Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012
BCheck if applicable:
CName of organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1121 SW SALMON STREET 100
 
Room/suite
City or town, state or country, and ZIP + 4
PORTLAND, OR972052021
D Employer identification number

93-0579589
E Telephone number

G Gross receipts $ 29,323,201
F Name and address of principal officer:
MARY TURINA
1121 SW SALMON STREET 100
PORTLAND,OR972052021
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.DOERNBECHERFOUNDATION.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1924
M State of legal domicile: OR
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION IS A NONPROFIT ORGANIZATION ESTABLISHED IN 1924 THAT EXISTS TO SECURE PRIVATE PHILANTHROPIC SUPPORT FOR DOERNBECHER CHILDREN'S HOSPITAL.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 34
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 32
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 0
6 Total number of volunteers (estimate if necessary) .... 6 350
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 58,617
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b  
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 13,737,614 9,640,829
9 Program service revenue (Part VIII, line 2g) ......... 16,053 71,397
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 1,440,094 1,064,636
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 38,310 171,672
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 15,232,071 10,948,534
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 6,618,624 6,742,542
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 0 0
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet2,045,131    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 2,681,848 2,979,665
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 9,300,472 9,722,207
19 Revenue less expenses. Subtract line 18 from line 12....... 5,931,599 1,226,327
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 48,770,282 49,578,599
21 Total liabilities (Part X, line 26)............. 2,941,315 4,059,587
22 Net assets or fund balances. Subtract line 21 from line 20..... 45,828,967 45,519,012
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION IS A NONPROFIT ORGANIZATION ESTABLISHED IN 1924 THAT EXISTS TO SECURE PRIVATE PHILANTHROPIC SUPPORT FOR DOERNBECHER CHILDREN'S HOSPITAL.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 6,818,241 including grants of $ 6,742,542 ) (Revenue $ 130,014 )
CONTRIBUTIONS, GRANTS, TRANSFERS TO DOERNBECHER CHILDREN'S HOSPITAL MAKE POSSIBLE COMPREHENSIVE AND INNOVATIVE HEALTHCARE, EDUCATION AND RESEARCH FOR THE CHILDREN OF OUR REGION. SEE SCHEDULE O FOR MORE INFORMATION.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 6,818,241
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
Yes
 
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part IClick to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II.......... Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements.
20b
 
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
35
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
0
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
 
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletUK
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
No
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
No
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
No
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
No
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
34
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
32
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
Yes
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
OR , WA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
LORI MUELLER VP FIN ADM
1121 SW SALMON STREET SUITE 100
PORTLAND,OR97205
(503) 220-8313
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) DONALD M ANTONUCCI
DIRECTOR
 1.0 X           0 0 0
(2) NATHAN M AYOTTE
DIRECTOR
 1.0 X           0 0 0
(3) NATHAN J BAILEY
DIRECTOR
 1.0 X           0 0 0
(4) JEFF M BOURLAG
DIRECTOR
 1.0 X           0 0 0
(5) RONALD G BRAKE
DIRECTOR
 1.0 X           0 0 0
(6) DIRK T DAVIS
EXECUTIVE VICE PRESIDENT
 1.0 X   X       0 0 0
(7) KEVIN M DIRECTOR
DIRECTOR
 1.0 X           0 0 0
(8) MICHAEL F DOHERTY
DIRECTOR
 1.0 X           0 0 0
(9) CAROL K EHLEN
DIRECTOR
 1.0 X           0 0 0
(10) ALLYN C FORD
DIRECTOR
 1.0 X           0 0 0
(11) TERRY J GROVER
DIRECTOR
 1.0 X           0 0 0
(12) LINDA RAE HICKEY
DIRECTOR
 1.0 X           0 0 0
(13) SIOUXSIE JENNETT
DIRECTOR
 1.0 X           0 0 0
(14) ELIZABETH K JOHNSON
DIRECTOR
 1.0 X           0 0 0
(15) KELLY J JOHNSON
PRESIDENT
 10.0 X   X       0 0 0
(16) BRUCE E KERR
DIRECTOR
 1.0 X           0 0 0
(17) SEAN T KEYS
DIRECTOR
 1.0 X           0 0 0
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) MITCHELL W MACK
DIRECTOR
 1.0 X           0 0 0
(19) LINDA B MALETIS
DIRECTOR
 1.0 X           0 0 0
(20) CATHRINE L MCCOY
DIRECTOR
 1.0 X           0 0 0
(21) ROGER W MILLS
VICE PRESIDENT FINANCE
 1.0 X   X       0 0 0
(22) HENRY S NICHOLSON MD
DIRECTOR
 1.0 X           0 382,428 41,751
(23) ANDREW J OVER
DIRECTOR
 1.0 X           0 0 0
(24) SHIRLEY N PAP
DIRECTOR
 1.0 X           0 0 0
(25) GERALD E RESER
DIRECTOR
 1.0 X           0 0 0
(26) JOSEPH E ROBERTSON MD
DIRECTOR
 1.0 X           0 1,223,542 102,650
(27) PATRICIA E SMITH
DIRECTOR
 1.0 X           0 0 0
(28) TODD R STUCKY
DIRECTOR
 1.0 X           0 0 0
(29) BRYAN L TIMM
DIRECTOR
 1.0 X           0 0 0
(30) SOHRAB S VOSSOUGHI
DIRECTOR
 1.0 X           0 0 0
(31) J C WESSEL
DIRECTOR
 1.0 X           0 0 0
(32) DJ WILSON
SECRETARY
 1.0 X   X       0 0 0
(33) RICHARD L WRIGHT JR
DIRECTOR
 1.0 X           0 0 0
(34) CANDACE D YOUNG PhD
DIRECTOR
 1.0 X           0 0 0
(35) LORI MUELLER
VICE PRESIDENT
 40.0     X       174,108 0 43,382
(36) MARY TURINA
EXECUTIVE DIRECTOR
 40.0     X       112,920 0 6,875
(37) SUSAN NICOL
EXECUTIVE DIRECTOR
 40.0           X 206,529 0 31,955
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 493,557 1,605,970 226,613
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet3
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
Yes
 
