Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2010 and ending 12-31-2010
BCheck if applicable:
CName of organization
Gillette Children's Specialty Healthcare
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
200 University Avenue East
 
Room/suite
City or town, state or country, and ZIP + 4
St Paul, MN55101
D Employer identification number

36-3379150
E Telephone number

G Gross receipts $ 170,179,737
F Name and address of principal officer:
James Haddican
200 UNIVERSITY AVENUE EAST
STPAUL,MN55101
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
gillettechildrens.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1897
M State of legal domicile: MN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Provides specialized health care for people who have disabilities that began during childhood.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 24
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 19
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 1,223
6 Total number of volunteers (estimate if necessary) .... 6 241
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 132,247
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -52,685
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 3,018,152 5,067,246
9 Program service revenue (Part VIII, line 2g) ......... 137,349,151 158,145,526
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... -487,211 684,368
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 13,053 -2,219
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 139,893,145 163,894,921
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 23,564 23,850
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 75,321,973 85,347,103
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 56,825,654 63,659,407
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 132,171,191 149,030,360
19 Revenue less expenses. Subtract line 18 from line 12...... 7,721,954 14,864,561
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 184,711,936 230,454,867
21 Total liabilities (Part X, line 26)............ 64,819,274 94,452,058
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 119,892,662 136,002,809
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: Gillette helps children and adults who have disabilities to improve their health and well-being. Gillette's staff treats people who have cerebral palsy, spinal cord injuries, spina bifida, brain injuries, complex orthopaedic needs, craniofacial anomalies and other disorders.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 124,375,280 including grants of $ 23,850 ) (Revenue $ 157,794,437 )
Patient Services:Inpatient: In 2010, Gillette treated 2,238 inpatients, who stayed at Gillette for a total of 10,774 days. Gillette sees children who need craniofacial surgery, neurosurgery, orthopedic surgery, and other pediatric surgical services. Gillette also serves patients who are hospitalized for brain injuries, spinal cord injuries, comprehensive medical rehabilitation services, baclofen pump implantations and ventilator support.See Schedule OGillette has the region's largest pediatric rehabilitation program and is one of only three pediatric programs in the five-state area accredited by the Commission for Accreditation of Rehabilitation Facilities. Gillette's pediatric intensive care unit serves patients who need critical-care services. Regions Hospital - in partnership with Gillette - was named Minnesota's first Level I Pediatric Trauma Center in 2009. That year, Gillette also became the nation's first accredited motion laboratory, certified by the Commission for Motion Laboratory Accreditation. In 2010, U.S. News Media group ranked Gillette 17th in the nation for orthopedics in its annual edition of America's Best Children's Hospitals. The Joint Commission in 2008 again granted Gillette a three-year accreditation. The American Nurses Credentialing Center has granted Gillette Magnet designation under the Magnet Recognition Program. According to the Minnesota Hospital Association, Gillette has repeatedly had the highest case mix index among all pediatric and adult hospitals in the Twin Cities. Case mix index reflects the diversity, clinical complexity and need for resources among a population of hospital patients.Outpatient: Use of Gillette's outpatient services continues to grow: patients made 133,117 visits to Gillette outpatient clinics in 2010, an increase of 10.7 percent over 2009. (This number includes visits for casting, neurodiagnostics and sleep health as well as for more typical outpatient care.) The increase reflects patients seen at our clinic locations and through Gillette's Mobile Outreach Clinic, which brings Gillette services closer to patients' homes in greater Minnesota. The Mobile Outreach Clinic operates out of St. Paul, Minnesota, and sets up more than 200 mobile clinics throughout the year. We have saved our patients more than three million miles of travel during the past 10 years. Mobile Outreach Clinic staff held 517 clinic days in 2010, at which they provided 3,277 services - including orthotics fittings, assistive-technology customizations, and physician and nurse practitioner appointments. In addition, Gillette Lifetime Specialty Healthcare's St. Paul - Phalen Clinic coordinates medical services for people 16 and older who have disabilities that began during childhood. To accommodate significant growth, Gillette embarked on a major expansion in 2010-including a new and larger Pediatric Intensive Care Unit (PICU), a 52,000-square-foot patient care building, a new Brainerd Lakes Clinic and an expansion of services at our Maple Grove Clinic. Gillette's PICU serves a growing surgical practice and Regions Hospital's Level I Pediatric Trauma Center, which Gillette supports with pediatric intensivists, pediatric neurosurgeons, pediatric orthopedic surgeons, pediatric surgeons, pediatric rehabilitation medicine physicians and a state-of-the-art facility. The unit's technology and design enhance patient safety and privacy. Ten private rooms each have their own nursing stations and space for a parent or caregiver to stay overnight. The patient care building houses Rehabilitation Therapies and the James R. Gage Center for Gait and Motion Analysis. It provides more space for motion analysis research and enhances the rehabilitation experience of patients.In 2010, Gillette added audiology services for children who have special needs. Hearing loss is more common in people who have disabilities, and early diagnosis and treatment helps minimize negative effects on communication and development.Because Gillette's services are vital for children who have disabilities, the organization is committed to bringing care to families throughout the region. In 2010, Gillette expanded services at its Maple Grove Clinic and built a Brainerd Lakes Clinic. Focusing on children who have cerebral palsy, a pediatric orthopedist joined the Maple Grove Clinic's team. The Brainerd Lakes Clinic provides assistive technology services and is a hub for outreach efforts in central and northern Minnesota.Gillette offers outpatient services through seven centers of excellence. In the Center for Cerebral Palsy, services range from infant evaluations to specialty care for adults. Treatment plans might include developmental assessments, rehabilitation therapies, orthoses and other types of assistive technology, tone-management techniques (including surgery, botulinum toxin, neurolytic agents, and intrathecal baclofen), gait and motion analysis, and orthopedic care.In the Center for Craniofacial Services, Gillette diagnoses and treats children with congenital or acquired conditions involving the head and neck. Outpatient