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 09-01-2010 and ending 08-31-2011
BCheck if applicable:
CName of organization
THE CHILDREN'S MEMORIAL HOSPITAL
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2300 CHILDRENS PLAZA BOX 268
 
Room/suite
City or town, state or country, and ZIP + 4
CHICAGO, IL606143394
D Employer identification number

36-2170833
E Telephone number

G Gross receipts $ 1,075,095,296
F Name and address of principal officer:
Patrick M Magoon
2300 CHILDRENS PLAZA BOX 268
CHICAGO,IL606143394
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.CHILDRENSMEMORIAL.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: 1894
M State of legal domicile: IL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: THE HOSPITAL IS A PEDIATRIC ACADEMIC MEDICAL CENTER PROVIDING PATIENT CARE AND EDUCATION AND TRAINING FOR THE PHYSICIANS AND OTHER MEDICAL PROFESSIONALS. IT IS ALSO A LEADER IN PEDIATRIC RESEARCH AND ADVOCACY.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 107
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 91
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 4,700
6 Total number of volunteers (estimate if necessary) .... 6 1,418
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 498,404
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 191,048
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 38,771,094 49,693,298
9 Program service revenue (Part VIII, line 2g) ......... 540,004,869 539,278,122
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 20,776,943 3,804,118
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -206,542 574,881
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 599,346,364 593,350,419
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 24,129,924 28,319,947
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) 265,327,945 282,320,559
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).... 256,919,352 239,202,347
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 546,377,221 549,842,853
19 Revenue less expenses. Subtract line 18 from line 12...... 52,969,143 43,507,566
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 1,952,509,066 2,042,087,930
21 Total liabilities (Part X, line 26)............ 846,750,270 789,111,961
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 1,105,758,796 1,252,975,969
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: WE ARE DEDICATED TO THE HEALTH AND WELL-BEING OF ALL CHILDREN. AS THE PEDIATRIC TEACHING FACILITY FOR NORTHWESTERN UNIVERSITY'S FEINBERG SCHOOL OF MEDICINE, THIS COMMITMENT DRIVES US TO BE A LEADER IN: - PEDIATRIC HEALTH CARE DELIVERY - RESEARCH INTO THE PREVENTION, CAUSES AND TREATMENT OF DISEASES THAT AFFECT CHILDREN - EDUCATION FOR PHYSICIANS, NURSES AND ALLIED HEALTH PROFESSIONALS - ADVOCACY FOR CHILDREN AS A CHARITABLE ORGANIZATION, WE SERVE CHILDREN AND THEIR FAMILIES TO THE BEST OF OUR ABILITIES AND TO THE LIMITS OF OUR RESOURCES.
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 $ 485,878,448 including grants of $ 28,319,947 ) (Revenue $ 540,348,288 )
The Children's Memorial Hospital ("CMH") in Chicago, Illinois owns and operates the only full-service, independent, freestanding pediatric hospital in Illinois. This not-for-profit, tertiary care hospital, founded in 1882, provides patient care 24 hours per day, 7 days per week. CMH has 270 licensed beds and provides a full range of inpatient and outpatient care and related ancillary services. CMH provides more care than any other hospital provider in Illinois in nearly every pediatric medical and surgical specialty. As a major academic tertiary care medical center, CMH has served patients from every county in Illinois, as well as patients from every state and 35 countries. CMH is a designated Level I pediatric trauma center for the City of Chicago, with a Level III neonatal nursery that serves as a regional referral center in the State of Illinois Perinatal Network. CMH's ability to treat the most critically ill infants in its neonatal intensive care unit ("NICU") is demonstrated by statistics for calendar year 2011 which show that 60% of all transports into its NICU were from other Level III nurseries in metropolitan Chicago. CMH has also been ranked among the best in the nation in a U.S. News & World Report opinion-based survey of top pediatric hospitals for the past three years. CMH is home to the world's first pediatric center for Autonomic Medicine and was the first pediatric hospital in Illinois to perform the Berlin Heart procedure, a breakthrough technology that helps children awaiting heart transplants. In the fiscal year ending August 31, 2011, CMH, through nearly 549,700 patient visits, served more than 148,000 children who came from all over the State of Illinois and beyond to access the more than 70 specialties offered by CMH. During this period there were 465,818 visits including 315,658 outpatient visits in Lincoln Park (including 6,541 observation cases), including 61,691 emergency room visits and 88,469 outpatient visits at the satellite facilities. CMH is the largest provider of Medicaid services to Illinois children. In total, during the State of Illinois' fiscal year 2011, CMH provided approximately 55% more outpatient and inpatient Medicaid services than the next highest Illinois hospital. CMH's pediatric-specialist physicians provide more specialty care to children insured by the State of Illinois' All Kids (Medicaid) program than any other specialty care provider. CMH maintains a charity care policy under which it provides healthcare services free of charge or at a greatly reduced rate to children whose families are unable to pay for the charges associated with their medical care. For the fiscal year ended August 31, 2011, the total unreimbursed care and community benefit as reported in the Fiscal Year 2011 audit of CMH and its affiliates was approximately $100 million, including $66.2 million in costs associated with unreimbursed services provided by the Hospital and its affiliated physician groups to children on Medicaid and $34.9 million for charity care and other community benefit including, but not limited to, resident and fellow expenses $15.5 million, research funding $4.3 million, operation of a community clinic support $2.9 million, child advocacy programs $557 thousand and the provision of language assistance, pastoral care, social work, art and music therapies, hospital volunteer services, transplant family housing and other family support services $6.6 million. CMH undertakes a broad range of services and activities in addition to patient care that support its charitable mission. CMH functions as a teaching and research institution whose efforts have contributed considerably to improvements in the quality of life and healthcare for children. CMH supports community medical needs through a variety of outreach programs and educational programs. In December 2001, CMH became the first pediatric hospital in the nation and the first hospital in Illinois to receive the Magnet Award from the American Nurses Credentialing Center. CMH was awarded this designation again in November 2005. Only 6% of the nation's hospitals currently hold this distinction. CMH is one of the major pediatric teaching hospitals in the U.S., serving as the pediatric teaching facility and the primary pediatric practice site of Northwestern University's Feinberg School of Medicine ("NUFSM") for resident physicians, fellows and medical students in pediatric specialties and sub-specialties. This program is consistently one of the most sought after in the country. In fiscal year 2011, over 1,170 individuals applied for the 93 available positions. Including the NUFSM pediatric residents and fellows, CMH has 110 residents and 88 fellows in various training programs. CMH also offers clinical experiences in pediatrics to medical students, nursing students, and students in other allied health fields. CMH is affiliated with 19 nursing education programs. In fiscal year 2011, there were 1,297 student placements, including 315 third and fourth year medical students, 668 nursing students, and 314 allied health students. CMH is undertaking the development, construction and equipping of a new, 288-licensed bed, acute care, pediatric hospital to replace its existing hospital facilities which will be named the "Ann & Robert H. Lurie Children's Hospital of Chicago." This new facility, in close proximity to NUFSM, will facilitate CMH's ability to continue to build upon its academic and research ties in a family-centered environment and state-of-the-art pediatric care facility that will foster the provision of compassionate care. CMH's role as a regional referral center for a variety of pediatric diseases and illnesses has created many research opportunities to study and treat them and CMH's research arm, Children's Memorial Research Center, is one of the nation's few centers dedicated solely to pediatric research. See the tax information return of CMH's affiliate, Children's Memorial Research Center [36-3357005]. Alone, or in conjunction with other community partners, CMH provides programs to support the health and well-being of children in our local community and beyond involving patient care and prevention; research; education and advocacy. Much of CMH's community work is in schools, particularly for children with special health and learning needs and the capacities of school personnel serving them. In the past 17 years, CMH has served more than 15,000 children and faculty of the Chicago Public Schools to enhance the health and safety programs and accommodations of chronically ill children. Programs address specific conditions such as epilepsy, ADHD, HIV infection, and impaired hearing. Other programs educate personnel about advanced medical technologies and aiding children transitioning from the CMH setting back to school. Other community health activities include a partnership by CMH hematologists with the American Red Cross Blood Services to launch a cooperative sickle cell blood donor program to increase the number of blood donations by African Americans to help children with sickle cell disease who require frequent blood transfusions. CMH is a driving member of the Consortium to Lower Obesity in Chicago Children (CLOCC) to confront childhood obesity in Chicago. CLOCC is currently working with the City of Chicago to promote healthy eating and physical activity and is also piloting programs in Englewood, Humboldt Park, Lower West Side, Rogers Park, West Garfield Park, and West Town neighborhoods in Chicago. CMH operates an Injury Prevention and Research Center to educate and to improve public policy and foster protective environments, in addition to coordinating injury prevention initiatives at CMH. CMH has also developed programs to teach children sports injury prevention. CMH's Consortium for Children with Complex Medical Needs seeks to assist children with special health care needs to overcome barriers in obtaining care by assuring a medical home, building alliances to facilitate increased access to care and services, raising awareness, and helping those children to obtain the services needed to transition to adulthood. CMH participates in a community partnership to create a one-stop center to coordinate medical, social and housing services for Chicago's most vulnerable youth. The Broadway Youth Center addresses the unique medical and psychological needs of youth who are homeless; those at risk for HIV; and young people who are lesbian, gay, bisexual or transgender. There are fewer than 10 such centers in the nation and this is the first in Chicago. CMH offers a summer internship for Latino high school students to introduce them to promising career opportunities and a mentoring program for high school students that promotes participation in community service and literacy. CMH also educates in child maltreatment awareness and child abuse prevention, lead poisoning detection, and automobile safety programs and has developed fitness programs f
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services. (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 485,878,448
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 III........................
5
 
