET COMPARISON REPORTS PREPARED BY AN EXTERNAL INDEPENDENT COMPENSATION CONSULTANT WITH SIGNIFICANT EXPERIENCE IN PERFORMING EXECUTIVE AND PHYSICIAN COMPENSATION ASSESSMENTS FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS. THE COMMITTEE'S PROCESS TS DESTGNED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS FOR THOSE INDIVIDUALS WHO ARE DISQUALIFIED PERSONS. THE PEER GROUP FOR EXECUTIVES GENERALLY INCLUDES LARGE AND COMPLEX ACADEMIC MEDICAL CENTERS AND HEALTH SYSTEMS. FOR PHYSICIANS AND SCIENTISTS, THE PEER GROUP GENERALLY INCLUDES ACADEMIC MEDICAL CENTERS. INFORMATION FROM OTHER ORGANIZATIONS MAY ALSO BE CONSIDERED WHERE APPROPRIATE FOR THE POSITION. FORM 990, PART VI, LINE 19 FORM 990 AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. THE CONFLICTS OF INTEREST POLICY IS AVAILABLE ON THE CHILDREN'S HOSPITAL OF PHILADELPHIA'S WEBSITE. FORM 990, PART VIT CERTAIN OFFICERS AND KEY EMPLOYEES OF THE CHILDREN'S HOSPITAL OF PHILADELPHIA ALSO DEVOTE SIGNIFICANT TIME EACH WEEK TO OTHER RELATED ORGANIZATIONS AS FOLLOWS S. ALTSCHULER a ‘Scheie 0 (Form 00 or OED) 210 sa3i2y 1467 v 10-8.3 PAGE 115PUBLIC DISCLOSURE COPY Schmte0 Fo 96099062) 2010, Page 2 are oft opinaor ‘Enployraeieaon pombor JHE CHILDREN'S HOSPITAL OF PHILADELPHIA 231352166 40 HOURS TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA ~ 1 HOUR TO PGH DEVELOPMENT CORPORATION = 1 HOUR 70 CHOP CLINICAL ASSOCIATES INC. = 1 HOUR TO CHOP PRACTICE PLAN ASSOCIATION = 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION N. AozIcK = 40 HOURS TO CHILDREN'S SURGICAL ASSOCIATES INC. = 1 HOUR = 1 HOUR = 1 HOUR = 1 HOUR = 1 HOUR A. COHEN 10 0 0 0 0 THE CHILDREN'S HOSPITAL OF PHTLADELPRIA CHOP PRACTICE PLAN ASSOCIATION THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION CHILDREN'S SURGICAL ASSOCIATES OF NJ, INC. SURGICAL ASSOCIATES RESEARCH AND EDUCATION FOUNDATION - 40 HOURS 70 CHILDREN'S HEALTH CARE ASSOCIATES INC. = 1 HOUR = 1 HOUR = 1 HOUR = 1 HOUR = 1 HOUR S. BURKE 1 HOUR 1 HOUR 70 70 70 10 70 10 70 THE CHILDREN'S HOSPITAL OF PHILADELPHIA CHOP CLINICAL ASSOCIATES INC. ‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION CHILDREN'S HEALTH CARE ASSOCIATES OF NEW JERSEY CHOP PRACTICE PLAN ASSOCIATION ‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION Schedule 0 Fom 000 0 OEE) 7010 s43i2y 1467 v 10-8.3 PAGE 116PUBLIC DISCLOSURE COPY ‘Setmtue 0 (Fam 09 990-62) 2010, THE CHILDREN'S HOSPITAL OF PHILADELPHIA ., c. A M. Lk n. conker, 1 HOUR TO 1 HOUR TO BARUCH 1 HOUR TO 1 HOUR TO 1 HOUR TO DANTCHTK 1 HOUR TO 1 HOUR TO FISHMAN 1 HOUR TO 1 HOUR TO 1 HOUR TO GARBOSE 1 HOUR TO 1 HOUR TO LATINI 1 HOUR TO oR. THE CHILDREN’S HOSPITAL OF PHILADELPHIA THE CHILDREN’S HOSPITAL OF PHILADELPHIA THE CHILDREN'S HOSPITAL OF PHILADELPHIA CHOP PRACTICE PLAN ASSOCIATION THE CHILDREN'S HOSPITAL