services include fittings for and moldings of the Gillette CranioCap (R) orthosis, a custom-made brace for the skull that corrects deformational plagiocephaly. For many children with clefts, Gillette orthodontists custom-make Gillette's OrthoCleft Retainer (R), a presurgical appliance that reduces the gap in the mouth, improving feeding abilities. Gillette also treats children who have craniosynostosis, hemangiomas and vascular malformations.In the James R. Gage Center for Gait and Motion Analysis, Gillette uses advanced computer technology to analyze how muscles, joints and nerves make movement possible. The analyses measure motion, force production, energy expenditure and plantar pressure. Physicians use the analyses to plan appropriate care for patients.Gillette's Center for Pediatric Neurosciences is the first such center in Minnesota and one of a few in the U.S. It provides interdisciplinary services for patients who have neurological conditions (such as epilepsy), neuromuscular conditions, and neurological complications related to disabilities. Gillette uses ImPACT neurocognitive software to help determine when children can safely return to activities following brain injuries. Gillette has the largest spina bifida program in the five-state area, offering care for the medical complications associated with the condition, including tethered spinal cord; bladder, bowel and kidney problems; eye problems; seizures; and hydrocephalus. In the Center for Pediatric Orthopedics, Gillette treats patients who have complex orthopedic problems resulting from cerebral palsy, traumatic brain injuries, neuromuscular conditions, trauma-related fractures, strokes and sports-related injuries. Gillette sees patients who have permanent joint contractures, extra or missing fingers or toes, brittle-bone disease, and clubfoot. Gillette creates prostheses and treats patients with complex leg- and arm-length discrepancies. Orthopedic surgeons treat children with scoliosis and other spine disorders. Gillette doctors also see patients who have joint disease, joint-overuse symptoms, and other musculoskeletal conditions.In addition to offering comprehensive inpatient rehabilitation programs for children who sustain brain and spinal cord injuries, Gillette's Center for Pediatric Rehabilitation offers outpatient physical therapy, occupational therapy, speech and language therapy, and related services. Gillette provides aquatic therapy for patients who have neurological and musculoskeletal problems. On-site therapy gyms offer specialized therapy and fitness equipment. Gillette's is the largest pediatric rehabilitation program in the region.The Center for Pediatric Subspecialty Care offers programs for patients who have Rett syndrome or rheumatic and related inflammatory conditions, including juvenile rheumatoid arthritis, lupus, and scleroderma. The center sees patients who have neuromuscular disorders, neurodevelopmental problems, and diagnoses requiring neuropalliative care. Staff treat such conditions with medications, rehabilitation therapy and assistive technology. See continuation of patient services narrative on Part III, Line 4d.
4b (Code:   ) (Expenses $ 1,509,527 including grants of $   ) (Revenue $ 93,389 )
Research:Gillette's research activities concentrate on clinical applications devoted to finding effective medical interventions for disabling conditions and their related effects. In 2010, Gillette's research efforts cost more than $1,600,000. Gillette has four designated research areas: gait and motion analysis, pain and comfort, bone and joint conditions, and neurosciences. Gillette has studied human movement, conducting both basic and clinical research that has gained international recognition, for more than 20 years.See Schedule OGillette researchers have focused on projects that include studying the quality of life for families after sleep intervention and characteristics of a successful transition to adult independence for young adults who have spina bifida. Staff members also are studying such issues as whether intrathecal baclofen is associated with changes in the frequency or progression of scoliosis. Each year, Gillette doctors and staff publish research studies in medical journals and speak at medical conferences. Through its priority areas for coordinated research, Gillette is working to increase the amount and quality of clinically relevant research conducted in the organization.
4c (Code:   ) (Expenses $ 1,690,158 including grants of $   ) (Revenue $ 257,700 )
Education:Through fellowships, seminars and other educational programs, Gillette strives to share expertise and benefit patients. For physicians who desire in-depth training, Gillette offers residencies and fellowships in such specialties as pediatrics, orthopedics, and pediatric rehabilitation medicine. As a teaching hospital, Gillette trains the physicians of the future. Residents from the University of Minnesota and Henry Ford Hospital in Detroit spend one to three months under the mentorship of Gillette's medical staff. In many cases, Gillette offers physicians their only exposure during residency to patients who have certain disabilities.See Schedule OThe organization's training programs include the specialties of orthopedics, pediatrics, neurodevelopmental pediatrics, and rehabilitation medicine. Gillette also offers shadowing and mentorship programs for students, along with professional education opportunities in such areas as physical therapy, radiology, nursing, respiratory care and assistive technology.Gillette covers the unreimbursed costs of medical education and is fully accredited by the Minnesota Medical Association to provide continuing medical education (CME) for physicians. Each year, Gillette sponsors conferences on topics such as cerebral palsy, orthopedics and motion analysis. The conferences educate medical professionals about treatment options for children who have disabilities. Typical audiences include pediatricians, family practitioners and other physicians. CME activities are open to other health professionals. Gillette's CME audiences might include nurse practitioners, physician assistants, nurses, physical therapists, occupational therapists, speech and language therapists, orthotists and prosthetists.
(Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
Surgery: Gillette physicians performed 3,509 surgeries in 2010, an increase of 16 percent since 2005. Those numbers include same-day surgery and surgeries that require an overnight hospital stay. Gillette surgeons specialize in orthopedic surgery, neurosurgery and craniofacial surgery.Gillette's orthopedic surgeons correct multiple soft tissue and bone problems during one operation, called a single-event multilevel surgery (SEMLS). SEMLS helps children with spasticity improve or maintain walking ability and lessens pain and health issues that stem from misaligned muscles and bones. Gillette's orthopedic surgeons also treat hip and spine conditions and limb-length discrepancies. Some children with spasticity benefit from selective dorsal rhizotomy surgery, in which neurosurgeons selectively severs nerve roots in the spinal cord. Gillette neurosurgeons also might implant intrathecal baclofen pumps (to treat muscle spasticity), shunts (to treat hydrocephalus) and vagus nerve stimulators (to treat epilepsy). Gillette's craniofacial specialists use advanced microsurgical and craniofacial techniques for children with cleft lip and palate and complex malformations, such as those resulting from craniosynostosis.
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 127,574,965
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. .....
20b
 