 
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
 
No
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
Yes
 
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
 
No
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......... Click to see attachment
14b
Yes
 
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.. Click to see attachment
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.. Click to see attachment
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. ..... Click to see list of attachments
20b
Yes
 
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
 
No
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
Yes
 
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 MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I........................... Click to see attachment
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
 
No
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
319
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
Yes
 
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
4,700
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
107
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
91
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
Yes
 
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
 
No
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
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
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
 
No
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
Yes
 
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
IL
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
PAULA M NOBLE
2300 CHILDRENS PLAZA BOX 268
CHICAGO,IL60614
(312) 573-4578
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) John J Allen
Director
 1.0 X           0 0 0
(2) John Amboian Jr
Director
 1.0 X           0 0 0
(3) Sarah Baine
Ex-Officio Director w/vote
 1.0 X           0 0 0
(4) Stephen W Baird
Director
 1.0 X           0 0 0
(5) Peter B Bensinger
Director
 1.0 X           0 0 0
(6) Andrew T Berlin
Director
 1.0 X           0 0 0
(7) Barbara L Bowles
Director
 1.0 X           0 0 0
(8) Jill Brennan
Director
 1.0 X           0 0 0
(9) David Bunning
Director
 1.0 X           0 0 0
(10) Gregory C Case
Director
 1.0 X           0 0 0
(11) John A Challenger
Director
 1.0 X           0 0 0
(12) Alan Chapman
Director
 1.0 X           0 0 0
(13) Robert Clark
Director
 1.0 X           0 0 0
(14) Mrs Charles F Clarke Jr
Director
 1.0 X           0 0 0
(15) Kevin M Connelly
Director
 1.0 X           0 0 0
(16) John D Cooney
Director
 1.0 X           0 0 0
(17) John M Crocker Jr
Vice-Chair & Director
 1.0 X           0 0 0
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) Lester Crown
Director
 1.0 X           0 0 0
(19) Paula H Crown
Director
 1.0 X           0 0 0
(20) Leticia Peralta Davis
Director
 1.0 X           0 0 0
(21) Susan DePree
Director
 1.0 X           0 0 0
(22) James DeRose
Director
 1.0 X           0 0 0
(23) William J Devers Jr
Director
 1.0 X           0 0 0
(24) John Doerge Jr
Director
 1.0 X           0 0 0
(25) James Donaldson MD
Ex-Officio Director w/vote
 1.0 X           0 518,299 136,176
(26) Charles W Douglas
Director
 1.0 X           0 0 0
(27) Dennis J Drescher
Director
 1.0 X           0 0 0
(28) Michael Evangelides
Director
 1.0 X           0 0 0
(29) Tyrone C Fahner
Director
 1.0 X           0 0 0
(30) Mitchell Feiger
Director
 1.0 X           0 0 0
(31) Diana S Ferguson
Director
 1.0 X           0 0 0
(32) Michael W Ferro Jr
Director
 1.0 X           0 0 0
(33) David Fox Jr
Director
 1.0 X           0 0 0
(34) John S Gates Jr
Director
 1.0 X           0 0 0
(35) Laurence S Geller
Director
 1.0 X           0 0 0
(36) Bert A Getz Jr
Director
 1.0 X           0 0 0
(37) Jeffrey Glassroth MD
Director
 1.0 X           0 0 0
(38) Thomas P Green MD
Ex-Officio Dir/Pres&Chair PFF
 1.0 X           0 653,691 55,432
(39) Joseph Gregoire
Director
 1.0 X           0 0 0
(40) David D Grumhaus
Director
 1.0 X           0 0 0
(41) Arlington Guenther
Director
 1.0 X           0 0 0
(42) Joseph D Gutman
Director
 1.0 X           0 0 0
(43) Bruce R Hague
Director
 1.0 X           0 0 0
(44) Paul F Hanzlik
Director
 1.0 X           0 0 0
(45) Brett J Hart
Director
 1.0 X           0 0 0
(46) Mary JC Hendrix PhD
EX-OFF DIR W/VOTE/PRES/SCI OFF
 1.0 X           0 602,933 44,526
(47) Daniel J Hennessy
Vice Chair & Director
 1.0 X           0 0 0
(48) James Hickey
Director
 1.0 X           0 0 0
(49) Gary E Holdren
Director
 1.0 X           0 0 0
(50) Mark Hoppe
Director
 1.0 X           0 0 0
(51) Charles H James III
Director
 1.0 X           0 0 0
(52) J Larry Jameson MD
Ex-officio Director w/vote
 1.0 X           0 0 0
(53) Kirk B Johnson
Director
 1.0 X           0 0 0
(54) W Bruce Johnson
Director
 1.0 X           0 0 0
(55) Bennet A Kaye MD
Ex-Officio Director w/vote
 1.0 X           0 0 0
(56) George D Kennedy
Director
 1.0 X           0 0 0
(57) Anthony K Kesman
Director
 1.0 X           0 0 0
(58) Richard P Kiphart
Director
 1.0 X           0 0 0
(59) Fred L Krehbiel
Director
 1.0 X           0 0 0
(60) Adam A Kriger
Director
 1.0 X           0 0 0
(61) Gerald R Lanz
Director
 1.0 X           0 0 0
(62) Eric Lefkofsky
Director
 1.0 X           0 0 0
(63) Lyle Logan
Director
 1.0 X           0 0 0
(64) Shelley A Longmuir
Director
 1.0 X           0 0 0
(65) Daniel TW Lum MD
Director
 1.0 X           0 0 0
(66) Patrick M Magoon
Ex-Officio Dir/CEO, CMH/CMMC
 40.0 X   X       1,275,634 0 598,066
(67) Mitchell J Manassa
Director
 1.0 X           0 0 0
(68) John F Manley
Vice Chair & Director
 1.0 X           0 0 0
(69) Roxanne Martino
Director
 1.0 X           0 0 0
(70) Peter D McDonald
Director
 1.0 X           0 0 0
(71) Jack L McGinley
Director
 1.0 X           0 0 0
(72) Andrew J McKenna
Director
 1.0 X           0 0 0
(73) William J McKenna
Director
 1.0 X           0 0 0
(74) James J McNulty
Director
 1.0 X           0 0 0
(75) Louise C Mills
Director
 1.0 X           0 0 0
(76) Robert S Murley
Vice Chair & Director
 1.0 X           0 0 0
(77) David Neithercut
Director
 1.0 X           0 0 0
(78) Leslie Newman
Director
 1.0 X           0 0 0
(79) Edward Ogata MD
Chief Medical Officer, CMH
 40.0 X   X       2,282,434 0 44,336
(80) Nancy Pacher
Director
 1.0 X           0 0 0
(81) Chaka Patterson
Director
 1.0 X           0 0 0
(82) Peer Pedersen
Vice Chair & Director
 1.0 X           0 0 0
(83) Lorna S Pfaelzer
Director
 1.0 X           0 0 0
(84) David C Pisor
Director
 1.0 X           0 0 0
(85) Ashish Prasad
Director
 1.0 X           0 0 0
(86) Seth Prostic
Director
 1.0 X           0 0 0
(87) Gerald D Putnam
Director
 1.0 X           0 0 0
(88) Mohan Rao Phd
Director
 1.0 X           0 0 0
(89) Andrea Redmond
Director
 1.0 X           0 0 0
(90) Susan Regenstein
Director
 1.0 X           0 0 0
(91) Thomas R Reusche
Director
 1.0 X           0 0 0
(92) J Christopher Reyes
CMMC/CMH Chair
 7.0 X           0 0 0
(93) Marleta Reynolds MD
Ex-Officio Director w/vote
 1.0 X           0 0 0
(94) Peter C Roberts
Director
 1.0 X           0 0 0
(95) Hilary Sallerson
Ex-Officio Director w/vote
 1.0 X           0 0 0
(96) Manuel Sanchez
Director
 1.0 X           0 0 0
(97) Deborah M Sawyer
Director
 1.0 X           0 0 0
(98) H William Schnaper MD
Ex-Officio Director/PFF MD
 1.0 X           0 285,948 50,017
(99) Christopher Segal
Director
 1.0 X           0 0 0
(100) Mrs Donald Shoemaker
Director
 1.0 X           0 0 0
(101) Stephen A Smith
Director
 1.0 X           0 0 0
(102) Thomas S Souleles
Director
 1.0 X           0 0 0
(103) Stephen T Steers
Director
 1.0 X           0 0 0
(104) Edward S Traisman MD
Ex-Officio Director w/vote
 1.0 X           0 0 0
(105) Monsignor Kenneth Velo
Director
 1.0 X           0 0 0
(106) Matthew Walsh
Director
 1.0 X           0 0 0
(107) Edward J Wehmer
Director
 1.0 X           0 0 0
(108) Brian E Williams
Director
 1.0 X           0 0 0
(109) Linda S Wolf
Director
 1.0 X           0 0 0
(110) James Wooten Jr
