Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 | ||||
| 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 |
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| 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 |
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| 9 Distributable amount for 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4a, Program Service Accomplishments: | Complex Pediatric and Subspecialty Services: Gillette's pediatric staff offers the region's most comprehensive program for the diagnosis and management of infants and children who have a wide variety of complex medical conditions. Complex Care physicians coordinate care across multiple services and serve as a single point of contact for families and primary care providers, managing the overall health of a child with medical complexity. Pediatricians are supported by medical specialists in areas such as rheumatology, endocrinology, integrative and palliative medicine, genetics, and infectious diseases. Level I Pediatric Trauma Center: In 2009, a collaborative effort between Gillette and Regions Hospital resulted in recognition by the American College of Surgeons as the State of Minnesota's first Level I Pediatric Trauma Center. To be certified as a Level I Pediatric Trauma Center, Regions in collaboration with Gillette had to meet the requirements of adult trauma centers while fulfilling pediatric guidelines, including additional specialists and critical care patient volumes. While Regions cares for critically injured adult patients, injured children are transferred to Gillette's Pediatric Intensive Care Unit, where a team of Gillette and Regions specialists provide critical care and medical intervention. Specialized Ancillary Services: Gillette also provides an array of highly specialized ancillary services that are interwoven into our delivery of a complete system of care for those we serve, including: Gait and Motion Analysis: Gillette operates one of the world's busiest and most respected pediatric clinical gain and motion analysis centers. The James R. Gage Center for Gait and Motion Analysis is known worldwide for expertise in diagnosing and planning treatments for people who have disorders affecting their gait and ability to control movement. Using innovative computer technology, motion analysis captures movements, muscle activity and forces that help physicians understand and recognize how orthopedic, neurological and muscular conditions can hinder motions that are critical to daily living. Information from gait analysis-together with imaging scans, medical history and the results of other evaluations-helps physicians recommend the best treatments for a wide variety of conditions that disrupt movement. Gillette's gait lab is one of the three busiest labs in the world, performing 549 gait and motion analyses during 2019. Orthotics, Prosthetics and Seating: Gillette is one of the Twin Cities' largest providers of custom-made orthotics, prosthetics and seating (wheelchair and related mobility support) services. Gillette employs certified prosthetists and orthotists, who identify, design and manufacture customized equipment for correcting skeletal disorders, providing skeletal support, managing muscle tone, and fostering independence. Gillette's staff provides customized braces, artificial limbs, assistive communication devices, protective headgear, specialized seating, and customized wheelchair construction and modifications. Rehabilitation Therapies: Gillette employs physical, occupational and speech/language therapists with extensive training in the therapeutic treatment and rehabilitation of children and adults with compels neurological and musculoskeletal conditions. Specializations include intensive brain and spinal cord injury rehabilitation, Schroth therapy for scoliosis (spinal curvature), augmentative and alternative communication for individuals without the ability to speak, food and swallowing therapy for individuals post- tracheotomy, and speech and language therapy for children after the repair of cleft lip, palate or major facial reconstruction. Care Management Services: The complexity of the conditions managed by Gillette medical providers require a high level of scheduling, insurance, and coordination with other services including schools, social service providers, and transportation providers. Gillette's care management team, in collaboration with other areas of the hospital, provide a range of supports and services to families to help them proactively manage their child's care. Dental Care: 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 are important, as many disabilities make it difficult for patients to be seen by a traditional dentist, and there is a strong link between physical health and oral health. People who have cerebral palsy, for example, might have muscles that involuntarily move and tighten, impeding the ability to brush and floss daily. Gillette also offers orthodontia and dental services for children born with cleft lip and/or palate or other craniofacial anomalies. Gillette has custom exam chairs designed to meet the needs of people who have conditions, a station suited for patients who use wheelchairs, and sedation for patients who are unable to tolerate dental procedures without it. Child and Family Services: Gillette's Child and Family Services (CFS) is a team of social workers, psychologists and neuropsychologists, child life specialists, therapeutic recreation specialists and a chaplain. CFS team members work closely with children and families to help them understand their medical care and minimize stress through play, relaxation, and special events and activities. Child life professionals are trained in child development and are part of the multi-disciplinary care team. They partner with the whole family, including siblings, to foster a positive and supportive care experience. Gillette maintains numerous accreditation and memberships, including the following: Joint Commission: Gillette has earned and maintained the Joint Commission's Gold Seal of Approval since 2008. To be eligible, organizations must undergo an on-site survey at least once every three as a symbol of quality. Rehabilitation: Gillette's inpatient rehabilitation program has maintained accreditation by the Commission on Accreditation of Rehabilitation Facilities ("CARF") since 1992. Gillette's pediatric brain injury specialty program is also accredited by CARF. In 2019, CARF issued a three-year accreditation to Gillette. Gillette is the region's largest pediatric rehabilitation program and is one of only three pediatric programs in Minnesota accredited by CARF. In addition, Gillette is one of eight health care providers in the country with designations in pediatric inpatient rehabilitation and brain injury. Quality: In 2019, the National Committee for Quality