OF PHILADELPHIA THE CHILDREN'S HOSPITAL OF PHILADELPHIA THE CHILDREN'S HOSPITAL OF PHILADELPHIA THE CHILDREN'S HOSPITAL OF PHILADELPHIA THE CHILDREN’S HOSPITAL OF PHILADELPHIA CHOP PRACTICE PLAN ASSOCIATION ‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA ‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA THE CHILDREN'S HOSPITAL OF PHILADELPHIA Pogo rployr arian nome 23-1352166 FOUNDATION FOUNDATION FOUNDATION FOUNDATION FOUNDATION s43i2y 1467 v 10-8.3 ‘eheduleO (For 000 or OEE) 250 PAGE 117‘Scheu 0 (Fam 90 00462) 2010 THE CHILDREN'S HOSPITAL OF PHILADELPHIA 1 HOUR 70 THE LEMMON JR. 1 HOUR TO THE 1 HOUR TO THE + MCCABE 1 HOUR TO THE 1 HOUR TO THE MILLIGAN 1 HOUR TO THE 1 HOUR TO THE BIESECKER 1 HOUR TO THE 1 HOUR TO THE | NAKAHARA 1 HOUR TO THE 1 HOUR TO THE PERELMAN 1 HOUR TO THE 1 HOUR TO THE CHILDREN’S CHILDREN'S CHILDREN'S CHILDREN'S CHILDREN'S CHILDREN'S CHILDREN'S CHILDREN'S CHILDREN'S CHILDREN'S CHILDREN'S CHILDREN'S CHILDREN'S HOSPITAL HOSPITAL, HOSPITAL, HosPrTAL. HOSPITAL, HOSPITAL HOSPITAL, HOSPITAL HOSPITAL. HoserTaL HosprTaL, HOSPITAL HOSPITAL. PUBLIC DISCLOSURE COPY oF oF oF oF oF oF oF oF oF oF oF oF oF PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA FOUNDATION FOUNDATION FOUNDATION FOUNDATION FOUNDATION FOUNDATION FOUNDATION Employer nication wumber 2371352166 s4a12y 1467 v 10-8.3 ‘Secale Oram owen 0 PAGE 118PUBLIC DISCLOSURE COPY Sere 0 Fom 000 90527) 2010 Page2 are ofthe eranaton| Epler oierton amber THE CHILDREN'S HOSPITAL OF PHILADELPHIA 23-1352166 D. caauso 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA 1 HOUR TO THE CHILDREN*S HOSPITAL OF PHILADELPHIA FOUNDATION A, BREAUX 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION 1. TopoRow 40 HOURS TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA 1 HOUR TO FIRST MEDICAL INSURANCE COMPANY 1 HOUR TO CHOP CLINICAL ASSOCIATES, INC. 1 HOUR 70 THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION M. JONES 40 HOURS 70 THE CHILDREN'S HOSPITAL OF PHILADELPHIA 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION D. RUBENSTEIN = 1 HOUR 70 THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION = 1 HOUR 70 THE CHILDREN'S HOSPITAL OF PHILADELPHIA R. PEW 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION a ‘ehoauie 0 (Fm 00 or O00EZ) 070 s43i2y 1467 v 10-8.3 PAGE 119PUBLIC DISCLOSURE COPY Sereae 0 (Fern 990 99029 2010 Page? ane ft openaston ‘rployrieiicaon nur THE CHILDREN'S HOSPITAL OF PHILADELPHIA 23-1352166 1 HOUR 70 THE CHILDREN'S HOSPITAL M. DENNEEN 1 HOUR TO THE CHILDREN'S HOSPITAL 1 HOUR TO THE CHILDREN'S HOSPITAL G. QUILL 1 HOUR TO THE CHILDREN'S HOSPITAL 1 HOUR TO THE CHILDREN’S HOSPITAL S. SAUNDERS, JR. 1 HOUR 70 THE CHILDREN'S HOSPITAL 1 HOUR 70 THE CHILDREN'S HOSPITAL A. FAULKNER SCHOEMAKER 1 HOUR 70 THE CHILDREN'S HOSPITAL 