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet0
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a 65,225
b Membership dues....1b  
c Fundraising events....1c 1,781,206
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		7,794,398
g Noncash contributions included in lines 1a-1f:$ 327,685
h Total. Add lines 1a-1f.......MediumBullet 9,640,829
Program Service Revenue Business Code
2a OUTREACH ACTIVITIES 900,099 49,996 49,996    
b PUBLIC EDUCATION 900,099 21,401 21,401    
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 71,397
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 510,491     510,491
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 13,735,164 5,043,888
b Less: cost or other basis and sales expenses 13,332,583 4,892,323
c Gain or (loss) 402,581 151,565
d Net gain or (loss)..........MediumBullet 554,145     554,145
8a Gross income from fundraising events (not including
$ 1,781,206
of contributions reported on line 1c). See Part IV, line 18 ...
a 262,816
b Less: direct expenses ...b 149,761
c Net income or (loss) from fundraising events..MediumBullet 113,055   113,055
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a HOLIDAY CARD SALES 453,220 58,617   58,617  
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 58,617
12 Total revenue. See Instructions....MediumBullet 10,948,534 71,397 58,617 1,177,691
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 6,742,542 6,742,542
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 0 0 0 0
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 0 0 0 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 0      
9 Other employee benefits ....... 0      
10 Payroll taxes ........... 0      
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 1,040 40 458 542
c Accounting ........... 89,000 7,209 81,791  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 158,836 259 2,940 155,637
12 Advertising and promotion .... 15,934     15,934
13 Office expenses ....... 49,665 989 11,222 37,454
14 Information technology ...... 1,067     1,067
15 Royalties .. 0      
16 Occupancy ........... 69,179     69,179
17 Travel ............ 26,041 123 1,396 24,522
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 6,168 18 207 5,943
20 Interest ........... 0      
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 4,518 366 4,152  
23 Insurance .............. 20,716 1,625 18,431 660
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a CONTRACTED STAFF 850,582 16,422 186,325 647,835
b DONOR CULTIVATION 166,753     166,753
c MANAGEMENT & ADMIN FEE 733,391 12,524 142,070 578,797
d MEMBERSHIP FEES 143,774 607 6,887 136,280
e
f All other expenses 643,001 35,517 402,956 204,528
25 Total functional expenses. Add lines 1 through 24f 9,722,207 6,818,241 858,835 2,045,131
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 280,094 1 161,140
2 Savings and temporary cash investments ....... 1,700,599 2 757,025
3 Pledges and grants receivable, net ......... 1,995,215 3 1,287,863
4 Accounts receivable, net ......... 684,616 4 740,562
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 177,199 7 122,713
8 Inventories for sale or use .............. 0 8 0
9 Prepaid expenses and deferred charges ............ 2,500 9 14,299
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 43,431
b Less: accumulated depreciation. ..... 10b 31,010 16,939 10c 12,421
11 Investments—publicly traded securities .......... 32,033,271 11 34,381,808
12 Investments—other securities. See Part IV, line 11 ...... 11,849,198 12 12,074,671
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 0 14 0
15 Other assets. See Part IV, line 11 ........... 30,651 15 26,097
16 Total assets. Add lines 1 through 15 (must equal line 34)... 48,770,282 16 49,578,599
Liabilities 17 Accounts payable and accrued expenses . 491,245 17 158,480
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 0
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 0 23 0
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 2,450,070 25 3,901,107
26 Total liabilities. Add lines 17 through 25..... 2,941,315 26 4,059,587
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .....   27  
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ..... 31,840,392 30 31,616,004
31 Paid-in or capital surplus, or land, building or equipment fund ..... 16,939 31 12,421
32 Retained earnings, endowment, accumulated income, or other funds 13,971,636 32 13,890,587
33 Total net assets or fund balances ..... 45,828,967 33 45,519,012
34 Total liabilities and net assets/fund balances ..... 48,770,282 34 49,578,599
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
10,948,534
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
9,722,207
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
1,226,327
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
45,828,967
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-1,536,282
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
45,519,012
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
 
