PUBLIC DISCLOSURE COPY THE SHRINERS HOSPITAL FOR

Transcription

1 Cution: Forms printe from within Aoe Arot prouts my not meet IRS or stte txing geny speifitions. When using Arot 9.x prouts n lter prouts, selet "None"in the "Pge Sling" seletion ox in the Aoe "Print" ilog. PUBLIC DISCLOSURE COPY

2 ** PUBLIC DISCLOSURE COPY ** OMB No. -00 Return of Orgniztion Exempt From Inome Tx Form 990 Uner setion 0(),, or 9()() of the Internl Revenue Coe (exept privte fountions) 0 Deprtment of the Tresury Do not enter soil seurity numers on this form s it my e me puli. Open to Puli Internl Revenue Servie Informtion out Form 990 n its instrutions is t Inspetion A For the 0 lenr yer, or tx yer eginning n ening B Chek if C Nme of orgniztion D Employer ientifition numer pplile: Aress hnge Nme hnge Initil return THE SHRINERS' HOSPITAL FOR CHILDREN Doing usiness s Numer n street (or P.O. ox if mil is not elivere to street ress) Room/suite E 0- Telephone numer Finl return/ POST OFFICE BO ()-000 terminte City or town, stte or provine, ountry, n ZIP or foreign postl oe G Gross reeipts $,,9. Amene return TAMPA, FL - H() Is this group return Applition F Nme n ress of prinipl offier: DOUGLAS MAWELL for suorintes? ~~ Yes No pening 900 ROCKY POINT DRIVE, TAMPA, FL 0 H() Are ll suorintes inlue? Yes No I Tx-exempt sttus: 0()() 0() ( ) (insert no.) 9()() or If "No," tth list. (see instrutions) J Wesite: H() Group exemption numer K Form of orgniztion: Corportion Trust Assoition Other L Yer of formtion: 9 M Stte of legl omiile: MA Prt I Summry Briefly esrie the orgniztion s mission or most signifint tivities: WE PROVIDE PEDIATRIC SPECIALTY CARE WITHOUT FINANCIAL OBLIGATION TO PATIENTS OR THEIR FAMILIES. Ativities & Governne Revenue Expenses Net Assets or Fun Blnes Sign Here 9 0 Chek this ox Net unrelte usiness txle inome from Form 990-T, line Professionl funrising fees (Prt I, olumn (A), line e) ~~~~~~~~~~~~~~ Totl funrising expenses (Prt I, olumn (D), line ) true, orret, n omplete. Delrtion of preprer (other thn offier) is se on ll informtion of whih preprer hs ny knowlege. Signture of offier DOUGLAS MAWELL, PRESIDENT Type or print nme n title if the orgniztion isontinue its opertions or ispose of more thn % of its net ssets. Numer of voting memers of the governing oy (Prt VI, line ) ~~~~~~~~~~~~~~~~~~~~ Numer of inepenent voting memers of the governing oy (Prt VI, line ) ~~~~~~~~~~~~~~ Totl numer of iniviuls employe in lenr yer 0 (Prt V, line ) ~~~~~~~~~~~~~~~~ Totl numer of volunteers (estimte if neessry) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Totl unrelte usiness revenue from Prt VIII, olumn (C), line ~~~~~~~~~~~~~~~~~~~~ Contriutions n grnts (Prt VIII, line h) ~~~~~~~~~~~~~~~~~~~~~ Progrm servie revenue (Prt VIII, line g) ~~~~~~~~~~~~~~~~~~~~~ Investment inome (Prt VIII, olumn (A), lines,, n ) ~~~~~~~~~~~~~ Other revenue (Prt VIII, olumn (A), lines,,, 9, 0, n e) ~~~~~~~~ Totl revenue - lines through (must equl Prt VIII, olumn (A), line ) Grnts n similr mounts pi (Prt I, olumn (A), lines -) Benefits pi to or for memers (Prt I, olumn (A), line ) ~~~~~~~~~~~ ~~~~~~~~~~~~~ Slries, other ompenstion, employee enefits (Prt I, olumn (A), lines -0) ~~~ = = Prior Yer Current Yer,,9.,0,. 9,,,99,9. 0,,0. 0,,,00,9.,0,. 9,99,,,.,9,0. 0,9,. Other expenses (Prt I, olumn (A), lines -, f-e) ~~~~~~~~~~~~~ 9,9,. 9,,0 Totl expenses. A lines - (must equl Prt I, olumn (A), line ) ~~~~~~~,9,. 0,,. 9 Revenue less expenses. Sutrt line from line,0,09.,,09. Beginning of Current Yer En of Yer 0 Totl ssets (Prt, line ) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~,099,0,.,0,,. Totl liilities (Prt, line ) ~~~~~~~~~~~~~~~~~~~~~~~~~~~,9, 9,, Net ssets or fun lnes. Sutrt line from line 0,0,0, 9,9, Prt II Signture Blok Uner penlties of perjury, I elre tht I hve exmine this return, inluing ompnying sheules n sttements, n to the est of my knowlege n elief, it is Print/Type preprer s nme Preprer s signture Dte Chek PTIN if Pi PAUL DUNHAM self-employe P0000 Preprer Firm s nme CBIZ MHM, LLC Firm s EIN -099 Use Only Firm s ress FEATHER SOUND DRIVE, # CLEARWATER, FL Phone no. ()-00 My the IRS isuss this return with the preprer shown ove? (see instrutions) Yes No LHA For Pperwork Reution At Notie, see the seprte instrutions. Form 990 (0) Dte

3 Form 990 (0) THE SHRINERS' HOSPITAL FOR CHILDREN 0- Prt III Sttement of Progrm Servie Aomplishments Chek if Sheule O ontins response or note to ny line in this Prt III Briefly esrie the orgniztion s mission: SEE SCHEDULE O Pge Di the orgniztion unertke ny signifint progrm servies uring the yer whih were not liste on the prior Form 990 or 990-EZ? If "Yes," esrie these new servies on Sheule O. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion ese onuting, or mke signifint hnges in how it onuts, ny progrm servies? ~~~~~~ If "Yes," esrie these hnges on Sheule O. Desrie the orgniztion s progrm servie omplishments for eh of its three lrgest progrm servies, s mesure y expenses. Setion 0()() n 0()() orgniztions re require to report the mount of grnts n llotions to others, the totl expenses, n revenue, if ny, for eh progrm servie reporte. ( Coe: ) ( Expenses $ 9,, inluing grnts of $ ) ( Revenue $,, ) TREATMENT OF PEDIATRIC BURN VICTIMS: ADMISSIONS: OUTPATIENT CLINIC VISITS:, OUTPATIENT CLINIC SURGERIES: EVERY YEAR THOUSANDS OF CHILDREN HAVE A GREATER CHANCE OF SURVIVING FROM ALL TYPES OF BURN INJURIES, DUE TO SHC'S SPECIALIZED BURN CARE, WHICH PROVIDES CRITICAL, SURGICAL, AND REHABILITATIVE CARE TO CHILDREN WITH VARYING DEGREES OF NEW AND HEALED BURNS. Yes Yes No No,9,.,,. ( Coe: ) ( Expenses $ inluing grnts of $ ) ( Revenue $ ) TREATMENT OF ORTHOPEDIC PEDIATRIC PATIENTS: ADMISSIONS: 90 OUTPATIENT CLINIC VISITS:,0 OUTPATIENT CLINIC SURGERIES: SHC IS DEDICATED TO PROVIDING MEDICAL AND REHABILITATIVE SERVICES TO CHILDREN WITH CONGENITAL DEFORMITIES AND CONDITIONS, PROBLEMS RESULTING FROM ORTHOPEDIC INJURIES AND DISEASES OF THE NEUROMUSCULOSKELETAL SYSTEM. COMMONLY TREATED CONDITIONS INCLUDE CLUBFOOT, HAND DISORDERS, LIMB DEFICIENCIES, HIP DISORDERS, SCOLIOSIS, OSTEOGENSIS PERFECTA, JUVENILE ARTHRITIS, CEREBRAL PALSY AND SPINA BIFIDA. ALL CARE IS PROVIDED REGARDLESS OF THE PATIENT'S OR FAMILIY'S ABILITY TO PAY.,,. MEDICAL RESEARCH IS PERFORMED AND HAS A STRONG, POSITIVE IMPACT ON THE CARE AND CURE OF CHILDREN WITH ORTHOPAEDIC PROBLEMS, BURN AND SPINAL CORD INJURIES. SHRINERS HOSPITALS FOR CHILDREN IS COMMITTED TO THE SUSTAINED INVESTMENT IN CLINICALLY USEFUL RESEARCH SO THAT FUNDAMENTAL KNOWLEDGE CAN BE ACQUIRED, IMPROVING THE QUALITY OF LIFE FOR CHILDREN WITH ORTHOPAEDIC PROBLEMS, BURN AND SPINAL CORD INJURIES. ( Coe: ) ( Expenses $ inluing grnts of $ ) ( Revenue $ ) e Other progrm servies (Desrie in Sheule O.) ( Expenses $ inluing grnts of $ ) ( Revenue $ ) Totl progrm servie expenses 0,,. Form 990 (0)

