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
2012
Open to Public Inspection
Name of the organization
CHILDRENS HEMIPLEGIA AND STROKE ASSOCIATION
Employer identification number
75-2831215
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
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—2011.
If the organization did not check a 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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
27,408
48,125
59,574
94,651
145,692
375,450
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......
6,209
29,507
38,359
26,978
26,230
127,283
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
2,785
3,340
6,125
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.
33,617
80,417
101,273
121,629
171,922
508,858
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.
1,209
1,209
c
Add lines 7a and 7b..
1,209
1,209
8
Public support (Subtract line 7c from line 6.)
507,649
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
33,617
80,417
101,273
121,629
171,922
508,858
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.)..
33,617
80,417
101,273
121,629
171,922
508,858
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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
99.760 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
99.660 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012
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.
EXPENSES SUPPLIES 1,114 INTERNET/WEBSITE 3,075 INSURANCE 1,621 BANK FEES 30 PAYPAL FEES 157 TELEPHONE 890 RETREAT EXPENSES 22,709 FAMILY FUN DAYS/LOCAL GRP 2,125 AWARENESS CAMPAIGN 1,897 ANNUAL FEE 300 KANDU 55 ORTHOTIC GRANT 652 NEW WEBSITE DESIGN 3,900 TOTAL 38,525
PRIMARY EXEMPT PURPOSE
FORM 990-EZ, PART III
IS DEDICATED TO IMPROVING LIVES OF CHILDREN AND FAMILIES AFFECTED BY PEDIATRIC STROKE AND OTHER CAUSES OF HEMIPLEGIA AND TO IMPROVING LIVES OF ADULTS WHO HAVE HAD A DIAGNOSIS OF HEMIPLEGIA SINCE CHILDHOOD.
SECOND ACCOMPLISHMENT
FORM 990-EZ, PART III, LINE 29
SUPPORT FOR FAMILIES, CHILDREN, AND ADULTS WITH HEMIPLEGIA 1.NATIONAL FAMILY RETREAT ALLOWS CHILDREN AND FAMILIES TO MEET AND SHARE SUPPORT AND INFORMATION 2.LOCAL NEIGHBORHOOD GROUPS 3.ONLINE DISCUSSION GROUPS SERVING OVER 5000 FAMILIES 4.COLLEGE AND VOCATIONAL SCHOOL SCHOLARSHIPS FOR INDIVIDUALS WITH HEMIPLEGIA 5.ATHLETIC SCHOLARSHIPS FOR INDIVIDUALS WITH HEMIPLEGIA 6.NATIONAL FAMILY RETREAT SCHOLARSHIPS 7.ORTHOTIC (HAND AND FOOT BRACE) GRANTS FOR CHILDREN 16 AND UNDER WITH HEMIPLEGIA 8.CHASA CARES - STUFFED ANIMAL SENT TO CHILDREN FOR ENCOURAGEMENT 9.GRANTS FOR REGIONAL GATHERINGS OF FAMILIES WITH HEMIPLEGIA 10.GRANTS FOR REGIONAL FAMILY FUN ACTIVITIES FOR FAMILIES 11.PROFESSIONAL SPEAKERS 12.EDUCATIONAL INFORMATION - DAILY LIVING, SCHOOL, FINANCES, TRANSITIONING TO ADULTHOOD
THIRD ACCOMPLISHMENT
FORM 990-EZ, PART III, LINE 30
PEDIATRIC STROKE AWARENESS AND EDUCATION 1.EDUCATIONAL WEBSITE AND FACT SHEETS 2.CREATOR AND SPONSOR OF PEDIATRIC STROKE AWARENESS DAY AND MONTH 3.EXHIBITS AT DISABILITY CONFERENCES AND FAIRS 4.AWARENESS PRODUCTS AND IMAGES 5.SUPPORT FOR NEWS AND PRINT INTERVIEWS AND ARTICLES 6.AWARENESS VIDEOS 7.SOCIAL NETWORKING SITES 8.SUPPORT FOR NATIONAL, STATE, COUNTY, AND CITY PEDIATRIC STROKE AWARENESS PROCLAMATIONS AND DECLARATIONS 9.PARTICIPATION IN BRIEFING ON CAPITOL HILL TO RAISE AWARENESS OF PEDIATRIC STROKE AMONG CONGRESS AND STAFF
ALL OTHER ACCOMPLISHMENT
FORM 990-EZ, PART III, LINE 31
RESEARCH SUPPORT: 1.FUNDING INNOVATIVE RESEARCH 2.TEAM WITH INVESTIGATORS TO RECRUIT PARTICIPANTS FOR RESEARCH STUDIES 3.COLLABORATE WITH RESEARCHER ON RESEARCH STUDY DESIGN 4.THE CHILDREN'S HEMIPLEGIA AND STROKE ASSOCIATION CO-SPONSORED THE NEUROBIOLOGY OF DISEASE IN CHILDREN (NDC) SYMPOSIUM WITH THE CHILD NEUROLOGY SOCIETY (CNS) AND THE NATIONAL INSTITUTES OF HEALTH (NIH), WHICH INCLUDES THE NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE (NINDS) AND THE OFFICE OF RARE DISEASES RESEARCH. FOCUSING ON INFANT AND PEDIATRIC STROKE, THIS SYMPOSIUM FEATURED PRESENTATIONS FROM PEDIATRIC STROKE RESEARCHERS FROM AROUND THE WORLD AND PROVIDED INFORMATION TO HUNDREDS OF CHILD NEUROLOGISTS REGARDING THE LATEST RESEARCH ON PEDIATRIC STROKE. THE DISCUSSIONS AT THIS SYMPOSIUM HELPED DETERMINE THE FUTURE OF PEDIATRIC STROKE RESEARCH. 5. SPONSORED 18 TALENTED AND ENERGETIC YOUNG INVESTIGATORS ENABLING THEM TO ATTEND THE NDC SYMPOSIUM TO INTERACT WITH PEERS, ADVISOR, CHILD NEUROLOGY SOCIETY MEMBERS AND NATIONAL INSTITUTE OF HEALTH PROGRAM DIRECTORS TO FACILITATE FUTURE RESEARCH INTEREST IN AREAS RELATING TO PEDIATRIC STROKE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.