No
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
Yes
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
38
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
 
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,223
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 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 . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
24
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
19
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
 
No
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
 
No
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
MN , WI
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
Scott Ryberg
200 University Avenue East
St Paul,MN55101
(651) 291-2848
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet 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 reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Carol Clark
Director
 1.00 X           0 0 0
(2) John Diehl
Secretary
 1.00 X   X       0 0 0
(3) Bonnie Dougherty
Director
 1.00 X           0 0 0
(4) Heidi Erspamer
Director
 1.00 X           0 0 0
(5) Todd Fisher
Director
 1.00 X           0 0 0
(6) David Glaser
Director
 1.00 X           0 0 0
(7) James Hynes
Director
 1.00 X           0 0 0
(8) Theresa McEnaney
Director
 1.00 X           0 0 0
(9) Bruce O'Brien
Director
 1.00 X           0 0 0
(10) Margaret Perryman
President, CEO
 40.00 X   X       834,194 0 102,570
(11) Jerome Kahnke
Director
 1.00 X           0 0 0
(12) Deborah Quanbeck MD
Chief of Staff - Elect
 40.00 X           403,082 0 44,087
(13) Scott Ward
Chairman
 1.00 X   X       0 0 0
(14) Cassandra Warner
Director
 1.00 X           0 0 0
(15) Beverly Wical MD
Chief of Staff
 40.00 X           203,941 0 29,326
(16) Braxton Haulcy
Director
 1.00 X           0 0 0
(17) Michael Partington MD
Director
 40.00 X           565,360 0 44,993
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) Chuck Amos
Director
 1.00 X           0 0 0
(19) James Bradshaw
Director
 1.00 X           0 0 0
(20) Jeff Evanson
Director
 1.00 X           0 0 0
(21) John Guider
Director
 1.00 X           0 0 0
(22) Robert Folkes
Treasurer
 1.00 X   X       0 0 0
(23) Robert Long
Director
 1.00 X           0 0 0
(24) Dale Schoonover
Vice Chair
 1.00 X   X       0 0 0
(25) James Haddican
VP of Finance
 40.00       X     305,714 0 51,633
(26) Steven E Koop MD
Medical Director, Ex Off
 40.00       X     667,179 0 105,854
(27) Elizabeth Rivard
VP of Human Resources
 40.00       X     270,472 0 41,049
(28) Kathryn Wardrop
VP of Marketing
 40.00       X     312,114 0 39,768
(29) Karen Brill
VP of Patient Services
 40.00       X     237,716 0 43,330
(30) Patrick Graupman
Physician
 40.00         X   572,593 0 64,993
(31) Thomas Novacheck
Physician
 40.00         X   525,973 0 73,916
(32) Joseph Petronio
Physician
 40.00         X   615,583 0 44,153
(33) Robert Wood
Physician
 40.00         X   558,962 0 36,487
(34) Steven Sundberg
Physician
 40.00         X   693,455 0 50,700
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 6,766,338 0 772,859
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet109
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
McGough Construction Co Inc
NW5979 PO Box 1450
Minneapolis,MN554855970 		Construction 12,079,592
Regions Hospital
640 Jackson Street
St Paul,MN55101 		Direct Patient Charges, Employee Health 7,116,294
BWBR Architects
380 St Peter St Suite 600
St Paul,MN551021996 		Architects 2,337,240
Quality Nurse Anesthesia Professionals
5600 Edgewater Blvd
Minneapolis,MN55417 		Anesthesiology Services 1,920,488
Children's Respiratory & Critical Care S
2545 Chicago Avenue Suite 517
Minneapolis,MN55404 		Respiratory personnel Services 1,719,341
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet10
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 3,906,935
e Government grants (contributions)1e 1,160,311
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 5,067,246
Program Service Revenue Business Code
2a Patient Services 621,400 115,991,515 115,991,515    
b Medicare/Medicaid 621,400 41,580,618 41,580,618    
c Parking 812,930 376,237     376,237
d HTL-Plastic Joint 621,400 132,247   132,247  
e Admin. Services 561,000 63,240     63,240
f All other program service revenue . 1,669     1,669
g Total. Add lines 2a–2f........MediumBullet 158,145,526
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 592,963     592,963
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross Rents 46,469  
b Less: rental expenses 48,688  
c Rental income or (loss) -2,219  
d Net rental income or (loss).......MediumBullet -2,219     -2,219
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 6,327,533  
b Less: cost or other basis and sales expenses 6,016,700 219,428
c Gain or (loss) 310,833 -219,428
d Net gain or (loss)..........MediumBullet 91,405     91,405
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet  
12 Total revenue. See Instructions....MediumBullet 163,894,921 157,572,133 132,247 1,123,295
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 23,850 23,850
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 4,302,382 2,344,868 1,957,514  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 63,965,845 57,237,379 6,728,466  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 2,772,557 2,394,376 378,181  
9 Other employee benefits ....... 9,923,045 8,373,384 1,549,661  
10 Payroll taxes ........... 4,383,274 3,816,738 566,536  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 116,191 2,735 113,456  
c Accounting ........... 231,000   231,000  
d Lobbying ........... 312,093   312,093  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ...... 75,030 75,030    
g Other .......... 15,996,775 12,939,486 3,057,289  
12 Advertising and promotion .... 499,640 16,611 483,029  
13 Office expenses ....... 4,154,975 3,292,077 862,898  
14 Information technology ...... 3,653,851 1,468,075 2,185,776  
15 Royalties ..        
16 Occupancy ........... 6,065,852 5,479,067 586,785  
17 Travel ............ 1,018,091 853,053 165,038  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings ....        
20 Interest ........... 1,455,031 1,455,031    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 7,444,330 6,191,400 1,252,930  
23 Insurance .............. 808,839 332,351 476,488  
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a Medical Supplies 15,687,608 15,418,495 269,113 0
b MinnesotaCare Tax 2,548,876 2,548,876 0 0
c Medical Assistance Surc 1,664,608 1,664,608 0 0
d Bad Debt Expense 1,183,793 1,183,793 0 0
e Misc. Expense 333,410 225,133 108,277 0
f All other expenses 409,414 238,549 170,865  
25 Total functional expenses. Add lines 1 through 24f 149,030,360 127,574,965 21,455,395 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 294,145 1  
2 Savings and temporary cash investments ....... 66,656,538 2 76,406,010
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 18,916,769 4 21,566,038
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 1,059,765 8 1,049,994
9 Prepaid expenses and deferred charges ............ 7,552,404 9 7,794,938
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 124,511,053
b Less: accumulated depreciation. ..... 10b 46,626,952 51,859,835 10c 77,884,101
11 Investments—publicly traded securities .......... 13,115,943 11 14,986,554
12 Investments—other securities. See Part IV, line 11 ...... 9,913,561 12 14,939,016
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 15,342,976 15 15,828,216
16 Total assets. Add lines 1 through 15 (must equal line 34)... 184,711,936 16 230,454,867
Liabilities 17 Accounts payable and accrued expenses . 20,480,379 17 25,154,290
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities .......... 43,913,639 20 68,907,526
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties .. 425,256 23 390,242
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D.....   25  
26 Total liabilities. Add lines 17 through 25..... 64,819,274 26 94,452,058
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 112,021,431 27 130,174,243
28 Temporarily restricted net assets ..... 5,637,866 28 3,594,951
29 Permanently restricted net assets ..... 2,233,365 29 2,233,615
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 119,892,662 33 136,002,809
34 Total liabilities and net assets/fund balances ..... 184,711,936 34 230,454,867
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
163,894,921
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
149,030,360
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
14,864,561
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
119,892,662
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
1,245,586
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
136,002,809
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% 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 III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2010
Name of organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule—
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part I
Name of organization
Gillette Children's Specialty Healthcare
  		Employer identification number

36-3379150
Part I
Contributors (see Instructions)
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Aggregate contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is
a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part II
Name of organization
Gillette Children's Specialty Healthcare
  		Employer identification number