4 Form 990 (0) THE SHRINERS' HOSPITAL FOR CHILDREN 0- Prt IV Cheklist of Require Sheules Is the orgniztion esrie in setion 0()() or 9()() (other thn privte fountion)? If "Yes," omplete Sheule A~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the orgniztion require to omplete Sheule B, Sheule of Contriutors? ~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion engge in iret or iniret politil mpign tivities on ehlf of or in opposition to nites for puli offie? If "Yes," omplete Sheule C, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Setion 0()() orgniztions. Di the orgniztion engge in loying tivities, or hve setion 0(h) eletion in effet uring the tx yer? If "Yes," omplete Sheule C, Prt II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the orgniztion setion 0()(), 0()(), or 0()() orgniztion tht reeives memership ues, ssessments, or similr mounts s efine in Revenue Proeure 9-9? If "Yes," omplete Sheule C, Prt III ~~~~~~~~~~~~~~ Di the orgniztion mintin ny onor vise funs or ny similr funs or ounts for whih onors hve the right to provie vie on the istriution or investment of mounts in suh funs or ounts? If "Yes," omplete Sheule D, Prt I Di the orgniztion reeive or hol onservtion esement, inluing esements to preserve open spe, the environment, histori ln res, or histori strutures? If "Yes," omplete Sheule D, Prt II~~~~~~~~~~~~~~ Di the orgniztion mintin olletions of works of rt, historil tresures, or other similr ssets? If "Yes," omplete Sheule D, Prt III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 9 Di the orgniztion report n mount in Prt, line, for esrow or ustoil ount liility, serve s ustoin for mounts not liste in Prt ; or provie reit ounseling, et mngement, reit repir, or et negotition servies? If "Yes," omplete Sheule D, Prt IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0 Di the orgniztion, iretly or through relte orgniztion, hol ssets in temporrily restrite enowments, permnent enowments, or qusi-enowments? If "Yes," omplete Sheule D, Prt V ~~~~~~~~~~~~~~~~~~~~~~~~ If the orgniztion s nswer to ny of the following questions is "Yes," then omplete Sheule D, Prts VI, VII, VIII, I, or s pplile. Di the orgniztion report n mount for ln, uilings, n equipment in Prt, line 0? If "Yes," omplete Sheule D, Prt VI ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report n mount for investments - other seurities in Prt, line tht is % or more of its totl ssets reporte in Prt, line? If "Yes," omplete Sheule D, Prt VII ~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report n mount for investments - progrm relte in Prt, line tht is % or more of its totl ssets reporte in Prt, line? If "Yes," omplete Sheule D, Prt VIII ~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report n mount for other ssets in Prt, line tht is % or more of its totl ssets reporte in Prt, line? If "Yes," omplete Sheule D, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e Di the orgniztion report n mount for other liilities in Prt, line? If "Yes," omplete Sheule D, Prt ~~~~~~ f Di the orgniztion s seprte or onsolite finnil sttements for the tx yer inlue footnote tht resses the orgniztion s liility for unertin tx positions uner FIN (ASC 0)? If "Yes," omplete Sheule D, Prt ~~~~ Di the orgniztion otin seprte, inepenent uite finnil sttements for the tx yer? If "Yes," omplete Sheule D, Prts I n II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ws the orgniztion inlue in onsolite, inepenent uite finnil sttements for the tx yer? If "Yes," n if the orgniztion nswere "No" to line, then ompleting Sheule D, Prts I n II is optionl ~~~~~ Is the orgniztion shool esrie in setion 0()()(A)(ii)? If "Yes," omplete Sheule E ~~~~~~~~~~~~~~ Di the orgniztion mintin n offie, employees, or gents outsie of the Unite Sttes? ~~~~~~~~~~~~~~~~ Di the orgniztion hve ggregte revenues or expenses of more thn $0,000 from grntmking, funrising, usiness, investment, n progrm servie tivities outsie the Unite Sttes, or ggregte foreign investments vlue t $00,000 or more? If "Yes," omplete Sheule F, Prts I n IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report on Prt I, olumn (A), line, more thn $,000 of grnts or other ssistne to or for ny foreign orgniztion? If "Yes," omplete Sheule F, Prts II n IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report on Prt I, olumn (A), line, more thn $,000 of ggregte grnts or other ssistne to or for foreign iniviuls? If "Yes," omplete Sheule F, Prts III n IV ~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report totl of more thn $,000 of expenses for professionl funrising servies on Prt I, olumn (A), lines n e? If "Yes," omplete Sheule G, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report more thn $,000 totl of funrising event gross inome n ontriutions on Prt VIII, lines n? If "Yes," omplete Sheule G, Prt II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 9 Di the orgniztion report more thn $,000 of gross inome from gming tivities on Prt VIII, line 9? If "Yes," omplete Sheule G, Prt III 9 0 e f Yes Pge No 9 Form 990 (0) 00 --