1 HOUR TO THE CHILDREN'S HOSPITAL S. SHUCHMAN oF oF oF oF oF oF oF oF oF PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA, PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA PHILADELPHIA 1 HOUR TO CHOP PRACTICE PLAN ASSOCIATION 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA 1 HOUR TO CHOP PRACTICE PLAN ASSOCIATION FOUNDATION FOUNDATION FOUNDATION FOUNDATION FOUNDATION s43i2y 1467 Vv 10-8.3 ‘Schade © For O90 or OED 210 PAGE. 120PUBLIC DISCLOSURE COPY ‘Shoat 0 Farm 940 $6042) 2010 Page 2 ame oft oranaston Employer Wniicaton number ‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA 231352166 A. TALLEY WIETLISBACH HATRSTON RAN 1 HOUR TO THE 1 HOUR TO PGH BUCKLEY 1 HOUR TO THE 1 HOUR TO THE WOLESON 1 HOUR 70 THE 1 HOUR 70 THE 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION 1 HOUR 70 THE CHILDREN'S HOSPITAL OF PHILADELPHIA 40 HOURS TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA 1 HOUR 70 THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION 1 HOUR 70 PGH DEVELOPMENT CORPORATION 40 HOURS 70 THE CHILDREN'S HOSPITAL OF PHILADELPHIA CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION DEVELOPMENT CORPORATION CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION CHILDREN'S HOSPITAL OF PHILADELPHIA CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION CHILDREN'S HOSPITAL OF PHILADELPHIA sa3i2y 1467 Schedule 0 (Fom 000 0 OED 070 Vv 10-8.3 PAGE 121PUBLIC DISCLOSURE COPY Serette 0 (Fo 00 or 80:22) 2010 Page 2 Nae ofa onarcaton Epler Woenton number THE CHILDREN'S HOSPITAL OF PHILADELPHIA 23-1352166 D. ZIFF = 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDATION = 1 HOUR TO THE CHILDREN'S HOSPITAL OF PHILADELPHIA FORM 990, PART XI, LINE 5 UNREALIZED APPRECIATION 7,380, 640 CHANGES TO TEMPORARY RESTRICTED ASSETS 13,222,065 PENSION ADJUSTMENT 28,901,714 TRANSFER 70 SELF INSURANCE ENTITY (40,516, 631) OTHER CHANGES/TRANSFERS (420,703) TOTAL 8,567, 085 SCHEDULE K, PART IIT, LINE 6 ‘THE ORGANIZATION HAS MADE AN EQUITY ALLOCATION TO THE SMALL AMOUNT OF SPACE WITHIN THE FACILITIES FINANCED BY ITS SERIES 2007 BONDS WHERE ANY ACTIVITIES THAT COULD RESULT IN PRIVATE BUSINESS USE EXIST, AND HENCE, SCHEDULE K, PART IIT, LINE 6 IS ZERO FOR THIS ISSUE. SCHEDULE L, PART I, COLUMN (B) DESCRIPTION OF TRANSACTION CUMULATIVE FOR MULTIPLE YEARS RECEIPT OF APPROXIMATELY $1,724,340 FROM FRAUDULENT INVOICES SUBMITTED BY DISQUALIFIED PERSON. NO ORGANIZATION MANAGER OTHER THAN DISQUALIFIED PERSON PARTICIPATED IN THE SUBMISSION OF FRAUDULENT INVOICES. THE DISQUALIFIED PERSON DIVERTED FUNDS BY SUBMITTING FRAUDULENT INVOICES. DURING FISCAL YEAR 2011, CHOP DISCOVERED = ‘Schedule 6 (om 990 0 OED) 210 sa312y 1467 v 10-8.3 PAGE 122,PUBLIC DISCLOSURE COPY ‘Senedd © Fam 00 9.622010 Page? me oft orerasten| Epler deerton number