Form990
Click to see attachment
Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
A For the 2015 calendar year, or tax year beginning 01-01-2015 , and ending 12-31-2015
BCheck if applicable:
CName of organization
Gillette Children's Specialty Healthcare
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
200 University Avenue East
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
St Paul, MN55101
D Employer identification number

36-3379150
E Telephone number

G Gross receipts $ 257,590,918
F Name and address of principal officer:
James Haddican
200 University Avenue East
St Paul,MN55101
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.gillettechildrens.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1897
M State of legal domicile: MN
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Provides specialized health care for people who have disabilities that began during childhood.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 19
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 15
5 Total number of individuals employed in calendar year 2015 (Part V, line 2a) ...... 5 1,759
6 Total number of volunteers (estimate if necessary) ............. 6 296
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 31,704
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -53,289
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 4,744,255 7,967,703
9 Program service revenue (Part VIII, line 2g) ......... 221,690,301 228,497,539
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 4,092,796 3,818,926
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 37,342 -124,823
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 230,564,694 240,159,345
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 19,000 16,500
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) 123,335,901 125,527,267
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–24e).... 82,935,169 98,052,981
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 206,290,070 223,596,748
19 Revenue less expenses. Subtract line 18 from line 12....... 24,274,624 16,562,597
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 282,653,498 285,568,432
21 Total liabilities (Part X, line 26)............. 75,979,206 70,663,694
22 Net assets or fund balances. Subtract line 21 from line 20..... 206,674,292 214,904,738
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 Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2015)
Form 990 (2015)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: Gillette helps children and adults who have complex and rare medical conditions affecting the musculoskeletal and neurological systems improve their health and well-being. Gillette's staff treats people who have cerebral palsy, complex orthopedic conditions, craniofacial anomalies, neurological conditions, brain and spinal cord injuries, spina bifida, and juvenile arthritis, and other childhood-onset disabilities.
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 organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations 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 $ 188,588,723 including grants of $ 16,500 ) (Revenue $ 227,892,929 )
Gillette Children's Specialty Healthcare ("Gillette") is an independent and nonprofit hospital based in St. Paul, Minnesota. Although smaller than many children's hospitals, Gillette's reach is vast. During 2015, the organization saw 25,957 patients from all 87 Minnesota counties, 41 U.S. states, and 11 other countries. Gillette operates four pediatric clinics in the Twin Cities metro area (in St. Paul, Minnetonka, Maple Grove and Burnsville); four clinic hubs in greater Minnesota (in Baxter, Duluth, Mankato and Willmar); and 11 Outreach Clinics in communities throughout greater Minnesota. See Schedule O.Gillette Lifetime Specialty Healthcare, also based in St. Paul, provides outpatient care for adults who have disabilities that began during childhood. Rather than providing care for all health issues, Gillette concentrates on treating people who have childhood-onset disabilities and complex, rare and traumatic medical conditions affecting the musculoskeletal and neurological systems. Those patients need more advanced medical care and a greater number of specialists than most individuals. Gillette is accredited by the Joint Commission for all services surveyed under the comprehensive accreditation manual for hospitals. Gillette also has the nation's first accredited motion analysis laboratory, certified by the Commission for Motion Laboratory Accreditation. Committed to continuous improvement, Gillette participates in the Children's Hospitals' Solutions for Patient Safety, a national collaborative of pediatric hospitals throughout the U.S. focused on eliminating adverse health events and patient harm. Inpatient: Gillette's inpatient services focus on patients who have specific disabilities and complex conditions, including those resulting from trauma. In 2015, Gillette had 2,477 total hospital admissions. Gillette surgeons treat children who need craniofacial surgery, neurosurgery (including selective dorsal rhizotomy surgery to treat spasticity), orthopedic surgery, urology surgery and other pediatric surgical services. Gillette also serves patients who are hospitalized for traumatic and acquired brain injuries, spinal cord injuries, comprehensive medical rehabilitation services, baclofen pump implantations and ventilator support.Gillette developed its integrated care model to focus on people who have medically complex diagnoses. As a result, our providers treat conditions that others rarely see. The tangible results of this approach have made a significant impact on the health of a unique and underserved patient population. Gillette's 2015 unplanned readmission rate, for instance, was 6.7 percent, lower than the Children's Hospitals Solutions for Patient Safety benchmark of 7.8 percent. Through its presurgical preparation program, discharge planning program, and telehealth nursing services, Gillette identifies patients at risk of complications and develops plans to reduce those risks. Gillette inpatient nursing teams play an active role as well. For instance, nurses recently piloted a concept, called the TyMed Toolkit, which helps families track their children's medication needs and manage their pain following hospital discharge. Gillette's Pediatric Intensive Care Unit (PICU) serves patients who need critical care services following a major surgery or a traumatic injury. In 2015, the PICU received a prestigious Gold-level Beacon Award for Excellence, the highest honor given by the American Association of Critical-Care Nurses. Gillette is the only children's hospital in the five-state region to hold this honor. Together, Gillette and Regions Hospital operate Minnesota's first Level I Pediatric Trauma Center. The organizations offer a combined team of pediatric specialists who provide immediate stabilization and coordinated intervention through Regions' emergency department and Gillette's PICU. Gillette provides the services of pediatric intensivists, pediatric neurosurgeons, pediatric orthopedic surgeons, pediatric surgeons, and pediatric rehabilitation medicine physicians. Many children seen in the Level 1 Pediatric Trauma Center later transfer to Gillette's inpatient rehabilitation program-the region's largest rehabilitation program for children and teens. Gillette is also one of only three pediatric specialty programs in Minnesota accredited by the Commission for Accreditation of Rehabilitation Facilities to meet the needs of children and teens seeking acute inpatient rehabilitation care. Surgery: Gillette physicians performed 3,722 surgeries in 2015, including 240 dental surgeries. These numbers include same-day surgeries and surgeries that required an overnight hospital stay. The majority of Gillette procedures involve orthopedics, neurosurgery and craniofacial surgery.Gillette has the Midwest's largest team of fellowship-trained pediatric orthopedic surgeons. Among other services, they correct multiple soft tissue and bone problems during one operation, called a single-event multilevel surgery (SEMLS), to help children with spasticity improve or maintain walking ability and lessen pain and health issues that stem from misaligned muscles and bones. These surgeons also treat hip and spine conditions and limb-length discrepancies, utilizing advanced technology to improve treatment outcomes. Gillette surgeons were among the first in the region to treat severe scoliosis with magnetically driven growing rods, an advanced magnetic system that is less invasive than traditional treatment options. Our surgeons use similar technology, called motorized intramedullary limb lengthening rods, to treat limb-length deficiencies with decreased pain and scarring.Gillette is a regional leader in pediatric neurology and neurosurgery. Some children with muscle tightness, also called spasticity, benefit from selective dorsal rhizotomy surgery. During this procedure, neurosurgeons selectively sever certain nerve rootlets in the spinal cord that are contributing to spasticity. Gillette neurosurgeons also might implant intrathecal baclofen pumps (to treat muscle spasticity), shunts (to treat hydrocephalus) and vagus nerve stimulators (to treat epilepsy).Gillette's craniofacial specialists use advanced microsurgical and craniofacial techniques to ensure the best possible outcomes for children with cleft lip and palate and other complex malformations, such as those resulting from craniosynostosis. Recently pediatric craniofacial and plastic surgeon Robert Wood, M.D., developed and put into practice a technique for performing craniosynostosis repair surgery without blood transfusions. He is the first surgeon to consistently eliminate blood transfusions in this type of surgery. Since Wood put the groundbreaking technique into practice in 2013, patients' need for transfusions has steadily declined to less than five percent in 2015. By comparison, the typical approach used by other hospitals has a transfusion rate of 90-100 percent. Wood's technique has also reduced operative time for craniosynostosis repair to between one and one-and-a-half hours-the process can take between 3 and 7 hours at other facilities. Less time under anesthesia reduces the surgical risk for young patients. Wood presented his transfusion-less approach internationally during 2015. Outpatient: Patients made 155,517 visits to Gillette outpatient clinics in 2015. This number includes visits for casting and neurodiagnostics as well as for more typical outpatient care. The statistic reflects patients seen at the main campus in St. Paul, at all other Gillette clinic locations, and through Gillette's Outreach Clinics. During 2015 Gillette opened a therapy pool at its St. Paul outpatient facility. The pool, which includes features specifically designed to meet the needs of children who have disabilities, allows Gillette patients to practice new skills, build muscle strength, and work on improving balance. Both inpatients and outpatients can receive aquatic therapy services. The hospital advanced another important outpatient service during 2015-its production of the Gillette CranioCap orthosis to treat deformational plagiocephaly, or flat head syndrome. The purchase of the hospital's first 3D printer has reduced production costs and improved turnaround times on the custom cranial helmets, which gradually correct infants' head shape without the need for surgery. The printer also helps staff view and precisely design each model, ultimately producing a cap that's better suited to the unique needs of each patient. Because few traditional dentists have the facilities, equipment or trained staff to serve people who have disabilities. Gillette offers outpatient care from dentists and orthodontists who understand the unique needs of people who have complex conditions. Dental services designed specifically for this patient population is important, as many disabilities make it difficult for patients to be seen by a traditional dentist. People who have cerebral palsy, for example, might have muscles