5 Form 990 (0) THE SHRINERS' HOSPITAL FOR CHILDREN 0- Prt IV Cheklist of Require Sheules (ontinue) 0 Di the orgniztion operte one or more hospitl filities? If "Yes," omplete Sheule H ~~~~~~~~~~~~~~~~ If "Yes" to line 0, i the orgniztion tth opy of its uite finnil sttements to this return? ~~~~~~~~~~ Di the orgniztion report more thn $,000 of grnts or other ssistne to ny omesti orgniztion or omesti government on Prt I, olumn (A), line? If "Yes," omplete Sheule I, Prts I n II ~~~~~~~~~~~~~~ Di the orgniztion report more thn $,000 of grnts or other ssistne to or for omesti iniviuls on Prt I, olumn (A), line? If "Yes," omplete Sheule I, Prts I n III ~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion nswer "Yes" to Prt VII, Setion A, line,, or out ompenstion of the orgniztion s urrent n former offiers, iretors, trustees, key employees, n highest ompenste employees? If "Yes," omplete Sheule J ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion hve tx-exempt on issue with n outstning prinipl mount of more thn $00,000 s of the lst y of the yer, tht ws issue fter Deemer, 00? If "Yes," nswer lines through n omplete Sheule K. If "No", go to line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion invest ny proees of tx-exempt ons eyon temporry perio exeption? ~~~~~~~~~~~ Di the orgniztion mintin n esrow ount other thn refuning esrow t ny time uring the yer to efese ny tx-exempt ons? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion t s n "on ehlf of" issuer for ons outstning t ny time uring the yer? ~~~~~~~~~~~ Setion 0()(), 0()(), n 0()(9) orgniztions. Di the orgniztion engge in n exess enefit trnstion with isqulifie person uring the yer? If "Yes," omplete Sheule L, Prt I ~~~~~~~~~~~~~~~~ Is the orgniztion wre tht it engge in n exess enefit trnstion with isqulifie person in prior yer, n tht the trnstion hs not een reporte on ny of the orgniztion s prior Forms 990 or 990-EZ? If "Yes," omplete Sheule L, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion report ny mount on Prt, line,, or for reeivles from or pyles to ny urrent or former offiers, iretors, trustees, key employees, highest ompenste employees, or isqulifie persons? If "Yes," omplete Sheule L, Prt II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion provie grnt or other ssistne to n offier, iretor, trustee, key employee, sustntil ontriutor or employee thereof, grnt seletion ommittee memer, or to % ontrolle entity or fmily memer of ny of these persons? If "Yes," omplete Sheule L, Prt III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Ws the orgniztion prty to usiness trnstion with one of the following prties (see Sheule L, Prt IV instrutions for pplile filing threshols, onitions, n exeptions): A urrent or former offier, iretor, trustee, or key employee? If "Yes," omplete Sheule L, Prt IV ~~~~~~~~~~~ A fmily memer of urrent or former offier, iretor, trustee, or key employee? If "Yes," omplete Sheule L, Prt IV ~~ An entity of whih urrent or former offier, iretor, trustee, or key employee (or fmily memer thereof) ws n offier, iretor, trustee, or iret or iniret owner? If "Yes," omplete Sheule L, Prt IV~~~~~~~~~~~~~~~~~~~~~ 9 0 Di the orgniztion reeive more thn $,000 in non-sh ontriutions? If "Yes," omplete Sheule M ~~~~~~~~~ Di the orgniztion reeive ontriutions of rt, historil tresures, or other similr ssets, or qulifie onservtion ontriutions? If "Yes," omplete Sheule M ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion liquite, terminte, or issolve n ese opertions? If "Yes," omplete Sheule N, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion sell, exhnge, ispose of, or trnsfer more thn % of its net ssets? If "Yes," omplete Sheule N, Prt II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion own 00% of n entity isregre s seprte from the orgniztion uner Regultions setions 0.0- n 0.0-? If "Yes," omplete Sheule R, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~ Ws the orgniztion relte to ny tx-exempt or txle entity? If "Yes," omplete Sheule R, Prt II, III, or IV, n Prt V, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion hve ontrolle entity within the mening of setion ()()? ~~~~~~~~~~~~~~~~~~ If "Yes" to line, i the orgniztion reeive ny pyment from or engge in ny trnstion with ontrolle entity within the mening of setion ()()? If "Yes," omplete Sheule R, Prt V, line ~~~~~~~~~~~~~~~~~~~ Setion 0()() orgniztions. Di the orgniztion mke ny trnsfers to n exempt non-hritle relte orgniztion? If "Yes," omplete Sheule R, Prt V, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion onut more thn % of its tivities through n entity tht is not relte orgniztion n tht is trete s prtnership for feerl inome tx purposes? If "Yes," omplete Sheule R, Prt VI ~~~~~~~~ Di the orgniztion omplete Sheule O n provie explntions in Sheule O for Prt VI, lines n 9? Note. All Form 990 filers re require to omplete Sheule O Yes Pge No Form 990 (0) 00 --

6 Form 990 (0) THE SHRINERS' HOSPITAL FOR CHILDREN 0- Pge Prt V Sttements Regring Other IRS Filings n Tx Compline Chek if Sheule O ontins response or note to ny line in this Prt V Enter the numer reporte in Box of Form 09. Enter -0- if not pplile ~~~~~~~~~~~ Enter the numer of Forms W-G inlue in line. Enter -0- if not pplile ~~~~~~~~~~ Di the orgniztion omply with kup withholing rules for reportle pyments to venors n reportle gming If t lest one is reporte on line, i the orgniztion file ll require feerl employment tx returns? ~~~~~~~~~~ Note. If the sum of lines n is greter thn 0, you my e require to e-file (see instrutions) ~~~~~~~~~~~ Orgniztions tht my reeive eutile ontriutions uner setion 0(). Di the orgniztion reeive pyment in exess of $ me prtly s ontriution n prtly for goos n servies provie to the pyor? 9 0 e f g h Sponsoring orgniztions mintining onor vise funs. Di onor vise fun mintine y the Sponsoring orgniztions mintining onor vise funs. Setion 0()() orgniztions. Enter: Setion 0()() orgniztions. Enter: Setion 9()() non-exempt hritle trusts. Is the orgniztion filing Form 990 in lieu of Form 0? (gmling) winnings to prize winners? Enter the numer of employees reporte on Form W-, Trnsmittl of Wge n Tx Sttements, file for the lenr yer ening with or within the yer overe y this return ~~~~~~~~~~ Di the orgniztion hve unrelte usiness gross inome of $,000 or more uring the yer? ~~~~~~~~~~~~~~ If "Yes," hs it file Form 990-T for this yer? If "No," to line, provie n explntion in Sheule O ~~~~~~~~~~ At ny time uring the lenr yer, i the orgniztion hve n interest in, or signture or other uthority over, finnil ount in foreign ountry (suh s nk ount, seurities ount, or other finnil ount)?~~~~~~~ If "Yes," enter the nme of the foreign ountry: J See instrutions for filing requirements for FinCEN Form, Report of Foreign Bnk n Finnil Aounts (FBAR). Ws the orgniztion prty to prohiite tx shelter trnstion t ny time uring the tx yer? ~~~~~~~~~~~~ Di ny txle prty notify the orgniztion tht it ws or is prty to prohiite tx shelter trnstion? ~~~~~~~~~ If "Yes," to line or, i the orgniztion file Form -T? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Does the orgniztion hve nnul gross reeipts tht re normlly greter thn $00,000, n i the orgniztion soliit ny ontriutions tht were not tx eutile s hritle ontriutions? If "Yes," i the orgniztion inlue with every soliittion n express sttement tht suh ontriutions or gifts were not tx eutile? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," i the orgniztion notify the onor of the vlue of the goos or servies provie? Setion 0()(9) qulifie nonprofit helth insurne issuers. Note. See the instrutions for itionl informtion the orgniztion must report on Sheule O. Di the orgniztion reeive ny pyments for inoor tnning servies uring the tx yer? ~~~~~~~~~~~~~~~~ If "Yes," hs it file Form 0 to report these pyments? If "No," provie n explntion in Sheule O ~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion sell, exhnge, or otherwise ispose of tngile personl property for whih it ws require to file Form? ~~~~~~~~~~~~~~~ If "Yes," inite the numer of Forms file uring the yer ~~~~~~~~~~~~~~~~ Di the orgniztion reeive ny funs, iretly or iniretly, to py premiums on personl enefit ontrt? Di the orgniztion, uring the yer, py premiums, iretly or iniretly, on personl enefit ontrt? 0 0 ~~~~~~~ ~~~~~~~~~ If the orgniztion reeive ontriution of qulifie intelletul property, i the orgniztion file Form 99 s require? ~ If the orgniztion reeive ontriution of rs, ots, irplnes, or other vehiles, i the orgniztion file Form 09-C? sponsoring orgniztion hve exess usiness holings t ny time uring the yer? ~~~~~~~~~~~~~~~~~~~ Di the sponsoring orgniztion mke ny txle istriutions uner setion 9? Di the sponsoring orgniztion mke istriution to onor, onor visor, or relte person? Initition fees n pitl ontriutions inlue on Prt VIII, line ~~~~~~~~~~~~~~~ Gross reeipts, inlue on Form 990, Prt VIII, line, for puli use of lu filities ~~~~~~ Gross inome from memers or shreholers ~~~~~~~~~~~~~~~~~~~~~~~~~~ Gross inome from other soures (Do not net mounts ue or pi to other soures ginst mounts ue or reeive from them.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," enter the mount of tx-exempt interest reeive or rue uring the yer ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Is the orgniztion liense to issue qulifie helth plns in more thn one stte? ~~~~~~~~~~~~~~~~~~~~~ Enter the mount of reserves the orgniztion is require to mintin y the sttes in whih the orgniztion is liense to issue qulifie helth plns ~~~~~~~~~~~~~~~~~~~~~~ Enter the mount of reserves on hn~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0 9 e f g h 9 9 Yes No Form 990 (0)