Employer identification number

93-0579589
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
f
g
(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
(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.") .... 13,543,219 11,075,231 9,799,074 13,737,614 9,676,162 57,831,300
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.. 13,543,219 11,075,231 9,799,074 13,737,614 9,676,162 57,831,300
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)..           4,518,450
6 Public Support. Subtract line 5 from line 4.           53,312,850
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.. 13,543,219 11,075,231 9,799,074 13,737,614 9,676,162 57,831,300
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 410,252 172,588 341,832 450,513 510,491 1,885,676
9 Net income from unrelated business activities, whether or not the business is regularly carried on.. 0 0 0 0 0 0
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. 183,980 87,077 0 0 113,055 384,112
11 Total support (Add lines 7 through 10).           60,101,088
12
12
130,014
13
Section C. Computation of Public Support Percentage
14
14
88.705 %
15
15
86.470 %
16a
b
17a
b
18
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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
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
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
 
Employer identification number

93-0579589
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
  		Employer identification number

93-0579589
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
  		Employer identification number

93-0579589
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
  		Employer identification number

93-0579589
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
 
Employer identification number

93-0579589
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year ....... 1  
2 Aggregate contributions to (during year) ... 14,589  
3 Aggregate grants from (during year) ... 9,497  
4 Aggregate value at end of year ....... 134,694  
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 22,126,772 19,101,403 15,804,093 20,902,325
b Contributions ........ 1,606,964 562,118 2,627,373 657,043
c Net investment earnings, gains, and losses ... -440,654 3,694,025 1,769,021 -4,609,052
d Grants or scholarships ..... 9,273 9,453 10,128 10,419
e Other expenditures for facilities
and programs ........ 		881,909 894,483 884,440 899,161
f Administrative expenses .... 329,528 326,838 204,516 236,643
g End of year balance ...... 22,072,372 22,126,772 19,101,403 15,804,093
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet30.730 %
b
Permanent endowment SchDMd Bullet67.980 %
c
Temporarily restricted endowment SchDMd Bullet1.290 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............        
d Equipment ................        
e Other .................   43,431 31,010 12,421
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 12,421
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
(3)Other
(A) OTHER INVESTMENTS 		12,074,671 F








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 12,074,671
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
DUE TO OHSU-PROGRAM SUPPORT 1,873,384
DUE TO OTHER INSTITUTIONS 136,861
LIABILITY FOR LIFE INCOME AGREEMENT 1,890,862






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 3,901,107
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 10,948,534
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 9,722,207
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 1,226,327
4 Net unrealized gains (losses) on investments .......................... 4 -1,152,507
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6 -355,470
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8 -28,306
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 -1,536,283
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 -309,956
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 9,206,993
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a -1,152,507
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d -28,305
e Add lines 2a through 2d ..................... 2e -1,180,812
3 Subtract line 2e from line 1..................... 3 10,387,805
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b 590,730
c Add lines 4a and 4b....................... 4c 590,730
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 10,978,535
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 9,516,948
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3 9,516,948
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a -355,470
b Other (Describe in Part XIV.) ............ 4b 560,729
c Add lines 4a and 4b....................... 4c 205,259
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 9,722,207
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
INTENDED USE OF ENDOWMENT FUND PART V, LINE 4 AN ENDOWED FUND MAY SUPPORT A SPECIFIC DEPARTMENT, PROGRAM, PEOPLE OR PURPOSES SUCH AS A FACULTY PROFESSORSHIP OR CHAIR, SCHOLARSHIP OR FELLOWSHIP, RESEARCH ACTIVITY, VISITING LECTURER OR PATIENT CARE.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES SCHEDULE D, PART XI, LINE 8 CHANGE IN VALUE OF LIFE INCOME AGREEMENTS..........($28,305)
OTHER REVENUE INCLUDED IN F/S BUT NOT INCLUDED ON FORM 990 SCHEDULE D, PART XII, LINE 2D CHANGE IN VALUE OF LIFE INCOME AGREEMENTS..........($28,305)
REVENUE INCLUDED ON FORM 990 BUT NOT FINANCIAL STATEMENTS SCHEDULE D, PART XII, LINE 4B RECLASS SPECIAL EVENT EXPENSE....... (149,761) RECLASS INVESTMENT EXPENSE.......... 369,901 RECLASS OTHER NONOPERATING REVENUE.. 340,590 --------- TOTAL REVENUE INCLUDED ON FORM 990 BUT NOT FINANCIAL STATEMENTS........ 590,730
EXPENSE INCLUDED ON FORM 990 BUT NOT FINANCIAL STATEMENTS SCHEDULE D, PART XIII, LINE 4B RECLASS SPECIAL EVENT EXPENSE....... (149,761) RECLASS INVESTMENT FEES............. 355,470 RECLASS OTHER INVESTMENT LOSSES..... 14,431 RECLASS OTHER NONOPERATING REVENUE.. 340,589 --------- TOTAL REVENUE INCLUDED ON FORM 990 BUT NOT FINANCIAL STATEMENTS........ 560,729
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a.right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
 
Employer identification number

93-0579589
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
NONE     No      
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