4b (Code:   ) (Expenses $ 2,854,983 including grants of $   ) (Revenue $ 313,942 )
Research: Gillette's research activities concentrate on clinical applications devoted to finding effective medical interventions for disabling conditions and their related effects. Gillette has four designated research areas: gait and motion analysis, pain and comfort, musculoskeletal conditions, and neurological services. Gillette has studied human movement, conducting both basic and clinical research that has gained international recognition, for more than 25 years.See Schedule O.In 2015, Gillette researchers initiated 20 new projects, bringing the hospital's total active studies to 168. For example, the National Institutes of Health named Gillette a co recipient of a fiveyear, $1.6 million grant that will allow a team from the James R. Gage Center for Motion Analysis to continue improving treatment outcomes for people who have cerebral palsy. Gillette also became part of the Rett Natural History Study-one of only 14 U.S. hospitals engaged in a collaborative to research effective treatments for Rett syndrome. Gillette doctors and staff published 55 research studies in medical journals and spoke at numerous medical conferences throughout 2015. Through its key research areas of Motion Analysis, Musculoskeletal, Neuroscience, and Pain & Comfort, Gillette is pursuing lines of inquiry that are most relevant to its patient population. In addition to these priority areas, Gillette has launched an aggressive knowledge translation initiative that aims to advance patient outcomes and experience by better incorporating current medical research into ongoing clinical practice.
4c (Code:   ) (Expenses $ 2,426,196 including grants of $   ) (Revenue $ 290,668 )
Education: Through fellowships, seminars and other educational programs, Gillette strives to share expertise that benefits all children who have complex conditions. For physicians who desire in-depth training, Gillette offers residencies and fellowships in such specialties as pediatrics, orthopedics, and pediatric rehabilitation medicine. As a teaching hospital, Gillette trains the physicians of the future in pediatric specialties likely to be affected by a physician shortage, according to the American Academy of Pediatrics. Residents from the University of Minnesota and Henry Ford Hospital in Detroit spend one to three months under the mentorship of Gillette's medical staff. See Schedule O.In many cases, Gillette offers physicians their only exposure during residency to patients who have complex and rare conditions. Gillette provides training for more than 90 residents and fellows each year.The organization's training programs include the specialties of orthopedics, pediatrics, neurodevelopmental pediatrics, and rehabilitation medicine. Gillette also offers shadowing and mentorship programs for students, along with professional education opportunities in such areas as physical therapy, radiology, nursing, respiratory care and assistive technology.Gillette covers the unreimbursed costs of medical education and is fully accredited by the Minnesota Medical Association to provide continuing medical education (CME) for physicians. Each year, Gillette sponsors conferences on topics such as cerebral palsy, orthopedics and motion analysis. In 2015, Gillette provided 151 hours of clinical medical education to 525 physicians and 1,651 other health care providers.. The conferences educate medical professionals about treatment options for children who have disabilities. Typical audiences include pediatricians, family practitioners and other physicians. CME activities are open to other health professionals. Gillette's CME audiences might include nurse practitioners, physician assistants, nurses, physical therapists, occupational therapists, speech and language therapists, orthotists and prosthetists.
(Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
Focus Areas: Gillette serves a community of children and adults who have rare and complex conditions. These patients are outliers in the health care continuum and require specialized treatment unavailable in the primary care system. We focus on the following areas;Cerebral Palsy: Our services range from infant evaluations to specialty care for adults. Treatment plans might include developmental assessments, rehabilitation therapies, orthoses and other types of assistive technology, tone management techniques (including surgery, botulinum toxin, neurolytic agents, and intrathecal baclofen), gait and motion analysis, and orthopedic care.Craniofacial Services: Gillette diagnoses and treats children who have congenital or acquired conditions involving the head and neck. Outpatient services include on-site fittings for and moldings of the Gillette CranioCap orthosis, a custom-made brace for the skull that corrects deformational plagiocephaly. For many children with clefts, Gillette orthodontists custom-make Gillette's OrthoCleft retainer, a presurgical appliance that reduces the gap in the mouth, improving feeding abilities. Gillette also treats children who have craniosynostosis, hemangiomas and vascular malformations.Pediatric Orthopedics: With the largest team of fellowship-trained pediatric orthopedic surgeons in the Midwest, Gillette offers advanced expertise in treating musculoskeletal conditions associated with congenital or acquired childhood disorders, including cerebral palsy, spina bifida, neuromuscular conditions, trauma-related fractures, scoliosis and sports-related injuries. Gillette's orthopedists specialize in complex surgical techniques and have extensive experience in limb lengthening and reconstruction; spasticity evaluation and management; scoliosis and other spine problems; clubfoot; and gait and motion analysis. Gillette surgeons were among the first in the region to treat severe scoliosis with magnetically driven growing rods, an advanced technology that reduces the need for frequent invasive surgery to correct the condition. In the James R. Gage Center for Gait and Motion Analysis, Gillette clinicians use advanced computer technology to analyze how muscles, joints and nerves make movement possible. The analyses measure motion, force production, energy expenditure and plantar pressure. Physicians use the analyses to plan appropriate care for patients. Gillette is home to one of the busiest single-site clinical motion analysis centers in the nation, active in both clinical care and research. Pediatric Rehabilitation: Gillette offers comprehensive inpatient rehabilitation programs for children who sustain brain and spinal cord injuries, as well as inpatient rehabilitation care following complex orthopedic surgeries, neurosurgery, strokes and other conditions. In addition, Gillette offers outpatient physical therapy, occupational therapy, speech and language therapy, and related services. On-site therapy gyms offer specialized therapy and fitness equipment, and patients who have neurological and musculoskeletal problems can benefit from aquatic therapy. Gillette has the largest pediatric rehabilitation program in the region, and it employs the nation's largest group of board-certified pediatric rehabilitation medicine physicians.Pediatric Neurological Services: Gillette provides interdisciplinary services for patients who have neurological conditions, neuromuscular conditions, and neurological complications related to disabilities. In the Neurotrauma Clinic, Gillette staff help determine when children can safely return to activities following brain injuries. Gillette has the largest spina bifida program in the five-state area, offering care for the medical complications associated with the condition, including tethered spinal cord; bladder, bowel and kidney problems; eye problems; seizures; hydrocephalus; and orthopedic issues. In 2015 Gillette added neuroimmunology services for children who have conditions or infections that affect their autoimmune systems. One of Gillette's focused efforts involves enhancing clinical care for children who have dystonia (involuntary muscle contractions). Gillette is the only Twin Cities provider offering deep brain stimulation (DBS) as a surgical intervention for complex movement disorders often associated with cerebral palsy. DBS can help patients who have complex neurologic conditions that don't respond to medication, physical therapy or other treatments. Gillette is one of the first children's hospitals nationwide to perform the intervention as part of a coordinated care plan to treat complex movement disorders. Pediatric Subspecialty Care: Gillette brings together a wide range of pediatric specialists to treat complex, difficult-to-diagnose conditions and manage associated symptoms. For some patients, integrative care-including acupuncture, therapeutic massage, biofeedback and osteopathic manipulation therapy-is an important part of the overall care process. In addition, Gillette treats patients who have rare genetic conditions, like Rett syndrome, or rheumatic and related inflammatory conditions, including juvenile rheumatoid arthritis, lupus, and scleroderma. Gillette also sees patients who have neurodevelopmental problems and diagnoses requiring neuropalliative care.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet193,869,902
Form 990 (2015)
Form 990 (2015)
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 (see instructions)? 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, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment..............
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part IIIClick to see attachment.................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which 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 for escrow or custodial account liability; 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 temporarily restricted endowments, permanent endowments, 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, line 10?
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 VIIClick to see attachment.......
11b
 