Director
 1.0 X           0 0 0
(111) Ms Jia Zhao
Director
 1.0 X           0 0 0
(112) Gordon B Bass
Chief Operating Officer
 40.0     X       1,762,990 0 36,531
(113) Barbara B Bowman
Chief HR Officer
 40.0     X       503,896 0 31,018
(114) Susan H Gordon
Chief Public Policy Officer
 40.0     X       295,362 0 63,189
(115) Monica Heenan
Chief Ambulatory Srv/Med MGMT
 40.0     X       267,197 0 26,265
(116) Bruce Komiske
Chief New Hosp. Design/Const
 40.0     X       475,748 0 22,296
(117) Stanley B Krok
Chief Information Officer
 40.0     X       363,161 0 108,322
(118) Maureen T Mahoney
Chief Transition Occupancy
 40.0     X       254,740 0 26,204
(119) Maureen Murphy
Chief MKTG & MNGD Care Officer
 40.0     X       370,708 0 59,075
(120) Paula M Noble
CFO/Treasurer/CMMC& AFFILIATES
 40.0     X       517,921 0 139,612
(121) Michelle M Stephenson
Chief Nurse Executive
 40.0     X       324,960 0 58,709
(122) Donna S Wetzler
Gen CNSL&Corp Sec/CMMC&Afflts
 40.0     X       389,284 0 96,604
(123) Sherwood D Zellermayer
Chief Communications Officer
 40.0     X       260,676 0 28,154
(124) Thomas Sullivan
President CMF
 40.0       X     524,687 0 77,387
(125) Ron H Blaustein
Associate CFO
 40.0         X   233,242 0 31,910
(126) Nancy M Borders
Associate General Counsel
 40.0         X   233,432 0 34,983
(127) Morley I Kerschner
Admin Revenue Cycle
 40.0         X   223,793 0 22,253
(128) Edward T Schubnell
Admin Med-Surgical Svcs
 40.0         X   214,763 0 28,218
(129) Philip V Spina
Chief Admin Officer CMRC
 40.0         X   213,988 0 43,030
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 10,988,616 2,060,871 1,862,313
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet272
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
MORTENSON POWER
25 NW POINT BLVD
ELK GROVE VILLAGE,IL60007 		CONSTRUCTION 256,120,624
MCGAW MEDICAL CENTER
303 E CHICAGO AVE
CHICAGO,IL60611 		PROFESSIONAL MED SVC 15,317,270
ZIMMER GUNSUL FRASCA
1350 AVENUE OF THE AMERICAS SUITE
NEW YORK,NY10019 		ARCHITECTS 6,736,445
CHILDREN'S SURGICAL FOUNDATION
2300 CHILDRENS PLAZA
CHICAGO,IL60614 		PROF MED SVCS 3,858,628
ANDERSON MIKOS ARCHITECTS
17W110 22ND ST SUITE 200
OAKBROOK,IL60181 		ARCHITECTS 3,184,669
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet267
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 7,390,062
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		42,303,236
g Noncash contributions included in lines 1a-1f:$ 1,608,766
h Total. Add lines 1a-1f.......MediumBullet 49,693,298
Program Service Revenue Business Code
2a Patient Care & Program Services 621,110 339,830,398 339,830,398    
b Medicare/Medicaid 621,110 155,043,967 155,043,967    
c Grants-Fed/State/Agency/Subcontract/Private 621,110 39,522,324 39,522,324    
d Reference Lab Revenue 621,500 1,240,008 1,235,623 4,385  
e Parking Garages 812,930 1,037,912   406,271 631,641
f All other program service revenue . 2,603,513 1,167,393   1,436,120
g Total. Add lines 2a–2f........MediumBullet 539,278,122
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 12,389,259   87,748 12,301,511
4 Income from investment of tax-exempt bond proceeds..MediumBullet 1,224     1,224
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents 3,015,661  
b Less: rental expenses 2,440,780  
c Rental income or (loss) 574,881  
d Net rental income or (loss).......MediumBullet 574,881 1,070,166   -495,285
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 470,717,732  
b Less: cost or other basis and sales expenses 479,304,097  
c Gain or (loss) -8,586,365  
d Net gain or (loss)..........MediumBullet -8,586,365     -8,586,365
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 0    
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 0      
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 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 0
12 Total revenue. See Instructions....MediumBullet 593,350,419 537,869,871 498,404 5,288,846
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 28,319,947 28,319,947
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 9,488,446 3,003,900 6,484,546  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 213,474,866 190,692,033 22,782,833  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 10,298,820 8,490,820 1,808,000  
9 Other employee benefits ....... 32,966,942 28,218,647 4,748,295  
10 Payroll taxes ........... 16,091,485 14,240,744 1,850,741  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 1,519,553   1,519,553  
c Accounting ........... 405,999   405,999  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 4,851,427   4,851,427  
g Other .......... 19,114,005 11,405,493 7,708,512  
12 Advertising and promotion .... 2,232,652 1,009,442 1,223,210  
13 Office expenses ....... 89,417,932 89,037,280 380,652  
14 Information technology ...... 15,464,386 13,298,173 2,166,213  
15 Royalties .. 0      
16 Occupancy ........... 9,925,263 8,880,473 1,044,790  
17 Travel ............ 955,861 563,832 392,029  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 1,832,437 1,815,547 16,890  
20 Interest ........... 1,368,402 1,190,510 177,892  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 38,633,916 36,382,373 2,251,543  
23 Insurance .............. 7,936,149 7,934,696 1,453  
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 ADMIN & TEACHING 13,768,921 13,768,921    
b Medicaid provider tax 13,729,114 13,729,114    
c Bad debt provision 3,681,037 3,681,037    
d Dues & licenses 3,043,679 778,543 2,265,136  
e Board designated expenses 2,597,223 2,597,223    
f All other expenses 8,724,391 6,839,700 1,884,691  
25 Total functional expenses. Add lines 1 through 24f 549,842,853 485,878,448 63,964,405 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 ..........   1  
2 Savings and temporary cash investments ....... 277,812,336 2 148,262,276
3 Pledges and grants receivable, net ......... 109,425,109 3 95,284,016
4 Accounts receivable, net ......... 24,633,786 4 28,987,889
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 .............. 4,719,069 8 4,027,088
9 Prepaid expenses and deferred charges ............ 7,260,852 9 6,569,785
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,337,693,748
b Less: accumulated depreciation. ..... 10b 483,686,937 674,694,214 10c 854,006,811
11 Investments—publicly traded securities .......... 530,256,442 11 572,286,175
12 Investments—other securities. See Part IV, line 11 ...... 247,607,370 12 290,191,017
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 76,099,888 15 42,472,873
16 Total assets. Add lines 1 through 15 (must equal line 34)... 1,952,509,066 16 2,042,087,930
Liabilities 17 Accounts payable and accrued expenses . 119,183,716 17 90,876,396
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities .......... 550,776,275 20 550,882,715
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 ..   23  
24 Unsecured notes and loans payable to unrelated third parties .... 15,079,468 24 15,079,468
25 Other liabilities. Complete Part X of Schedule D..... 161,710,811 25 132,273,382
26 Total liabilities. Add lines 17 through 25..... 846,750,270 26 789,111,961
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 ..... 568,898,374 27 722,301,893
28 Temporarily restricted net assets ..... 375,900,235 28 390,048,649
29 Permanently restricted net assets ..... 160,960,187 29 140,625,427
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 ..... 1,105,758,796 33 1,252,975,969
34 Total liabilities and net assets/fund balances ..... 1,952,509,066 34 2,042,087,930
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
593,350,419
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
549,842,853
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
43,507,566
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
1,105,758,796
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
103,709,607
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
1,252,975,969
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
Yes
 
