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Nonprofiteer
← CHILD HEALTH PATIENT SAFETY ORGANIZATION INC

Form 990 for tax year 2023

Filed by CHILD HEALTH PATIENT SAFETY ORGANIZATION INC.

Totals

Total revenue
$1,061,647
Total expenses
$1,061,647
Contributions and grants received
$0
Grants paid
$0
Program service revenue
$1,041,275
Investment income
$20,372
Other revenue
$0
Total assets, end of year
$761,253
Total liabilities, end of year
$677,903
Net assets or fund balances, end of year
$83,350
Program services expenses (Part IX)
$896,792
Management and general expenses
$164,855
Fundraising expenses
$0
Program service expenses (Part III)
$896,792

Program services were 84.5% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 2a · Program service revenue: PARTICIPATION FEES

    total $1,041,275 · related or exempt $1,041,275

  • 3 · Investment income

    total $20,372 · excluded $20,372

Functional expenses

Part IX, the statement of functional expenses.

  • 11a · Fees: management

    total $164,854 · program services $139,255 · management and general $25,599

  • 11b · Fees: legal

    total $31,500 · program services $26,609 · management and general $4,891

  • 11c · Fees: accounting

    total $3,000 · program services $2,534 · management and general $466

  • 11f · Fees: investment management

    total $5 · program services $4 · management and general $1

  • 11g · Fees: other

    total $80,260 · program services $67,797 · management and general $12,463

  • 13 · Office expenses

    total $3,791 · program services $3,202 · management and general $589

  • 14 · Information technology

    total $104,863 · program services $88,580 · management and general $16,283

  • 16 · Occupancy

    total $30,034 · program services $25,370 · management and general $4,664

  • 17 · Travel

    total $3,478 · program services $2,938 · management and general $540

  • 19 · Conferences, conventions and meetings

    total $84,071 · program services $71,017 · management and general $13,054

  • 22 · Depreciation, depletion and amortization

    total $49,538 · program services $41,845 · management and general $7,693

  • 23 · Insurance

    total $1,596 · program services $1,348 · management and general $248

  • 24a · Other expenses: CONTRACTED STAFF

    total $473,169 · program services $399,695 · management and general $73,474

  • 24b · Other expenses: TAXES

    total $26,152 · program services $22,091 · management and general $4,061

  • 24e · All other expenses

    total $5,336 · program services $4,507 · management and general $829

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $130,056 · end of year $237,185

  • 9 · Prepaid expenses and deferred charges

    beginning of year $6,421 · end of year $35,113

  • 10a · Land, buildings and equipment: cost or other basis

    $72,566

  • 10c · Land, buildings and equipment, net

    beginning of year $0 · end of year $72,566

  • 11 · Investments: publicly traded securities

    beginning of year $75,174 · end of year $397,739

  • 15 · Other assets

    beginning of year $35,750 · end of year $18,650

  • 17 · Accounts payable and accrued expenses

    beginning of year $0 · end of year $42,179

  • 19 · Deferred revenue

    beginning of year $106,551 · end of year $238,600

  • 25 · Other liabilities

    beginning of year $59,698 · end of year $397,124

  • 27 · Net assets without donor restrictions

    beginning of year $81,152 · end of year $83,350

Mission and programs · 2023

Mission

TO IMPROVE THE SAFETY AND QUALITY OF CHILD HEALTH CARE DELIVERY BY CREATING A SECURE ENVIRONMENT WHERE CLINICIANS AND HEALTH CARE ORGANIZATIONS CAN COLLECT, AGGREGATE, AND ANALYZE DATA THAT WILL ENABLE THE IDENTIFICATION AND REDUCTION OF RISKS AND HAZARDS ASSOCIATED WITH PATIENT CARE.

  • THE CHILD HEALTH PATIENT SAFETY ORGANIZATION, INC. (PSO) WAS ORGANIZED TO IMPROVE THE SAFETY OF CHILDREN'S HOSPITALS BY SHARING DATA AND EXPERIENCES. MANDATED BY THE PATIENT SAFETY AND QUALITY IMPROVEMENT ACT (PSQIA), THE PSO PROVIDES FEDERAL PROTECTIONS FOR CHILDREN'S HOSPITALS TO LEAD IN PATIENT SAFETY AND ELIMINATE HARM, UTILIZING COLLABORATIVE INITIATIVES AND NATIONAL EXPERTS.

    Expenses $896,792 · Revenue $1,041,275

As filed on the 2023 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Thomas Shufflebarger

    CHAIR

    Total calculated
    $0
    Hours/week
    1
  • Carol Kemper

    SECRETARY

    Total calculated
    $0
    Hours/week
    1
  • Frank Belmote

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • Tina Cheng

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • Patricia Depompei

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • Callie Dobbins

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • James Fortenberry

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • Patrick Frias

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • Angelo Giardiano

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • Mark Gorelick

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • Barbara Joers

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • Paul Kempinski

    MEMBER

    Total calculated
    $0
    Hours/week
    1 + 2 related
  • Fiona Levy

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • Rustin Morse

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • John Nickens

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • Margaret Rush

    MEMBER

    Total calculated
    $0
    Hours/week
    1 + 2 related
  • Katy Welkie

    MEMBER

    Total calculated
    $0
    Hours/week
    1 + 2 related
  • Michael Wiggins

    MEMBER

    Total calculated
    $0
    Hours/week
    1
  • Mark Wietecha

    CEO EMERITUS

    Total calculated
    $1,636,280
    From this org
    $25,685
    From related orgs
    $1,258,586
    Other
    $352,009
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $18,372 + $900,241 related
    Bonus
    $7,176 + $351,624 related
    Other
    $137 + $6,721 related
    Deferred
    $6,601 + $323,463 related
    Nontaxable benefits
    $439 + $21,506 related
    Filer's total
    $32,725 + $1,603,555 related
  • Amy Knight

    PRESIDENT

    Total calculated
    $1,242,812
    From this org
    $118,610
    From related orgs
    $869,812
    Other
    $254,390
    Hours/week
    5 + 35 related

    Schedule J breakdown matched by us

    Base
    $74,190 + $544,065 related
    Bonus
    $44,271 + $324,654 related
    Other
    $149 + $1,093 related
    Deferred
    $26,201 + $192,140 related
    Nontaxable benefits
    $4,326 + $31,723 related
    Filer's total
    $149,137 + $1,093,675 related
  • Michelle Hogerty

    CFAO

    Total calculated
    $415,586
    From this org
    $10,970
    From related orgs
    $354,711
    Other
    $49,905
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $9,077 + $293,516 related
    Bonus
    $1,830 + $59,170 related
    Other
    $63 + $2,025 related
    Deferred
    $891 + $28,809 related
    Nontaxable benefits
    $606 + $19,599 related
    Filer's total
    $12,467 + $403,119 related
  • Matthew Cook

    CEO (BEG 10/16/23)

    Total calculated
    $227,627
    From this org
    $3,582
    From related orgs
    $175,511
    Other
    $48,534
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $3,572 + $175,037 related
    Bonus
    $0
    Other
    $10 + $474 related
    Deferred
    $870 + $42,630 related
    Nontaxable benefits
    $101 + $4,933 related
    Filer's total
    $4,553 + $223,074 related
  • Torey Mack

    CHIEF QUALITY & SOLUTIONS OFFICER

    Total calculated
    $439,973
    From this org
    $40,850
    From related orgs
    $367,650
    Other
    $31,473
    Hours/week
    4 + 36 related

    Schedule J breakdown matched by us

    Base
    $34,814 + $313,327 related
    Bonus
    $6,000 + $54,000 related
    Other
    $36 + $323 related
    Deferred
    $2,970 + $26,730 related
    Nontaxable benefits
    $177 + $1,596 related
    Filer's total
    $43,997 + $395,976 related
  • Lori Hotzel

    CTO

    Total calculated
    $338,149
    From this org
    $34,470
    From related orgs
    $252,785
    Other
    $50,894
    Hours/week
    5 + 35 related

    Schedule J breakdown matched by us

    Base
    $28,827 + $211,406 related
    Bonus
    $5,520 + $40,480 related
    Other
    $123 + $899 related
    Deferred
    $3,199 + $23,459 related
    Nontaxable benefits
    $2,908 + $21,328 related
    Filer's total
    $40,577 + $297,572 related
  • Kassandra K Jensen

    CHIEF LEARNING OFFICER

    Total calculated
    $334,541
    From this org
    $8,524
    From related orgs
    $275,585
    Other
    $50,432
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $7,084 + $229,020 related
    Bonus
    $1,410 + $45,590 related
    Other
    $30 + $975 related
    Deferred
    $788 + $25,491 related
    Nontaxable benefits
    $725 + $23,428 related
    Filer's total
    $10,037 + $324,504 related
  • Aimee Ossman

    VP, POLICY

    Total calculated
    $283,784
    From this org
    $7,300
    From related orgs
    $236,053
    Other
    $40,431
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $6,176 + $199,725 related
    Bonus
    $1,110 + $35,890 related
    Other
    $14 + $438 related
    Deferred
    $597 + $19,307 related
    Nontaxable benefits
    $616 + $19,911 related
    Filer's total
    $8,513 + $275,271 related
  • Kory K Kittle

    VP, ANALYTICS

    Total calculated
    $271,668
    From this org
    $4,518
    From related orgs
    $221,374
    Other
    $45,776
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $3,799 + $186,140 related
    Bonus
    $704 + $34,496 related
    Other
    $15 + $738 related
    Deferred
    $429 + $21,014 related
    Nontaxable benefits
    $487 + $23,846 related
    Filer's total
    $5,434 + $266,234 related
  • Matthew Hall

    PRINCIPAL, BIOSTATISTICIAN

    Total calculated
    $275,833
    From this org
    $6,696
    From related orgs
    $216,493
    Other
    $52,644
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $5,724 + $185,060 related
    Bonus
    $960 + $31,040 related
    Other
    $12 + $393 related
    Deferred
    $620 + $20,036 related
    Nontaxable benefits
    $960 + $31,028 related
    Filer's total
    $8,276 + $267,557 related
  • Troy Richardson

    VP, ANALYSTICS & DATA STRATEGY

    Total calculated
    $267,503
    From this org
    $4,295
    From related orgs
    $210,440
    Other
    $52,768
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $3,710 + $181,754 related
    Bonus
    $580 + $28,420 related
    Other
    $5 + $266 related
    Deferred
    $412 + $20,198 related
    Nontaxable benefits
    $643 + $31,515 related
    Filer's total
    $5,350 + $262,153 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

PART I, LINE 3
THE NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS, INC. (NACHRI) ACTS AS THE "COMMON PAYMASTER" FOR CHILD HEALTH PATIENT SAFETY ORGANIZATION (CHPSO). NACHRI ISSUES ALL W-2S FOR ALL EMPLOYEES OF THIS GROUP. THE W-2S ARE REPORTED ONLY ON THE NACHRI RETURN, WHILE COMPENSATION ALLOCATED BY TIME-SPENT IS REPORTED ON THE NACHRI AND NACH RETURNS. THE PROCESS FOR DETERMINING COMPENSATION FOR OFFICERS AND STAFF IS DONE THROUGH THE NACHRI BOARD. THEREFORE, ALL QUESTIONS REGARDING COMPENSATION POLICY ARE ANSWERED ON THE NACHRI RETURN. METHODS USED BY NACHRI INCLUDE COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, AND APPROVAL BY BOARD OR COMPENSATION COMMITTEE.
PART I, LINE 4B
THE FOLLOWING LISTED EMPLOYEES PARTICIPATED IN A 457(F) PLAN DURING THE YEAR: - MATTHEW COOK (NO DISTRIBUTION IN 2023, $43,500 WAS CONTRIBUTED TO THE PLAN) - MARK WIETECHA (NO DISTRIBUTION IN 2023, $279,864 WAS CONTRIBUTED TO THE PLAN) - AMY KNIGHT (NO DISTRIBUTION IN 2023, $188,640 WAS CONTRIBUTED TO THE PLAN)

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

No itemized grants to organizations on this return.

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Provenance

Return type
form_990
Tax year
2023
Filed
30 July 2024
IRS schema version
2023v5.1
Source object
202422139349300007

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