No
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 VIIIClick 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 IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If "Yes," complete Schedule D, Parts XI and XII 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 and XII 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, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........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 other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....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 other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...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 (see instructions) ....
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
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government 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 or other assistance to or for domestic individuals 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, line 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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............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), 501(c)(4), and 501(c)(29) 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
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? 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 employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? 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 direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I.
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ...........
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ........Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, 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
35b
Yes
 
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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2015)
Form 990 (2015)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
23
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
1,759
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” to line 3b, 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, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
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 as charitable contributions? ...
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.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? .........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring 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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2015)
Form 990 (2015)
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 or note to any line 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
19
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
15
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, 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," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
MN , WI
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletKyle Eidem200 University Ave East   St Paul,MN55101 (651) 325-2237
Form 990 (2015)
Form 990 (2015)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line 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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Brad Keil......................................................................
Chair
 1.00
.................
0.00 		X   X       0 0 0
(2) Warren Watson......................................................................
Vice Chair
 1.00
.................
0.00 		X   X       0 0 0
(3) Yvonne Cheek......................................................................
Secretary
 1.00
.................
0.00 		X   X       0 0 0
(4) Scott Robinson......................................................................
Treasurer
 1.00
.................
0.00 		X   X       0 0 0
(5) Barbara Joers......................................................................
President/CEO
 40.00
.................
0.00 		X   X       644,806 0 68,495
(6) Brad Winges......................................................................
Director
 1.00
.................
0.00 		X           0 0 0
(7) Dan Monson......................................................................
Director
 1.00
.................
0.00 		X           0 0 0
(8) David Bestler......................................................................
Director
 1.00
.................
0.00 		X           0 0 0
(9) David Fettig......................................................................
Director
 1.00
.................
0.00 		X           0 0 0
(10) Diane Harper......................................................................
Director
 1.00
.................
0.00 		X           0 0 0
(11) Fay DeBellis......................................................................
Director
 1.00
.................
0.00 		X           0 0 0
(12) John Ellenberger......................................................................
Director
 1.00
.................
0.00 		X           0 0 0
(13) John Foster......................................................................
Director
 1.00
.................
0.00 		X           0 0 0
(14) Mark Kimball......................................................................
Director
 1.00
.................
0.00 		X           0 0 0
(15) Phil Becker......................................................................
Director
 1.00
.................
0.00 		X           0 0 0
(16) Phillip Trier......................................................................
Director
 1.00
.................
0.00 		X           0 0 0
(17) Michael Healy MD......................................................................
Chief of Staff
 40.00
.................
0.00 		X           609,145 0 54,007
Form 990 (2015)
Form 990 (2015)
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 (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Marcie Ward MD........................................................................
Director
 40.00
.......................0.00 		X           266,884 0 46,091
(19) Robert Wagner MD........................................................................
Prior Chief of Staff
 40.00
.......................0.00 		X           262,739 0 47,011
(20) Elizabeth Rivard Jan 2015........................................................................
VP-HR, Ed, & Guest Exp
 40.00
.......................0.00 		      X     169,357 0 8,165
(21) Steven Koop MD........................................................................
Medical Director
 40.00
.......................0.00 		      X     812,311 0 141,811
(22) Timothy Getsay........................................................................
Vice Pres - Perf & Info Mgt
 40.00
.......................0.00 		      X     351,646 0 45,893
(23) James Haddican........................................................................
VP - Finance
 40.00
.......................0.00 		      X     371,199 0 46,921
(24) Karen Brady........................................................................
VP-HR, Ed, & Guest Exp
 40.00
.......................0.00 		      X     227,104 0 46,725
(25) Karen Brill........................................................................
VP - Patient Care
 40.00
.......................0.00 		      X     289,411 0 44,195
(26) Dennis Jolley........................................................................
VP Inst Adv
 27.00
.......................18.00 		      X     145,705 97,137 37,498
(27) Kathryn Wardrop........................................................................
VP-Strategy and Op
 40.00
.......................0.00 		      X     366,842 0 61,863
(28) Paula Montgomery........................................................................
General Counsel
 40.00
.......................0.00 		      X     187,989 0 39,922
(29) Stephen Sundberg MD........................................................................
Orthopaedic Surgeon
 40.00
.......................0.00 		        X   813,797 0 52,431
(30) Patrick Graupman MD........................................................................
Pediatric Neurosurgeon
 40.00
.......................0.00 		        X   813,470 0 43,532
(31) Michael Partington MD........................................................................
Pediatric Neurosurgeon
 40.00
.......................0.00 		        X   787,623 0 54,317
(32) Robert Wood MD........................................................................
Craniofacial Surgeon
 40.00
.......................0.00 		        X   759,763 0 50,189
(33) Debbie Song MD........................................................................
Pediatric Neurosurgeon
 40.00
.......................0.00 		        X   698,912 0 49,770
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 8,578,703 97,137 938,836
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet175
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
Regions Hospital

640 Jackson St
St Paul,MN55101 		Direct Patient Charges, Employee Health 9,740,542
Children's Resp & Critical Care

2545 Chicago Ave Ste 517
Minneapolis,MN55404 		Respiratory Personnel Services 4,198,116
Quality Nurse Anesthesia Professionals