THE CHILDREN'S HOSPITAL OF PHILADELPHIA 23-1352166, THE FRAUD AND CONDUCTED AN INTERNAL INVESTIGATION; TERMINATED THE EMPLOYEE; DEMANDED RETURN OF THE DIVERTED FUNDS; AND REPORTED THE MATTER TO LAW ENFORCEMENT AUTHORITIES. SCHEDULE L, PART IV, COLUNN (B) RELATIONSHIPS TRUSTEE STEPHEN B. BURKE IS A DIRECTOR OF J.P. MORGAN, TO WHICH CHOP PAID $1,222,589 IN FY 2011 (TY 2010) FOR BANKING SERVICES, SERVING AS A LIQUIDITY FACILITY AND A REMARKETING AGENT. KEY EMPLOYEE MARY TOMLINSON'S SISTER, JENNIE MINNICK, IS AN EMPLOYEE OF CHOP. TRUSTEE, SALEM D. SHUCHMAN'S WIFE, BARBARA KLOCK, M.D., IS AN EMPLOYEE OF CHOP. OFFICER THOMAS TODOROW'S DAUGHTER, CARLYN TODOROW IS AN EMPLOYEE OF A RELATED ORGANIZATION, CHILDREN'S SURGICAL ASSOCIATES, LTD. FORM 990, PART III ~ PROGRAM SERVICE, LINE 4A THE CHILDREN'S HOSPITAL OF PHILADELPHIA FOUNDED IN 1855, IS THE NATION'S FIRST HOSPITAL DEDICATED EXCLUSIVELY TO PEDIATRICS. THE HOSPITAL STRIVES TO BE THE WORLD LEADER IN THE ADVANCEMENT OF HEALTH CARE FOR CHILDREN BY INTEGRATING EXCELLENT PATIENT CARE, INNOVATIVE RESEARCH, AND QUALITY PROFESSIONAL EDUCATION INTO ALL OF ITS PROGRAMS. THE HOSPITAL IS AN INTEGRATED PEDIATRIC HEALTH CARE DELIVERY SYSTEM THAT PROVIDES QUATERNARY AND ACUTE LEVEL PEDIATRIC SERVICES AS WELL AS EMERGENCY, PRIMARY, SPECIALTY, HOME CARE, AND POISON CONTROL CARE FOR CHTLOREN. THE HOSPITAL TREATS CHILDREN WITHIN ITS SERVICE AREA IRRESPECTIVE OF ABILITY TO PAY. DURING THE YEAR ENDED JUNE 30, 2011, THE HOSPITAL WROTE OFF 961,266,000 IN CHARGES FOR SERVICES RENDERED APPLICABLE TO FREE a ‘Schedule O (Form 90 9 OEE) THE s43.2y 1467 v 10-8.3 PAGE 123,PUBLIC DISCLOSURE COPY _Stheaa © (Fo 090 90-62 2010, Page ‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA 231352166, CARE, CHARITY AND UNCOLLECTIBLE ACCOUNTS. THE CHILDREN'S HOSPITAL OF PHILADELPHIA HAS BEEN RATED AS THE BEST CHILDREN'S HOSPITAL IN THE COUNTRY BY U.S. NEWS 6 WORLD REPORT (2003-2011) AND PARENTS MAGAZINE, IN ITS FIRST SURVEY (2009). IN THE 2011 0.5.NEWS SURVEY, CHOP RANKED FIRST, SECOND OR THIRD IN NINE OUT OF 10 SPECIALTIES FOR THE YEAR ENDED JUNE 30, 2011 1) TOTAL INPATIENT DAYS: 146,143 2) TOTAL INPATIENT ADMISSIONS: 28, 401 3) TOTAL EMERGENCY DEPARTMENT VISITS: 85,749 4) TOTAL SPECIALTY CARE VISITS: 323, 404 5) TOTAL PRIMARY CARE VISI?: 690,778 6) TOTAL HOME CARE VISIT: 387, 380 (PATIENT DAYS) 19, 640(EQP. RENTAL) 1) DAY SURGERY VISITS: 42,268 REFACHMENT 2 PART VII ~ CONTINUATION OF OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES (1)=1ND.TRUSTEE/DIR. (2)=INS.TRUSTEE (3)=OFFICER (4)=KEY EMP. (5)=HIGHEST COMP. (6) “FORMER (c) Posrrron COMPENSATION FROM (A)NAME AND TITLE (B)HOURS (1) 2)(3)/4N5N6) (ORG. (E)REL. ORG. (F)OTHER 29 DOMINIC J CARUSO ‘TRUSTEE 1.00 x o 0. ° 30 AMINTA HAWKINS BREAUX ‘TRUSTER 1.000 x 31 THOMAS J TODOROW EXECUTIVE VP AND CFO 40.00 x 1,002,167 0. 