36-3379150
Part II
Noncash Property (see Instructions)
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
Page 1 of 1 of Part III
Name of organization
Gillette Children's Specialty Healthcare
  		Employer identification number

36-3379150
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
106,144
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
205,949
j
Total. lines 1c through 1i ...................................
312,093
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
Explanation of Other Lobbying Activities: Part II-B, Line 1i: Gillette employs Larkin, Hoffman, Daly & Lindgren Ltd. and Lockridge, Grindal & Nauen, PLLP as lobbyists to act as advocates on its behalf. Gillette is a member of the National Association of Children's Hospitals (NACH). A portion of membership dues paid to NACH relate to lobbying activities. Gillette is also a member of the Minnesota Hospital Association (MHA). A portion of membership dues paid to MHA relate to lobbying activities. Gillette Children's Specialty Healthcare reimburses certain professional memberships of employees. A portion of such membership dues are used by professional associations for lobbying activities. Certain Gillette executives engage in lobbying activities including, but not limited to, meeting with state and federal legislators, aides to the governor, and staff of the Minnesota Department of Human Services to discuss Medicaid payment rates and policies and other legislative issues that affect Gillette. These activities may also include providing public testimony on legislation that affects Gillette. Other activities indirectly related to lobbying include providing lobbyists with patient statistics and demographic information and developing and editing text used for lobbying efforts that define Gillette's programs and services.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 3,708,929 3,346,189 3,913,887
b Contributions ........ 7,209 67,528 265,401
c Investment earnings or losses ... 402,507 445,743 -667,021
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		180,146 48,639 63,695
f Administrative expenses .... 146,658 101,895 102,383
g End of year balance ...... 3,791,841 3,708,929 3,346,189
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet59.000 %
c
Term endowment: SchDMd Bullet41.000 %
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   55,000 55,000
b Buildings ................   53,188,475 18,718,179 34,470,296
c Leasehold improvements ............   16,184,969 5,584,194 10,600,775
d Equipment ................ 16,985,226 38,097,383 22,324,579 32,758,030
e Other .................        
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 77,884,101
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) Certificate of Deposits 		13,996,515 F

(B) Restricted Reserve Fund 		942,501 F







Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet 14,939,016
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Other Receivables 10,485
(2) Beneficial Interest in Foundation 14,533,902
(3) Employee Personal Computer Loans 114,266
(4) Bond Issuance Costs 1,169,563





Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 15,828,216
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes  








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet  
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 163,894,921
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 149,030,360
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 14,864,561
4 Net unrealized gains (losses) on investments .......................... 4 1,145,134
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8 100,452
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 1,245,586
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 16,110,147
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 165,241,566
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a 1,145,134
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d 201,511
e Add lines 2a through 2d ..................... 2e 1,346,645
3 Subtract line 2e from line 1..................... 3 163,894,921
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b  
c Add lines 4a and 4b....................... 4c 0
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 163,894,921
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 149,131,419
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d 101,059
e Add lines 2a through 2d...................... 2e 101,059
3 Subtract line 2e from line 1..................... 3 149,030,360
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b  
c Add lines 4a and 4b....................... 4c 0
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 149,030,360
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Description of Intended Use of Endowment Funds: Part V, Line 4: The Gillette Children's Hospital Foundation has endowment funds for capital, charity care, patient care, research and education, and unrestricted needs. These funds are used to provide and improve health-care and related services to patients of Gillette.
Description of Uncertain Tax Positions Under FIN 48: Part X: As a result of the implementation of authoritative guidance on the accounting for uncertainty in income taxes, the Organization was not required to recognize a liability. There were no unrecognized tax liabilities for the years ended December 31, 2010 and 2009.
Part XI, Line 8 - Other Adjustments:   Change in Beneficial Interest of Net Assets of Foundation 100,452. In accordance with FAS No. 136, "Transfers of assets to a not-for-profit or charitable trust that raises or holds contributions for others":
Part XII, Line 2d - Other Adjustments:   Beneficial Interest in Net Assets of Foundation $100,452 Rental expense $48,688 Grant Adjustment $52,371
Part XIII, Line 2d - Other Adjustments:   Rental expense $48,688 Grant Adjustment $52,371
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Does the organization have a charity care policy? If "No," skip to question 6a...........
1a
Yes
 
b
If "Yes," is it a written policy? .......................
1b
Yes
 
2
If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.
3
Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.
a
Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low
income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If
"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....
3b
Yes
 
c
If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Does the organization's policy provide free or discounted care to the "medically indigent"? ......
4
Yes
 
5a
Does the organization budget amounts for free or discounted care provided under its charity care policy? ...
5a
Yes
 
b
If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Does the organization prepare an annual community benefit report?.............
6a
 
No
6b
If "Yes," does the organization make it available to the public? ..............
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Charity Care and Certain Other Community Benefits at Cost
Charity Care and
Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Charity care at cost (from
Worksheets 1 and 2) .. 		    198,654   198,654 0.130 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		    59,727,946 39,274,498 20,453,448 13.830 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....            
dTotal Charity Care and
Means-Tested Government Programs ..... 		    59,926,600 39,274,498 20,652,102 13.960 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    1,502,212 0 1,502,212 1.020 %
f Health professions education
(from Worksheet 5) .. 		    1,947,858 257,700 1,690,158 1.140 %
g Subsidized health services
(from Worksheet 6) .. 		    31,876,661 23,695,244 8,181,417 5.530 %
h Research (from Worksheet 7)     1,602,916 93,389 1,509,527 1.020 %
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		    34,180   34,180 0.020 %
jTotal Other Benefits ...     36,963,827 24,046,333 12,917,494 8.730 %
kTotal. Add lines 7d and 7j. ..     96,890,427 63,320,831 33,569,596 22.690 %
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 2
Part II
Community Building Activities Complete this table if the organization conducted any community building activities.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense (at cost).....
2
605,628
3
Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..
3
224,921
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
2,643,703
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
4,488,701
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-1,844,998
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:
Section C. Collection Practices
9a
Does the organization have a written debt collection policy? ...............
9a
Yes
 