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
Yes
 
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
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number

36-2170833
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
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number

36-2170833
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
THE CHILDREN'S MEMORIAL HOSPITAL
  		Employer identification number

36-2170833
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
THE CHILDREN'S MEMORIAL HOSPITAL
  		Employer identification number

36-2170833
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
THE CHILDREN'S MEMORIAL HOSPITAL
  		Employer identification number

36-2170833
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
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number

36-2170833
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       0 0
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		        0
             
c Total lobbying expenditures       0 0
             
d Grassroots non-taxable amount       0 0
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		         0
             
f Grassroots lobbying expenditures       0 0
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? .........................................
Yes
 
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? .........................
Yes
 
2,342
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
 
522,223
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
57,694
j
Total. lines 1c through 1i ...................................
582,259
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
SUPPLEMENTAL INFORMATION 2010 FORM 990 SCHEDULE C To further their collective mission, The Children's Memorial Hospital ("CMH") and its affiliates, by virtue of their role in providing complex care for children, partner with and frequently interact with members of the government in developing policies applicable to children's health and well-being. In 1994, CMH established a Public Policy Committee of the Board of Directors to recommend institutional positions on legislation and regulation that would enable CMH and its affiliates to enhance the health and well-being of children. Over the years, the Public Policy Committee has recommended positions on public policy matters affecting children's health and well-being and to garner government funding to support the exempt activities of CMH and its affiliates and for the development and construction of a new hospital, replacing CMH'S existing facility, to be named "Ann & Robert H. Lurie Children's Hospital of Chicago." This new facility will facilitate CMH's ability to continue to build upon its academic and research ties in a family-centered environment and state-of-the-art facility that will foster the provision of compassionate care. Examples of policy initiatives for which CMH has advocated include: preventing transmission of HIV from mothers to newborns; prevention of childhood injury; prevention of child abuse; prevention of childhood obesity; and improving access to health insurance for children. Read more about our current institutional public positions at: http://www.childrensmemorial.org/newsroom/government-community/policy-posi tions.aspx. In addition, when state and federal legislators or committees need experts to analyze and testify as to how a pending bill would affect children's health in Illinois, they often look to CMH and its affiliates. In recent years, employees, officers and physicians of CMH and its affiliates have testified before elected officials and government policymakers in Washington, DC, Springfield and Chicago on issues ranging from the benefits of children passenger safety and helmet laws to the prevention of concussions in youth, funding for graduate medical education and Medicaid reform. In addition, CMH engages in lobbying activities to seek appropriate Medicaid funding of the substantial services provided by CMH and its affiliates to Medicaid-eligible patients in Illinois. CMH also seeks funding, on a state and federal level, for various initiatives that will enhance patient care. On the federal level, CMH, in connection with other children's teaching hospitals, works to protect and enhance funding for the Medicaid program and graduate medical education for 55 freestanding children's teaching hospitals in the United States.
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
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number

36-2170833
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 .... 355,075,654 345,631,973 376,042,568
b Contributions ........ 4,592,742 3,257,533 323,812
c Investment earnings or losses ... 21,332,401 10,720,980 -18,808,632
d Grants or scholarships ..... 7,066,285 1,635,773 11,500,978
e Other expenditures for facilities
and programs ........ 		  2,899,059 424,797
f Administrative expenses ....      
g End of year balance ...... 373,934,512 355,075,654 345,631,973
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet46.930 %
b
Permanent endowment: SchDMd Bullet37.610 %
c
Term endowment: SchDMd Bullet15.470 %
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)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
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 .................   39,289,353 39,289,353
b Buildings ................   306,370,108 254,234,761 52,135,347
c Leasehold improvements ............   12,181,129 8,569,714 3,611,415
d Equipment ................   273,454,486 220,882,462 52,572,024
e Other .................   706,398,672 0 706,398,672
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 854,006,811
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) ALTERNATIVE INVESTMENTS 		290,191,017 F








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet 290,191,017
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








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
SELF INSURANCE LIABILITY 105,342,973
DUE TO THIRD PARTIES 5,234,793
ACCRUED PENSION LIABILITY 17,772,947
ASSET RETIREMENT COSTS 3,428,569
LEASE OBLIGATIONS 494,100




Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 132,273,382
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  
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8  
9 Total adjustments (net). Add lines 4 - 8 ............................. 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
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  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
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  
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
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  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
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  
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5  
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
INTENDED USES OF ENDOWMENT FUNDS Schedule D, Part V, Line 4 CMH's endowment fund consists of individual donor-restricted endowment funds and funds designated by its Board to function as endowments. The net assets associated with endowment funds, including those funds designated by the Board to function as endowments, are classified and reported based on the existence or absence of donor-imposed restrictions. Effective June 30, 2009, Illinois passed Uniform Prudent Management of Institutional Funds Act ("UPMIFA"). CMh has, after obtaining advice of outside counsel, interpreted UPMIFA as sustaining the preservation of the original gift as of the gift date of the donor-restricted endowment funds absent explicit donor stipulations to the contrary. As a result of this interpretation, Cmh classifies as permanently restricted net assets, (a) the original value of gifts donated to the permanent endowment, (b) the original value of subsequent gifts to the permanent endowment, and (c) accumulations to the permanent endowment made in accordance with the direction of the applicable donor gift instrument at the time the accumulation is added to the fund. The remaining portion of the donor-restricted endowment fund that is not classified in permanently restricted net assets is classified as temporarily restricted net assets until those amounts are appropriated for expenditure by CMh in a manner consistent with the donor intent and standard of prudence prescribed by UPMIFA. Where the Board designates unrestricted funds to function as endowments they are classified as unrestricted net assets.
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE F
(Form 990)

Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,
Part IV, line 14b, 15, or 16.
Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number

36-2170833
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. 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
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of grant funds outside the
United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
Sub-Saharan Africa 0 0 Program Services Medical 20,000
South Asia 0 0 Investments   906,387
Central America and the Caribbean 0 0 Investments   78,485,887
Europe (Including Iceland and Greenland) 0 0 Investments   53,823,041
North America 0 0 Investments   372,745
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 133,608,060
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b) 0 0 133,608,060
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2010
Schedule F (Form 990) 2010
Page 5
Part V
Supplemental Information
Complete this part to provide the information (see instructions) required in Part I, line 2, and any additional information.
Identifier ReturnReference Explanation
Organization's Procedures for Monitoring Use of Grant Funds Outside the US Schedule F, Part V Travel grants of $2,500 are provided to third year medical residents that travel to the Bugando Medical Center in the United Republic of Tanzania to provide medical care on a volunteer basis. The travel grants are intended to cover some of the costs related to travel to and from the United Republic of Tanzania, as well as housing and meals while at the Bugando Medical Center. The medical residents are provided $1,250 prior to their departure and $1,250 upon their return to the U.S.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2010
Additional Data


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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
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number

36-2170833
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
Yes
 
6b
If "Yes," does the organization make it available to the public? ..............
6b
Yes
 
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) .. 		  0 1,147,944 0 1,147,944 0.210 %
b Unreimbursed Medicaid (from
Worksheet 3, column a) . 		  0 219,957,945 176,263,488 43,694,457 8.000 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....   0 0 0 0 0 %
dTotal Charity Care and
Means-Tested Government Programs ..... 		  0 221,105,889 176,263,488 44,842,401 8.210 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		  0 9,435,150 0 9,435,150 1.730 %
f Health professions education
(from Worksheet 5) .. 		  0 15,493,437 2,873,341 12,620,096 2.310 %
g Subsidized health services
(from Worksheet 6) .. 		  0 817,097 0 817,097 0.150 %
h Research (from Worksheet 7)   0 57,022,795 11,566,173 45,456,622 8.320 %
i Cash and in-kind contributions
to community groups
(from Worksheet 8) .. 		  0 7,747,693 0 7,747,693 1.410 %
jTotal Other Benefits ...   0 90,516,172 14,439,514 76,076,658 13.920 %
kTotal. Add lines 7d and 7j. ..   0 311,622,061 190,703,002 120,919,059 22.130 %
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
 