137,528. 32 JEFFREY D KAHN EXECUTIVE VP & GENERAL COUNSEL 40.00 x 498,854. 0. 13,651. 33 MARGARET M JONES EXECUTIVE VP & CAO 40.00 x 702,741. 103,013. 34_ROOSEVELT HAIRSTON a ‘Scheate 0 (For O00 or OED 2010 sa3i2y 1467 Vv 10-8.3 PAGE 124PUBLIC DISCLOSURE COPY ‘Seqaaue 0 Fam 550 £902) 2010 2 ame oe orpananton Employer doeston amber ‘THE CHILDREN'S HOSPITAL OF PHILADELENIA 23-1352166 ‘RETACHMENT 2 (CONT'D) EXECUTIVE VP & GENERAL COUNSEL 40.00 x 614,799.08, TE 35 MADELINE BELL PRESIDENT & COO 40.00 x 1,168,361 0. 254,900. 36 JOHN MCDONOUGH SENIOR VP FACILITIES 40.00 x 482,893. 121,863 37 PHILIP JOHNSON EXECUTIVE VP & CSO 40.00 x 1,784,147. 0. 178,301. 38 BRYAN WOLF SVP & CHIEF INFORM. OFFICER 40.00 x 810, 668. ° 23,648. 39. KATHLEEN GORMAN SVP & CHIEF NURSING OFFICER 40.00 x 538,873. ° 41,000. 40 CHARLES $ HOUGH SVP SUPPORT SERVICES 40.00 x 428,503. 1,470. 41 MARY TOMLINSON VP RESEARCH ADMIN & FINANCE 40.00 x 295,488 10,943. 42 TOM CURRAN DEPUTY CSO 40.00 x 973,401. ° 12,670 43. STUART SULLIVAN EVP & CHIEF DEVELOP. OFFICER 40.00 x 700, 636. 0. 8,217 44 CYNTHIA HATNES SVP INTERNATIONAL MEDICINE 40.00 x 659,766. 37,041. 45 NICHOLAS P PROCYK SVP & CHIEF INVESTMENT OFFICER 40.00 x 654,399. 9,471 46 ROBERT CRONER SVP HUMAN RESOURCES 40.00 x 444,581. 4,413 47 DAVID ALEXANDER vp OF FINANCE 40.00 x 434,367. 7 10,045. 48 MICHELE LLOYD SVP HIM & FAMILY SERVICES 40.00 x 402,352. 0. 9,443. ‘RPTACHMENT 3 990, PART VIT- COMPENSATION OF THE FIVE HIGHEST PATD IND. CONTRACTORS NAME AND ADDRESS DESCRIPTION OF SERVICES COMPENSATION FKP ARCHITECS ARCHTTECTUAL SERVICE 16,906,385 8 GREENWAY PLAZA, SUITE 300 FEASTERVILLE, PA 19053 LE DRISCOLL COMPANY LLC CONSTRUCTION SERVICE 6, 467,080. 9 PRESIDENTIAL BLVD. PHILADELPAIA, PA 19103 TARGET BUILDING CONSTRUCTION CONSTRUCTION SERVICE 6,052, 495. 1124 CHESTER PIKE FEASTERVILLE, PA 19053 TURNER CONSTRUCTION COMPANY CONSTRUCTION SERVICE 4,267, 268. Fy ‘Schedule 0 (Fam 090 or OEE) ITE sasizy 1467 Vv 10-8.3 PAGE 125PUBLIC DISCLOSURE COPY ‘Serato 0 For 060 9902 2010, THE CHILDREN'S HOSPITAL OF PHILADELPHIA Peo ‘Enployriaarticaen nab 23-1352166 990, PART VIT- COMPENSATION OF THE FIVE HIGHEST PAID IND. CONTRACTORS NAME AND ADDRESS 1835 MARKET ST., 2187 FLOOR HUNTINGDON VALLEY, PA 19006 CSC CONSULTING INC. JP MORGAN BANK ONE NEWARK, NJ 07188-0170 TOTAL COMPENSATION DESCRIPTION OF SERVICES COMPENSATION CONSULTING SERVICES 3,895,313 se sa s4312y 1467 v 10-8.3 ‘Schedule 0 (For 000 or OEE) 2010 PAGE 126L2t aowa 102 (oe wos) wonoers ere-ot A Loot Rzteps ome ten wo 1) evopanges ago anon oy wopanpey Womedeg 14 x TORS é Wa) RRS WENGE | __ ete ae ¥ aono| Ta-11T tT Ww Waasae x aH é Wa) aa HUTS x aH é a CT Elssove-22 ¥ Er} é EN] GaN HUAWSH | voova ow “Te ARO ¥ Eo 6] tery 10: va) aa HUTVae ¥ TOW) E]_ ter