b
If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......
9b
Yes
 
Part IV
Management Companies and Joint Ventures
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 3
Part VFacility Information
Section A. Hospital Facilities
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 ST PAUL CAMPUS
200 UNIVERSITY AVE E
ST PAUL,MN55101 		X   X X   X      
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
Name of Hospital Facility:NA
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet those needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Development of a community benefit plan for the facility
d Participation in community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the CHNA
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs. 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8    
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?.. 9    
If “Yes,” indicate the FPG family income limit for eligibility for free care:   %
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 5
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care to low income individuals?......... 10    
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
11 Explained the basis for calculating amounts charged to patients?................. 11    
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12    
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13    
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted at all times on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........ 14    
15 Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments or arrests
e Other (describe in Part VI)
16 Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?................................... 16    
If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other (describe in Part VI)
17 Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
e Other (describe in Part VI)
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 6
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18    
If “No,” indicate the reasons why (check all that apply):
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility did not have a policy relating to emergency medical care
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Charges for Medical Care
19 Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
a The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
b The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
c The hospital facility used the Medicare rate for those services
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20    
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?................................... 21    
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 7
Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, measured by total revenue per facility, from largest to smallest)
How many non-hospital facilities did the organization operate during the tax year?  
Name and address Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2010
Schedule H (Form 990) 2010
Page 8
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2 Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    Part I, Line 3c: The family income limit for eligibility for free care is 375% of the federal poverty guidelines.
    Part I, Line 7: Gillette's internal cost accounting system was used to calculate amounts reported in the table in Part I. The cost accounting system records revenue and direct expenses for all inpatient and outpatient services for each revenue-producing cost center. All non-revenue-producing cost centers are allocated back to revenue-producing cost centers using applicable statistics to arrive at a fully allocated cost for each cost center. A cost-to-charge ratio was not used in the table.
    Part I, L7 Col(f): Bad debt expense of $1,183,793 was excluded from total functional expenses for purposes of calculating the percent in column (F).
    Part III, Line 4: Bad debt expense is reported as an operating expense on the income statement. Statements and letters are sent every 30 days for each account that has a balance. Once an account is 120 days past due, it is sent to a pre-collection status and three more letters are sent out to collect on the account. If the account remains unpaid, it is then sent to collections and recognized as bad debt. Gillette's bad debt consists of services for which we anticipated we would receive payment but in the end did not. In contrast, Gillette offers charity care for patients who are financially unable to pay all or part of their medical bills. Uninsured patients are also given approximately the same discount as third party payors.After accounts have gone through the billing cycle, if payment on an account has not been satisfied either to a balance of $0.00 or a payment plan, accounts may be turned over to an outside collection agency and moved to a status of "bad debt." All billing and collection is done in accordance with the criteria established for all Minnesota hospitals by the Minnesota attorney general's office. The estimated bad debt expense at cost was calculated using the internal cost accounting system. Gillette's audited financial statements do not include a footnote on bad debt expense.
    Part III, Line 8: Gillette's internal cost-accounting system was used to calculate the Medicare-allowable costs. The entire shortfall amount is being treated as community benefit, but only part of it is included on Schedule H, Part I, Line 7. Gillette's mission is to provide services to children and adults with disabilities. In providing these mission-driven services, Gillette incurs losses from the Medicare program. However, Gillette accepts such losses as part of providing an important public service.
    Part III, Line 9b: Gillette does not turn away any patients based on their inability to pay, and charity care is handled on a case-by-case basis. If patients inform Gillette that they will have a difficult time meeting their financial obligations, Gillette will try to qualify patients for public assistance or Gillette's charity care program. To qualify for Gillette's charity care program, patients must first complete an application and submit verification of income. Gillette then reviews the collected information to determine eligibility for the program. Income eligibility for the program is based on national poverty guidelines.Part V: Gillette operates eight clinics throughout the state. They are located in Baxter, Burnsville, Duluth, Maple Grove, Minnetonka, St. Paul main campus, St. Paul - Phalen, and Willmar. All clinics throughout the state are licensed under Gillette Children's Specialty Healthcare.
    Part VI, Line 2: Specifically, Gillette periodically completes a community needs assessment. Gillette conducts surveys on health services in a five state area using various tools to gather information, such as online surveys, focus groups with families, phone calls, and one-on-one interviews. In addition, Gillette does specific assessments when considering new programs or services. Such new programs and services usually arise from suggestions by patients, referring physicians, or Gillette's own staff. More generally, Gillette staff members assess community health-care needs by the number of patients they see. Last year, more than 23,000 children and adults came to Gillette because Gillette staff have the specialized skills and advanced technology those patients need. In the past 10 years, Gillette has served patients from every Minnesota county, 48 of the United States, six Canadian provinces and 33 other countries. Gillette specializes in caring for people with short- and long-term disabilities that began during childhood. Among the predominant diagnoses are: cerebral palsy; complex orthopedic conditions; craniofacial anomalies; neurological conditions, such as epilepsy and muscular dystrophy; brain and spinal-cord injuries; spina bifida; and juvenile arthritis. Although the incidence of most of these conditions has not changed significantly, other factors have led to-and are expected to continue to drive-Gillette's dramatic volume increases. According to the Minnesota State Demographic Center, the population of children in Minnesota age 19 and under will increase by nearly 100,000 over the next 10 years and by more than 150,000 over the next 25 years. With more children living in the state, there will be a proportionate increase in children with needs for specialized health care requiring Gillette's unique services.Gillette has also demonstrated significant growth in orthopedic and neurological/neurosurgical care market share over the past 10 years. This market penetration is expected to increase as our contingent of pediatric orthopedic surgeons, pediatric neurologists and pediatric neurosurgeons continues to grow. By establishing second-ring suburban clinics and mobile outreach services throughout Minnesota, Gillette has made a concerted effort to meet the needs of patients outside the core Twin Cities area. Gillette's continuing focus on meeting the needs of underserved outstate