Nike Auction
(event type) 		(b) Event #2

Heart Auction
(event type) 		(c) Other Events

7
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 956,500 462,784 614,163 2,033,447
2 Less: Charitable
contributions . . . 		895,979 295,104 579,548 1,770,631
3 Gross income (line 1
minus line 2) . . . 		60,521 167,680 34,615 262,816
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .        
6 Rent/facility costs . .        
7 Food and beverages . .        
8 Entertainment . . .        
9 Other direct expenses . 88,296 51,098 10,366 149,760
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 149,760
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow 113,056
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
Schedule G (Form 990 or 990-EZ) 2011
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
 
Employer identification number
93-0579589
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) OREGON HEALTH AND SCIENCE UNIVERSITY3181 SAM JACKSON PARK RD
PORTLAND,OR97239 		93-1176109 OHSU 1,733,639 0 N/A N/A RESEARCH
(2) OREGON HEALTH AND SCIENCE UNIVERSITY3181 SAM JACKSON PARK RD
PORTLAND,OR97239 		93-1176109 OHSU 257,280 0 N/A N/A ACADEMIC SUPPORT
(3) OREGON HEALTH AND SCIENCE UNIVERSITY3181 SAM JACKSON PARK RD
PORTLAND,OR97239 		93-1176109 OHSU 25,026 0 N/A N/A CAPITAL PROJECTS
(4) OREGON HEALTH AND SCIENCE UNIVERSITY3181 SAM JACKSON PARK RD
PORTLAND,OR97239 		93-1176109 OHSU 3,952,358 90,461 FMV children's supplies CLINICAL SUPPORT
(5) OREGON HEALTH AND SCIENCE UNIVERSITY3181 SAM JACKSON PARK RD
PORTLAND,OR97239 		93-1176109 OHSU 608,183 110,928 FMV children's supplies INSTRUCTION














2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
1
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
PART I, LINE 2 - GRANTMAKER'S DESCRIPTION OF HOW GRANTS ARE USED   TRANSFERS ARE MADE TO OREGON HEALTH & SCIENCE UNIVERSITY FOR THE BENEFIT OF DOERNBECHER CHILDREN'S HOSPITAL (DCH) AND THE DEPARTMENT OF PEDIATRICS BASED UPON DCH PROVIDING AUTHORIZED DOCUMENTATION OF SATISFACTION OF DONORS' INTENT. AUTHORIZATION IS CONTROLLED AND LIMITED TO SELECT INDIVIDUALS WITH THE KNOWLEDGE AND RESPONSIBILITY OF ENSURING THE TRANSFERS ARE MADE IN ACCORDANCE WITH DONOR INTENT. DOCUMENTATION CAN INCLUDE PROVIDING LABOR, EQUIPMENT AND CONSTRUCTION REPORTS PRODUCED THAT SUBSTANTIATE SALARY EXPENSES, EQUIPMENT PURCHASES AND CONSTRUCTION COSTS INCURRED.
Schedule I (Form 990) 2011


Additional Data


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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
 
Employer identification number

93-0579589
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
 
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) HENRY S NICHOLSON MD (i)
(ii)		 0
369,317 		0
12,770 		0
341 		0
40,093 		0
1,658 		0
424,179 		0
0
(2) JOSEPH E ROBERTSON MD (i)
(ii)		 0
1,023,566 		0
168,726 		0
31,250 		0
92,623 		0
10,027 		0
1,326,192 		0
0
(3) LORI MUELLER (i)
(ii)		 174,108
0 		0
0 		0
0 		21,528
0 		21,854
0 		217,490
0 		0
0
(4) SUSAN NICOL (i)
(ii)		 155,597
0 		0
0 		50,932
0 		18,394
0 		13,561
0 		238,484
0 		0
0












Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
SEVERANCE PAYMENTS SCHEDULE J, PART I, LINE 4A SUSAN NICOL, FORMER DCHF EXECUTIVE DIRECTOR, RECEIVED SEVERANCE PAYMENTS TOTALLING $96,913.
COMPENSATION FROM UNRELATED ORGANIZATIONS SCHEDULE J, PART II LORI MUELLER'S BASE COMPENSATION, DEFERRED COMPENSATION AND NONTAXABLE BENEFITS ARE PAID BY AN UNRELATED ORGANIZATION, OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION (OHSUF). OHSUF AND DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION (DCHF) HAVE A SHARED SERVICES AGREEMENT WHEREBY OHSUF PROVIDES DCHF WITH MANAGEMENT, STAFFING, FACILITIES AND OTHER SERVICES. MS. MUELLER'S BASE COMPENSATION, DEFERRED COMPENSATION AND NONTAXABLE BENEFITS ARE INCLUDED IN THE SHARED SERVICES AGREEMENT FEE THAT DCHF PAYS TO OHSUF. SUSAN NICOL'S BASE COMPENSATION, DEFERRED COMPENSATION AND NONTAXABLE BENEFITS ARE PAID BY AN UNRELATED ORGANIZATION, OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION (OHSUF). OHSUF AND DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION (DCHF) HAVE A SHARED SERVICES AGREEMENT WHEREBY OHSUF PROVIDES DCHF WITH MANAGEMENT, STAFFING, FACILITIES AND OTHER SERVICES. MS. NICOL'S BASE COMPENSATION, DEFERRED COMPENSATION AND NONTAXABLE BENEFITS ARE INCLUDED IN THE SHARED SERVICES AGREEMENT FEE THAT DCHF PAYS TO OHSUF. OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION, AN UNRELATED ORGANIZATION, PAID A SOCIAL CLUB FEE FOR ITS EXECUTIVE DIRECTOR. THIS BENEFIT IS TREATED AS TAXABLE COMPENSATION. OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION (OHSUF) AND DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION (DCHF) HAVE A SHARED SERVICES AGREEMENT WHEREBY OHSUF PROVIDES DCHF WITH MANAGEMENT, STAFFING, FACILITIES AND OTHER SERVICES. THE FOLLOWING IS THE PROCESS THAT DCHF FOLLOWS TO DETERMINE COMPENSATION FOR THE EXECUTIVE DIRECTOR: 1. REVIEW AND APPROVAL BY A GOVERNING BODY - THE EXECUTIVE COMMITTEE, WHOSE MEMBERS ARE TO INCLUDE BUT NOT BE LIMITED TO THE BOARD CHAIR, IMMEDIATE PAST CHAIR, AND FINANCE CHAIR, REVIEWS THE DOCUMENTATION FOR APPROVAL PRIOR TO THE PRESENTATION OF THE BUDGET AT THE JUNE BOARD MEETING. 2. USE OF DATA AS TO COMPARABLE COMPENSATION - FOR THE EXECUTIVE DIRECTOR POSITION, COMPARABILITY DATA IS GATHERED FROM ANY OF THE FOLLOWING SOURCES: INDUSTRY SURVEYS, DOCUMENTED COMPENSATION OF PERSONS HOLDING SIMILAR POSITIONS IN SIMILAR ORGANIZATIONS, EXPERT COMPENSATION STUDIES, OR OTHER COMPARABLE DATA. FOR EACH TIME THERE IS A MATERIAL CHANGE TO THE SALARY RANGE OR COMPENSATION PACKAGE, NEW DATA IS GATHERED AND NEW DOCUMENTATION IS CREATED. 3. CONTEMPORANEOUS DOCUMENTATION REGARDING DECISIONS - ALL DOCUMENTATION ON FINAL DECISIONS MADE BY THE EXECUTIVE COMMITTEE IS KEPT ON RECORD IN OHSUF'S HUMAN RESOURCES DEPARTMENT. 4. THE EXECUTIVE DIRECTOR'S SALARY WAS LAST REVIEWED IN JUNE 2012. PROCESS OF DETERMINING COMPENSATION FOR OHSUF EMPLOYEES: A COMPENSATION COMMITTEE IS COMPOSED OF REPRESENTATIVES OF OHSU FOUNDATION BOARD OF TRUSTEES WITH MEMBERS TO INCLUDE BUT NOT LIMITED TO THE BOARD CHAIR, IMMEDIATE PAST CHAIR, AND FINANCE CHAIR. THE COMPENSATION COMMITTEE REVIEWS THE DOCUMENTATION FOR APPROVAL PRIOR TO THE PRESENTATION OF THE BUDGET AT THE JUNE BOARD MEETING. FOR EACH POSITION SUBJECT TO REVIEW, COMPARABILITY DATA IS GATHERED FROM ANY OF THE FOLLOWING SOURCES: INDUSTRY SURVEYS, DOCUMENTED COMPENSATION OF PERSONS HOLDING SIMILAR POSITIONS IN SIMILAR ORGANIZATIONS, EXPERT COMPENSATION STUDIES, OR OTHER COMPARABLE DATA. FOR EACH TIME THERE IS A MATERIAL CHANGE TO THE SALARY RANGE OR COMPENSATION PACKAGE OF THE AFFECTED POSITION AND/OR PERSON IN THAT POSITION, NEW DATA IS GATHERED AND NEW DOCUMENTATION IS CREATED. ANNUAL COST-OF-LIVING INCREASES, BASED ON GOVERNMENT COST-OF-LIVING FIGURES, WOULD NOT NECESSITATE NEW DOCUMENTATION. ALL DOCUMENTATION ON FINAL DECISIONS INCLUDING DELIBERATIONS MADE BY THE COMPENSATION COMMITTEE IS KEPT ON RECORD IN THE OHSU FOUNDATION HUMAN RESOURCE DEPARTMENT. THIS PROCESS WAS LAST UNDERTAKEN FOR THE INTERIM PRESIDENT IN MAY 2012.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
 
Employer identification number

93-0579589
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications .. X 3,531 COMPARABLE SALES
5 Clothing and household
goods ....... 		X 64,290 COMPARABLE SALES
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded . X 8 151,871 AVERAGE MARKET
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ... X 21 24,712 COMPARABLE SALES
20 Drugs and medical supplies . X 3 1,875 COMPARABLE SALES
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( AUCTION ITEMS ) X 174 81,406 FMV - SALES PRICE
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
1
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ............................
32a
Yes
 
