Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE INC
Employer identification number
71-0694931
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
(1)
ARKANSAS CHILDREN'S HOSPITAL
710236857
3
Yes
0
Total
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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 IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE INC
Employer identification number
71-0694931
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
DIRECTORS DEBRA FISER, M.D., JOHN FOWLKES, M.D.,RICHARD JACOBS, M.D., LAURA JAMES, M.D., AND DANIEL RAHN, M.D. WERE ALL EMPLOYEES OF THE UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES DURING THE TAX YEAR.
FORM 990, PART VI, SECTION A, LINE 7A
THE BOARD OF DIRECTORS OF ACHRI ARE ELECTED BY THE BOARD OF DIRECTORS OF ARKANSAS CHILDREN'S HOSPITAL, WHO ALSO RETAIN THE POWER TO REMOVE ANY OR ALL OF THE ACHRI BOARD MEMBERS.
FORM 990, PART VI, SECTION A, LINE 7B
ANY CHANGES TO ACHRI'S ARTICLES OF INCORPORATION MUST BE RATIFIED BY THE ARKANSAS CHILDREN'S HOSPITAL BOARD.
FORM 990, PART VI, SECTION B, LINE 11
THE DRAFT FORM 990, WHICH IS RECONCILED TO ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE'S (ACHRI) INTERNAL FINANCIALS AND THE ARKANSAS CHILDREN'S HOSPITAL CONSOLIDATED AUDIT REPORT, IS INITIALLY REVIEWED WITH ACHRI'S MANAGEMENT. SUBSEQUENTLY, THE RETURN IS REVIEWED WITH MEMBERS OF THE ACHRI BOARD OF DIRECTOR'S FINANCE COMMITTEE AND EXECUTIVE COMMITTEE BY BOTH THE SVP/CFO AND VP OF FINANCIAL OPERATIONS OF ARKANSAS CHILDREN'S HOSPITAL. IF THE REVIEW BY THE ACHRI ACHRI BOARD COMMITTEES RESULT IN REVISIONS TO THE FORM 990, THOSE REVISIONS ARE MADE AND THE VERSION OF THE FORM 990 TO BE FILED IS PROVIDED TO THE ENTIRE BOARD PRIOR TO ITS FILING WITH THE INTERNAL REVENUE SERVICE. IN ADDITION, THE FORM 990 IN ITS FINAL VERSION IS PROVIDED TO BOTH THE CHAIRMAN OF THE BOARD AND THE TREASURER OF ARKANSAS CHILDREN'S HOSPITAL.
FORM 990, PART VI, SECTION B, LINE 12C
ANNUAL DISCLOSURE OF CONFLICTS IS REQUIRED OF ALL BOARD MEMBERS IN ACCORDANCE WITH THE ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE BOARD OF DIRECTORS CONFLICT OF INTEREST POLICY. THE ANNUAL DISCLOSURES ARE REVIEWED AND APPROVED BY A MAJORITY OF THE DISINTERESTED DIRECTORS OF THE ACHRI EXECUTIVE COMMITTEE. DISCLOSURES ARE ALSO RECEIVED BY BOTH THE SVP/CFO AND VP OF FINANCIAL OPERATIONS OF ARKANSAS CHILDREN'S HOSPITAL FOR REPORTING PURPOSES. DURING THE YEAR, WHILE BOARD MEMBERS MAY PARTICIPATE IN INITIAL DISCUSSIONS, BOARD MEMBERS WHO HAVE A CONFLICT ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND DECISIONS IN THE RELATED TRANSACTION AND ABSTAIN FROM VOTING, WHICH IS NOTED IN THE MINUTES.
FORM 990, PART VI, SECTION B, LINE 15
THE ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE'S (ACHRI) PRESIDENT IS AN EMPLOYEE OF THE UNIVERSITY OF ARKANSAS FOR MEDICAL SERVICES (UAMS) AND COMPENSATION FOR HIS ROLE AS THE ACHRI PRESIDENT IS PAID THROUGH A CONTRACT WITH UAMS. COMPENSATION FOR THE ACHRI'S PRESIDENT, WHICH IS PRIMARILY BASED ON NATIONAL BENCHMARKING DATA, IS INITIALLY DETERMINED BY UAMS AND SUBSEQUENTLY REVIEWED BY THE ACHRI EXECUTIVE COMMITTEE BEFORE RENEWING THE ANNUAL CONTRACT. COMPENSATION FOR THE ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE VICE PRESIDENT IS REVIEWED BY THE ARKANSAS CHILDREN'S HOSPITAL BOARD COMPENSATION COMMITTEE WHICH IS ESTABLISHED THROUGH THE BYLAWS OF ARKANSAS CHILDREN'S HOSPITAL TO DISCHARGE THE DUTY OF THE BOARD IN FULFILLING ITS OVERSIGHT RESPONSIBILITIES FOR DETERMINING THE ADEQUACY AND REASONABLENESS OF THE COMPENSATION PAID THE CEO AND OTHER EMPLOYEES THAT THE COMMITTEE BELIEVES ARE IN A POSITION TO EXERCISE A SUBSTANTIAL INFLUENCE OVER THE AFFAIRS OF THE HOSPITAL AND ITS RELATED ORGANIZATIONS. THE COMMITTEE IS COMPOSED OF MEMBERS WHO PERSONALLY RECEIVE NO COMPENSATION, FEES, OR OTHER BENEFITS FROM THE HOSPITAL OR RELATED ORGANIZATIONS. THE COMMITTEE MAY RELY UPON REASONED WRITTEN OPINIONS OF QUALIFIED LEGAL, ACCOUNTING, VALUATION AND EXECUTIVE COMPENSATION EXPERTS. THE COMMITTEE HAS THE SOLE AUTHORITY TO RETAIN AND TERMINATE ANY SPECIAL ADVISORS USED TO ASSIST IN THE EVALUATION OF COMPENSATION. THE COMMITTEE CONTEMPORANEOUSLY, WITH MAKING ITS DETERMINATION OF REASONABLENESS WITH RESPECT TO THE COMPENSATION OF DISQUALIFIED PERSONS, DOCUMENTS IN A WRITTEN REPORT TO THE EXECUTIVE COMMITTEE AND THE BOARD, THE BASIS FOR ITS DECISIONS. SALARY RANGES FOR THE NOTED POSITIONS WERE REVIEWED IN DETAIL WITH EXTERNAL COMPENSATION CONSULTANTS IN 2007.