5600 Edgewood Blvd
Minneapolis,MN55417 		Anesthesiology Services 2,856,258
University of Minnesota Physicians

720 Washington Ave SE Ste 200
Minneapolis,MN55414 		Physician Contracts 1,778,604
Periscope

921 Washington Ave
Minneapolis,MN55415 		Advertising 1,422,019
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet29
Form 990 (2015)
Form 990 (2015)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 6,459,340
e Government grants (contributions)1e 1,508,363
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a-1f:$  
h Total.Add lines 1a-1f.......MediumBullet 7,967,703
Program Service RevenueAmt Business Code
2a Patient Services 621400 167,674,752 167,674,752    
b Medicare/Medicaid 621400 60,348,662 60,348,662    
c Parking Revenue 812930 442,421     442,421
d HTL Plastic Joint 621400 31,704   31,704  
e
f All other program service revenue.        
g Total.Add lines 2a–2f.....MediumBullet 228,497,539
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ..........MediumBullet 3,620,505     3,620,505
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   26,570
b Less: rental expenses   0
c Rental income or (loss)   26,570
d Net rental income or (loss)......MediumBullet 26,570     26,570
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory   17,629,994
b Less: cost or other basis and sales expenses 14,994 17,416,579
c Gain or (loss) -14,994 213,415
d Net gain or (loss).....MediumBullet 198,421     198,421
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Business Code Miscellaneous Revenue
11a Loss on Extinguishment 900099 -151,393     -151,393
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet -151,393
12 Total revenue. See Instructions......MediumBullet 240,159,345 228,023,414 31,704 4,136,524
Form 990 (2015)
Form 990 (2015)
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).Check if Schedule O contains a response or note to any line in this Part IX ..............
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 domestic organizations and domestic governments. See Part IV, line 21 16,500 16,500
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 5,378,735 4,703,763 674,972  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 94,629,603 83,844,635 10,784,968  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 4,626,728 3,993,975 632,753  
9 Other employee benefits ....... 14,531,593 13,016,731 1,514,862  
10 Payroll taxes ........... 6,360,608 5,649,062 711,546  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 98,650   98,650  
c Accounting ........... 276,000   276,000  
d Lobbying ........... 53,161   53,161  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 536,403   536,403  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 24,901,345 20,188,170 4,713,175  
12 Advertising and promotion .... 1,711,954 47,274 1,664,680  
13 Office expenses ....... 5,885,184 4,688,806 1,196,378  
14 Information technology ...... 3,903,582 2,732,507 1,171,075  
15 Royalties ..        
16 Occupancy ........... 9,969,508 8,901,129 1,068,379  
17 Travel ............ 1,008,786 774,592 234,194  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings ....        
20 Interest ........... 1,718,184 1,718,184    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 17,142,094 13,010,268 4,131,826  
23 Insurance ... 697,763 433,939 263,824  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a Medical Supplies 23,743,932 23,743,932    
b MN Care Tax 3,660,699 3,660,699    
c Med Assistance Surcharg 2,745,736 2,745,736    
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 223,596,748 193,869,902 29,726,846 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2015)
Form 990 (2015)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 5,079,257 1 12,011,511
2 Savings and temporary cash investments ......... 36,772,273 2 38,932,184
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 39,193,595 4 48,048,597
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net ....   7  
8 Inventories for sale or use ........ 5,597,855 8 3,617,440
9 Prepaid expenses and deferred charges ...... 7,946,268 9 7,909,405
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 186,756,139
b Less: accumulated depreciation 10b 97,170,648 91,636,054 10c 89,585,491
11 Investments—publicly traded securities . 66,664,285 11 65,771,877
12 Investments—other securities. See Part IV, line 11 ..... 6,584,948 12 0
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 23,178,963 15 19,691,927
16 Total assets. Add lines 1 through 15 (must equal line 34)... 282,653,498 16 285,568,432
Liabilities 17 Accounts payable and accrued expenses ..... 27,805,821 17 27,914,042
18 Grants payable ...   18  
19 Deferred revenue .........   19  
20 Tax-exempt bond liabilities ......... 47,945,052 20 42,568,309
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other 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 .. 228,333 23 181,343
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D   25  
26 Total liabilities. Add lines 17 through 25.. 75,979,206 26 70,663,694
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets 197,674,277 27 207,634,152
28 Temporarily restricted net assets ........... 6,760,994 28 5,031,565
29 Permanently restricted net assets 2,239,021 29 2,239,021
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 206,674,292 33 214,904,738
34 Total liabilities and net assets/fund balances ........ 282,653,498 34 285,568,432
Form 990 (2015)
Form 990 (2015)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
240,159,345
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
223,596,748
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
16,562,597
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
206,674,292
5
Net unrealized gains (losses) on investments ...............
5
-5,651,061
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-2,681,090
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
214,904,738
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line 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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2015)
Form 990 (2015)
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 Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4


5
6
7
8
9
10
11
a
b
c
d
e
f
Enter the number of supported organizations ..............  

g
Provide the following information about the supported organization(s).
(i)Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total      

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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) right arrow (a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) 2015 (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 VI.) ..            
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) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990 or 990-EZ) 2015

Schedule A (Form 990 or 990-EZ) 2015
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity		  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions		  
9 Distributable amount for 2015 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2015 		(iii)
Distributable
Amount for 2015
1 Distributable amount for 2015 from Section C, line
6 		 
2 Underdistributions, if any, for years prior to 2015
(reasonable cause required--see instructions)		  
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......  
e From 2014.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2015 distributable amount  
i Carryover from 2010 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2015 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2015 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2015, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)		  
6 Remaining underdistributions for 2015. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)		  
7 Excess distributions carryover to 2016. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a
b
c Excess from 2013.......  
d From 2014.......  
e From 2015.......  
Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2015


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.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

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





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on its Form 990PF, Part I, line 2, 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) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
Name of organization
Gillette Children's Specialty Healthcare
  		Employer identification number
36-3379150
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
 
 

   
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 3
Name of organization
Gillette Children's Specialty Healthcare
  		Employer identification number

36-3379150
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(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) (2015)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
Page 4
Name of organization
Gillette Children's Specialty Healthcare
  		Employer identification number

36-3379150
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(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) (2015)

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 BulletInformation about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

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

1
Provide a description of the organization’s direct and indirect political campaign activities 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 function 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-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2015

Schedule C (Form 990 or 990-EZ) 2015
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 SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2012 (b) 2013 (c) 2014 (d) 2015 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2015


Schedule C (Form 990 or 990-EZ) 2015
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)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
Yes
 
c
Media advertisements? ...................................................................................................
 
No
 
d
Mailings to members, legislators, or the public? .............................................................................
 
No
 
e
Publications, or published or broadcast statements? ...........................................................
 
No
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
Yes
 
43,008
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
No
 
i
Other activities? ...................................................................................................................
Yes
 
10,153
j
Total. Add lines 1c through 1i ....................................................................................................
53,161
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 carry over 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) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible 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
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Part II-B, Line 1: Gillette employs a Government Relations and Advocacy Specialist as a 0.75 FTE. Gillette employed Lockridge, Grindal & Nauen, PLLP as lobbyists to act as advocates on its behalf at the federal level. Gillette employed Fredrikson & Byron, P.A. to assist with state level lobbying. Gillette is a member of the Children's Hospital Association. A portion of membership dues paid to the Children's Hospital Association relate to lobbying activities. Gillette is a member of the American Hospital Association (AHA). A portion of membership dues paid to the AHA relate to lobbying activities. Gillette is a member of the Minnesota Consortium for Citizens with Disabilities (MN-CCD). A portion of membership dues paid to MN-CCD relate to lobbying activities. Gillette is a member of the Minnesota Business Partnership. A portion of membership dues paid to the Minnesota Business Partnership relate to lobbying activities. Gillette is a member of the Saint Paul Area Chamber of Commerce. A portion of membership dues paid to the Saint Paul Area Chamber of Commerce relate to lobbying activities. Gillette is also a member of the Minnesota Hospital Association (MHA). A portion of membership dues paid to MHA relate to lobbying activities. Gillette reimburses certain professional memberships of employees. A portion of such membership dues are used by professional associations for lobbying activities. Certain Gillette executives engage in lobbying activities including, but not limited to, meeting with government officials and staff at the state, local and federal level; and meeting with staff from the Minnesota Department of Human Services and Minnesota Department of Health to discuss Medicaid payment rates, policies, and other legislative issues that affect Gillette. These activities may also include providing public testimony on legislation that affects Gillette and providing letters of support for specific legislation. Gillette also provides education to employees on policy issues. Through the voluntary Gillette Advocacy Internal Network (GAIN!), Gillette encourages interested employees to contact government officials about specific legislation on behalf of the hospital Gillette volunteers, including patients, patient families, and members of Gillette's Board of Directors also contact government officials about specific legislation on behalf of Gillette. Other activities indirectly related to lobbying include providing lobbyists with patient statistics and demographic information and developing text used for lobbying efforts that define Gillette's programs and services.
Schedule C (Form 990 or 990EZ) 2015


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," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year ....    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of 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 can 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" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 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, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax 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, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, 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 section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, 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" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), 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 XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), 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)
Revenue included on 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 (ASC 958) relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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" on 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 XIII 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, for escrow or custodial account liability?
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a)Current year (b)Prior year (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 3,880,733 3,282,690 3,365,617 3,365,785 3,791,838
b Contributions ... 145,615 839,883 105,570 79,278 8,432
c Net investment earnings, gains, and losses -15,453 28,254 303,267 480,113 56,433
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		99,924 170,053 376,928 446,878 369,299
f Administrative expenses .... 111,266 100,041 114,836 112,681 121,619
g End of year balance ...... 3,799,705 3,880,733 3,282,690 3,365,617 3,365,785
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet0 %
b
Permanent endowment SchDMd Bullet59.000 %
c
Temporarily restricted endowment SchDMd Bullet41.000 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations .................
3a(i)
 
