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
CHILDRENS REHABILITATION CENTER INC
Employer identification number
27-1837787
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.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—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.") .
928,270
456,729
1,384,999
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......
2,777,855
3,703,897
6,481,752
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.
0
0
0
3,706,125
4,160,626
7,866,751
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
2,250
2,250
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..
0
0
0
0
2,250
2,250
8
Public Support (Subtract line 7c from line 6.)
7,864,501
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...
0
0
0
3,706,125
4,160,626
7,866,751
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
48
10
58
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
0
0
0
48
10
58
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.)
1,260
2,051
3,311
13
Total support (Add lines 9, 10c, 11 and 12.).
0
0
0
3,707,433
4,162,687
7,870,120
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
The $2,051 in Other Income is comprised of Medical Record Fees of $1,324 & Vending Machine Commissions of $727.
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
11000129
Software Version:
v1.00
-
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
CHILDRENS REHABILITATION CENTER INC
Employer identification number
27-1837787
Identifier
Return Reference
Explanation
F990_P06_S0A_L06
Form 990, Part VI, Section A, Line 6
CHILDREN'S REHABILITATION CENTER IS A MEMBERSHIP CORPORATION WHOSE ONLY MEMBER ARE CERTAIN MEMBERS OF THE SISTERS OF CHARITY OF SAINT VINCENT de PAUL OF NEW YORK.
F990_P06_S0A_L07a
Form 990, Part VI, Section A, Line 7a
CHILDREN'S REHABILIATION CENTER IS A MEMBERSHIP CORPORATION WHOSE ONLY MEMBER ARE CERTAIN MEMBERS OF THE SISTERS OF CHARITY OF SAINT VINCENT de PAUL OF NEW YORK WHO ELECT THE CHILDREN'S REHABILITATION CENTER'S BOARD OF TRUSTEES.
F990_P06_S0A_L07b
Form 990, Part VI, Section A, Line 7b
THE BOARD OF TRUSTEES INCLUDES SISTERS OF CHARITY OF SAINT VINCENT de PAUL OF NEW YORK WHO ARE MEMBERS, AND THESE MEMBERS, ALONG WITH THE ENTIRE BOARD OF TRUSTEES, VOTE ON PROPOSALS BROUGHT TO THE BOARD.
F990_P06_S0B_L11b
Form 990, Part VI, Section B, Line 11b
THE BOARD OF TRUSTEES HAVE ASSIGNED THE RESPONSIBILITY TO REVIEW AND APPROVE THE FORM 990 TO THE AUDIT COMMITTEE. THE AUDIT COMMITTEE IS COMPRISED OF FOUR INDEPENDENT TRUSTEES, ONE OF WHOM IS DEEMED TO BE THE FINANCIAL EXPERT AND THE OTHERS KNOWLEDGEABLE IN FINANCIAL AND COMPLIANCE MATTERS.THE AUDIT COMMITTEE RECEIVES AN ELECTRONIC DRAFT COPY OF THE FORM 990 PRIOR TO A SCHEDULED AUDIT COMMITTEE MEETING FOR WHICH THE FORM 990 IS A SCHEDULED AGENDA ITEM.THE AUDIT COMMITTEE MEMBERS' QUESTIONS RELATING TO THE FORM 990 CONTENTS ARE DISCUSSED WITH FINANCIAL MANAGEMENT AND ANY AUDIT COMMITTEE MEMBERS' QUESTIONS MUST BE RESOLVED PRIOR TO AUDIT COMMITTEE APPROVAL FOR THE FORM 990 TO BE FILED. AN ELECTRONIC COPY OF THE APPROVED FINAL FORM 990 IS PROVIDED TO ALL MEMBERS OF THE GOVERNING BODY BEFORE IT IS SUBMITTED TO THE IRS.