orto: Wa) SRO RETWaR ‘Sas992-E2 fove (oyena5 vor») uyanter eng | seam Rumored | smow enoscuey omc hu wert rn NEP HOP "RN 0 o ° @ ° ey y esneseq be oul "AlUed (066 We 4 Uo ,$@,A, pasomsue LoneZUeBLO ey)! @jeIdW05) suoneZ|UeBIO ydwex3-xE] PoIeIOY Jo UOREDYAUEP) (aeek xe oun Buunp suonezuetvo ydwoxe-xe} pajejai as0w 10 au0 = oe = — = = Sous] SOREREVAT | WT SES WS] 05 SRTOTOR [OOD=vOTeT Wa WINSTSOWIING__ 7a WSINGD STATS 9 LaSWIS Mave eeeazts-52 = en twateremg | swe nena | cussamo, | ammosuernin | Ame nny open en a ro a o ra wi ((ee oun ‘AI Hed ‘068 uno UO S04, pesonsue uonezueB.0 eigy eo}4wOD) seNDUA penseBer8Ia Jo uoNe=ynue! — EETET STESET-te THSTSOVTINE JO TETASOW SNGROTTAD SHE oquny voprynuep ort, opens 091 ou erat) ‘uoyenacay aude 05 “es uoy arom Seen “4¢10°9¢'st‘P¢ CF OU 'AL Rd ‘066 we OF 60), avemeuR vopETVEBLO wg 1 eIIdOD (086 wo) sdiysiauped payejesun pue suoneziueBio peyeiay uanaaHos ‘Adoo Sunsovosia anandezt gow 10 (oss es) yee ere-0T A cert azteps ¥ 30D T ve iogans ¥ a0HD 3 TN] Sav AUIWaH ¥ FORD € Wa) aos NWISISANS ¥ aon] Ta-Ttt tt TA) SNORING Sas ¥ aon) Ta-T1t 1 we Todas x co eter aro TR) aS wETHa ‘TavaREE-2 oe (ong vores») nero ua 0 fusomino pea | arn tama area | voreeemorues | es) rouop tay | Aeon us eqeautio pon putea o o o @ @ o (120k x61 ou Buunp suogezus6i0 auuere xe peels 30170 30 ry ey | BsneeG HE OUI ‘AI Hed '066 UWOJ UO SA, paremsue 12610 ej @)e\duWO) SuoREZ|UEEIO Jdwoxg-xe4 POre|OY JO UOREDYRUEP! 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BuUMo} ‘pOJOMSUE UOREZIUBELO Wp p SjaIdWOD)dlysIOUPEd B Se e}qexe, SUOREZIUEBIC parejas Tee CURT OIRO ‘Ado0 aunso79sia anandPUBLIC DISCLOSURE COPY 23-1352166 Scrat 8 (Form 990) 2010 005 [ZEMIN Supplemental information ‘Complete this part to provide additonal information for responses to questions on Schedule R (see instructions). ‘Schedule R (Form 990) 2070 sagi2y 1467 Vv 10-8.3 PAGE 133‘THE CHILDREN'S HOSPITAL OF PHILADELPHIA FORM 990 RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX FOR THE YEAR ENDED JUNE 30, 2011 PUBLIC DISCLOSURE COPYrom 8868 Application for Extension of Time To File an {Rev Jnay2080 Exempt Organization Return (OMB No 1545-1708 ona Renee bones.” > File» separate appleavon foreach return. ‘= Ifyou are filing for an Automatic S-Month Extension, complete only Partland check this bax...» ‘ Ifyou are fing for an Additional (Not Automatic) 3-Month Extension, complete only Part (on page 2 ofthis fom) ‘Do not complete Part unless you have already been granted an automatic 3-month extension on a previously fied Form 8868 Etectront fling (fe). You can electronica fe Form 8668 i you need a 2-month avtomatc extension of time to fie (6 months for 2 corporation requred to fle Form S90-N, oF an additonal (not asomt)@-month extension of ne. You cen electioneal fe Form 868 