Assurance awarded Gillette the Patient Centered Specialty Practice Recognition for orthopedic practices at their St. Paul campus, Minnetonka Clinic, Maple Grove Clinic and Burnsville Clinic. Gillette is the first pediatric health care organization in Minnesota receive this distinction. Patient Safety: The Children's Hospitals' Solutions for Patient Safety National Children's Network recognized Gillette with "Navigator" status in 2018. Gillette is one of only thirteen to be recognized with this status out of over 130 hospitals in the network. Orthotics and Prosthetics: The American Board for Certification in Orthotics, Prosthetics and Pedorthics, the national accrediting body for the orthotic and prosthetic professions, has certified each of Gillette's prosthetists and orthotists. Gait and Motion: In 2009, the Commission for Motion Laboratory Accreditation named Gillette's Center for Gait and Motion Analysis the nation's first accredited motion analysis laboratory. Health Care Home: In 2019, Gillette's Complex Care Specialty Clinic was certified as a Health Care Home for medically complex patients. Patient Safety Committed to continuous improvement, Gillette participates in the Solutions for Patient Safety (SPS), a national collaborative of hospitals throughout the U.S. focused on eliminating adverse health events and patient harm. As part of the SPS collaboration, Gillette developed and implements best practices for preventing 13 patient safety issues, called healthcare-acquired conditions. 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. These efforts have paid off in reducing the incidence of healthcare-acquired conditions. |
| Form 990, Part III, Line 4a, Program Service Accomplishments: | In 2019, Gillette expanded their harm prevention work to include preventing serious employee injuries, focusing on preventing workplace violence events, slips/trips/falls overexertion injuries and patient behavioral events. Gillette also implemented daily casting rounds to prevent and identify pressure injuries in patients with casts or orthoses. Since its implementation in 2019, Gillette's hospitalized patients have not had a serious pressure injury event. Gillette continues to meet and exceed milestones on harm prevention. As of December 2019, it has been over 4 years without a serious fall, almost 4 years since the last ventilator associated event, over 3 years without a serious PIV extravasation, 1.5 years since the last neuroshunt surgical site infection, over 1 year since the last adverse drug event (F-I), and 1 year since the last unplanned extubation. Gillette launched in 2019 the first phase of their Safety Coach program, designed to increase both patient and employee safety. |
| Form 990, Part VI, Section A, line 2 | Members of the Gillette Children's Specialty Healthcare (Hospital) Board are also members of the Gillette Children's Hospital Foundation (Foundation) board resulting in common control of both entities and the sharing of community oversight, strategic planning, financial oversight, and fundraising responsibilities equally among all board members. The following individuals have a business relationship: Barbara Joers, Dan Monson, David Bestler, David Fettig, Dennis Jolley, Diane Harper, Jeffrey Freyer, John Ellenberger, John Foster, Julie Neville, Kathy Tune, Kevin Klemz,, Linda Ireland, Mark Kimball, Martin (Brad) Winges, Marshall Stanton, MD, Phil Becker, Philip Trier, Rulon Stacey, Scott Robinson, Tenner Guillaume, Thomas Novacheck, MD |
| Form 990, Part VI, Section A, line 4 | The organization revised it bylaws to realign committee structures and responsibilities. The Executive Committee of the Board of Directors is now responsible for certain compensation related matters, including the review and approval of President and executive management compensation packages. The responsibilities of the Investment Committee were combined with the Finance Committee. |
| Form 990, Part VI, Section B, line 11b | Gillette provided a copy of the Form 990 to every member of the governing body before filing the form. A committee including representatives Gillette executive leadership completed the form, including all necessary documentation. Gillette's accounting firm compiled the forms. Gillette's chief executive officer, chief financial officer and vice president of institutional advancement 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 prior to filing. |
| 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. 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. |
| Form 990, Part VI, Section B, line 15 | As directed by the Executive Committee of the Board of Directors, an independent consultant provides the committee with survey data containing recommendations for the President & CEO and other executive salary ranges. The ranges are developed by the external consultant based on Gillette's compensation philosophy, which was developed by the Committee and adopted by the Board of Directors. The compensation philosophy is reviewed regularly. The members of the Committee determine the President & CEO salary and the salary ranges for other executives. The committee oversees the executive incentive plan, approves 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 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 annual report and summarized financial statements to its public website. The annual report was also provided to certain outside entities, including the Minnesota Hospital Association and Children's Hospital Association; Children's Miracle Network Hospitals partner organizations; donors; and prospective donors. An email directing to the online annual report was sent to Gillette employees, volunteers, 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 17,219,996. Management and general expenses 127,012. Fundraising expenses 0. Total expenses 17,347,008. Regions Services: Program service expenses 4,816,509. Management and general expenses 393,266. Fundraising expenses 0. Total expenses 5,209,775. Temp Staffing: Program service expenses 1,852,471. Management and general expenses 247,781. Fundraising expenses 0. Total expenses 2,100,252. Interpreter Services: Program service expenses 863,780. Management and general expenses 0. Fundraising expenses 0. Total expenses 863,780. Contracted Services: Program service expenses 2,660,245. Management and general expenses 1,379,251. Fundraising expenses 0. Total expenses 4,039,496. Consulting: Program service expenses 91,024. Management and general expenses 1,616,580. Fundraising expenses 0. Total expenses 1,707,604. Other Services: Program service expenses 1,740,495. Management and general expenses 467,699. Fundraising expenses 0. Total expenses 2,208,194. |
| Form 990, Part XI, line 9: | Change in Beneficial Interest in Net Assets of Foundation 691,108. |
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