populations who require specialized pediatric services will also contribute to steady organizational growth.Moreover, Gillette is a teaching hospital, training the physicians of the future. Because we focus exclusively on specialty care for children who have disabilities and complex medical conditions, we are a regional resource of specialists, technology, facilities and comprehensive services. Last year, residents from the University of Minnesota and Henry Ford Hospital in Detroit spent one to three months under the mentorship of Gillette's medical staff. In many cases, Gillette offers physicians their only exposure during residency to patients with certain disabilities. Gillette's training programs include the specialties of orthopedics, pediatrics, neurodevelopmental pediatrics, and rehabilitation medicine. One of the organization's next projects will be to create a surgery simulation center. It will allow teams to practice performing complex procedures and using new technologies. New staff members, medical residents and multidisciplinary teams will be able to learn and practice in a true-to-life environment. The result will be hands-on education for staff and enhanced safety for patients. Gillette covers the unreimbursed costs of medical education. Gillette is fully accredited by the Minnesota Medical Association to provide continuing medical education.
    Part VI, Line 3: Gillette provides free or reduced-cost medical care to community residents, primarily by:*Providing services at no charge to uninsured patients*Providing uninsured patients who do not qualify for charity care approximately the same discount as our third party payors*Covering the difference between public-program payments (primarily Medicare and Medicaid) and the related costs of providing such services*Providing services to patients who express a willingness to pay but who are unable to do so because of socioeconomic factors*Coordinating care with a patient's primary-care physician, school, and community agenciesForty-six percent of Gillette patients receive Medicaid-the highest percentage of any hospital in the state. Because Medicaid reimburses only 62 percent of the costs that Gillette incurs, caring for such patients created a gap of $20 million in 2010. Gillette has a documented policy for providing financial assistance in the form of charity care to patients who are financially without the means to pay for medically necessary care and who satisfy certain requirements. Each patient's situation is evaluated according to relevant circumstances, such as income, assets and other resources. Gillette staff will identify a family's charity-care needs before services are performed, whenever possible, as part of the admission process. Families complete a financial assistance application that Gillette provides. (Proof of participation in Medicaid or any other public assistance program indicates that the patient has been deemed financially indigent and, therefore, the patient is not required to provide his/her income on Gillette's assistance application.) In addition to doing so during the admission process, Gillette makes patients aware of financial assistance programs by listing them on patient statements as well as on the Gillette website.
    Part VI, Line 4: As noted above, in the past 10 years Gillette has seen patients from all of Minnesota's counties. Some patients come to the Twin Cities for care; others receive care through our Mobile Outreach Clinic, which travels to 17 communities in greater Minnesota. Gillette staff members also see patients who come to Gillette for care from throughout the U.S. and other countries.Demographically, Gillette provides specialized health care for people who have short-term or long-term disabilities that began during childhood.
    Part VI, Line 6: Gillette provides a wide variety of benefits to the community. Patients rely on the organization to address the physical, mental and emotional effects of their disabilities from birth through adulthood. To do so, Gillette provides a team of social workers, psychologists and neuropsychologists, child life specialists, therapeutic recreation specialists and a chaplain, who offer social-service and support counseling for patients and families. Gillette serves as a gathering place for interested citizens (including the board of directors, other volunteers, skilled professionals, patients and families) to address the problems and needs of children who have physical disabilities, to define the needs of the families of those children, and to advocate for support of those families in meeting their needs. For example, Gillette offers stress-relief techniques and support activities-such as aroma therapy, guided imagery and hand massage-for caregivers. In conjunction with PACER organization and United Cerebral Palsy, Gillette has sponsored support sessions for parents and grandparents who are raising children who have cerebral palsy.Gillette provides educational programs and videos about specific conditions, information services available by telephone (which is free to families and for which Gillette is not reimbursed by insurance programs), and programs to improve the general standards of health in the community. Gillette uses our website and social media tools to share information from our medical experts with the community; topics include water safety, head injuries, nutrition for children, and using electronic media to help children learn. To help diagnose and treat head injuries, Gillette's website offers access to the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) system. This research-based tool tests reaction time, memory, attention span and other skills. For a minimal cost, athletes can take baseline or post-injury tests. Early and proper treatment of traumatic brain injuries can reduce or eliminate their long-term effects.Gillette offers in-hospital schooling to hospitalized patients. A partnership between Gillette and St. Paul Public Schools means that children and teens who are recovering from a major surgery or traumatic injury can continue their lessons at Gillette. Gillette's two classrooms are outfitted with the latest technology-including webcams, laptops, a touch-screen computer, and a state-of-the-art SmartBoard. Teachers work one-on-one with patients on lesson plans designed for their unique needs.Gillette funds a program to help children with disabilities obtain the equipment needed to participate in adapted sports and recreational activities in their communities. Each year, in collaboration with Courage Center, Gillette co-sponsors the Bike Expo and Sports Jam, an event that helps children who have disabilities find adaptive bicycles that meet their unique needs and help promote independence. Demonstrations of adaptive sports, information about adaptive sports programs, and a used bike swap are also available. In 2010, Gillette co-hosted a free night of adapted waterskiing and fishing, and we co-sponsored an event to raise funds for the adaptive skiing program at Buck Hill ski area in Burnsville, Minn. In addition, we sponsored a snow skiing opportunity for children who have disabilities. Gillette also offers space for community groups to use at no charge and reduced parking fees for patients and families. In addition, Gillette performs clinical research devoted to finding effective medical interventions for disabling conditions and their related effects and to improving outcomes in patients who have disabilities. The organization's commitment to research dates back at least to the 1940s, when Gillette began testing Sister Elizabeth Kenny's methods for treating polio. Beginning with the formation of the organization's Spine Service in 1947, Gillette surgeon John Moe, M.D., completely changed the surgical treatment of severe deformities of the spine. In 1965 he was one of the founders of the Scoliosis Research Society.Gillette's commitment to research continued to grow over the years. In 2010, the organization's research efforts cost more than $1,600,000. Gillette funds a program to help children with disabilities obtain the equipment needed to participate in adapted sports and recreational activities in their communities. Through community support and generous contributions to Gillette Children's Foundation, Gillette continues to expand, create new services, and research treatments for children with disabilities. The organization's goal, as it has been for more than 110 years, is to help children and adults who have disabilities, and their families, to improve their health, achieve greater well-being and enjoy life.
    Part VI, Line 7:
Schedule H (Form 990) 2010
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number
36-3379150
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Epilepsy Foundation of Minnesota1600 University Avenue
St Paul,MN55104 		41-0874541 501(C)(3) 12,000   FMV   Educational Seminar
(2) Regions Hospital Foundation640 Jackson Street
St Paul,MN551012595 		41-1888902 501(C)(3) 10,000   FMV   Spinal Cord Center Construction




