No
2
Enter the amount of the organization's bad debt expense (at cost).....
2
1,147,944
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
0
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
0
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
0
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
0
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 THE CHILDREN'S MEMORIAL HOSPITAL
2300 CHILDRENS PLAZA BOX 268
CHICAGO,IL606143394 		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:THE CHILDREN'S MEMORIAL HOSPITAL
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?10
Name and address Type of Facility (Describe)
1 Outpatient Center in Lincoln Park
2515 N Clark Street/467 W Deming
Chicago,IL60614 		Outpatient Medical Services
2 Outpatient Center in Lincoln Park
2515 N Clark Street/467 W Deming
Chicago,IL60614 		Outpatient Medical Services
3 Outpatient Center in Lincoln Park
2515 N Clark Street/467 W Deming
Chicago,IL60614 		Outpatient Medical Services
4 Outpatient Center in Lincoln Park
2515 N Clark Street/467 W Deming
Chicago,IL60614 		Outpatient Medical Services
5 Outpatient Center in Lincoln Park
2515 N Clark Street/467 W Deming
Chicago,IL60614 		Outpatient Medical Services
6 Outpatient Center in Lincoln Park
2515 N Clark Street/467 W Deming
Chicago,IL60614 		Outpatient Medical Services
7 Outpatient Center in Lincoln Park
2515 N Clark Street/467 W Deming
Chicago,IL60614 		Outpatient Medical Services
8 Outpatient Center in Lincoln Park
2515 N Clark Street/467 W Deming
Chicago,IL60614 		Outpatient Medical Services
9 Outpatient Center in Lincoln Park
2515 N Clark Street/467 W Deming
Chicago,IL60614 		Outpatient Medical Services
10 Outpatient Center in Lincoln Park
2515 N Clark Street/467 W Deming
Chicago,IL60614 		Outpatient Medical Services
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
Supplemental Information   Part I, Line 3c: N/A Part I, line 6a: The Children's Memorial Hospital prepares an annual community benefit report. The report can be found at: http://www.childrensmemorial.org/newsroom/serving-our-communities.aspx. The calculation for "charity care and certain other community benefits at cost" reflects the Form 990 definitions and will not necessarily correspond to calculations prepared for similar state of Illinois reporting requirements and our audited financial statement reporting, each of which may require the use of specified methodologies that may differ from Form 990. Part I, line 7g: Subsidized health services reported in Part I, Line 7g include details from two different community benefit programs of the Children's Memorial Hospital ("CMH"), namely the Uptown Primary Care and Dentistry Clinics. The operating costs attributable to Primary Care and Dentistry clinics are $817,097. Both programs are operated despite financial losses to the organization. The clinics provide healthcare to a largely underserved community. Part I, line 7, column (f): Total expense from Form 990, Part IX, Line 25, column (A) was $549,842,853. The bad debt expense included in this amount was $3,681,037. Therefore, total expense of $546,161,816 was used for purposes of calculating Form 990, Schedule H, Part I, line 7, column (f). Part I, Line 7: Cost to charge ratio is calculated using the total expense reflected in the FY 2011 audited financial statements reduced by community benefits reflected on Schedule H, bad debt, provider tax, and non-patient related activity expenses found in the CMH cost report divided by gross patient charges. Part II: N/A Part III, line 4: CMH considers self-pay as bad debt when a family is not eligible for financial assistance and is unwilling or unable to pay an outstanding account balance. The most common patient bad debt scenarios include unpaid self-pay portions of account balances after insurance or third party assistance payments or unpaid account balances after a bankruptcy filing. CMH is sensitive to the financial health of our patients and their families and recognizes that family financial concerns may not always be shared. At times, a patient may be reluctant to complete a financial assessment to determine their eligibility for charity care. It is possible that because of these circumstances, a portion of bad debt expense could represent patients that are unable to pay and might qualify for financial assistance. However, accurate data to estimate this amount is unavailable. CMH is committed to managing collection efforts in a sensitive and respectful manner. In this regard, CMH sends a minimum of four letters/statements to the families before taking further action. For high balance accounts, CMH will attempt to contact the patient/family by telephone. Should CMH receive no reply, the self-pay balances are sent to a collection agency for further action. With few exceptions, CMH does not credit list its patients or take court action in its attempts to collect the outstanding balances. The allowance for uncollectible accounts at the amount of charges written off (net of contractuals and discounts) is presented as a separate line item on the face of the financial statements. Bad debt expense on Schedule H, Part III, Line 2 is calculated based on aging accounts receivable and applying historical bad debt percentages. Part III, line 8: N/A Part III, line 9b : Collection policies are the same for all CMH patients. If, at any point in the collection process, documentation is received that indicates the patient is potentially eligible for financial assistance but has not applied for it, the account is referred back for a financial assistance review. Through the use of numerous pamphlets, signage and website notices, patients are notified of CMH's financial assistance policy. On receipt of the information, CMH will determine eligibility for financial assistance and notify the patient as quickly as possible. The Hospital does not pursue collection of amounts from patients who are being reviewed for financial assistance eligibility or who are determined to qualify for charity care. In addition, all patients having difficulty paying their bills are directed to financial counselors. The financial counselors will work with patients to qualify them for charity care or government programs such as Medicaid. After a patient meets the qualifications for financial assistance, the account balance is either partially or entirely written off in accordance with our financial assistance policy. If there is any remaining balance, only that balance would be subject to the debt collection policy. If a patient has requested and/or filled out a financial aid application, all debt collection activities stop until eligibility for financial assistance can be determined. Our policy provides that once we have received the necessary documentation we will not refer any accounts for collection until we can determine whether the individual is insured and not eligible for financial assistance. Part III: N/A Part VI, Line 2 Needs Assessment: CMH assesses the health care needs of the larger and diverse community it serves in a variety of ways. Community needs are identified by the CMH board of directors as well as several advisory boards which are comprised of individuals from the community served who are active members of the community and attuned to community needs. For example, CMH has a very active Family Advisory Board which CMH relies upon to assist in making decisions about programming and policies. Family Advisory Board members, comprised of parents of children who have had extensive inpatient and outpatient experiences at CMH, advise administration and medical leadership on patient needs and hospital priorities from the family perspective. Family Advisory Board Members contribute through participation in planning, operating and policy committees of CMH. Similarly, the Kids' Advisory Board is intended to give a voice to children who have been treated at CMH. The Kids' Advisory Board makes recommendations on issues related to patient care from the perspective of a child, teenager and sibling of a patient. CMH also has established a Community Advisory Board for patients/caregivers of HIV-infected children, HIV-infected health care workers and other interested people in the community. This advisory board seeks input and feedback regarding clinic operations and patient needs to improve services and research for all HIV-affected patients at CMH. The Community Advisory Board meets to discuss improvements for the program's services; help in implementing new pediatric, adolescent and perinatal research; review HIV education materials used in the community; and to assess the effectiveness of the CMH HIV/AIDS program. CMH also has established an adolescent community advisory board established to address similar issues, specific to teens with HIV/AIDS. Moreover, CMH has strong relationships with other not-for-profit organizations (such as health clinics and social service agencies) and community leaders who help identify existing community needs and ways to address such needs. CMH is also a leader in pediatric research aimed at advancements in the prevention, diagnosis and treatment of diseases that affect the development of children through adolescence as well as adult disorders that derive from them. Children's Memorial Research Center is one of a few institutions in the U.S. dedicated exclusively to pediatric research. This research aids in the identification of unmet needs faced by the community and, in particular, the children Children's Memorial is privileged to serve. CMH assesses pediatric health needs in the community through its Child Health Data Lab, which provides current and accurate data on the health of children and adolescents throughout Illinois in a readily understandable format. By analyzing health status in particular areas over periods of time, the data lab assists policy-makers and public health planners to identify the health promotion and disease and injury prevention needs in local communities in Illinois. The data lab publishes reports including detailed analyses of child and adolescent injury, death and hospitalization in Illinois by county, and child injury and well-being by Chicago community area. The data lab provides statistical analysis and proposes solutions to address the leading causes of injury for different age groups. The data lab also houses the Illinois health survey which is the first broad-based survey of Illinois youth and adults, designed to provide county-level estimates of a broad range of health conditions for Illinois youth and adults and is intended to guide health policy in Illinois. Based upon all these varied assessments, CMH, in concert with others in the community, strives to address identified needs which it is positioned to assist with, particularly those related to the health and well-being of ch
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
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number
36-2170833
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) The Children's Memorial Research Center2300 Childrens Plaza
Chicago,IL60614 		36-3357005 501(C)(3) 2,561,497       Net asset transfer
(2) The Children's Memorial Medical Center2300 Childrens Plaza
Chicago,IL60614 		36-3357004 501(C)(3) 443,930       Net Asset Transfer
(3) Pediatric Faculty Foundation Inc2300 Childrens Plaza
Chicago,IL60614 		36-3279680 501(C)(3) 7,647,693       NET ASSET TRANSFER
(4) The Children's Memorial Research Center2300 Childrens Plaza
Chicago,IL60614 		36-3357005 501(C)(3) 3,152,327       FUNDS RELEASED FROM RESTRICTION
(5) Pediatric Faculty Foundation Inc2300 Childrens Plaza
Chicago,IL60614 		36-3279680 501(C)(3) 8,172,773       FUNDS RELEASED FROM RESTRICTION
(6) The Children's Memorial Medical Center2300 Childrens Plaza
Chicago,IL60614 		36-3357004 501(C)(3) 299,917       Funds released from restriction
(7) Children's Surgical Foundation2300 Childrens Plaza
Chicago,IL60614 		36-3283051 501(C)(3) 1,041,810       ACADEMIC GRANT
(8) Ronald McDonald House Charities622 WEST DEMING PLACE
CHICAGO,IL60614 		36-2861369 501(c)(3) 5,000,000       CONSTRUCTION SUPPORT FOR NEW FACILITY








2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
5
3
Enter total number of other organizations ................................ . Bullet Image
0
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
Form 990, Schedule I Description of Organization's Procedures for Monitoring the Use of Grants We review all grant funds on a monthly basis. Financial reports are generated monthly and distributed electronically to all fund directors and the Office of Sponsored Projects (OSP) for review. Expenditures are reviewed for appropriateness and against budgetary guidelines by the Finance Office (Fund Accounting). OSP and Fund Accounting work with the investigators to monitor their activity and make sure they are in compliance with the terms of the award.
Schedule I (Form 990) 2010


Additional Data


Software ID:  
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
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number