No
(ii) related organizations .................
3a(ii)
Yes
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ...   55,000 55,000
b Buildings   44,836,935 24,208,799 20,628,136
c Leasehold improvements   56,196,105 21,866,021 34,330,084
d Equipment ...   71,680,818 51,095,828 20,584,990
e Other ...   13,987,281   13,987,281
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 89,585,491
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11b. 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)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) Employee Personal Computer Loans 65,317
(2) Beneficial Interest in Net Assets of Foundation 19,626,610
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 19,691,927
Part X
Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2015

Schedule D (Form 990) 2015
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 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 XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 XIII.) ............ 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 XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  

Part XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Part V, Line 4: The Gillette Children's Hospital Foundation has endowment funds for capital, charity care, patient care, research and education, and unrestricted needs. These funds are used to provide and improve health care and related services to patients of Gillette.
Part X, Line 2: The Internal Revenue Service has determined that the Medical Center and Foundation are tax-exempt organizations under Section 501(c)(3) of the Internal Revenue Code ("IRC") and are not private institutions as defined by Section 509(a) of the IRC. There were no unrecognized tax liabilities or uncertain tax positions for the years ended December 31, 2015 and 2014.
Schedule D (Form 990) 2015


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.Right pointing arrow large image Information about Schedule F (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
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 its grants and
other 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 its grants and other assistance outside the United States.
3
Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees, agents, and independent contractors in region (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 and investments
in region
Europe (including Iceland and Greenland) 0 0 Program services Attend Seminars 19,183
North America 0 0 Program services Attend Seminars 2,021
Middle East and North Africa 0 0 Program services Attend Seminars 2,092
East Asia and the Pacific 0 0 Program services Attend Seminars 9,485
Central America & the Caribbean 0 0 Program services Attend Seminars 1,810
           
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total ..... 0 0 34,591
b Total from continuation sheets to Part I ... 0 0 0
c Totals (add lines 3a and 3b) 0 0 34,591
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2015
Schedule F (Form 990) 2015
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. Part II can be duplicated if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (a)(c) Region (b)(d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount
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) 2015
Schedule F (Form 990) 2015Page 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.
Part III can be duplicated 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) 2015
Schedule F (Form 990) 2015
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, Return by a U.S. Transferor of Property to a Foreign Corporation (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 separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (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, Information 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 separately file Form 5713, International Boycott Report (see Instructions for Form 5713).. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule F (Form 990) 2015
Schedule F (Form 990) 2015
Page 5
Part V
Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
ReturnReference Explanation
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule F (Form 990) 2015
Additional Data


Software ID:  
Software Version:  



SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance 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 discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
 
No
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
 
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance 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 Financial Assistance at cost
(from Worksheet 1) . . . 		    530,493 3,000 527,493 0.240 %
b Medicaid (from Worksheet 3, column a) . . . . .     99,077,735 56,314,591 42,763,144 19.130 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     99,608,228 56,317,591 43,290,637 19.370 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     3,081,035   3,081,035 1.380 %
f Health professions education (from Worksheet 5) . . .     2,426,196 290,668 2,135,528 0.960 %
g Subsidized health services (from Worksheet 6) . . . .     40,714,413 28,974,627 11,739,786 5.250 %
h Research (from Worksheet 7) .     2,854,983 313,942 2,541,041 1.140 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     49,097   49,097 0.020 %
j Total. Other Benefits . .     49,125,724 29,579,237 19,546,487 8.750 %
k Total. Add lines 7d and 7j .     148,733,952 85,896,828 62,837,124 28.120 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(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
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
654,943
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
242,329
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
2,239,725
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
6,788,230
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-4,548,505
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
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(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) 2015
Schedule H (Form 990) 2015
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Gillette Children's Specialty Healthcare
200 University Ave E
St Paul,MN55101
www.gillettechildrens.org
2025454 		X   X X   X        
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Gillette Children's Specialty Healthcare
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): www.gillettechildrens.org/why-gillette/our-mission-and-principles-of-care/
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b   No
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
Gillette Children's Specialty Healthcare
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
 
b
http://www.gillettechildrens.org
c
d
e
f
g
h
i
Billing and Collections
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 6
Part VFacility Information (continued)

