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
2011
Open to Public Inspection
Name of the organization
RONALD MCDONALD HOUSE CHARITIES NORTHERN CALIFORNIA
Employer identification number
68-0147193
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)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
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
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
1,781,425
1,854,525
1,839,555
1,883,990
2,002,622
9,362,117
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3..
1,781,425
1,854,525
1,839,555
1,883,990
2,002,622
9,362,117
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)..
677,084
6
Public Support. Subtract line 5 from line 4.
8,685,033
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
1,781,425
1,854,525
1,839,555
1,883,990
2,002,622
9,362,117
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
70,511
68,741
67,869
58,624
63,113
328,858
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
35,970
109,602
2,415,719
2,375,819
236,122
5,173,232
11
Total support (Add lines 7 through 10).
14,864,207
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
1,630,449
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
58.430 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
58.840 %
16a
33 1/3% support test—2011.
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—2010.
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—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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
Part II, Line 10--Reported revenue on Line 10 for 2007 through 2011 consists of gross revenue from special fundraising events and gaming activities and other miscellaneous income from activities that are not regularly carried on.
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
11000144
Software Version:
2011v1.2
-
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
2011
Open to Public Inspection
Name of the organization
RONALD MCDONALD HOUSE CHARITIES NORTHERN CALIFORNIA
Employer identification number
68-0147193
Identifier
Return Reference
Explanation
FORM 990, PART III, LINE 4B
Camp Ronald McDonald at Eagle Lake: RMHC of Northern California owns and operates Camp Ronald McDonald at Eagle Lake. Accredited by the American Camp Association, Camp Ronald McDonald at Eagle Lake is a fully accessible residential summer camp for children who are 'at-risk' with a variety of special medical needs, economic hardship and/or emotional, developmental or physical disabilities. In partnership with the Lassen National Forest, each summer we collaborate with other non-profit groups to bring a week of traditional camping activities such as arts & crafts, hikes, fishing, canoeing, sports, swimming, talent show and campfires. Our campers typically have special challenges that would normally hinder their ability to experience the joys of nature and camp; however, this is not an issue at Camp Ronald McDonald at Eagle Lake. Here all barriers- physical and mental, are removed.The mission of Camp Ronald McDonald at Eagle Lake is to provide confidence-building experiences and programs that are designed to support each camper's individuality through the challenges of outdoor group living and teamwork in a supportive environment. Our totally accessible facility sits on 35 acres on the shores of beautiful Eagle Lake in the middle of Lassen National Forest. Our site boasts 9 cabins (sleeping 13 each), two shower houses, dining hall, amphitheater, campfire pit, beach volleyball court, sand pit, fully accessible dock and water front, basketball court and a grassy playing field. In addition to our beautiful layout and environment, we offer an array of programs adapted to meet the individual needs of each camper. We staff experienced and well trained specialists in the fields of drama, arts & crafts, outdoor education, nutrition education, sports and waterfront activities.In 2011 we had over 768 participants and over 71 different disabilities. 740 campers were from California and 28 from Arizona, Maryland, Nevada, Oregon, and Texas.
FORM 990, PART III, LINE 4A
Sacramento Ronald McDonald House: RMHC of Northern California owns and operates the Ronald McDonald House. This is a 20 bedroom facility that provides temporary housing for families with children who are ill and must leave their community and seek medical treatment for their child. In 2011, more than 642 families stayed at the Ronald McDonald House. The average length of stay was 10 nights. The average room occupancy rate was 97%, causing us to turn away over 1,494 families. 667 families were from 21 US states including 462 families from California. The families are asked to make a nominal donation of $20 per night but no one is turned away for the lack of ability to pay. We serve all five hospitals in the greater Sacramento, UC Davis Medical Center (43%); Shriners Hospitals for Children (42%); Sutter Medical Center (11%), Kaiser Permanente (1%) and Mercy General Hospital (2%).RMHC Northern California is operated with 8 full time and 7 part-time staff. Also, a volunteer pool of over 1,500 volunteers assist with the day-to-day operations with over 13,500 hours annually.
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
THE CHARITY'S FINANCIAL INFORMATION AND CONFLICT OF INTEREST POLICIES ARE AVAILABLE UPON REQUEST.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
THE RAFFLE DIRECTOR WAS HIRED FOR THE SOLE PURPOSE OF CONDUCTING THE HOUSE RAFFLE. THE RAFFLE DIRECTOR'S COMPENSATION IS ESTABLISHED BY CONTRACT. HIS COMPENSATION IS EQUAL TO 10.0% OF THE GROSS HOUSE RAFFLE TICKET SALES REVENUE. UPON REVIEW, THE DOCUMENTATION OF THE DECISION TO HIRE THE RAFFLE DIRECTOR WAS INSUFFICIENT PURSUANT TO TREASURY REGULATION SECTION 53.4958-6(C)(3). THE DOCUMENTATION PROCESS WILL BE BROUGHT INTO COMPLIANCE WITH THE REGULATION.THE EXECUTIVE DIRECTOR EVALUATES ALL OF THE OTHER EMPLOYEES' PERFORMANCE ANNUALLY. THE BOARD APPROVES A MERIT POOL FOR THE PURPOSE OF AWARDING MERIT INCREASES TO STAFF. THE POOL IS SET AS A PERCENTAGE OF STAFF SALARIES (EXCLUDING THE E.D. AND RAFFLE DIRECTOR) AND AWARDED BY THE E.D. BASED ON EMPLOYEE PERFORMANCE.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
All Board members sign the conflict of interest questionnaire and it is reviewed annually.
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
The audited financial statements, management letter, and tax information returns are maintained in the permanent files of the corporation. Copies are presented to the Audit Committee, Finance Committee, management staff and members of the Board. Distribution to others is done at the discretion of the Treasurer.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d : Other Program Services Description
OTHER PROGRAM SERVICES 4: Grant-Making Program: RMHC of Northern California provides grants to area not-for-profit organizations in order to positively impact as many children and families as possible. Grants are given to not-for-profit organizations whose programs provide services in three distinct areas: Civic and Social Services, Education and the Arts, Health Care and Medical Research. Funds are raised through community partners and matched by Global Ronald McDonald House Charities.During 2011, the charity awarded 32 grants. The total value of distributed funds was $142,000. (Funds included $71,000 of matching funds from Global Ronald McDonald House Charities.)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.