2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
2
3
Enter total number of other organizations ................................ . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Occasionally, Gillette grants monies to other tax-exempt organizations which are conducting programs that will ultimately benefit the children that Gillette serves. During calendar year 2010, Gillette made grants to the Regions Hospital Foundation and to the Epilepsy Foundation of Minnesota. The Regions Hospital Foundation grant supported an event raising money to establish a new center for spine and spinal cord injury at Regions Hospital. The Epilepsy Foundation grant sponsored an educational seminar on living with seizures for parents of children who have epilepsy and for teens and adults who have epilepsy. Grant requests are reviewed and approved by Gillette management. Grant amounts are awarded after careful consideration of the appropriate needs and budget requirements of the organization. The Hospital ensures that the purpose of the grant is clearly understood by the recipient.
Schedule I (Form 990) 2010


Additional Data


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Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Margaret Perryman (i)
(ii)		 451,442
0 		152,627
0 		230,125
0 		88,646
0 		13,924
0 		936,764
0 		227,970
0
(2) Deborah Quanbeck MD (i)
(ii)		 400,792
0 		1,010
0 		1,280
0 		28,590
0 		15,497
0 		447,169
0 		0
0
(3) Beverly Wical MD (i)
(ii)		 203,281
0 		660
0 		0
0 		12,752
0 		16,574
0 		233,267
0 		0
0
(4) Michael Partington MD (i)
(ii)		 503,583
0 		61,777
0 		0
0 		23,388
0 		21,605
0 		610,353
0 		0
0
(5) James Haddican (i)
(ii)		 240,736
0 		64,438
0 		540
0 		33,824
0 		17,809
0 		357,347
0 		0
0
(6) Steven E Koop MD (i)
(ii)		 560,249
0 		106,930
0 		0
0 		81,499
0 		24,355
0 		773,033
0 		0
0
(7) Elizabeth Rivard (i)
(ii)		 213,464
0 		56,744
0 		264
0 		26,198
0 		14,851
0 		311,521
0 		0
0
(8) Kathryn Wardrop (i)
(ii)		 237,049
0 		74,884
0 		181
0 		34,804
0 		4,964
0 		351,882
0 		0
0
(9) Karen Brill (i)
(ii)		 186,349
0 		49,954
0 		1,413
0 		27,833
0 		15,497
0 		281,046
0 		0
0
(10) Patrick Graupman (i)
(ii)		 506,583
0 		66,010
0 		0
0 		48,419
0 		16,574
0 		637,586
0 		0
0
(11) Thomas Novacheck (i)
(ii)		 504,864
0 		21,109
0 		0
0 		30,206
0 		43,710
0 		599,889
0 		0
0
(12) Joseph Petronio (i)
(ii)		 506,583
0 		66,528
0 		42,472
0 		23,111
0 		21,042
0 		659,736
0 		42,472
0
(13) Robert Wood (i)
(ii)		 556,347
0 		2,615
0 		0
0 		14,712
0 		21,775
0 		595,449
0 		0
0
(14) Steven Sundberg (i)
(ii)		 579,455
0 		114,000
0 		0
0 		36,495
0 		14,205
0 		744,155
0 		0
0


Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  Part I, Line 4b Certain employees of Gillette are provided with the opportunity to participate in the pension restoration plan (The Plan). The Plan requires employees to be executives of Gillette to be eligible to participate in the Plan. Payments from The Plan occur annually by July 1 of the year following the end of The Plan year. This Plan is a "gap" plan, which provides participants with a deposit that closes the gap between the limits of IRC 403(b) and the actual cash compensation of the participant. Margaret Perryman $29,132 Steven E. Koop, M.D. $20,297 James Haddican $1,175
Supplemental Information Part III Part I, Line 3: The chair of Gillette's personnel committee requests information from the external consultant. The personnel committee is empowered to evaluate the reasonableness of compensation and other financial transactions in which the hospital is engaged. In all cases, it does so in accord with the compensation policy set by the Board of Directors, by referencing recognized objective resources on the reasonableness of and market value for the types of personnel and services being considered. That is the data that is prepared for and distributed to the personnel committee members. Compensation policy is approved by the board of directors. Actions related to chief executive officer (CEO)/president and other executive compensation are discussed and voted upon at personnel committee meetings. Meeting minutes are recorded.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number
36-3379150
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A Housing & Redevelopment Authority of the City of St Paul MN
  		41-6005521 792909AP8 02-16-2005 9,617,806 Hosp:Pur&Install CIS Burnsville   X   X   X
B Housing & Redevelopment Authority of the City of St Paul MN
  		52-1440935 792909CA9 11-12-2009 36,076,928 Hosp:Expansion Project (ACC)   X   X   X
C Housing & Redevelopment Authority of the City of St Paul MN
  		52-1440935 792909DT7 11-17-2010 27,004,892 Hosp:Expansion Project (Surgery)   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . . 4,200,000      
2 Amount of bonds defeased . . . .        
3 Total proceeds of issue . . . . 10,076,883 36,202,596 27,025,738  
4 Gross proceeds in reserve funds . . 1,150,557 4,436,360 1,715,471  
5 Capitalized interest from proceeds.        
6 Proceeds in refunding escrow. . . . .        
7 Issuance costs from proceeds . . . 235,625 615,702 503,247  
8 Credit enhancement from proceeds.        
9 Working capital expenditures from proceeds . .        
10 Capital expenditures from proceeds . . 8,898,758 26,001,847 621,431  
11 Other spent proceeds . .        
12 Other unspent proceeds. . . 6,190,132 6,190,132 24,251,054  
13 Year of substantial completion . . . 2009 2010
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue?   X   X X      
15 Were the bonds issued as part of an advance refunding issue?   X   X   X    
16 Has the final allocation of proceeds been made? . . X     X   X    
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . X   X   X      
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .   X   X   X    
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2010
Schedule K (Form 990) 2010
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use? X   X   X      
b Are there any research agreements that may result in private business use of bond-financed property? . .   X   X   X    
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .   X   X   X    
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . . SchKMediumBullet 0 % 0 % 0 %  
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . SchKMediumBullet 0 % 0 % 0 %  
6 Total of lines 4 and 5 . . .. . . . . . 0 % 0 % 0 %  
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities? X   X   X      
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X    
2 Is the bond issue a variable rate issue?   X   X   X    
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   X   X   X    
b Name of provider .  
  		 
  		 
  		 
 
c Term of hedge . .        
d Was the hedge superintegrated? .                
e Was a hedge terminated? .                
4a Were gross proceeds invested in a GIC? . X     X   X    
b Name of provider . Royal Bank of
Canada 		 
  		 
  		 
 
c Term of GIC . . 10.000000000000      
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . X              
5 Were any gross proceeds invested beyond an available temporary period? . X     X   X    
6 Did the bond issue qualify for an exception to rebate? . . .   X X   X      
Schedule K (Form 990) 2010

Schedule K (Form 990) 2010
Page 3
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K, Part I, Line A:   The hospital project consists of acquisition and installation of a clinical information system and digital radiography. The Burnsville Clinic project consists of the build out and equipping of a 12,420-square-foot clinic facility and acquisition and installation of a digital radiography system. Phase I of the Burnsville Clinic, comprising approximately 12,420 square feet, was completed in May 2004 and opened in June 2004. Phase II of the Burnsville Clinic, comprising approximately 5,538 square feet, will house the therapy pool, which was completed in 2005, along with the radiography system.
Schedule K, Part I, Line B:   The patient care building consists of constructing and equipping an approximately 52,000-square-foot building located across the street from the Hospital campus. It will consist of a three-story facility with the potential for expansion to approximately 180,000 square feet (eight stories). A skyway will connect the new building with the Hospital campus, allowing easy access for patients and staff. This project also involves the remodeling of existing spaces at the Hospital campus to create a 5,000-square-foot reprocessing area that will sterilize tools used in surgery and prepare them for reuse; a 6,600-square-foot Pediatric Intensive Care Unit; a 2,000-square-foot renovation to the outpatient waiting and registration areas; and an 850-square-foot renovation and expansion of the Child and Family Services area.
Schedule K, Part I, Line C:   The 2010 project will renovate the existing surgical and inpatient space on the Hospital campus. The surgical expansion will add 23,350 square feet, and the inpatient renovation will improve 5,700 square feet. The surgical expansion includes six large operating rooms, another smaller operating room for same-day procedures, an eight-bed postanesthesia unit, a surgery simulation center, a 14-bed pre- and postsurgical area, and an additional MRI sedation bay. The inpatient renovation will include the creation of 10 private rooms on the Neurosciences Unit. Gillette also plans to build a Ronald McDonald Family Room(R) for use by families of inpatients based on the medical condition of the patient and the family's/caregiver's need for respite. Lastly, nursing stations positioned outside patient rooms, a play room for children who are hospitalized, consulting rooms for providers, and a treatment room will also be created.
Schedule K, Part II, Line 3:   Part II, Line 3 varies from what was reported on Part I, Column (e) due to investment earnings.
Schedule K, Part III, Line 3A:   Gillette's current management or service contracts with respect to the financed property do not result in private business use.
Schedule K, Part IV, Line 5:   Investments made with all proceeds held beyond an allowable temporary period were appropriately yield-restricted.
Schedule K (Form 990) 2010