7 Form 990 (0) THE SHRINERS' HOSPITAL FOR CHILDREN 0- Pge Prt VI Governne, Mngement, n Dislosure For eh "Yes" response to lines through elow, n for "No" response to line,, or 0 elow, esrie the irumstnes, proesses, or hnges in Sheule O. See instrutions. Chek if Sheule O ontins response or note to ny line in this Prt VI Setion A. Governing Boy n Mngement Enter the numer of voting memers of the governing oy t the en of the tx yer ~~~~~~ If there re mteril ifferenes in voting rights mong memers of the governing oy, or if the governing 9 Is there ny offier, iretor, trustee, or key employee liste in Prt VII, Setion A, who nnot e rehe t the orgniztion s miling ress? If "Yes," provie the nmes n resses in Sheule O Setion B. Poliies (This Setion B requests informtion out poliies not require y the Internl Revenue Coe.) exempt sttus with respet to suh rrngements? Setion C. Dislosure List the sttes with whih opy of this Form 990 is require to e file JMA 9 oy elegte ro uthority to n exeutive ommittee or similr ommittee, explin in Sheule O. Enter the numer of voting memers inlue in line, ove, who re inepenent ~~~~~~ Di ny offier, iretor, trustee, or key employee hve fmily reltionship or usiness reltionship with ny other offier, iretor, trustee, or key employee? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion elegte ontrol over mngement uties ustomrily performe y or uner the iret supervision of offiers, iretors, or trustees, or key employees to mngement ompny or other person? ~~~~~~~~~~~~~~ Di the orgniztion mke ny signifint hnges to its governing ouments sine the prior Form 990 ws file? ~~~~~ Di the orgniztion eome wre uring the yer of signifint iversion of the orgniztion s ssets? ~~~~~~~~~ Di the orgniztion hve memers or stokholers? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion hve memers, stokholers, or other persons who h the power to elet or ppoint one or more memers of the governing oy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Are ny governne eisions of the orgniztion reserve to (or sujet to pprovl y) memers, stokholers, or persons other thn the governing oy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion ontemporneously oument the meetings hel or written tions unertken uring the yer y the following: The governing oy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Eh ommittee with uthority to t on ehlf of the governing oy? Desrie in Sheule O the proess, if ny, use y the orgniztion to review this Form 99 Di the orgniztion hve written onflit of interest poliy? If "No," go to line ~~~~~~~~~~~~~~~~~~~~ Were offiers, iretors, or trustees, n key employees require to islose nnully interests tht oul give rise to onflits? ~~~~~~ Di the orgniztion regulrly n onsistently monitor n enfore ompline with the poliy? If "Yes," esrie in Sheule O how this ws one ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ for puli inspetion. Inite how you me these ville. Chek ll tht pply. Own wesite Another s wesite Upon request Other (explin in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 0 Di the orgniztion hve lol hpters, rnhes, or ffilites? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," i the orgniztion hve written poliies n proeures governing the tivities of suh hpters, ffilites, n rnhes to ensure their opertions re onsistent with the orgniztion s exempt purposes? ~~~~~~~~~~~~~ Hs the orgniztion provie omplete opy of this Form 990 to ll memers of its governing oy efore filing the form? Di the orgniztion hve written whistlelower poliy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion hve written oument retention n estrution poliy? ~~~~~~~~~~~~~~~~~~~~~~ Di the proess for etermining ompenstion of the following persons inlue review n pprovl y inepenent persons, omprility t, n ontemporneous sustntition of the eliertion n eision? The orgniztion s CEO, Exeutive Diretor, or top mngement offiil Other offiers or key employees of the orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes" to line or, esrie the proess in Sheule O (see instrutions). ~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion invest in, ontriute ssets to, or prtiipte in joint venture or similr rrngement with txle entity uring the yer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," i the orgniztion follow written poliy or proeure requiring the orgniztion to evlute its prtiiption in joint venture rrngements uner pplile feerl tx lw, n tke steps to sfegur the orgniztion s Setion 0 requires n orgniztion to mke its Forms 0 (or 0 if pplile), 990, n 990-T (Setion 0()()s only) ville Desrie in Sheule O whether (n if so, how) the orgniztion me its governing ouments, onflit of interest poliy, n finnil sttements ville to the puli uring the tx yer. 0 Stte the nme, ress, n telephone numer of the person who possesses the orgniztion s ooks n reors: SHARON RUSSELL ROCKY POINT DR., TAMPA, FL Form 990 (0) Yes Yes No No