36-2170833
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
Yes
 
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
Yes
 
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
Yes
 
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) James Donaldson MD (i)
(ii)		 0
429,422 		0
86,890 		0
1,987 		0
115,539 		0
20,637 		0
654,475 		0
0
(2) Thomas P Green MD (i)
(ii)		 0
463,491 		0
189,408 		0
792 		0
24,500 		0
30,932 		0
709,123 		0
0
(3) Mary JC Hendrix PhD (i)
(ii)		 0
455,307 		0
147,110 		0
516 		0
24,500 		0
20,026 		0
647,459 		0
0
(4) Patrick M Magoon (i)
(ii)		 652,966
0 		587,146
0 		35,522
0 		583,079
0 		14,987
0 		1,873,700
0 		137,833
0
(5) Edward Ogata MD (i)
(ii)		 417,187
0 		213,082
0 		1,652,165
0 		19,647
0 		24,689
0 		2,326,770
0 		1,216,586
0
(6) H William Schnaper MD (i)
(ii)		 0
249,067 		0
36,089 		0
792 		0
24,500 		0
25,517 		0
335,965 		0
0
(7) Gordon B Bass (i)
(ii)		 388,372
0 		197,861
0 		1,176,757
0 		18,375
0 		18,156
0 		1,799,521
0 		784,200
0
(8) Barbara B Bowman (i)
(ii)		 225,159
0 		91,584
0 		187,153
0 		16,751
0 		14,267
0 		534,914
0 		0
0
(9) Susan H Gordon (i)
(ii)		 206,164
0 		83,486
0 		5,712
0 		59,376
0 		3,813
0 		358,551
0 		0
0
(10) Monica Heenan (i)
(ii)		 189,588
0 		77,189
0 		420
0 		12,934
0 		13,331
0 		293,462
0 		0
0
(11) Bruce Komiske (i)
(ii)		 324,884
0 		130,913
0 		19,951
0 		13,365
0 		8,931
0 		498,044
0 		0
0
(12) Stanley B Krok (i)
(ii)		 248,541
0 		102,951
0 		11,669
0 		86,387
0 		21,935
0 		471,483
0 		0
0
(13) Maureen T Mahoney (i)
(ii)		 177,043
0 		72,124
0 		5,573
0 		13,142
0 		13,062
0 		280,944
0 		0
0
(14) Maureen Murphy (i)
(ii)		 254,433
0 		103,120
0 		13,155
0 		49,297
0 		9,778
0 		429,783
0 		0
0
(15) Paula M Noble (i)
(ii)		 342,846
0 		173,529
0 		1,546
0 		125,105
0 		14,507
0 		657,533
0 		0
0
(16) Michelle M Stephenson (i)
(ii)		 227,491
0 		92,774
0 		4,695
0 		44,680
0 		14,029
0 		383,669
0 		0
0
(17) Donna S Wetzler (i)
(ii)		 256,438
0 		131,159
0 		1,687
0 		80,490
0 		16,114
0 		485,888
0 		0
0
(18) Sherwood D Zellermayer (i)
(ii)		 184,485
0 		75,098
0 		1,093
0 		15,011
0 		13,143
0 		288,830
0 		0
0
(19) Thomas Sullivan (i)
(ii)		 337,258
0 		173,649
0 		13,780
0 		51,801
0 		25,586
0 		602,074
0 		0
0
(20) Ron H Blaustein (i)
(ii)		 185,677
0 		47,414
0 		151
0 		10,558
0 		21,352
0 		265,152
0 		0
0
(21) Nancy M Borders (i)
(ii)		 202,002
0 		30,997
0 		433
0 		12,850
0 		22,133
0 		268,415
0 		0
0
(22) Morley I Kerschner (i)
(ii)		 193,276
0 		27,210
0 		3,307
0 		11,215
0 		11,038
0 		246,046
0 		0
0
(23) Edward T Schubnell (i)
(ii)		 177,325
0 		27,000
0 		10,438
0 		18,255
0 		9,963
0 		242,981
0 		0
0
(24) Philip V Spina (i)
(ii)		 184,532
0 		28,723
0 		733
0 		18,867
0 		24,163
0 		257,018
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
Supplemental Compensation Information Schedule J, Part I, Question 1a The organization provides membership in a club and a professional organization used by Patrick Magoon, CMH/CMMC Chief Executive Officer, for business purposes. Such membership is treated by the organization as a working-condition fringe benefit and is, therefore, excluded from the individual's taxable income. The organization provides membership in a professional organization used by Edward Ogata, M.D., Chief Medical Officer, for business purposes. Such membership is treated by the organization as a working-condition fringe benefit and is, therefore, excluded from the individual's taxable income. The organization provides membership in a club used by Thomas Sullivan, President of the Children's Memorial Foundation, for business purposes. Such membership is treated by the organization as a working-condition fringe benefit and is therefore, excluded from the individual's taxable income. Schedule J, Part I, Line 3 Pursuant to the bylaws of The Children's Memorial Medical Center ("CMMC"), the Governance Committee of CMMC is charged to review and approve senior executive compensation for CMMC and its affiliates. The Governance Committee has adopted a written executive compensation philosophy which it follows when it reviews and approves the compensation and benefits of the organization's senior management, including the President/Chief Executive Officer and the other senior managers. The compensation philosophy is subject to periodic review for continued appropriateness by the Governance Committee. With the assistance of a compensation consultant and information from a variety of sources (specified on Schedule J), the Governance Committee confirmed the total amounts to be paid were reasonable and comparable to amounts paid by similarly situated organizations for functionally similar positions. Outside legal counsel also serves an integral role in advising the Governance Committee with respect to federal tax requirements in setting compensation and the establishment of the rebuttable presumption of reasonableness under the federal tax law intermediate sanctions rules. The process followed by the Governance Committee, including a description of the data relied upon and the Governance Committee's decisions, was thoroughly and contemporaneously documented. The Governance Committee has expressly reviewed the reasonableness of all such payments, and has concluded, as the result of a process that is designed to qualify for the rebuttable presumption of reasonableness, that all such amounts are reasonable and do not exceed fair market value for the services provided. The Governance Committee was comprised of members of the Children's Memorial Medical Center and The Children's Memorial Hospital Boards of Directors who were determined to be disinterested for these purposes. The Governance Committee conducts an ongoing, regular review of the disinterested status of its members, and will take appropriate action with respect to anyone having an interest with respect to one or more executives so as to preserve the application of the rebuttable presumption of reasonableness. Schedule J, Part I, Question 4b The following listed individuals participated in the organization's supplemental executive retirement plan ("SERP") and earned unvested benefits during 2010, which are reported in Column (C): James Donaldson, MD $ 93,402 Susan H. Gordon $ 42,786 Stanley B. Krok $ 67,612 Patrick Magoon $448,147 Maureen Murphy $ 30,199 Paula M. Noble $105,908 Michelle M. Stephenson $ 28,163 Donna Wetzler $ 64,327 Benefits earned under the SERP are non-vested forms of deferred compensation that fund the employee's eventual retirement benefit. These benefits are provided in exchange for all of the employee's years of service to the organization, and the cost of the benefits will vary from year to year based on interest rates, age, and many other factors. The amounts are at risk and will not be paid unless and until the employee has provided substantial future services to the organization. Benefits under the SERP vest at age 62 and are forfeited if the employee leaves the organization voluntarily before age 62 (except upon the sole discretion of the Board, and only if the participant has reached at least age 55 with at least 10 years of service). Participants who voluntarily leave the organization before age 55 forfeit their entire SERP benefit upon termination. Also in response to question 4b, the following listed individuals became vested in supplemental retirement benefits under the SERP, and therefore had multi-year SERP benefits included in their taxable income: Gordon Bass, $1,162,035; Barbara Bowman, $185,735; and Edward Ogata, MD $1,623,308. In each case, the vested and taxable amount represents the value of benefits earned over many years of service to the organization, and which became vested and taxable in 2010. These benefits were subject to a substantial risk of forfeiture before 2010. Of the amounts reported on Form 990, the amounts already reported on Forms 990 in prior years were $784,200 for Gordon Bass and $1,216,586 for Dr. Ogata, and these amounts are reported in Schedule J-1, column (F). The Governance Committee of the organization's Board of Directors annually reviews all forms of executive compensation and benefits, including all reported vested and nonvested SERP benefits, and has concluded, as the result of a process that it is designed to qualify for the rebuttable presumption of reasonableness, that total compensation and the benefits provided are reasonable. Schedule J, Part I, Question 7 The organization provides annual incentive compensation to senior management under a senior management incentive compensation plan. These amounts are included in Schedule J, Part II, Column B (ii). The plan is designed to offer opportunities for additional compensation tied to performance against pre-determined financial, patient satisfaction, patient safety and individual goals approved in advance by the Governance Committee of the Children's Memorial Hospital and the Children's Memorial Medical Center, which serves as the Compensation Committee of The Children's Memorial Medical Center, and The Children's Memorial Hospital. Due to the CEO's unique role in setting and driving the long term strategic mission and operational performance of the entire organization, the Governance Committee of the Children's Memorial Hospital and The Children's Memorial Medical Center has established a long term incentive Program ("LTI") under which the CEO, Patrick Magoon, is the sole participant. Mr. Magoon is eligible to earn additional compensation for achievement of very challenging, long term goals that are established in advance by the Governance Committee. The LTI also serves as a retention vehicle since amounts earned are vested on a rolling basis over a multi-year period. During the reporting year and included in schedule J, Part II, column B (ii), are $138,718 of LTI paid to the CEO, and of this amount, $137,833 was previously reported as deferred compensation. The Governance Committee has expressly reviewed the reasonableness of all such payments, and has concluded, as the result of a process that is designed to qualify for the rebuttable presumption of reasonableness under federal tax law, that all such amounts are reasonable and do not exceed fair market value for the services provided. Schedule J, Part II The following individuals are not compensated by the reporting organization for his or her service as a director. Rather, the compensation reported on Form 990, Part VII and on Schedule J, Part II reflects compensation paid by Pediatric Faculty Foundation for the individual's substantial and full-time services as an employee. For more details, please refer to the 2010 Form 990 of Pediatric Faculty Foundation, EIN 36-3279680. Thomas P. Green, MD Mary J.C. Hendrix, PhD H. William Schnaper, MD James Donaldson, MD is not compensated by the reporting organization for his service as a director. Rather, the compensation reported on Form 990, Part VII and on Schedule J, Part II reflects compensation paid by The Children's Memorial Medical Center for the individual's substantial and full-time services as an employee. For more details, please refer to the 2010 Form 990 of The Children's Memorial Medical Center, EIN 36-3357004.
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
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number
36-2170833
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 Illinois Finance Authority
  		86-1091967 45200FGC7 05-15-2008 377,043,130 SEE SCHEDULE K PART V   X   X   X
B ILLINOIS FINANCE AUTHORITY
  		86-1091967 45200FGR4 05-15-2008 173,490,000 SEE SCHEDULE K PART V   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired. . . . .        
2 Amount of bonds defeased . . . .        
3 Total proceeds of issue . . . . 383,717,102 173,514,604    
4 Gross proceeds in reserve funds . . 14,546,968 0    
5 Capitalized interest from proceeds. 45,332,159 0    
6 Proceeds in refunding escrow. . . . . 0 172,714,594    
7 Issuance costs from proceeds . . . 3,119,559 589,202    
8 Credit enhancement from proceeds. 6,305,197 52,764    
9 Working capital expenditures from proceeds . . 158,044 158,044    
10 Capital expenditures from proceeds . . 314,403,923      
11 Other spent proceeds . .        
12 Other unspent proceeds. . . 0 0    
13 Year of substantial completion . . . 2012 2006
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue?   X X          
15 Were the bonds issued as part of an advance refunding issue?   X   X        
16 Has the final allocation of proceeds been made? . .   X X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . 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        
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .   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          
b Are there any research agreements that may result in private business use of bond-financed property? . .   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          
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 %    
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 %    
6 Total of lines 4 and 5 . . .. . . . . . 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          
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          
2 Is the bond issue a variable rate issue?   X X          
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?   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        
b Name of provider .  
  		 
