Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
CHOC Foundation
Employer identification number
95-6097416
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
15,602,800
13,561,991
18,351,396
48,406,024
20,654,820
116,577,031
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..
15,602,800
13,561,991
18,351,396
48,406,024
20,654,820
116,577,031
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)..
30,310,055
6
Public Support. Subtract line 5 from line 4.
86,266,976
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..
15,602,800
13,561,991
18,351,396
48,406,024
20,654,820
116,577,031
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
556,256
479,980
155,902
423,050
329,296
1,944,484
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
1,204,491
748,754
611,425
932,335
964,203
4,461,208
11
Total support (Add lines 7 through 10).
122,982,723
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
70.146 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
68.586 %
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
CHOC Foundation
Employer identification number
95-6097416
Identifier
Return Reference
Explanation
Information Regarding Common Paymaster
Form 990, Part I, Line 5 and Part V, Line 2
Children's Hospital of Orange County (CHOC) acts as a common paymaster, issuing forms W-2 and 1099 on behalf of CHOC Foundation. CHOC Foundation has 27 employees, however because of the common paymaster arrangement resulting in the Forms W-2 being issued under CHOC's employer identification number, there are no W-2s issued directly by CHOC Foundation.
members or stockholders
Form 990, Part VI, Section A, Line 6
The sole member of CHOC Foundation is Children's HealthCare of California (CHC).
persons who may elect members of the governing body
Form 990, Part VI, Section A, Line 7a
Directors of CHOC Foundation shall be elected annually by the Member, based on the nomination(s) provided by CHOC Foundation'S Board of Directors.
the governing body's decisions subject to approval
Form 990, Part VI, Section A, Line 7b
The approval of the Member shall be required with respect to any of the following actions: (1) Changing the purposes and powers of CHOC Foundation; (2) Obligating CHOC Foundation to undertake any capital expenditure in excess of $1,000,000; (3) Adopting CHOC Foundation's annual operating and capital budgets; (4) Adopting a long-term capital budget; (5) Buying, selling, leasing, mortgaging, pledging, or otherwise hypothecating any real property; (6) Incurring any indebtedness in excess of $1,000,000; (7) Obligating CHOC Foundation to act as guarantor with respect to any debt of any person or other entity; (8) Accepting any donation which is conditioned upon CHOC Foundation's undertaking any unbudgeted capital expenditure in excess of $1,000,000 or any unbudgeted expenditure in excess of $1,000,000; (9) Entering into any contract which involves any of the following: (a) any financial obligation on the part of CHOC Foundation in an amount in excess of $1,000,000, (b) any purpose or activity which is outside the scope of CHOC Foundation's ordinary course of business, or (c) a term in excess of five years (unless the contract is terminable at will); (10) involving CHOC Foundation in any merger, acquisition, corporate restructuring, or formal affiliation; (11) Involving CHOC Foundation as a member, shareholder, or partner in any new corporation, partnership, or other legal entity; (12) Dissolving CHOC Foundation; (13) Entering into any transaction involving the sale, lease, conveyance, exchange, transfer or other disposition of all or substantially all of CHOC Foundation's assets; (14) Amending CHOC Foundation's articles of Incorporation; (15) Adopting new bylaws or amending existing bylaws, in the event that such action would affect any of the Member's rights under the bylaws or as provided by applicable law.
PROCESS OF REVIEW
Form 990, Part VI, Section B, Line 11A
Prior to filing, the tax return and related schedules are provided to the executive compensation committee, an empowered board committee delegated with this authority. The Chief Financial Officer reviews the report with the committee prior to filing the return. Prior to the filing of the form 990 with the Internal Revenue Service, a complete copy of the final form 990 is also sent electronically to all board members via Director's Desk, a secure web site that provides a confidential and secure access for all board materials to our board members. The form 990 is also a scheduled agenda item at the May 2013 board of directors meeting.
MONITORNING AND ENFORCING COMPLIANCE OF CONFLICT INTEREST POLICY
FORM 990, PART VI, SECTION B, LINE 12C
The Compliance Officer is charged with monitoring proposed or ongoing transactions for conflicts of interest and addressing any potential or actual conflicts. Pursuant to the conflict of interest policy, an annual conflict of interest questionnaire, aimed at determining any family and business relationships and transactions or other transactions that may pose a potential conflict, is distributed to all covered persons (i.e., board members, officers and executive leadership). Covered persons are required to disclose real or potential conflicts at the time when such conflicts arise. When an individual becomes a covered person and annually thereafter, each covered person is required to sign a statement affirming that he/she: (1)has received a copy of the Conflict of Interest Policy and understands said policy; (2)has read the policy and understands said policy; and (3)agrees to comply with all requirements of the policy, including completing the conflict of interest questionnaire. The completed questionnaires are reviewed by the Compliance Officer and any persons with actual or potential conflicts are contacted via written communication. The procedures for addressing any conflict of interest may include but are not limited to the following: (1)the conflicting interest is fully disclosed to the Board of Directors; (2)the interested person responds to factual questions related to the conflict, the substance of the transaction or the arrangement being considered; (3)the person with the conflict of interest is excluded from any discussion or approval of such transaction; (4)if applicable alternatives to the proposed transaction are investigated, competitive bids or comparable valuations are obtained; and (5)the transaction or action must be approved by a majority of disinterested persons.
PROCESS OF DETERMINING COMPENSATION OF THE CEO AND OFFICERS
FORM 990, PART VI, SECTION B, LINE 15
Line 15A - Compensation Determination Process - Top Management Official: An independent Board committee, charged with the duties of the compensation committee, whose members are disinterested and independent, is in place with a written compensation committee charter. This committee annually retains an independent healthcare compensation firm to provide relevant comparability data and other compensation studies. The officers and executive management salaries and incentives, as well as overall compensation philosophy and policies, are discussed with the independent consultant representatives and the compensation committee members, in person, in executive sessions with no staff members present. All comparative salary data is well documented and there are minutes from these meetings that document the members present and voting, the comparative data used and the deliberations and decisions of the committee. The results and recommendations from the committee are shared in an executive session with the board of directors. Line 15B - Compensation Determination Process - Other Officers and Key Employees: The Organization has no other officers or key employees. Kimberly C. Cripe and Kerri Ruppert Schiller are employees of Children's Healthcare of California (CHC) and are compensated by CHC. An independent Board Committee of CHC charged with the duties of the compensation committee, whose members are disinterested and independent, is in place with a written compensation committee charter. This Committee annually retains an independent healthcare compensation firm to provide relevant comparability data and other compensation studies. The officers and key employees of CHC salaries and incentives, as well as overall compensation philosophy and policies, are discussed with the independent consultant representatives and the compensation committee members, in person, in closed sessions with no staff members present. All comparative salary data is well documented and there are minutes from these meetings that document the members present and voting, the comparative data used and the deliberations and decisions of the committee. The results and recommendations from the committee are shared in a closed session with the Board of Directors.
disclosure copy - FORM 990, PART VI, SECTION C, 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 inspection, the organization makes its financial statements available upon request.
Form 990, Part XI, Line 5
Unrealized Gains $ (642,651) Change in value of Split-Interest Agreement ( 7,928) Donated services/use of facilities 1,650,000 ------------ Total change in Net Assets $ 999,421