Gillette Children's Specialty Healthcare
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual 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? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 7
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Gillette Children's Specialty Healthcare Part V, Section B, Line 5: In conducting its most recent CHNA, Gillette met with the Minnesota Department of Health's (MDH) Children with Special Health Care Needs division. Gillette used the following methods to receive input for those representing the community:- Literature review- Key informant interviews with 21 referring clinicians across the region- Telephone interviews with 158 parents of children who receive services at Gillette- Focus groups with parents of children who have complex medical conditions- Key informant interviews with Gillette staff and community representatives of cultural communities- Key informant interviews with non-competing clinicsSee the full Community Health Needs Report on our website: http://www.gillettechildrens.org/why-gillette/our-mission -and-principles-of-care/Gillette Children's Specialty Healthcare:Part V, Section B, Line 7a: The full Community Health Needs Assessment is available at the following link: http://www.gillettechildrens.org/uploads/general/GilletteCHNA_04_13_FINAL_BOD_Approved2.pdf
Gillette Children's Specialty Healthcare Part V, Section B, Line 11: Families are also seeking assistance in locating non-medical supports, such as transportation, support groups and home modification. Since a number of organizations are providing this service in the community to meet this need, Gillette Children's Specialty Healthcare is not providing additional services in this area.
Gillette Children's Specialty Healthcare Part V, Section B, Line 22d: In accordance with Gillette's agreement with the Minnesota Attorney General, the maximum amount charged for any uninsured treatment for a patient whose annual household income is less than $125,000, shall not be more than Gillette would be reimbursed directly from its most favored insurer and from that insurer's policyholder under any applicable and allowable copayments, deductibles or coinsurance. The "most favored insurer" means the nongovernmental third party payor that provide the most revenue to Gillette during the previous calendar year.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 8
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?  
Name and address Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2015
Schedule H (Form 990) 2015
Page 9
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
Part I, Line 3c: The family income limit for eligibility for free care is 375% of the federal poverty guidelines.
Part I, Line 7: Gillette's internal cost accounting system was used to calculate amounts reported in the table in Part I. The cost accounting system records revenue and direct expenses for all inpatient and outpatient services for each revenue-producing cost center. All non-revenue-producing cost centers are allocated back to revenue-producing cost centers using applicable statistics to arrive at a fully allocated cost for each cost center. A cost-to-charge ratio was not used in the table.
Part I, Line 7g: Subsidized health services attributable to physician clinics are $11,739,786
Part I, Ln 7 Col(f): There is no bad debt expense included in Form 990, Part IX as an expense. Due to the adoption of new GAAP reporting, the bad debt expense has been netted with patient service revenue on Part VIII of Form 990.
Part III, Line 4: The audited financial statements of Gillette Children's Sepcialty Healthcare include bad debt footnotes in the Net Patient Service Revenue and Patient Accounts Receivable Section footnotes on pages 12 and 13.
Part III, Line 8: Gillette's internal cost-accounting system was used to calculate the Medicare-allowable costs. The entire shortfall amount is being treated as community benefit, but only part of it is included on Schedule H, Part I, Line 7. Gillette's mission is to provide services to children and adults with disabilities. In providing these mission-driven services, Gillette incurs losses from the Medicare program. However, Gillette accepts such losses as part of providing an important public service.
Part III, Line 9b: Gillette does not turn away any patients based on their inability to pay, and charity care is handled on a case-by-case basis. If patients inform Gillette that they will have a difficult time meeting their financial obligations, Gillette will try to qualify patients for public assistance or Gillette's charity care program. To qualify for Gillette's charity care program, patients must first complete an application and submit verification of income. Gillette then reviews the collected information to determine eligibility for the program. Income eligibility for the program is based on national poverty guidelines.Part V, Section D:Gillette operates four pediatric clinics in the Twin Cities metro area (in St. Paul, Minnetonka, Maple Grove and Burnsville); four clinic hubs in greater Minnesota (in Baxter, Duluth, Mankato and Willmar); and 11 Outreach Clinics throughout greater Minnesota. Gillette also operates an adult clinic, Gillette Lifetime Specialty Healthcare, located in St. Paul. All clinics throughout the state are licensed under Gillette Children's Specialty Healthcare.
Part VI, Line 2: As required by law Gillette completes a community needs assessment every three years. Gillette conducts surveys on health services using various tools to gather information, such as online surveys, focus groups with families, phone calls, and one-on-one interviews. In addition, Gillette conducts specific assessments when considering new programs or services. Such new programs and services usually arise from suggestions by patients and families, referring physicians, or Gillette's own staff. More generally, Gillette staff members assess community health care needs by the number of patients they see. In 2015, 25,957 children and adults came to Gillette because hospital staff has the specialized skills and advanced technology those patients need. Gillette treated patients from all 87 Minnesota counties, 41 U.S. states, and 11 other countries during 2015.Gillette specializes in caring for people who have complex and often rare conditions that impact the musculoskeletal and neurological systems. Some of these diagnoses include: cerebral palsy; complex orthopedic conditions; craniofacial anomalies; neurological conditions, such as epilepsy and muscular dystrophy; brain and spinal cord injuries; spina bifida; and juvenile arthritis. As more people learn of Gillette's expertise, the organization anticipates a proportionate increase in children with needs for specialized health care requiring Gillette's unique services. In addition, there are shortages of pediatric specialists in many areas of the five-state Midwest region, which will continue to bring patients to Gillette. By establishing second-ring suburban clinics, Outreach Clinics throughout Minnesota, and developing collaborative relationships with other health systems Gillette has made a concerted effort to meet the needs of patients outside the Twin Cities metro region. Gillette's continuing focus on meeting the needs of underserved and rural populations who require specialized pediatric services will also contribute to steady organizational growth.Gillette continues to play a leading role in provision of specialty healthcare services. In 2015, for example, Gillette performed more cranial fault surgeries to treat craniosynostosis than all other Minnesota hospitals combined. Additionally, more than half of the procedures performed in Twins Cities metro hospitals to repair cleft lip and palate were done at Gillette (source: Minnesota Hospital Association custom report, inpatients ages 0-14). Gillette is a teaching hospital committed to training the physicians of the future. Because Gillette focuses exclusively on specialty care for children who have disabilities and complex medical conditions, it is a regional resource of specialists, technology, facilities and comprehensive services. In 2015, residents and fellows from the University of Minnesota and Henry Ford Hospital in Detroit spent one to three months under the mentorship of Gillette's medical staff. In many cases, Gillette offers trainees their only exposure during residency to patients who have complex conditions like cerebral palsy or spina bifida, and rare disorders like osteogenesis imperfect or Rett syndrome. Gillette's physician training programs include the specialties of orthopedics, pediatrics, neurodevelopmental pediatrics, and rehabilitation medicine. Gillette has a surgery simulation center that allows teams to practice performing complex procedures and using new technologies. New staff members, medical residents and multidisciplinary teams learn and practice in a true-to-life environment. The result is hands-on education for staff and enhanced safety for patients. Gillette covers the unreimbursed costs of medical education. Gillette is fully accredited by the Minnesota Medical Association to provide continuing medical education.
Part VI, Line 3: Gillette provides free or reduced-cost medical care to community residents, primarily by:*Providing services at no charge to uninsured patients*Providing uninsured patients who do not qualify for charity care approximately the same discount as our third party payers*Covering the difference between public-program payments (primarily Medicare and Medicaid) and the related costs of providing such services*Providing services to patients who express a willingness to pay but who are unable to do so because of socioeconomic factors*Coordinating care with a patient's primary-care physician, school, and community agenciesIn 2015, 60 percent of Gillette visits were patients eligible for, or covered under, Medical Assistance (Minnesota's Medicaid program). Gillette has a documented policy for providing financial assistance in the form of charity care to patients who are financially without the means to pay for medically necessary care and who satisfy certain requirements. Each patient's situation is evaluated according to relevant circumstances, such as income, assets and other resources. Gillette staff will identify a family's charity-care needs before services are performed, whenever possible, as part of the admission process. Families complete a financial assistance application that Gillette provides. (Proof of participation in Medicaid or any other public assistance program indicates that the patient has been deemed financially indigent and, therefore, the patient is not required to provide his/her income on Gillette's assistance application.) In addition to doing so during the admission process, Gillette makes patients aware of financial assistance programs by listing them on patient statements as well as on the Gillette website.
Part VI, Line 4: In 2015, Gillette treated patients from all of Minnesota's counties. Some patients come to the Twin Cities for care; others receive care through our Outreach Clinics, located in 11 communities in greater Minnesota. Gillette staff members also see patients who come to Gillette for care from throughout the U.S. and other countries. Demographically, Gillette provides specialized health care for people who have complex and often rare diagnoses or traumatic injuries.
Part VI, Line 5: Gillette provides a wide variety of benefits to the community. Patients rely on the organization to address the physical, mental and emotional effects of their disabilities from birth through adulthood. To do so, Gillette provides a team of social workers, psychologists and neuropsychologists, child life specialists, therapeutic recreation specialists and a chaplain, who offer social-service and support counseling for patients and families. Gillette also provides community benefit by serving as an advocate for children who have complex medical conditions. For example, during 2015 Gillette published a children's book, "It's Okay to Ask!" that promotes acceptance and inclusion for children of all ability levels. A copy of the book was sent free-of-charge to every Minnesota elementary school and public library. Gillette serves as a gathering place for interested citizens (including the board of directors, other volunteers, skilled professionals, patients and families) to address the problems and needs of children who have disabilities affecting the musculoskeletal or neurological systems, to define the needs of the families of those children, and to advocate for support of those families in meeting their needs. In conjunction with United Cerebral Palsy, Gillette has sponsored support sessions for caregivers of children who have cerebral palsy. Gillette is part of the United Cerebral Palsy (UCP) organization; UCP is devoted to educating, advocating for and providing support services to people who have a spectrum of disabilities. In addition, Gillette works closely with the Muscular Dystrophy Association (the world's leading nonprofit health agency dedicated to finding treatments and cures for muscular dystrophy and other neuromuscular diseases) to help people receive the services they need throughout all stages of the condition. Gillette also teams with Family Voices of Minnesota to support Parent to Parent, a network connecting experienced families with families of children who have disabilities, cognitive issues and other health needs and who need emotional support.Gillette provides educational materials, programs and videos about specific conditions, information services available by telephone (which is free to families and for which Gillette is not reimbursed by insurance programs), and programs to improve the general standards of health in the community. Gillette uses its website and social media channels to share information from its medical experts with the community; topics include working through childhood diagnoses, , talking with a child's peers about his or her disability, brain injury prevention, nutrition for children, seasonal safety, and strategies for helping children overcome bullying. Gillette also uses its website and social channels to advocate on behalf of children who have complex conditions.Gillette offers in-hospital schooling to patients who will be hospitalized two weeks or longer during the traditional school year. A partnership between Gillette and St. Paul Public Schools means that children and teens who are recovering from a major surgery or traumatic injury can continue their academic lessons at Gillette. Gillette's classroom is outfitted with the latest technology-including webcams, laptops, a touch-screen computer, and a state-of-the-art SmartBoard. Our teacher works one-on-one with students on lesson plans designed for their unique needs and in collaboration with the student's home district.Gillette funds a program called the Adapted Sports Equipment Fund to help children with disabilities obtain the equipment needed to participate in adapted sports and recreational activities in their communities. Gillette also hosts an annual Adaptive Bike & Sports Expo to help children who have disabilities find customized bicycles and other equipment that meets their unique needs and helps promote independence. The hospital's annual Pedal In Place fundraiser supports the program. In addition, Gillette performs clinical and translational research devoted to finding effective medical interventions for complex conditions and their related effects and to improving outcomes in patients who have disabilities. Gillette researchers initiated 20 new research projects in 2015, bringing the hospital's total active studies to 168. Key research areas include Motion Analysis, Musculoskeletal, Neuroscience, and Pain & Comfort. Gillette has also launched an aggressive knowledge translation initiative that aims to advance patient outcomes and experience by better incorporating current medical research into ongoing clinical practice.Through community support and generous contributions to Gillette Children's Foundation, Gillette continues to create new services and expand existing ones, pioneer new treatments, and pursue research that benefits children who have complex and rare medical conditions. The organization's goal remains, as it has for nearly 120 years, to help children and adults who have disabilities, and their families, improve their health, achieve greater well-being and enjoy life.
Schedule H (Form 990) 2015
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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," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number
36-3379150
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC 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) Regions Hospital Foundation
640 Jackson St
St Paul,MN55101 		41-1888902 501(c)(3) 10,000       Support Burn Unit
(2) March of Dimes Minnesota Chapter
5233 Edina Industrial Blvd
Edina,MN55439 		13-1846366 501(c)(3) 6,500       Sponsorship of Nurse of the Year Award
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
2
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2015