  		 
  		 
 
c Term of GIC . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .                
5 Were any gross proceeds invested beyond an available temporary period? .   X   X        
6 Did the bond issue qualify for an exception to rebate? . . .   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 (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
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number

36-2170833
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) Alexis Baby Family Member of Baine 55,926 Employment   No
(2) AON Case is President/CEO 607,478 Insurance Brokerage Services   No
(3) JPMorgan Chase L.Crown's son is a Dir 1,396,346 Financial Services   No
(4) JPMorgan Chase P.Crown's spouse is a Dir 1,396,346 Financial Services   No
(5) Sidley Austin LLP Douglas is Ptnr & CoChair 274,783 Legal Services   No
(6) Merge Healthcare Ferro is an Officer 133,937 Information Technology Svcs   No
(7) Northern Trust Logan is an Officer 500,726 Financial Services   No
(8) AON A. McKenna is a Director 607,478 Insurance Brokerage Services   No
(9) Mauricio Santiago Family Member of Ogata 46,912 Employment   No
(10) US Equities Realty Pacher is an Officer 117,449 Real Estate Consulting Svcs   No
(11) Element79 Partners LLC Williams is President/CEO 392,194 Advertising Services   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 M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number

36-2170833
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded . X 35 1,608,766 market
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( )
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell non-cash
contributions? ............................
32a
Yes
 
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2010
Schedule M (Form 990) 2010
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33. Also complete this part for any additional information.
Identifier Return Reference Explanation
Third parties hired to process noncash contributions Schedule M, Part I, line 32b All securities (non-cash donations) are sent directly to Northern Trust. Northern Trust as Custodian and broker sells the securities immediately. For donor recognition purposes, gifts are valued at the median prices on the day the securities are received. For accounting purposes, values are reconciled for any gain/loss on the sale of securities.
Schedule M (Form 990) 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
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number