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2011
Schedule M (Form 990) 2011
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33 and whether the organization is reporting in Part I, column (b) the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
HIRE AND USE OF THIRD PARTIES PART I, LINE 32B THE ORGANIZATION PARTNERS WITH VOLUNTEERS OF AMERICA FOR THE COLLECTION AND SALE OF GIFTS OF AUTOMOBILES. THE ORGANIZATION ALSO ENGAGES THE SERVICES OF REAL ESTATE AGENTS WHEN SELLING GIFTS OF REAL PROPERTY. THE ORGANIZATION USES STOCK BROKERS TO PROCESS AND SELL SECURITIES. THE SERVICES OF MARKETING FIRMS IN THE SOLICITATION OF PLANNED GIFTS IS ALSO USED.
ADDITIONAL INFORMATION SCHEDULE M, PART I, COLUMN (B) THE FOUNDATION IS REPORTING A COMBINATION OF METHODS - THE NUMBER OF CONTRIBUTIONS AND THE NUMBER OF ITEMS RECEIVED.
Schedule M (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
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.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
 
Employer identification number

93-0579589
Identifier Return Reference Explanation
PROGRAM SERVICES FORM 990, PART III, LINE 4A Doernbecher Children's Hospital Foundation is a 501(c)(3) organization that exists to solicit private philanthropic support for OHSU Doernbecher Children's Hospital and to invest and manage gifts to honor donors' wishes. Each year the commitment and generosity of thousands of donors - individuals, companies, foundations and organizations - helps provide innovative health care, educate tomorrow's pediatric experts, and support pioneering research to benefit children in Oregon, southwest Washington and beyond. Among other accomplishments during the 2011-2012 fiscal year, the Doernbecher Foundation: 1) Supported pediatric congenital heart research at Doernbecher with a $500,000 commitment from the Alyce R. Cheatham Family Fund of the Oregon Community Foundation. The funds will benefit the work of Stephen Langley, M.B.B.S., M.D., an internationally known pediatric heart surgeon at OHSU Doernbecher Children's Hospital. 2) Raised $956,500 in the 2011-12 fiscal period from Doernbecher Freestyle, a partnership with Oregon-based Nike, Inc. Entering its ninth year, this innovative program gives six Doernbecher patients the chance to design unique athletic shoes. This year's shoes were marketed nationally, with proceeds, including funds raised during an annual unveiling/auction event, benefiting Doernbecher. 3) Received $543,460 collectively raised for Doernbecher by children from more than 100 schools across Oregon and southwest Washington through the annual Kids Making Miracles program. Celebrating its 20th year, the program helps kids hold a wide range of fund-raising events in their communities, instilling the values of philanthropy while providing valuable experience in organization and leadership. 4) Generated more than $250,000 in pledges through the annual Doernbecher radiothon on radio station 99.5 FM "The Wolf." 5) Raised $462,784 at the 14th Annual Heart of Doernbecher Auction to support the Doernbecher Neonatal Care Center including $505,410 from credit unions in Oregon and southwest Washington.
FORM 990 REVIEW PROCESS FORM 990, PART VI, LINE 11B AN OUTSIDE ACCOUNTING FIRM PREPARES FORM 990. THE VP OF FINANCE AND THE CONTROLLER OF THE OREGON HEALTH AND SCIENCE UNIVERSITY FOUNDATION THEN REVIEW THE FINAL DRAFT OF THE FORM. THIS DRAFT IS THEN PROVIDED TO THE ORGANIZATION'S FINANCE AND AUDIT COMMITTEE AND THEN TO THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE REVIEWS THE FORM AND UPON ITS APPROVAL, THE COMMITTEE RECOMMENDS IT TO THE BOARD FOR ACCEPTANCE AND AUTHORIZATION. THE FINAL COPY OF THE RETURN IS APPROVED BY THE VOTING BOARD. THE EXECUTIVE DIRECTOR OF THE FOUNDATION REVIEWS AND SIGNS THE RETURN BEFORE IT IS FILED. TO PROTECT THE PRIVACY OF OUR DONORS, DONOR ADDRESSES AND NAMES OF ANONYMOUS DONORS (IF ANY) WERE REDACTED FROM THE VERSION OF SCHEDULE B THAT WAS REVIEWED BY THE COMMITTEES AND THE BOARD OF DIRECTORS.
EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS FORM 990, PART VI, LINE 12C AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE AND STATEMENT TO SIGN ARE PROVIDED TO EACH COVERED PERSON TO DISCLOSE ANY INTERESTS THAT COULD GIVE RISE TO CONFLICTS OF INTEREST. COVERED PERSONS INCLUDE ANY CURRENT AND FORMER OFFICER, DIRECTOR, MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS, HIGHEST COMPENSATED EMPLOYEES, OR KEY EMPLOYEE, ANY OF WHOM HELD THE NAMED POSITION WITHIN FIVE YEARS FROM DATE THE POSITION TERMINATED. EACH RESPONDENT IS ASKED TO SIGN A DISCLOSURE STATEMENT WHICH AFFIRMS THAT THEY HAVE RECEIVED A COPY OF THE POLICY, HAVE READ AND UNDERSTAND THE POLICY, HAVE AGREED TO COMPLY WITH THE POLICY, AND HAVE