to reavest an extension of time 10 ite any ofthe fxme Hated In Pad or Part wth the excepton of Fann 8870, Information Relum for Tasfors Assocated With Certain Personal Geneft Contac, which must be sent to the IRS in paper format (se instructions). Far more detaison the elecirone ting of ths frm, vst warwifsgowelle and cick on orl for Ghanios & Nonoronts [ERED Automatic s-ntonth Extension of Timo. Only submit orginal (no copies needed) ‘corporation required to fle Form 990-T and requesting an automat month extension - check hs box and compe pane eee eee eee Oo All other corporations (including 1120-6 fers), ponnarsips REMC, and sts mus uso Fin 7004 fo eaves an eitnon of ime {o fle ncome tox returns Type oF [Nore ot oom waaRRTST TT BRIDE TT print | THE CHILDREN'S HOSPITAL OF PHILADELPRIA 23-135216 Ramer set and oor steno Wa .O box soe ota 34TH ST. & CIVIC CENTER BLVD. iy, on POT OT. a aN 7 Se, Por oT Be ea TAROT PHILADELPHIA, Pa 19104-4388 ET Enter the Return code for the return that this applicaton is for (fle @ separate apphoation foreach return) , Application Return [Application 2 Return tn For Code [ts For Code Form 990 01 [Form 900-7 (carport) or Form 99080 = 02 [Form 1041-8 08 Form 990-62 03 | Form 4720 08 Fon $80-PF 04 [Form 6727 10 Form S00sT (gee 40a) AOR) ta) 05 | Form 6060 44 Form 990-T (rus other than above) (06 [Fo 6670 12 * The books are nthe cae of b JOE HEDIGER Telephone No » _267 580-1000 FAK No * if the organization does not have an office or place of business in the United States, check Wis BOX... . ...>L) «this is fora Goup Reta, enter the organzation’s four dt Group Exemption Number (GEN) iris forthe whole group. check ths box... . ® L_] . fits for par ofthe group, check this box... PL_Jand attach alist wth the names and EINs of all members the edension i for ‘1 Teequest an automatic 3-month (8 months for a corporation required to fle Form 960-7) extension of ne nti 02/15 , 20.12 _ to file the exempt organzation return for the organization named above The extension for the organization's return or »[_ calendar year20___ or > [i] tax year beginning 07/02, 2030 _, and ending 06/30, 20.12 2 the tax year entered ntine 1 1s for tas than 12 months, check reason. [ina return] Fina return ‘Change in accounting period Ta Wikis application & for Form GOBL, BOOPF, O50-T, A7ZO, or GOED, enler the Tenatve tax, Was any noncefundable edits See instuctons sals o. » if ths appicotion is for Form 9G0-PF, OG0-T, 4750, or G0B8, enter any relundabie creda and] estimated tax payments made Include any prior year overpayment allowed a a creat sols. o. € Balance Ove. Subiract ine 30 from ine 3a Include your payment with ths form, Hrequred, by using EFTPS| (Electrone Federal Tax Payment System) See instructions sels 9. Gaution. If you are going to make