36-2170833
Identifier Return Reference Explanation
Description of Relationships Form 990, Part VI, Question 2 *Gregory C. Case has a business relationship with Andrew J. McKenna. *Lester Crown has a family relationship with Paula H. Crown. *William J. McKenna has a family and business relationship with Andrew J. McKenna. *Lyle Logan has a business relationship with Charles H. James III. *William J. Devers Jr. has a business relationship with Andrew J. McKenna *William J. Devers Jr. has a business relationship with Michael W. Ferro Jr. *John M. Crocker Jr. had a business relationship with Bert A. Getz Jr. *Bert A. Getz Jr. has a business relationship with Edward J. Wehmer and Charles H. James III. *Anthony K. Kesman has a business relationship with Daniel J. Hennessy. *Adam A. Kriger has a business relationship with Andrew J. McKenna. *Stephen A. Smith has a business relationship with Peer Pedersen. *Linda S. Wolf and Eric Lefkofsky have a business relationship. Description of Classes of Members or Stockholders Form 990, Part VI, Question 6 THE CHILDREN'S MEMORIAL MEDICAL CENTER ("CMMC") IS THE ORGANIZATION'S SOLE CORPORATE MEMBER. Description of Classes of Persons and the Nature of Their Rights Form 990, Part VI, Question 7a THE ORGANIZATION'S SOLE CORPORATE MEMBER, THE CHILDREN'S MEMORIAL MEDICAL CENTER, HAS CERTAIN RESERVED POWERS, INCLUDING THE POWER TO APPOINT AND REMOVE ALL DIRECTORS OF THE ORGANIZATION.
Descr Classes of Persons, Decisions Requiring Appr & Type of Voting Rights Form 990, Part VI, Question 7b THE CHILDREN'S MEMORIAL MEDICAL CENTER, THROUGH ITS BOARD OF DIRECTORS OR DESIGNATED COMMITTEE, AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, HAS CERTAIN RESERVE POWERS WITH RESPECT TO APPOINTMENT AND REMOVAL OF DIRECTORS, APPOINTMENT OF CERTAIN OFFICERS, APPROVAL OF AMENDMENTS TO GOVERNING DOCUMENTS, APPROVAL OF FINANCIAL MATTERS, AND APPROVAL OF SIGNIFICANT TRANSACTIONS INCLUDING, BUT NOT LIMITED TO, MERGER, DISSOLUTION, DISPOSITION OF ASSETS OTHER THAN IN THE ORDINARY COURSE OF BUSINESS, AND CREATION OF SUBSIDIARIES.
Describe the Process used by Management &/or Governing Body to Review 990 Form 990, Part VI, Question 11B A PUBLIC DISCLOSURE COPY OF THE ORGANIZATION'S FISCAL YEAR 2011 TAX RETURN ("FORM 990") WAS PROVIDED TO EACH MEMBER OF THE ORGANIZATION'S AUDIT COMMITTEE (OF THE BOARD) BEFORE A REGULARLY SCHEDULED AUDIT COMMITTEE MEETING AND BEFORE THE FORM 990 WAS FILED. THE AUDIT COMMITTEE IS THE COMMITTEE OF THE ORGANIZATION CHARGED WITH OVERSIGHT OF AUDIT AND TAX MATTERS. THE AUDIT COMMITTEE WAS PROVIDED A DETAILED OVERVIEW OF THE FORM 990 BY THE CHIEF FINANCIAL OFFICER ("CFO") AND THE ORGANIZATION'S DIRECTOR OF TAX COMPLIANCE. THE CFO AND DIRECTOR OF TAX COMPLIANCE ALSO RESPONDED TO THE AUDIT COMMITTEE MEMBERS' QUESTIONS AND AFFORDED THE OPPORTUNITY FOR DETAILED DISCUSSION OF THE FORM 990, PRIOR TO THE AUDIT COMMITTEE TAKING ACTION TO APPROVE THE FILING OF THE FORM 990. AS PART OF ITS TAX PREPARATION PROCESS, THE ORGANIZATION ON AN ONGOING BASIS CONSULTED ITS TAX CONSULTING FIRM AND OUTSIDE TAX LEGAL COUNSEL, BOTH OF WHICH POSSESS EXPERTISE IN HEALTH CARE AND TAX-EXEMPT RETURN PREPARATION, TO ADVISE AND ASSIST IN THE PREPARATION OF FORM 990. THESE ADVISORS WORKED CLOSELY WITH THE ORGANIZATION'S FINANCE AND INTERNAL LEGAL PERSONNEL AND OTHER MEMBERS OF THE ORGANIZATION'S TEAM ASSEMBLED TO PARTICIPATE IN THE PREPARATION OF THE FORM 990. PRIOR TO PRESENTING THE FORM 990 TO THE BOARD'S AUDIT COMMITTEE, THE ORGANIZATION'S TEAM, INCLUDING ITS ADVISORS, MET FREQUENTLY TO DISCUSS AND REVIEW DRAFTS OF THE FORM.
Description of Process to Monitor Transactions for Conflicts of Interest Form 990, Part VI, Question 12c ON AN ANNUAL BASIS, THE CHILDREN'S MEMORIAL MEDICAL CENTER AND ITS AFFILIATES ("CMMC") PROVIDE A COMPREHENSIVE QUESTIONNAIRE TO ITS BOARD MEMBERS, SENIOR MANAGEMENT AND PURCHASING PERSONNEL POSING QUESTIONS ABOUT ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. CMMC INITIATES FOLLOW UP CONTACT TO THOSE WHO DO NOT RESPOND AND TO CLARIFY RESPONSES, WHERE NECESSARY. CMMC REVIEWS EACH DISCLOSURE AND PROVIDES A SUMMARY OF RELEVANT DISCLOSURES FOR THE REVIEW AND APPROVAL OF ITS GOVERNANCE COMMITTEE. Pursuant to the Conflicts of Interest Policy of The Children's Memorial Medical Center and affiliates ("Corporation"), directors, officers, physician leaders, and others who are subject to the policy are required to promptly and fully disclose in writing any actual, apparent or potential conflict of interest to the President of the Corporation and General Counsel. This disclosure shall be provided to the Governance Committee of the Corporation which shall consider all conflicts of interest issues and, if appropriate, shall provide such written disclosure to the Directors, Board committees considering the proposed transaction or other appropriate parties. In addition, on an annual basis, the Corporation surveys each individual subject to the policy as to the existence of actual or potential conflicts of interest. The Corporation will not enter into an agreement, transaction or other arrangement involving a conflict of interest unless the disinterested members of the Governance Committee of the Corporation's Board of Directors determine by a majority vote that appropriate safeguards to protect the charitable mission of the Corporation have been implemented. The subject interested person may not be present when the vote is taken. If it is determined that a conflict of interest exists, a disinterested person or committee of disinterested members may be assigned to investigate alternatives to the proposed transaction or arrangement. After exercising due diligence, the Board or committee shall determine whether the Corporation can obtain a more advantageous transaction or arrangement, with reasonable efforts, from a person or entity that would not give rise to a conflict of interest. If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the Board or committee shall determine by a majority vote of the disinterested directors whether the transaction is in the Corporation's best interest and for its own benefit and whether the transaction is fair and reasonable to the Corporation, and shall make its decision as to whether to enter into the transaction or arrangement.
Offices & Positions for Which Process was Used, & Year Process was Begun Form 990, Part VI, Question 15a & 15b The authority to review and approve executive compensation has been delegated to the Governance Committee of the Children's Memorial Medical Center board of directors ("Governance Committee"). The Governance Committee has adopted a written executive compensation philosophy which it follows when it reviews and approves the compensation and benefits of the organization's senior management, including the President/Chief Executive Officer and the other senior managers. The compensation philosophy is subject to periodic review for continued appropriateness by the Governance Committee. With the assistance of a compensation consultant and information from a variety of external sources (specified on schedule J), the Governance Committee confirmed the total amounts to be paid were reasonable and comparable to amounts paid by similarly situated organizations for functionally similar positions. Outside Legal counsel also serves an integral role in advising the Governance Committee with respect to federal tax requirements in setting compensation and the establishment of the rebuttable presumption of reasonableness. The process followed by the Governance Committee, including a description of the data relied upon and the Governance Committee's decisions, was thoroughly and contemporaneously documented. The Governance Committee has expressly reviewed the reasonableness of all such payments, and has concluded, as the result of a process that is designed to qualify for the rebuttable presumption of reasonableness under federal tax law, that all such amounts are reasonable and do not exceed fair market value for the services provided. The Governance Committee was comprised of members of The Children's Memorial Medical Center and The Children's Memorial Hospital Boards of Directors who were determined disinterested for these purposes. The Governance Committee conducts an ongoing and periodic review of the disinterested status of its members, and will take appropriate action with respect to anyone having an interest with respect to one or more executives so as to preserve the application of the rebuttable presumption of reasonableness.
Avail of Gov Docs, Conflict of Interest Policy, & Fin Stmts to Gen Public Form 990, Part VI, Question 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE ONLINE AT WWW.DACBOND.COM. THE ORGANIZATION'S ARTICLES OF INCORPORATION AND ANNUAL REPORTS ARE AVAILABLE THROUGH THE ILLINOIS SECRETARY OF STATE. THE ORGANIZATION ALSO MAKES ITS GENERAL GOVERNING DOCUMENTS AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST.
AVG. HOURS WORKED FOR RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A, LINE 1A THE FOLLOWING INDIVIDUALS ARE EMPLOYEES OF THE CHILDREN'S MEMORIAL HOSPITAL AND GENERALLY WORK 40 HOURS PER WEEK. APPROXIMATELY 2 HOURS OF ADDITIONAL TIME EACH WEEK IS SPENT PROVIDING SERVICES TO RELATED ORGANIZATIONS: PATRICK M. MAGOON PAULA M. NOBLE EDWARD OGATA, MD THOMAS SULLIVAN DONNA S. WETZLER SHERWOOD D. ZELLERMAYER THE FOLLOWING INDIVIDUAL IS AN EMPLOYEE OF THE CHILDREN'S MEMORIAL MEDICAL CENTER AND GENERALLY WORKS 40 HOURS PER WEEK. APPROXIMATELY 10 HOURS OF HIS REGULAR WORK WEEK IS SPENT PROVIDING SERVICES TO RELATED ORGANIZATIONS: JAMES DONALDSON, MD THE FOLLOWING INDIVIDUALS ARE EMPLOYEES OF PEDIATRIC FACULTY FOUNDATION AND GENERALLY WORK 40 HOURS PER WEEK. APPROXIMATELY 2 HOURS OF ADDITIONAL TIME EACH WEEK IS SPENT PROVIDING SERVICES TO RELATED ORGANIZATIONS: THOMAS P. GREEN, MD MARY J.C. HENDRIX, PHD H. WILLIAM SCHNAPER, MD OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 Net unrealized gains on investments 84,841,236 Grants released from restrictions 1,910,282 Other (restricted) 222,653 Pension adjustment 14,000,336 Founders' Board Activities 311,764 Change in fair value of perpetual trusts 2,423,336 ---------- 103,709,607
Tax-exempt Bonds Description of Purpose Form 990 Schedule K Part I Bond 1: Illinois Finance Authority Revenue Bonds, Series 2008 A/B, The Children's Memorial Hospital (borrower) The proceeds of the sale of the series 2008 A/B bonds will be used to (i) Pay or reimburse the borrower for the payment of a portion of the costs of acquiring, constructing and equipping the Ann & Robert H. Lurie Children's Hospital of Chicago ("Lurie children's"), (ii) pay a portion of the interest on the series 2008 A/B bonds during the period of construction of Lurie Children's, (iii) fund a debt service reserve fund for the series 2008 B bonds, and (iv) pay certain expenses incurred in connection with the issuance of the series 2008 A/B bonds. Bond 2: Illinois Finance Authority Revenue Bonds, Series 2008 C/D The Children's Memorial Hospital (borrower) The borrower utilized the proceeds of the series 2008 C/D bonds to (i) refund the outstanding principal amount of the series 1999 B-1 bonds (issued: 9/1/99), 1999 B-2 bonds (issued: 9/1/99), 2003 A bonds (issued: 11/18/03), 2003 B bonds (issued: 11/18/03) and 2004 bonds (issued: 4/14/04) and, (ii) pay certain expenses incurred in connection with the issuance of the series 2008 C/D bonds. Form 990 Schedule K Part I Line 3 Bond 1: The amount of $383,717,102 reported in Part I Line 3, includes total issue proceeds of $377,043,130 and investment income of $6,673,972. Bond 2: The amount of $173,514,604 reported in Part I Line 3, includes total issue proceeds of $173,513,033 and investment income of $1,571. Form 990 Schedule K Part II Line 9 Working capital expenditure includes monies remaining from the initial allocation of bonds towards bond issuance costs (and placed in the Expense Funds) that were then transferred per the requirements of the bond documents and used towards interest payments.
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


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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
THE CHILDREN'S MEMORIAL HOSPITAL
 
Employer identification number

36-2170833
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) The Children's Memorial Research Center

2300 Childrens Plaza

Chicago,IL60614
36-3357005 		RESEARCH IL 501(c)(3) 4 CMMC
 
 
 
(2) The Children's Memorial Foundation

2300 Childrens Plaza

Chicago,IL60614
36-3357006 		FUNDRAISING IL 501(c)(3) 7 CMMC
 
 
 
(3) The Children's Memorial Medical Center

2300 Childrens Plaza

Chicago,IL60614
36-3357004 		HEALTH CARE IL 501(c)(3) 11 III-FI NA
 
 
 
(4) Pediatric Faculty Foundation Inc

2300 Childrens Plaza

Chicago,IL60614
36-3279680 		HLTH CRE/RSCH IL 501(c)(3) 11 III-FI CMMC
 
 
 
(5) CMH Self Insurance Foundation

2300 Childrens Plaza

Chicago,IL60614
36-6638400 		INSURANCE IL 501(c)(3) 11 III-FI CMMC
 
 
 
(6) MCGAW MEDICAL CTR OF NORTHWESTERN UNIV

645 NORTH MICHIGAN AVE 1058

CHICAGO,IL60611
36-2656113 		SUPPORTNG ORG IL 501(C)(3) 11 III-FI NA
 
 
 


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
(1) CMMC Insurance Co LTD
2300 Childrens Plaza
CHICAGO,IL60614
000000000 		SELF INSURANCE CJ NA
  		CORPORATION      












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
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
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
Yes
 
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
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
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)
(2)
(3)
(4)
(5)
(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


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