RESPONDED TO THE QUESTIONNAIRE TO THE BEST OF THEIR ABILITY. THE COMPLETED QUESTIONNAIRE WILL BE PROVIDED TO THE EXECUTIVE COMMITTEE PRIOR TO JUNE 30 OF EACH YEAR. AFTER REVIEWING THE DISCLOSURE STATEMENTS AS WELL AS ANY OTHER POTENTIAL OR REAL CONFLICTS OF INTEREST THAT ARE IDENTIFIED, THE EXECUTIVE COMMITTEE SHALL NOTIFY THE OHSU FOUNDATION VICE-PRESIDENT OF FINANCE AND ADMINISTRATION OF ANY POSITIVE RESPONSES TO ANY QUESTIONS ON THE DISCLOSURE STATEMENT; AND WILL FOLLOW UP WITH RESPECT TO ANY OTHER DISCLOSURES THAT INDICATE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST. THIS MAY INCLUDE, BUT NOT LIMITED TO, ASKING THE PERSON NOT TO PARTICIPATE IN RELATED DECISIONS OR RECOMMENDING APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION TO THE FOUNDATION EXECUTIVE DIRECTOR AND/OR THE PRESIDENT OF THE BOARD OF DIRECTORS FOR THE DOERNBECHER FOUNDATION. AS POTENTIAL CONFLICTS OF INTEREST ARE IDENTIFIED THROUGHOUT THE COURSE OF A YEAR, EACH RESPONDENT HAS AN OBLIGATION TO ADVISE THE EXECUTIVE COMMITTEE IN WRITING OF THE EXISTENCE OF ANY SUCH REAL OR POTENTIAL CONFLICT OF INTEREST. A RESPONDENT MAY MAKE A PRESENTATION AT THE EXECUTIVE COMMITTEE MEETING, BUT AFTER SUCH PRESENTATION, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT CREATES THE ACTUAL OR POTENTIAL CONFLICT OF INTEREST. THE EXECUTIVE COMMITTEE SHALL DETERMINE TO ITS SATISFACTION WHETHER THE FOUNDATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, THE EXECUTIVE COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED COMMITTEE MEMBERS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE FOUNDATION'S BEST INTEREST AND WHETHER THE TRANSACTION IS FAIR TO THE FOUNDATION, AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. THE EXECUTIVE COMMITTEE WILL INFORM THE RESPONDENT, IN WRITING, OF ITS DECISION. IF THE EXECUTIVE COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A RESPONDENT HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL INFORM THE RESPONDENT OF THE BASIS FOR SUCH BELIEF AND AFFORD THE RESPONDENT AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE RESPONDENT AND MAKING FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE EXECUTIVE COMMITTEE DETERMINES THAT THE RESPONDENT HAS IN FACT FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL RECOMMEND APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION TO THE FOUNDATION EXECUTIVE DIRECTOR AND/OR THE PRESIDENT OF THE BOARD OF DIRECTORS FOR THE DOERNBECHER FOUNDATION.
FORM 990, PART VI, LINES 15A & 15B   OREGON HEALTH & SCIENCE UNIVERSITY FOUNDATION (OHSUF) AND DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION (DCHF) HAVE A SHARED SERVICES AGREEMENT WHEREBY OHSUF PROVIDES DCHF WITH MANAGEMENT, STAFFING, FACILITIES AND OTHER SERVICES. THE FOLLOWING IS THE PROCESS THAT DCHF FOLLOWS TO DETERMINE COMPENSATION FOR THE EXECUTIVE DIRECTOR: 1. REVIEW AND APPROVAL BY A GOVERNING BODY - THE EXECUTIVE COMMITTEE, WHOSE MEMBERS ARE TO INCLUDE BUT NOT BE LIMITED TO THE BOARD CHAIR, IMMEDIATE PAST CHAIR, AND FINANCE CHAIR, REVIEWS THE DOCUMENTATION FOR APPROVAL PRIOR TO THE PRESENTATION OF THE BUDGET AT THE JUNE BOARD MEETING. 2. USE OF DATA AS TO COMPARABLE COMPENSATION - FOR THE EXECUTIVE DIRECTOR POSITION, COMPARABILITY DATA IS GATHERED FROM ANY OF THE FOLLOWING SOURCES: INDUSTRY SURVEYS, DOCUMENTED COMPENSATION OF PERSONS HOLDING SIMILAR POSITIONS IN SIMILAR ORGANIZATIONS, EXPERT COMPENSATION STUDIES, OR OTHER COMPARABLE DATA. FOR EACH TIME THERE IS A MATERIAL CHANGE TO THE SALARY RANGE OR COMPENSATION PACKAGE, NEW DATA IS GATHERED AND NEW DOCUMENTATION IS CREATED. 3. CONTEMPORANEOUS DOCUMENTATION REGARDING DECISIONS - ALL DOCUMENTATION ON FINAL DECISIONS MADE BY THE EXECUTIVE COMMITTEE IS KEPT ON RECORD IN OHSUF'S HUMAN RESOURCES DEPARTMENT. 4. THE EXECUTIVE DIRECTOR'S SALARY WAS REVIEWED IN JUNE 2012. PROCESS OF DETERMINING COMPENSATION FOR OHSUF EMPLOYEES: A COMPENSATION COMMITTEE IS COMPOSED OF REPRESENTATIVES OF OHSU FOUNDATION BOARD OF TRUSTEES WITH MEMBERS TO INCLUDE BUT NOT LIMITED TO THE BOARD CHAIR, IMMEDIATE PAST CHAIR, AND FINANCE CHAIR. THE COMPENSATION COMMITTEE REVIEWS THE DOCUMENTATION FOR APPROVAL PRIOR TO THE PRESENTATION OF THE BUDGET AT THE JUNE BOARD MEETING. FOR EACH POSITION SUBJECT TO REVIEW, COMPARABILITY DATA IS GATHERED FROM ANY OF THE FOLLOWING SOURCES: INDUSTRY SURVEYS, DOCUMENTED COMPENSATION OF PERSONS HOLDING SIMILAR POSITIONS IN SIMILAR ORGANIZATIONS, EXPERT COMPENSATION STUDIES, OR OTHER COMPARABLE DATA. FOR EACH TIME THERE IS A MATERIAL CHANGE TO THE SALARY RANGE OR COMPENSATION PACKAGE OF THE AFFECTED POSITION AND/OR PERSON IN THAT POSITION, NEW DATA IS GATHERED AND NEW DOCUMENTATION IS CREATED. ANNUAL COST-OF-LIVING INCREASES, BASED ON GOVERNMENT COST-OF-LIVING FIGURES, WOULD NOT NECESSITATE NEW DOCUMENTATION. ALL DOCUMENTATION ON FINAL DECISIONS INCLUDING DELIBERATIONS MADE BY THE COMPENSATION COMMITTEE IS KEPT ON RECORD IN THE OHSU FOUNDATION HUMAN RESOURCE DEPARTMENT. THIS PROCESS WAS LAST UNDERTAKEN FOR THE INTERIM PRESIDENT IN MAY 2012.
OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE FORM 990, PART VI, LINE 19 WHILE FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTIONS, LIMITED INFORMATION ON THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS IS AVAILABLE AT THE ORGANIZATION'S WEBSITE. THIS INFORMATION IS NOT READILY AVAILABLE FOR THE GENERAL PUBLIC AND REQUESTS FOR THIS INFORMATION ARE ASSESSED ON A CASE BY CASE BASIS BY THE RELEVANT FOUNDATION EMPLOYEE BEFORE DISCLOSURE.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 NET UNREALIZED GAIN ON INVESTMENTS...................(1,152,507) CHANGE IN VALUE OF LIFE INCOME AGREEMENT............. (28,306) INVESTMENT FEES...................................... (355,470) ----------- OTHER CHANGES IN NET ASSETS OR FUND BALANCES.........(1,536,284)
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DONALD M. ANTONUCCI TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NATHAN M. AYOTTE TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:NATHAN J. BAILEY TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JEFF M. BOURLAG TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RONALD G. BRAKE TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DIRK T. DAVIS TITLE:EXECUTIVE VICE PRESIDENT HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEVIN M. DIRECTOR TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL F. DOHERTY TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CAROL K. EHLEN TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ALLYN C. FORD TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TERRY J. GROVER TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LINDA RAE HICKEY TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SIOUXSIE JENNETT TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELIZABETH K. JOHNSON TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KELLY J. JOHNSON TITLE:PRESIDENT HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BRUCE E. KERR TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SEAN T. KEYS TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MITCHELL W. MACK TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LINDA B. MALETIS TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CATHRINE L. MCCOY TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROGER W. MILLS TITLE:VICE PRESIDENT FINANCE HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:HENRY S. NICHOLSON, MD TITLE:DIRECTOR HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ANDREW J. OVER TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SHIRLEY N. PAP TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GERALD E. RESER TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOSEPH E. ROBERTSON, MD TITLE:DIRECTOR HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PATRICIA E. SMITH TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TODD R. STUCKY TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BRYAN L. TIMM TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SOHRAB S. VOSSOUGHI TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:J. C. WESSEL TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:D.J. WILSON TITLE:SECRETARY HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RICHARD L. WRIGHT, JR. TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CANDACE D. YOUNG, Ph.D TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LORI MUELLER TITLE:VICE PRESIDENT HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARY TURINA TITLE:EXECUTIVE DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SUSAN NICOL TITLE:EXECUTIVE DIRECTOR HOURS:
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
DOERNBECHER CHILDREN'S HOSPITAL FOUNDATION
 
Employer identification number

93-0579589
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) OREGON HEALTH AND SCIENCE UNIVERSITY

3181 SW SAM JACKSON PARK ROAD

PORTLAND,OR97239
93-1176109 		HOSP & UNIV OR   N/A NA
 
 
No
(2) DOERNBECHER CHILDREN'S HOSPITAL GROUP

1121 SW SALMON STREET 100

PORTLAND,OR97205
93-1329815 		FUNDRAISING OR 501(c)(3) 7 NA
 
Yes
 










For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) CHARITABLE REMINDER TRUST (8)
 
 
CRT OR OHSUF
  		T   1,144,472  












Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) OREGON HEALTH AND SCIENCE UNIVERSITY

 B 7,046,673 CASH PAID
(2) DOERNBECHER CHILDREN'S HOSP FOUNDATION GROUP

 C 241,283 CASH PAID
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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