FORM 990, PART VI, SECTION C, LINE 19
THE ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AS REQUIRED.
FORM 990, PART VI, SECTION A, LINE 1:
DURING THE INTERVALS BETWEEN THE MEETINGS OF THE ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE (ACHRI) BOARD OF DIRECTORS, THE ACHRI EXECUTIVE COMMITTEE POSSESSES AND EXERCISES ALL POWERS AND FUNCTIONS OF THE BOARD OF DIRECTORS IN THE MANAGEMENT AND DIRECTION OF THE AFFAIRS OF ACHRI IN ALL CASES IN WHICH SPECIFIC DIRECTION HAS NOT BEEN GIVEN BY THE BOARD OF DIRECTORS. ALL ACTIONS BY THE EXECUTIVE COMMITTEE ARE REPORTED TO THE BOARD OF DIRECTORS AT ITS MEETING NEXT SUCCEEDING SUCH ACTION. THE EXECUTIVE COMMITTEE IS COMPRISED OF THE FOLLOWING: THE CHAIRMAN OF THE ACHRI BOARD OF DIRECTORS, THE CHAIRMAN OF THE DEPARTMENT OF PEDIATRICS AT UAMS, THE CHIEF EXECUTIVE OFFICER OF ARKANSAS CHILDREN'S HOSPITAL, AND THE DEAN OF THE UAMS COLLEGE OF MEDICINE, THE ACHRI PRESIDENT SERVES AS A NONVOTING MEMBER. IF ONE PERSON HOLDS MORE THAN ONE OF THESE POSITIONS, HE/SHE WILL HAVE ONLY ONE VOTE ON THE COMMITTEE.
FORM 990, PART VII, SECTION A, COLUMNS E & F:
COMPENSATION REPORTED IN THESE COLUMNS IS ATTRIBUTABLE TO EMPLOYEES' TIME DEVOTED EACH WEEK TO THIS ENTITY AS WELL AS RELATED ORGANIZATIONS, AS FOLLOWS: JONATHAN BATES, M.D.: ARKANSAS CHILDREN'S HOSPITAL - 40 HOURS ARKANSAS CHILDREN'S HOSPITAL FOUNDATION - 3 HOURS ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE - 1 HOUR ARKANSAS CHILDREN'S HOSPITAL BUILDING RESEARCH FACILITY - .1 HOURS RICHARD JACOBS, M.D.: ARKANSAS CHILDREN'S HOSPITAL - 8 HOURS ARKANSAS CHILDREN'S HOSPITAL FOUNDATION - 1 HOUR ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE - 16 HOURS ARKANSAS CHILDREN'S HOSPITAL BUILDING RESEARCH FACILITY - .25 HOURS ALL OTHER COMPENSATION LISTED IN COLUMNS E OR F RELATES TO EMPLOYEES' TIME THAT IS DEVOTED TO ARKANSAS CHILDREN'S HOSPITAL RESEARCH INSTITUTE. ARKANSAS CHILDREN'S HOSPITAL ACCOUNTING DEPARTMENT MANAGES THE PAYROLL FUNCTION CENTRALLY FOR ARKANSAS CHILDREN'S HOSPITAL AND ALL RELATED ORGANIZATIONS.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
TRANSFER FUNDS TO ACHF FOR INVESTMENT PURPOSES -5,000,000. TOTAL TO FORM 990, PART XI, LINE 5: -5,000,000.
FORM 990, PART XI, LINE 3B:
THE CONSOLIDATED ORGANIZATION IS REQUIRED TO UNDERGO AN AUDIT AS SET FORTH IN THE SINGLE AUDIT ACT AND OMB CIRCULAR A-133 AND DID UNDERGO THAT REQUIRED AUDIT.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.