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) Medtronic Inc
  		Scott Ward, Senior Vice President 3,551,146 Medical Device Purchases: Gillette Purchases Pumps and Implants from Medtronic, Inc   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Identifier Return Reference Explanation
Form 990, Part VI, Section A, line 4   In 2010, Gillette revised its governance structure to one in which the members of the hospital board are also members of the Foundation board, resulting in common control of both entities.
Form 990, Part VI, Section B, line 11   A copy of the Form 990 was provided to every member of the governing body before it was filed. The form was completed by a committee that included representatives from finance, human resources, development and communications. This committee prepared all the documentation necessary; the forms were compiled by Gillette's accounting firm and reviewed by our legal counsel. The draft documents were then reviewed by Gillette's vice president of Finance and vice president of Strategic Planning. After all internal reviews were complete, the final version was presented to the finance committee and the board of directors for approval.
  Form 990, Part VI, Section B, line 12c Gillette enforces policies on external professional activities. Gillette employees, officers, volunteers, board members, and medical staff members are expected to disclose outside activities that involve potential conflicts of interest. In fact, directors must sign a conflict of interest statement acknowledging any potential conflicts related to Gillette. Gillette requires staff members to discuss potential conflicts with their immediate manager and with the manager of quality improvement resources. The disclosure includes a written description of the activity, the extent of the staff member's participation, and the possible duration of the relationship. If a conflict exists, the employee must not engage in the activity.
  Form 990, Part VI, Section B, line 15 At the request of the personnel committee of the Board of Directors, an independent consultant provides the committee with survey data containing recommendations for CEO/president and other executive salary ranges. The ranges are developed by the external consultant based on Gillette's compensation philosophy, which was developed by the personnel committee and adopted by the Board of Directors. The compensation philosophy is reviewed regularly. The members of this committee determine the CEO/president's salary and the salary ranges for other executives. The committee oversees the executive incentive plan, approves any incentive plan payouts, and regularly evaluates the benefits provided to executives. The external consultant has provided an opinion that total compensation for all executives is well within the standards of reasonableness and fair market value. In addition to the oversight function of executive total compensation, the personnel committee approves total compensation offers for employed physicians, oversees any payments under any incentive compensation plans, and evaluates all transactions with "disqualified persons."
  Form 990, Part VI, Section C, line 19 Gillette mails its annual report (which includes the audited financial statements) to Gillette employees, medical staff and board members; Gillette donors; Minnesota pediatricians; media representatives; the Minnesota Hospital Association (MHA); and the presidents and chief executive officers of the National Association of Children's Hospitals and Related Institutions. Gillette's Form 990s are available from the states of Minnesota and Wisconsin and at Guidestar.org. Gillette discloses financial statements to bondholders, the MHA and the Minnesota attorney general's office. The governing documents and conflict of interest policy are made available to the public upon request.
  Part VI, Section B, Line 14 According to new accounting guidelines, Gillette is obligated to answer "no" to this question because the Gillette board of directors or a subcommittee of the board of directors does not review Gillette's document retention and destruction policy. In fact, Gillette has written record retention policies for both patient medical records and for other records, including those of legal, historical, fiscal/tax and operational value. Gillette's chief executive officer, Margaret Perryman, has reviewed and approved the policies.
  Form 990, Part VII: The following individuals held positions at both Gillette Children's Specialty Healthcare and Gillette Children's Hospital Foundation. The hours listed on Part VII are the average hours per week these individuals devoted to Gillette Children's Specialty Healthcare during the year. In addition, these individuals also devoted the following average hours per week to Gillette Children's Hospital Foundation. Margaret E. Perryman 15.0 hours James L. Haddican 5.0 hours Deborah Quanback 1.0 hours Carol Clark 1.0 hours John Diehl 1.0 hours Bonnie Dougherty 1.0 hours Heidi Erspamer 1.0 hours Todd Fisher 1.0 hours David Glaser 1.0 hours James Hynes 1.0 hours Theresa McEnaney 1.0 hours Bruce O'Brien 1.0 hours Jerome Kahnke 1.0 hours Scott Ward 1.0 hours Cassandra Warner 1.0 hours Beverly Wical 1.0 hours Braxton Haulcy 1.0 hours Michael Partington 1.0 hours Chuck Amos 1.0 hours James Bradshaw 1.0 hours Jeff Evanson 1.0 hours John Guider 1.0 hours Robert Folkes 1.0 hours Robert Long 1.0 hours Dale Schoonover 1.0 hours
Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 1,145,134. Change in Beneficial Interest of Net Assets of Foundation 100,452. In accordance with FAS No. 136, "Transfers of assets to a not-for-profit or charitable trust that raises or holds contributions for others": Total to Form 990, Part XI, Line 5: 1,245,586.
  Part XII, Line 2B: Gillette financials are prepared by Gillette finance staff and audited by Deloitte and Touche LLP. Gillette's annual independent audit report is a consolidated report for Gillette Children's Specialty Healthcare and Gillette Children's Hospital Foundation.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) Gillette Children's Hospital Foundation

200 University Avenue East

St Paul,MN55101
41-1200302 		Healthcare MN 501(c)(3) Line 11, Type II N/A
Yes
 












For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership












Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Gillette Children's Hospital Foundation

 A 27,024 FMV
(2) Gillette Children's Hospital Foundation

 C 3,906,935 FMV
(3) Gillette Children's Hospital Foundation

 Q 97,551 FMV
(4) Gillette Children's Hospital Foundation

 P 3,368,866 FMV
(5) Gillette Children's Hospital Foundation

 R 6,258 FMV
(6)
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


Software ID:  
Software Version: