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 ShufflebargerTHOMAS SHUFFLEBARGER
CHAIR
- Total calculated
- $0
- Hours/week
- 1
-
Carol KemperCAROL KEMPER
SECRETARY
- Total calculated
- $0
- Hours/week
- 1
-
Frank BelmoteFRANK BELMOTE
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
Tina ChengTINA CHENG
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
Patricia DepompeiPATRICIA DEPOMPEI
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
Callie DobbinsCALLIE DOBBINS
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
James FortenberryJAMES FORTENBERRY
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
Patrick FriasPATRICK FRIAS
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
Angelo GiardianoANGELO GIARDIANO
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
Mark GorelickMARK GORELICK
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
Barbara JoersBARBARA JOERS
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
Paul KempinskiPAUL KEMPINSKI
MEMBER
- Total calculated
- $0
- Hours/week
- 1 + 2 related
-
Fiona LevyFIONA LEVY
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
Rustin MorseRUSTIN MORSE
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
John NickensJOHN NICKENS
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
Margaret RushMARGARET RUSH
MEMBER
- Total calculated
- $0
- Hours/week
- 1 + 2 related
-
Katy WelkieKATY WELKIE
MEMBER
- Total calculated
- $0
- Hours/week
- 1 + 2 related
-
Michael WigginsMICHAEL WIGGINS
MEMBER
- Total calculated
- $0
- Hours/week
- 1
-
Mark WietechaMARK 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 KnightAMY 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 HogertyMICHELLE 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 CookMATTHEW 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 MackTOREY 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 HotzelLORI 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 JensenKASSANDRA 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 OssmanAIMEE 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 KittleKORY 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 HallMATTHEW 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 RichardsonTROY 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.
-
NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS INC (NACH)
501(C)(6) · ASSIST CHILDREN'S HOSPITALS IN COMMON BUSINESS INTEREST AND ECON. WELFARE · GA
-
NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS INC
501(C)(3) · TO PROMOTE SUPPORT OF CHILDREN'S HOSPITALS · GA
Directly controlled by NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS
Provenance
- Return type
- form_990
- Tax year
- 2023
- Filed
- 30 July 2024
- IRS schema version
- 2023v5.1
- Source object
- 202422139349300007
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