8 Form 990 (0) THE SHRINERS' HOSPITAL FOR CHILDREN 0- Pge Prt VII Compenstion of Offiers, Diretors, Trustees, Key Employees, Highest Compenste Employees, n Inepenent Contrtors Chek if Sheule O ontins response or note to ny line in this Prt VII Setion A. Offiers, Diretors, Trustees, Key Employees, n Highest Compenste Employees Complete this tle for ll persons require to e liste. Report ompenstion for the lenr yer ening with or within the orgniztion s tx yer. List ll of the orgniztion s urrent offiers, iretors, trustees (whether iniviuls or orgniztions), regrless of mount of ompenstion. Enter -0- in olumns (D), (E), n (F) if no ompenstion ws pi. List ll of the orgniztion s urrent key employees, if ny. See instrutions for efinition of "key employee." List the orgniztion s five urrent highest ompenste employees (other thn n offier, iretor, trustee, or key employee) who reeive reportle ompenstion (Box of Form W- n/or Box of Form 099-MISC) of more thn $00,000 from the orgniztion n ny relte orgniztions. List ll of the orgniztion s former offiers, key employees, n highest ompenste employees who reeive more thn $00,000 of reportle ompenstion from the orgniztion n ny relte orgniztions. List ll of the orgniztion s former iretors or trustees tht reeive, in the pity s former iretor or trustee of the orgniztion, more thn $0,000 of reportle ompenstion from the orgniztion n ny relte orgniztions. List persons in the following orer: iniviul trustees or iretors; institutionl trustees; offiers; key employees; highest ompenste employees; n former suh persons. Chek this ox if neither the orgniztion nor ny relte orgniztion ompenste ny urrent offier, iretor, or trustee. (A) (B) (C) (D) (E) (F) Nme n Title Averge hours per week (list ny hours for relte orgniztions elow line) Position (o not hek more thn one ox, unless person is oth n offier n iretor/trustee) Iniviul trustee or iretor Institutionl trustee Offier Key employee Highest ompenste employee Former Reportle ompenstion from the orgniztion (W-/099-MISC) Reportle ompenstion from relte orgniztions (W-/099-MISC) Estimte mount of other ompenstion from the orgniztion n relte orgniztions () RAOUL L. FREVAL, SR..00 TRUSTEE 00 () DOUGLAS E. MAWELL.00 PRESIDENT, TRUSTEE.00 9,00 () DAVID H. BURSTEIN.00 TRUSTEE 00 () KEVIN J. HECHT, ESQ..00 TRUSTEE 00 () BOBBY B. SIMMONS.00 TRUSTEE 00 () SKIP D.F. STANAWAY.00 TRUSTEE.00 () PETER P. DIAZ, M.D..00 TRUSTEE.00 () JOHN A. CINOTTO.00 TRUSTEE 00 (9) STEVEN E. BEHE.00 TRUSTEE 00 (0) JAMES L. MCCONNELL.00 TREASURER, TRUSTEE 00 () DALE W. STAUSS.00 CHAIRMAN OF THE BOARD, TRUSTEE.00,0 () ROGER SUMNER BABB.00 TRUSTEE 00 () ROBERT L. BAKER, CPA.00 TRUSTEE 00 () BARRY J. GATES.00 TRUSTEE 00 () ANTHONY M. WEST.00 TRUSTEE.00 () JERRY G. GANTT.00 VICE PRESIDENT, TRUSTEE.00,0 () TIMOTHY J. LUTTRELL.00 ASSISTANT TREASURER, TRUSTEE Form 990 (0)

9 Form 990 (0) THE SHRINERS' HOSPITAL FOR CHILDREN 0- Pge Prt VII Setion A. Offiers, Diretors, Trustees, Key Employees, n Highest Compenste Employees (ontinue) (A) (B) (C) (D) (E) (F) Nme n title Averge Position (o not hek more thn one Reportle Reportle Estimte hours per ox, unless person is oth n ompenstion ompenstion mount of week offier n iretor/trustee) from from relte other (list ny the orgniztions ompenstion hours for orgniztion (W-/099-MISC) from the relte (W-/099-MISC) orgniztion orgniztions n relte elow orgniztions line) Su-totl~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Totl from ontinution sheets to Prt VII, Setion A ~~~~~~~~~~ Totl ( lines n ) Iniviul trustee or iretor Institutionl trustee Di the orgniztion list ny former offier, iretor, or trustee, key employee, or highest ompenste employee on line? If "Yes," omplete Sheule J for suh iniviul ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di ny person liste on line reeive or rue ompenstion from ny unrelte orgniztion or iniviul for servies renere to the orgniztion? If "Yes," omplete Sheule J for suh person Setion B. Inepenent Contrtors Totl numer of iniviuls (inluing ut not limite to those liste ove) who reeive more thn $00,000 of reportle ompenstion from the orgniztion For ny iniviul liste on line, is the sum of reportle ompenstion n other ompenstion from the orgniztion n relte orgniztions greter thn $0,000? If "Yes," omplete Sheule J for suh iniviul~~~~~~~~~~~~~ Offier () JAMES A. DOEL.00 TRUSTEE.00 (9) CHRIS L. SMITH.00 TRUSTEE 00 (0) ROBERT L. TURNER.00 TRUSTEE 00 () JACK H. JONES.00 ASSISTANT SECRETARY.00,.. () CHARLES H. WEAVER.00 CLERK 00 () DAVID M. DRVARIC, M.D. 00 CHIEF OF STAFF 00,0.,. () PETER D. MASSO, M.D. 00 ASSISTANT CHIEF OF STAFF 00,,0 () MARJORIE MCETTRICK-MALONEY 00 DIRECTOR PATIENT CARE SERVICES 00,.,09. () H LEE KIRK 00 ADMINISTRATOR 00,.,. Complete this tle for your five highest ompenste inepenent ontrtors tht reeive more thn $00,000 of ompenstion from the orgniztion. Report ompenstion for the lenr yer ening with or within the orgniztion s tx yer. (A) (B) (C) Nme n usiness ress Desription of servies Compenstion THE GENERAL HOSPITAL CORPORATION FRUIT ST, BOSTON, MA 0 OUTSIDE PATIENT SERVICES,,9. SPRINGFIELD ANESTHESIA SERVICES 90 ALLEN ST, SPRINGFIELD, MA 00 ANESTHESIOLOGY SERVICES 0, DR. EDWARD BITTNER GARDEN ST, BOSTON, MA 0 MEDICAL SERVICES,. CRITICAL CARE MEDFLIGHT INC MEDICAL TRANSPORTATION PO BO, LAWRENCEVILLE, GA 00-0 SERVICES 9,. RADIOLOGY AND IMAGING INC 9 MOODY ST, LUDLOW, MA 00- DIAGNOSTIC IMAGING SERVICES 9,. Totl numer of inepenent ontrtors (inluing ut not limite to those liste ove) who reeive more thn $00,000 of ompenstion from the orgniztion SEE PART VII, SECTION A CONTINUATION SHEETS Form 990 (0) Key employee Highest ompenste employee Former,,9.,.,.,.,.,0,9.,.,. Yes No

10 Form 990 Prt VII Setion A. THE SHRINERS' HOSPITAL FOR CHILDREN 0- Offiers, Diretors, Trustees, Key Employees, n Highest Compenste Employees (ontinue) (A) (B) (C) (D) (E) (F) Nme n title Averge hours per week (list ny hours for relte orgniztions elow line) Position (hek ll tht pply) Iniviul trustee or iretor Institutionl trustee Offier Key employee Highest ompenste employee Former Reportle ompenstion from the orgniztion (W-/099-MISC) Reportle ompenstion from relte orgniztions (W-/099-MISC) Estimte mount of other ompenstion from the orgniztion n relte orgniztions () JOHN DONLIN 00 REGIONAL DIRECTOR, HR 00,.,. Totl to Prt VII, Setion A, line,.,

11 Form 990 (0) THE SHRINERS' HOSPITAL FOR CHILDREN 0- Prt VIII Sttement of Revenue Contriutions, Gifts, Grnts n Other Similr Amounts Progrm Servie Revenue Other Revenue e f g Nonsh ontriutions inlue in lines -f: $ h e f Totl. A lines -f Business Coe PATIENT SERVICE 0,99,9.,99,9. e f g 9 0 Government grnts (ontriutions) All other ontriutions, gifts, grnts, n similr mounts not inlue ove ~~ Totl. A lines -f Business Coe Pge 9 Chek if Sheule O ontins response or note to ny line in this Prt VIII (A) (B) (C) (D) Totl revenue Relte or Unrelte Revenue exlue exempt funtion usiness from tx uner setions revenue revenue - Feerte mpigns Memership ues ~~~~~~ ~~~~~~~~ Funrising events ~~~~~~~~ Relte orgniztions ~~~~~~ All other progrm servie revenue ~~~~~ Investment inome (inluing iviens, interest, n other similr mounts) ~~~~~~~~~~~~~~~~~ Inome from investment of tx-exempt on proees Roylties Gross rents ~~~~~~~ Less: rentl expenses~~~ Rentl inome or (loss) ~~ Net rentl inome or (loss) Gross mount from sles of ssets other thn inventory Less: ost or other sis n sles expenses ~~~ Gin or (loss) ~~~~~~~ (i) Rel (ii) Personl,0,.,0,. (i) Seurities 9,,. (ii) Other Net gin or (loss) Gross inome from funrising events (not inluing $ of ontriutions reporte on line ). See Prt IV, line ~~~~~~~~~~~~~ Less: iret expenses~~~~~~~~~~ Net inome or (loss) from funrising events Gross inome from gming tivities. See Prt IV, line 9 ~~~~~~~~~~~~~ Less: iret expenses ~~~~~~~~~ Net inome or (loss) from gming tivities Gross sles of inventory, less returns n llownes ~~~~~~~~~~~~~ Less: ost of goos sol ~~~~~~~~ Net inome or (loss) from sles of inventory Misellneous Revenue All other revenue ~~~~~~~~~~~~~,,.,,9.,,. 0,0.,,9. -0,0.,0,.,99,9.,,.,,.,0,.,0,.,,.,,. e Totl. A lines - ~~~~~~~~~~~~~~~ Totl revenue. See instrutions.,,.,99,9.,, Form 990 (0) 0

12 Form 990 (0) THE SHRINERS' HOSPITAL FOR CHILDREN 0- Prt I Sttement of Funtionl Expenses Setion 0()() n 0()() orgniztions must omplete ll olumns. All other orgniztions must omplete olumn (A). Chek if Sheule O ontins response or note to ny line in this Prt I Do not inlue mounts reporte on lines, (A) (B) (C) (D),, 9, n 0 of Prt VIII. Totl expenses Progrm servie Mngement n Funrising expenses generl expenses expenses Grnts n other ssistne to omesti orgniztions n omesti governments. See Prt IV, line ~ e f g Grnts n other ssistne to omesti iniviuls. See Prt IV, line ~~~~~~~ Grnts n other ssistne to foreign orgniztions, foreign governments, n foreign iniviuls. See Prt IV, lines n ~~~ Benefits pi to or for memers ~~~~~~~ Compenstion of urrent offiers, iretors, trustees, n key employees ~~~~~~~~ Compenstion not inlue ove, to isqulifie persons (s efine uner setion 9(f)()) n persons esrie in setion 9()()(B) ~~~ Other slries n wges ~~~~~~~~~~ Pension pln ruls n ontriutions (inlue setion 0(k) n 0() employer ontriutions) Other employee enefits ~~~~~~~~~~ Pyroll txes ~~~~~~~~~~~~~~~~ Fees for servies (non-employees): Mngement ~~~~~~~~~~~~~~~~ Legl ~~~~~~~~~~~~~~~~~~~~ Aounting ~~~~~~~~~~~~~~~~~ Loying ~~~~~~~~~~~~~~~~~~ Professionl funrising servies. See Prt IV, line Investment mngement fees ~~~~~~~~ Other. (If line g mount exees 0% of line, olumn (A) mount, list line g expenses on Sh O.) Avertising n promotion ~~~~~~~~~ Offie expenses~~~~~~~~~~~~~~~ Informtion tehnology ~~~~~~~~~~~ Roylties ~~~~~~~~~~~~~~~~~~ Oupny ~~~~~~~~~~~~~~~~~ Trvel ~~~~~~~~~~~~~~~~~~~ Pyments of trvel or entertinment expenses for ny feerl, stte, or lol puli offiils Conferenes, onventions, n meetings ~~ Interest ~~~~~~~~~~~~~~~~~~ Pyments to ffilites ~~~~~~~~~~~~ Depreition, epletion, n mortiztion ~~ Insurne ~~~~~~~~~~~~~~~~~ Other expenses. Itemize expenses not overe ove. (List misellneous expenses in line e. If line e mount exees 0% of line, olumn (A) e All other expenses Totl funtionl expenses. A lines through e Joint osts. Complete this line only if the orgniztion reporte in olumn (B) joint osts from omine eutionl mpign n funrising soliittion. Chek here if following SOP 9- (ASC 9-0),,9.,,9.,,.,,.,,0,,0,,9.,,9.,,.,,.,9,,9,,,,0,9.,0,9.,9,9,9,9.,9,9.,9.,9.,0,0.,0,0.,.,. mount, list line e expenses on Sheule O.) ~~ MEDICAL SUPPLIES,0,,0, PATIENT TRAVEL COSTS 9,. 9,. SUPPORT SERVICES,00,00 DUES AND REGISTRATIONS,9.,9. Pge 0,.,. 0,,. 0,, Form 990 (0)

13 Form 990 (0) THE SHRINERS' HOSPITAL FOR CHILDREN 0- Pge Prt Blne Sheet Net Assets or Fun Blnes Liilities Assets Chek if Sheule O ontins response or note to ny line in this Prt (A) (B) Beginning of yer En of yer Csh - non-interest-ering ~~~~~~~~~~~~~~~~~~~~~~~~~,,9. Svings n temporry sh investments ~~~~~~~~~~~~~~~~~~ Pleges n grnts reeivle, net ~~~~~~~~~~~~~~~~~~~~~ Aounts reeivle, net ~~~~~~~~~~~~~~~~~~~~~~~~~~ Lons n other reeivles from urrent n former offiers, iretors, trustees, key employees, n highest ompenste employees. Complete,0,9.,,. Prt II of Sheule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Lons n other reeivles from other isqulifie persons (s efine uner setion 9(f)()), persons esrie in setion 9()()(B), n ontriuting employers n sponsoring orgniztions of setion 0()(9) voluntry employees enefiiry orgniztions (see instr). Complete Prt II of Sh L ~~ Notes n lons reeivle, net ~~~~~~~~~~~~~~~~~~~~~~~ Inventories for sle or use ~~~~~~~~~~~~~~~~~~~~~~~~~~ 9, 9,. 9 Prepi expenses n eferre hrges ~~~~~~~~~~~~~~~~~~,. 9, 0 Ln, uilings, n equipment: ost or other sis. Complete Prt VI of Sheule D ~~~ 0,9, Less: umulte epreition ~~~~~~ 0,0, 0,,9. 0,9,. Investments - pulily tre seurities ~~~~~~~~~~~~~~~~~~~ Investments - other seurities. See Prt IV, line ~~~~~~~~~~~~~~ 9,9,9. 9,,. Investments - progrm-relte. See Prt IV, line ~~~~~~~~~~~~~ 9 Intngile ssets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other ssets. See Prt IV, line ~~~~~~~~~~~~~~~~~~~~~~ Totl ssets. A lines through (must equl line ) Aounts pyle n rue expenses ~~~~~~~~~~~~~~~~~~ Grnts pyle ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Deferre revenue ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~,0,.,099,0,.,,.,,9. 9 9,09,.,0,,.,90,.,,. 0 Tx-exempt on liilities ~~~~~~~~~~~~~~~~~~~~~~~~~ 0 Esrow or ustoil ount liility. Complete Prt IV of Sheule D ~~~~ Lons n other pyles to urrent n former offiers, iretors, trustees, key employees, highest ompenste employees, n isqulifie persons. Complete Prt II of Sheule L ~~~~~~~~~~~~~~~~~~~~~~~ Seure mortgges n notes pyle to unrelte thir prties ~~~~~~ Unseure notes n lons pyle to unrelte thir prties ~~~~~~~~ Other liilities (inluing feerl inome tx, pyles to relte thir prties, n other liilities not inlue on lines -). Complete Prt of Sheule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~,,9.,,. Totl liilities. A lines through,9, 9,, Orgniztions tht follow SFAS (ASC 9), hek here n omplete lines through 9, n lines n. Unrestrite net ssets ~~~~~~~~~~~~~~~~~~~~~~~~~~~,0,0, 9,9, 9 Temporrily restrite net ssets Permnently restrite net ssets ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~ 9 Orgniztions tht o not follow SFAS (ASC 9), hek here n omplete lines 0 through. 0 Cpitl stok or trust prinipl, or urrent funs ~~~~~~~~~~~~~~~ Pi-in or pitl surplus, or ln, uiling, or equipment fun ~~~~~~~~ 0 Retine ernings, enowment, umulte inome, or other funs ~~~~ Totl net ssets or fun lnes ~~~~~~~~~~~~~~~~~~~~~~,0,0, 9,9, Totl liilities n net ssets/fun lnes,099,0,.,0,,. Form 990 (0) 0 --

14 Form 990 (0) THE SHRINERS' HOSPITAL FOR CHILDREN 0- Pge Prt I Reonilition of Net Assets Chek if Sheule O ontins response or note to ny line in this Prt I 9 Totl revenue (must equl Prt VIII, olumn (A), line ) Totl expenses (must equl Prt I, olumn (A), line ) ~~~~~~~~~~~~~~~~~~~~~~~~~~ Revenue less expenses. Sutrt line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Net ssets or fun lnes t eginning of yer (must equl Prt, line, olumn (A)) ~~~~~~~~~~ Net unrelize gins (losses) on investments Donte servies n use of filities Investment expenses Prior perio justments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other hnges in net ssets or fun lnes (explin in Sheule O) ~~~~~~~~~~~~~~~~~~~ 0 Net ssets or fun lnes t en of yer. Comine lines through 9 (must equl Prt, line, olumn (B)) 0 9,9, Prt II Finnil Sttements n Reporting Chek if Sheule O ontins response or note to ny line in this Prt II Yes No Aounting metho use to prepre the Form 990: Csh Arul Other If the orgniztion hnge its metho of ounting from prior yer or heke "Other," explin in Sheule O. Were the orgniztion s finnil sttements ompile or reviewe y n inepenent ountnt? ~~~~~~~~~~~~ If "Yes," hek ox elow to inite whether the finnil sttements for the yer were ompile or reviewe on seprte sis, onsolite sis, or oth: Seprte sis Consolite sis Both onsolite n seprte sis Were the orgniztion s finnil sttements uite y n inepenent ountnt? ~~~~~~~~~~~~~~~~~~~ If "Yes," hek ox elow to inite whether the finnil sttements for the yer were uite on seprte sis, onsolite sis, or oth: Seprte sis Consolite sis Both onsolite n seprte sis If "Yes" to line or, oes the orgniztion hve ommittee tht ssumes responsiility for oversight of the uit, review, or ompiltion of its finnil sttements n seletion of n inepenent ountnt?~~~~~~~~~~~~~~~ If the orgniztion hnge either its oversight proess or seletion proess uring the tx yer, explin in Sheule O. As result of feerl wr, ws the orgniztion require to unergo n uit or uits s set forth in the Single Auit At n OMB Cirulr A-? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," i the orgniztion unergo the require uit or uits? If the orgniztion i not unergo the require uit or uits, explin why in Sheule O n esrie ny steps tken to unergo suh uits 9,,. 0,,.,,09.,0,0, -,09,0-9,,9. Form 990 (0) 0 --

15 OMB No. -00 SCHEDULE A (Form 990 or 990-EZ) Puli Chrity Sttus n Puli Support Complete if the orgniztion is setion 0()() orgniztion or setion 0 9()() nonexempt hritle trust. Deprtment of the Tresury Atth to Form 990 or Form 990-EZ. Open to Puli Internl Revenue Servie Informtion out Sheule A (Form 990 or 990-EZ) n its instrutions is t Inspetion Nme of the orgniztion Employer ientifition numer THE SHRINERS' HOSPITAL FOR CHILDREN 0- Prt I Reson for Puli Chrity Sttus (All orgniztions must omplete this prt.) See instrutions. The orgniztion is not privte fountion euse it is: (For lines through, hek only one ox.) 9 0 e f g A hurh, onvention of hurhes, or ssoition of hurhes esrie in setion 0()()(A)(i). A shool esrie in setion 0()()(A)(ii). (Atth Sheule E (Form 990 or 990-EZ).) A hospitl or oopertive hospitl servie orgniztion esrie in setion 0()()(A)(iii). A meil reserh orgniztion operte in onjuntion with hospitl esrie in setion 0()()(A)(iii). Enter the hospitl s nme, ity, n stte: An orgniztion operte for the enefit of ollege or university owne or operte y governmentl unit esrie in setion 0()()(A)(iv). (Complete Prt II.) A feerl, stte, or lol government or governmentl unit esrie in setion 0()()(A)(v). An orgniztion tht normlly reeives sustntil prt of its support from governmentl unit or from the generl puli esrie in setion 0()()(A)(vi). (Complete Prt II.) A ommunity trust esrie in setion 0()()(A)(vi). (Complete Prt II.) An orgniztion tht normlly reeives: () more thn /% of its support from ontriutions, memership fees, n gross reeipts from tivities relte to its exempt funtions - sujet to ertin exeptions, n () no more thn /% of its support from gross investment inome n unrelte usiness txle inome (less setion tx) from usinesses quire y the orgniztion fter June 0, 9. See setion 09()(). (Complete Prt III.) An orgniztion orgnize n operte exlusively to test for puli sfety. See setion 09()(). An orgniztion orgnize n operte exlusively for the enefit of, to perform the funtions of, or to rry out the purposes of one or more pulily supporte orgniztions esrie in setion 09()() or setion 09()(). See setion 09()(). Chek the ox in lines through tht esries the type of supporting orgniztion n omplete lines e, f, n g. Type I. A supporting orgniztion operte, supervise, or ontrolle y its supporte orgniztion(s), typilly y giving the supporte orgniztion(s) the power to regulrly ppoint or elet mjority of the iretors or trustees of the supporting orgniztion. You must omplete Prt IV, Setions A n B. Type II. A supporting orgniztion supervise or ontrolle in onnetion with its supporte orgniztion(s), y hving ontrol or mngement of the supporting orgniztion veste in the sme persons tht ontrol or mnge the supporte orgniztion(s). You must omplete Prt IV, Setions A n C. Type III funtionlly integrte. A supporting orgniztion operte in onnetion with, n funtionlly integrte with, its supporte orgniztion(s) (see instrutions). You must omplete Prt IV, Setions A, D, n E. Type III non-funtionlly integrte. A supporting orgniztion operte in onnetion with its supporte orgniztion(s) tht is not funtionlly integrte. The orgniztion generlly must stisfy istriution requirement n n ttentiveness requirement (see instrutions). You must omplete Prt IV, Setions A n D, n Prt V. Chek this ox if the orgniztion reeive written etermintion from the IRS tht it is Type I, Type II, Type III funtionlly integrte, or Type III non-funtionlly integrte supporting orgniztion. Enter the numer of supporte orgniztions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Provie the following informtion out the supporte orgniztion(s). (i) Nme of supporte (ii) EIN (iii) Type of orgniztion (iv) Is the orgniztion (v) Amount of monetry (vi) Amount of orgniztion (esrie on lines -9 liste in your support (see other support (see ove (see instrutions)) governing oument? instrutions) instrutions) Yes No Totl LHA For Pperwork Reution At Notie, see the Instrutions for Sheule A (Form 990 or 990-EZ) 0 Form 990 or 990-EZ