an electron fund withdrawal with this Form 6868, see Form 6483-E0 and Form 6B7®-EO for payment instructions For Paperwork Reduction Act Nac, coo Inetrucions, Fom 8 for a s43i2y 1467 11/3/2011 1 9:07 AM V 10-8.2 PAGE 1fom aor 120% oe 2 * Ifyou are fling for an Adational (Not Avtomaiic)S-Month Extension, completo on Pantand check bie box...» L&I ‘Note. Only complete Pat Ili you have aeady been granted an automatic Sanh extension ona prev led Form 8868 It you are fing fr an Automatic 3-Month Extension, complate only Part (on page 1 BRR Acationar quot automate) s-month Estraier of Yine- Only We the SGT (nS Copley needa, ————— Tame of extn organ Silo ertnGsToN TEST THE CHILDREN'S HOSPITAL OF PATLADELPHIA 23-1352166 NumBar, ret, and eon osteo. Wa POBox Soe rab 34TH ST. 6 CIVIC CENTER BLVD. iy Ow o Rafe as and ZIPS Fors Tah SGT, Bs SO PHILADELPHIA, PA 19104-4368 Enter the Return code for the return that this application s for (fle @ separate application fr each return) ‘Application Return [Application Return leFor Code _| te For Code Form 980, 7 an oe ee Form 980-5 (02 [Form 1047. 8 Form 990-EZ (03 [Form 4720, 08. Form 990-PF (04 [Form 5227 10 Form 990-T (see. 40%(a) or 408(@) trust) (05 | Form 6089 14 Form 990-T (trust other than above) (06 — [Form 9870, 42 STOPIDo not complet Part Ii you were ot already granted an avtomati Smonihextralon on prviouly Med Form 668. The books are nthe care of p-THOHAS TODOROW Telephone No». 267. 999=1000 FAXNO + the orgarizaton does nothave an ofa place Of business inthe Unted Sues, cack a BOX .-O * this i fora Grou Return enter the organization’ our digh Group Exemption Nur (GEN) itini's forthe whole group, check thisbox, [| ls for pat of the grou, check bs Bo © Land attach a tstth the names and EINs of al iembérs ine earn i fo ’Trequest an addibonal month extension of tne ur OS7is 2012 5 Foreslenieryoar or aher tax year begnnarg 07703, 36 30 and end 06/30, 2033 ine tox year efsrod ine si ress han 1 monte iedaason [| iach] Fnalveum TL_lenange n accounting period 7 Stale mdetai why you need the extension ADDITIONAL TIWE I$ NEEDED TO GATHER INFORMATION 20 FILE. A COMPLETE. AND ACCURATE” RETURN ‘Ga If this application w for Form G90-BL, G90-PF, 690-7, 4720, or 6060, ener the Tentative tax Wess any| ‘nonrefundable credits. See instructions als. o. bb if this applicaton is for Form 900PF, 690-7, 4720, or 6069, onler any refundable credits and ‘estimated tax payments made. Include any pnor year overpayment allowed as a credit and any ‘amount pad previously with Fom 8868, bls. 9. © Balance Due. Subtract line 8 from line 8a, Include your payment with hs form, required, By using EFTPS (Electron Federal Tax Payment System). See instructons lecls. o. Sonate “Tip TAX MANAGER, bee be 02/10/2012 ‘ev 1307) sa3izy 1467 v 10-8.2 PAGE 1