Schedule I (Form 990) 2015
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated 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
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
Part I, Line 2: Occasionally, Gillette grants monies to other tax-exempt organizations which are conducting programs that will ultimately benefit the children that Gillette serves. During calendar year 2015, Gillette made grants to the Regions Hospital Foundation and the March of Dimes. The Regions Hospital Foundation grant supported the Burn Unit at Regions Hospital. The March of Dimes Minnesota Chapter grant sponsorship of Nurse of the Year Award.
Schedule I (Form 990) 2015



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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" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on 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 or provision of all of the expenses described above? If "No," complete Part III to explain .........
1b
 
No
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
Yes
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on 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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on 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," on line 5a or 5b, describe in Part III.
6
For persons listed on 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," on line 6a or 6b, describe in Part III.
7
For persons listed on 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 on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (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 in column(B) reported as deferred on prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1Barbara JoersPresident/CEO (i)

(ii)		 499,224
-------------
0 		78,578
-------------
0 		67,004
-------------
0 		29,397
-------------
0 		39,098
-------------
0 		713,301
-------------
0 		15,352
-------------
0
2Michael Healy MDChief of Staff (i)

(ii)		 550,969
-------------
0 		11,119
-------------
0 		47,057
-------------
0 		14,045
-------------
0 		39,962
-------------
0 		663,152
-------------
0 		0
-------------
0
3Marcie Ward MDDirector (i)

(ii)		 228,518
-------------
0 		825
-------------
0 		37,541
-------------
0 		12,056
-------------
0 		34,035
-------------
0 		312,975
-------------
0 		0
-------------
0
4Robert Wagner MDPrior Chief of Staff (i)

(ii)		 237,249
-------------
0 		1,000
-------------
0 		24,490
-------------
0 		12,847
-------------
0 		34,164
-------------
0 		309,750
-------------
0 		0
-------------
0
5Elizabeth Rivard Jan 2015VP-HR, Ed, & Guest Exp (i)

(ii)		 0
-------------
0 		0
-------------
0 		169,357
-------------
0 		7,412
-------------
0 		753
-------------
0 		177,522
-------------
0 		0
-------------
0
6Steven Koop MDMedical Director (i)

(ii)		 693,280
-------------
0 		101,031
-------------
0 		18,000
-------------
0 		95,994
-------------
0 		45,817
-------------
0 		954,122
-------------
0 		23,567
-------------
0
7Timothy GetsayVice Pres - Perf & Info Mgt (i)

(ii)		 290,633
-------------
0 		29,771
-------------
0 		31,242
-------------
0 		16,790
-------------
0 		29,103
-------------
0 		397,539
-------------
0 		2,745
-------------
0
8James HaddicanVP - Finance (i)

(ii)		 288,796
-------------
0 		34,992
-------------
0 		47,411
-------------
0 		16,174
-------------
0 		30,747
-------------
0 		418,120
-------------
0 		3,754
-------------
0
9Karen BradyVP-HR, Ed, & Guest Exp (i)

(ii)		 196,654
-------------
0 		8,099
-------------
0 		22,351
-------------
0 		11,701
-------------
0 		35,024
-------------
0 		273,829
-------------
0 		0
-------------
0
10Karen BrillVP - Patient Care (i)

(ii)		 226,510
-------------
0 		23,636
-------------
0 		39,265
-------------
0 		14,098
-------------
0 		30,097
-------------
0 		333,606
-------------
0 		53
-------------
0
11Dennis JolleyVP Inst Adv (i)

(ii)		 113,641
-------------
75,761 		16,200
-------------
10,800 		15,864
-------------
10,576 		6,092
-------------
4,062 		16,406
-------------
10,938 		168,203
-------------
112,137 		0
-------------
0
12Kathryn WardropVP-Strategy and Op (i)

(ii)		 263,521
-------------
0 		34,145
-------------
0 		69,176
-------------
0 		16,747
-------------
0 		45,116
-------------
0 		428,705
-------------
0 		2,618
-------------
0
13Paula MontgomeryGeneral Counsel (i)

(ii)		 176,365
-------------
0 		0
-------------
0 		11,624
-------------
0 		10,553
-------------
0 		29,369
-------------
0 		227,911
-------------
0 		0
-------------
0
14Stephen Sundberg MDOrthopaedic Surgeon (i)

(ii)		 745,137
-------------
0 		12,700
-------------
0 		55,960
-------------
0 		14,045
-------------
0 		38,386
-------------
0 		866,228
-------------
0 		0
-------------
0
15Patrick Graupman MDPediatric Neurosurgeon (i)

(ii)		 738,793
-------------
0 		700
-------------
0 		73,977
-------------
0 		14,045
-------------
0 		29,487
-------------
0 		857,002
-------------
0 		0
-------------
0
16Michael Partington MDPediatric Neurosurgeon (i)

(ii)		 747,223
-------------
0 		700
-------------
0 		39,700
-------------
0 		19,076
-------------
0 		35,241
-------------
0 		841,940
-------------
0 		0
-------------
0
17Robert Wood MDCraniofacial Surgeon (i)

(ii)		 631,481
-------------
0 		700
-------------
0 		127,582
-------------
0 		18,342
-------------
0 		31,847
-------------
0 		809,952
-------------
0 		0
-------------
0
18Debbie Song MDPediatric Neurosurgeon (i)

(ii)		 629,970
-------------
0 		700
-------------
0 		68,242
-------------
0 		14,045
-------------
0 		35,725
-------------
0 		748,682
-------------
0 		0
-------------
0
Schedule J (Form 990) 2015

Schedule J (Form 990) 2015
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Part I, Line 1a Robert Wood, MD, Craniofacial Surgeon (MD) received a first class travel. This amount is taxable to the employee and included on their 2015 W-2.
Part I, Line 3 The chair of Gillette's personnel committee requests information from the external consultant. The personnel committee is empowered to evaluate the reasonableness of compensation and other financial transactions in which the hospital is engaged. In all cases, it does so in accordance with the compensation policy set by the board of directors, by referencing recognized objective resources on the reasonableness of and market value for the types of personnel and services being considered. That data is prepared for and distributed to the personnel committee members. Compensation policy is approved by the board of directors. Actions related to chief executive officer (CEO)/President and other executive compensation are discussed and voted upon at personnel committee meetings. Meeting minutes are recorded.
Part I, Line 4b Certain employees of Gillette are provided with the opportunity to participate in the pension restoration plan (The Plan). The Plan requires employees to be executives of Gillette to participate in the Plan. Payments from The Plan occur annually by July 1 of the year following the end of The Plan year. This Plan is a "gap" plan, which provides participants with a deposit that closes the gap between the limits of IRC 403(b) and the actual cash compensation of the participant. Karen Brill $53 Tim Getsay $2,745 James Haddican $3,754 Barbara Joers $15,352 Steven Koop $23,567 Kathryn Wardrop $2,618
Part I, Line 7 Certain employees are eligible for an annual one-time award to recognize employees. The amount and payment of the award is made at the discretion of the Personnel Committee of the Board of Directors.
Schedule J (Form 990) 2015
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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 Part VI.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number
36-3379150
Part I
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A Housing & Redevelopment Authority St Paul MN
  		52-1440935 792909DU4 02-04-2015 9,160,000 Refinance of previous bonds issued 11/17/2010   X   X   X
B Housing & Redevelopment Authority St Paul MN
  		52-1440935 792909CA9 11-12-2009 36,076,928 Hosp Expansion Project 205 Building   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired ..................   1,930,000    
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 9,160,000 36,221,971    
4 Gross proceeds in reserve funds .............   5,665,341    
5 Capitalized interest from proceeds .............        
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ............... 179,097 615,702    
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds .............   32,235,732    
11 Other spent proceeds ............. 8,980,903      
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2012
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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2015