16 Sheule A (Form 990 or 990-EZ) 0 THE SHRINERS' HOSPITAL FOR CHILDREN 0- Pge Prt II Support Sheule for Orgniztions Desrie in Setions 0()()(A)(iv) n 0()()(A)(vi) (Complete only if you heke the ox on line,, or of Prt I or if the orgniztion file to qulify uner Prt III. If the orgniztion fils to qulify uner the tests liste elow, plese omplete Prt III.) Setion A. Puli Support Clenr yer (or fisl yer eginning in) Totl. A lines through ~~~ Puli support. Sutrt line from line. Clenr yer (or fisl yer eginning in) 9 0 ssets (Explin in Prt VI.) ~~~~ Totl support. A lines through 0 () 0 () 0 () 0 () 0 (e) 0 (f) Totl () 0 () 0 () 0 () 0 (e) 0 (f) Totl First five yers. If the Form 990 is for the orgniztion s first, seon, thir, fourth, or fifth tx yer s setion 0()() orgniztion, hek this ox n stop here Setion C. Computtion of Puli Support Perentge /% support test - 0. If the orgniztion i not hek the ox on line, n line is /% or more, hek this ox n 0% -fts-n-irumstnes test - 0. If the orgniztion i not hek ox on line,, or, n line is 0% or more, Gifts, grnts, ontriutions, n memership fees reeive. (Do not inlue ny "unusul grnts.") ~~ Tx revenues levie for the orgniztion s enefit n either pi to or expene on its ehlf ~~~~ The vlue of servies or filities furnishe y governmentl unit to the orgniztion without hrge ~ The portion of totl ontriutions y eh person (other thn governmentl unit or pulily supporte orgniztion) inlue on line tht exees % of the mount shown on line, olumn (f) ~~~~~~~~~~~~ Setion B. Totl Support Amounts from line ~~~~~~~ Gross inome from interest, iviens, pyments reeive on seurities lons, rents, roylties n inome from similr soures ~ Net inome from unrelte usiness tivities, whether or not the usiness is regulrly rrie on ~ Other inome. Do not inlue gin or loss from the sle of pitl Gross reeipts from relte tivities, et. (see instrutions) ~~~~~~~~~~~~~~~~~~~~~~~ Puli support perentge for 0 (line, olumn (f) ivie y line, olumn (f)) ~~~~~~~~~~~~ Puli support perentge from 0 Sheule A, Prt II, line ~~~~~~~~~~~~~~~~~~~~~ stop here. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ /% support test - 0. If the orgniztion i not hek ox on line or, n line is /% or more, hek this ox n stop here. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ n if the orgniztion meets the "fts-n-irumstnes" test, hek this ox n stop here. Explin in Prt VI how the orgniztion meets the "fts-n-irumstnes" test. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~~~~~~~~ 0% -fts-n-irumstnes test - 0. If the orgniztion i not hek ox on line,,, or, n line is 0% or more, n if the orgniztion meets the "fts-n-irumstnes" test, hek this ox n stop here. Explin in Prt VI how the orgniztion meets the "fts-n-irumstnes" test. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~ Privte fountion. If the orgniztion i not hek ox on line,,,, or, hek this ox n see instrutions Sheule A (Form 990 or 990-EZ) 0 % %

17 Sheule A (Form 990 or 990-EZ) 0 Prt III Support Sheule for Orgniztions Desrie in Setion 09()() Clenr yer (or fisl yer eginning in) The vlue of servies or filities furnishe y governmentl unit to the orgniztion without hrge ~ Totl. A lines through ~~~ Amounts inlue on lines,, n reeive from isqulifie persons Amounts inlue on lines n reeive from other thn isqulifie persons tht exee the greter of $,000 or % of the mount on line for the yer ~~~~~~ A lines n ~~~~~~~ Puli support. (Sutrt line from line.) Clenr yer (or fisl yer eginning in) 9 Amounts from line ~~~~~~~ 0 Gross inome from interest, iviens, pyments reeive on seurities lons, rents, roylties n inome from similr soures ~ Unrelte usiness txle inome (less setion txes) from usinesses quire fter June 0, 9 ~~~~ () 0 () 0 () 0 () 0 (e) 0 (f) Totl () 0 () 0 () 0 () 0 (e) 0 (f) Totl First five yers. If the Form 990 is for the orgniztion s first, seon, thir, fourth, or fifth tx yer s setion 0()() orgniztion, hek this ox n stop here Setion C. Computtion of Puli Support Perentge Puli support perentge from 0 Sheule A, Prt III, line Setion D. Computtion of Investment Inome Perentge Pge Puli support perentge for 0 (line, olumn (f) ivie y line, olumn (f)) ~~~~~~~~~~~~ % 9 /% support tests - 0. If the orgniztion i not hek the ox on line, n line is more thn /%, n line is not 0 (Complete only if you heke the ox on line 9 of Prt I or if the orgniztion file to qulify uner Prt II. If the orgniztion fils to qulify uner the tests liste elow, plese omplete Prt II.) Setion A. Puli Support Gifts, grnts, ontriutions, n memership fees reeive. (Do not inlue ny "unusul grnts.") ~~ Gross reeipts from missions, merhnise sol or servies performe, or filities furnishe in ny tivity tht is relte to the orgniztion s tx-exempt purpose Gross reeipts from tivities tht re not n unrelte tre or usiness uner setion ~~~~~ Tx revenues levie for the orgniztion s enefit n either pi to or expene on its ehlf ~~~~ Setion B. Totl Support A lines 0 n 0 ~~~~~~ Net inome from unrelte usiness tivities not inlue in line 0, whether or not the usiness is regulrly rrie on ~~~~~~~ Other inome. Do not inlue gin or loss from the sle of pitl ssets (Explin in Prt VI.) ~~~~ Totl support. (A lines 9, 0,, n.) Investment inome perentge for 0 (line 0, olumn (f) ivie y line, olumn (f)) Investment inome perentge from 0 Sheule A, Prt III, line ~~~~~~~~~~~~~~~~~~ ~~~~~~~~ % more thn /%, hek this ox n stop here. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~~~ /% support tests - 0. If the orgniztion i not hek ox on line or line 9, n line is more thn /%, n line is not more thn /%, hek this ox n stop here. The orgniztion qulifies s pulily supporte orgniztion~~~~ Privte fountion. If the orgniztion i not hek ox on line, 9, or 9, hek this ox n see instrutions Sheule A (Form 990 or 990-EZ) 0 % %