Schedule K (Form 990) 2015
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 of bond-financed property? ............. X   X          
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?   X   X        
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X        
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
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 Does the bond issue meet the private security or payment test? ...   X   X        
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X        
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X          
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X        
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? ....... X     X        
b Exception to rebate? ........   X   X        
c No rebate due? .........   X X          
If "Yes" to line 2c, provide in Part VI the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X   X        
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X        
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
Schedule K (Form 990) 2015

Schedule K (Form 990) 2015
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (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? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X        
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X          
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X          
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
Schedule K, Part II, Line 3: Part II, Line 3 varies due to what was reported on Part I Column (e) due to investment earnings.
Schedule K, Part III, Line 3a: Gillette's current management or service contracts with respect to the financed property do not result in private business use.
Schedule K, Part II, Line 4, Column B: The amount shown consists of $3,370,538 in a reasonably required reserve or replacement fund plus $2,294,803 in a bona fide debt service fund.
Schedule K, Part IV, Line 2, Column B: Rebate Calculations prepared February 18, 2014.
Schedule K (Form 990) 2015

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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, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) 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) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by 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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefiting 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 assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2015
Schedule L (Form 990 or 990-EZ) 2015
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) Sunshine Larrazabal
  		Family Member of Robert Wagner MD - Director 36,381 Employment   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L, Part V: Sunshine is the daughter of Robert Wagner a board member.
Schedule L (Form 990 or 990-EZ) 2015


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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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Return Reference Explanation
Form 990, Part VI, Section A, line 4 Gillette has changed its bylaws for the composition of its board of directors. The new bylaws state that the board of directors shall be not less than eleven no more than twenty-five including ex-officio directors. There shall be not less than nine nor more than twenty-three directors, plus two directors who serve as ex-officio officer, the President of the Hospital and the elected chief of the Medical Staff. Gillette has amended its bylaws to create a compensation committee to replace its Personnel committee. The Compensation Committee shall, (1) develop and recommend to the board of directors a plan for the total compensation package, including benefits, of the president and executive management, (2) operating within such plans as approved by the board, evaluate the performance and fix the compensation of the president, (3) approve or disapprove payments under any variable pay arrangement for any employees, (4) evaluate and approve or disapprove any and all transactions with "disqualified persons, and in doing so it shall determine the reasonableness of such transactions under the standards recognized by the Internal Revenue Code Section 4958, and approve only those transactions that are found to be reasonable, and (5) carry out other functions delegated by the board of directors.
Form 990, Part VI, Section B, line 11 Gillette provided a copy of the Form 990 to every member of the governing body before filing the form. A committee including representatives of our Administrative Council completed the form. This committee prepared all the documentation necessary; Gillette's accounting firm compiled the forms. Gillette's vice president of Finance and vice president of Institutional Advancement then reviewed the draft documents. After all internal reviews were complete, the final version was presented to the finance committee and the board of directors for approval.
Form 990, Part VI, Section B, line 12c Gillette enforces policies on external professional activities. Gillette employees, officers, volunteers, board members, and medical staff members are expected to disclose outside activities that involve potential conflicts of interest. In fact, directors must sign a conflict of interest statement acknowledging any potential conflicts related to Gillette. Gillette requires staff members to discuss potential conflicts with their immediate manager and with the compliance officer. The disclosure includes a written description of the activity, the extent of the staff member's participation, and the possible duration of the relationship. If a conflict exists, the employee must not engage in the activity. Part VI, Section B, Line 14 According to accounting guidelines, Gillette is obligated to answer "no" to this question because the Gillette board of directors or a subcommittee of the board of directors does not review Gillette's document retention and destruction policy. In fact, Gillette has written record retention policies for patient medical records and other records, including those of legal, historical, fiscal/tax and operational value. Gillette reviewed and approved the policies in April 2014.
Form 990, Part VI, Section B, line 15 At the request of the personnel committee of the board of directors, an independent consultant provides the committee with survey data containing recommendations for CEO/President and other executive salary ranges. The ranges are developed by the external consultant based on Gillette' compensation philosophy, which was developed by the personnel committee and adopted by the board of directors. The compensation philosophy is reviewed regularly. The members of this committee determine the CEO/President's salary and the salary ranges for other executives. The committee oversees the executive incentive plan, approves any incentive plan payouts, and regularly evaluates the benefits provided to executives. The external consultant has provided total compensation data for all executives, and the committee has diligently followed the process for establishing a presumption of reasonableness. In addition to the oversight function of executive total compensation, the personnel committee reviews and approves the salary offers for contract and employed physicians, oversees payments under any incentive compensation plans, and evaluates all transactions with disqualified persons.
Form 990, Part VI, Section C, line 19 Gillette posted its 2014 annual report (which includes the audited financial statements) to its public website. The annual report was also mailed to major business partners, including the Minnesota Hospital Association and Children's Hospital Association; Children's Miracle Network partner organizations; donors; and prospective donors. A postcard directing to the online annual report was mailed to Gillette employees and volunteers; Minnesota pediatricians and advance practice providers; members of the Minnesota Senate and Minnesota House of Representatives; the Mayor and City Council for all Minnesota communities with a Gillette Outreach Clinic location; and Gillette patients and families. The Gillette Form 990s are available from the states of Minnesota and Wisconsin and at Guidestar.org. Gillette discloses financial statements to bondholders, the Minnesota Hospital Association and the Minnesota attorney general's office. The governing documents and conflict of interest policy are made available to the public upon request.
Form 990, Part IX, line 11g Personnel Contracts: Program service expenses 12,317,332. Management and general expenses 236,098. Fundraising expenses 0. Total expenses 12,553,430. Outside Temp Help: Program service expenses 1,194,674. Management and general expenses 433,619. Fundraising expenses 0. Total expenses 1,628,293. Outside Consultants: Program service expenses 130,641. Management and general expenses 1,610,041. Fundraising expenses 0. Total expenses 1,740,682. Regions Services: Program service expenses 4,239,897. Management and general expenses 361,128. Fundraising expenses 0. Total expenses 4,601,025. Contracted Services: Program service expenses 1,629,282. Management and general expenses 784,441. Fundraising expenses 0. Total expenses 2,413,723. Miscellaneous: Program service expenses 676,344. Management and general expenses 1,287,848. Fundraising expenses 0. Total expenses 1,964,192.
Form 990, Part XI, line 9: Change in Beneficial Interest in Net Assets of Foundation -2,681,090. In accordance with FAS No. 136, "Transfers of assets to a not-for-profit or charitable trust that raises or holds contributions for others":
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


Additional Data


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Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2015
Open to Public Inspection
Name of the organization
Gillette Children's Specialty Healthcare
 
Employer identification number

36-3379150
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) 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 entity?
Yes No
(1)Gillette Children's Hospital Foundation
200 University Ave

St Paul,MN55101
41-1200302 		Healthcare MN 501(c)(3) Line 11, Type II: 50 N/A
Yes
 












For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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
 		(i)
Section 512(b)(13) controlled entity?
Yes No












Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
 
No
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
 
No
o Sharing of paid employees with related organization(s) ............................
1o
 
No
p Reimbursement paid to related organization(s) for expenses ............................
1p
 
No
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
 
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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) Gillette Children's Hospital Foundation

 C 6,459,340 FMV
(2) Gillette Children's Hospital Foundation

 R 2,288,131 FMV
(3) Gillette Children's Hospital Foundation

 Q 5,288,861 FMV



Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
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)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(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 Yes No






























Schedule R (Form 990) 2015
Schedule R (Form 990) 2015
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2015

Additional Data


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