F990_P06_S0B_L12c
Form 990, Part VI, Section B, Line 12c
THE CHILDREN'S REHABILITATION CENTER REQUIRES THAT ITS TRUSTEES, OFFICERS AND THE EMPLOYEES MAKE DECISIONS SOLELY ON THE BASIS OF A DESIRE TO PROMOTE THE BEST INTERESTS OF THE ORGANIZATION AND AVOID CONFLICTS OF INTEREST WHEN ACTING ON BEHALF OF THE ORGANIZATION. SIMILARLY, THE CENTER'S TRUSTEES, OFFICERS AND EMPLOYEES ARE PROHIBITED FROM USING THEIR RESPECTIVE POSITIONS WITHIN THE ORGANIZATION OR INFORMATION OBTAINED RELATING TO THE ORGANIZATION TO ACHIEVE A DIRECT/INDIRECT PERSONAL BENEFIT, FINANCIAL OR OTHERWISE. A POTENTIAL CONFLICT OF INTEREST WILL BE DEEMED TO OCCUR WHEN AN INDIVIDUAL'S PERSONAL OR PRIVATE INTERESTS MIGHT LEAD AN INDEPENDENT OBSERVER TO REASONABLY QUESTION WHETHER THE INDIVIDUAL'S ACTIONS OR DECISIONS ON BEHALF OF THE CENTER ARE INFLUENCED BY PERSONAL CONSIDERATIONS FINANCIAL OR OTHERWISE. AN ACTUAL CONFLICT OF INTEREST WILL BE DEEMED TO OCCUR WHERE IT REASONABLY APPEARS THAT DECISIONS MADE ON BEHALF OF THE ORGANIZATION BY A TRUSTEE, OFFICER OR EMPLOYEE WERE INFLUENCED BY THE TRUSTEE, OFFICER OR EMPLOYEES' DIRECT OR INDIRECT PERSONAL OR FINANCIAL INTEREST IN AN ENTITY THAT TRANSACTS BUSINESS WITH OR COMPETES AGAINST THE CENTER, OR RECEIPT OF GIFTS, ENTERTAINMENT OR OTHER FAVORS FROM ANY INDIVIDUAL OR ENTITY THAT DOES BUSINESS WITH OR COMPETES AGAINST THE CENTER. THE CENTER REQUIRES THAT PROPOSED COMPENSATION ARRANGEMENTS FOR ALL TRUSTEES, OFFICERS AND KEY EMPLOYEES AND ALL PROPOSED INITIAL OR RENEWAL CONTRACTS AND TRANSACTIONS THAT MAY IMPLICATE THE PERSONAL OR FINANCIAL INTERESTS OF ANY OF ITS TRUSTEES, OFFICERS, EMPLOYEES OR THEIR IMMEDIATE FAMILIES BE REVIEWED AND DULY AUTHORIZED BY THE BOARD OF TRUSTEES. ALL COMPENSATION ARRANGEMENTS WILL BE IN COMPLIANCE WITH THE CENTER'S POLICIES AND MISSIONS AND APPLICABLE LAWS INCLUDING BUT NOT LIMITED TO THE TAX AND OTHER REQUIREMENTS RELEVANT TO TAX EXEMPT ORGANIZATION. ANY TIME A TRANSACTION, CONTRACT OR COMPENSATION ARRANGEMENT THAT MAY GIVE RISE TO A CONFLICT OF INTEREST IS SCHEDULED TO COME BEFORE THE BOARD OF TRUSTEES, EACH TRUSTEE, OFFICER OR EMPLOYEE WHO MAY HAVE A CONFLICT OF INTEREST MUST MAKE KNOWN THE INTEREST THAT GIVES RISE TO THE CONFLICT WHETHER BY WRITTEN STATEMENT OR OTHERWISE AND DISCLOSE ALL MATERIAL FACTS ABOUT THE CONFLICT. AFTER DISCLOSURE OF THE INTEREST AND ALL MATERIAL FACTS AND AFTER ANY DISCUSSIONS, THE TRUSTEE, OFFICER OR EMPLOYEE MUST LEAVE THE MEETING WHILE THE REMAINING TRUSTEES DISCUSS THE INFORMATION AND MAKE A DETERMINATION IF A CONFLICT OF INTEREST EXISTS. THE MINUTES OF THE MEETING WILL REFLECT THAT A DISCLOSURE WAS MADE AND THE TRUSTEE, OFFICER OR EMPLOYEE WAS ABSENT DURING BOTH THE DISCUSSION AND ANY VOTING ON THE TRANSACTION, CONTRACT OR COMPENSATION ARRANGEMENT. THE CHAIRPERSON OF THE BOARD OR DESIGNEE WILL APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE AND REPORT TO THE BOARD OF TRUSTEES ALTERNATIVES TO THE PROPOSED TRANSACTION, CONTRACT OR COMPENSATION ARRANGEMENT. BASED UPON THE INFORMATION PROVIDED BY THE DISINTERESTED PERSON OR COMMITTEE, THE BOARD OF TRUSTEES WILL MAKE A DETERMINATION OF WHETHER THE CENTER CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR MORE REASONABLE ARRANGEMENT FROM AN ENTITY OR PERSON THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF THE BOARD HAS REASONABLE CAUSE TO BELIEVE THAT A TRUSTEE, OFFICER OR EMPLOYEE HAS FAILED TO DISCLOSE A CONFLICT OF INTEREST, IT WILL INFORM THE INDIVIDUAL OF THE BASIS FOR BELIEF AND AFFORD THE INDIVIDUAL TO EXPLAIN THE FAILURE TO DISCLOSE. THE BOARD MAY TAKE WHATEVER FOLLOW UP ACTION IT DEEMS NECESSARY AND, AT ITS OPTION, MAY VOID A TRANSACTION, CONTRACT OR ARRANGEMENT WHERE A CONFLICT OF INTEREST EXISTS THAT HAS NOT BEEN DISCLOSED. ANY TRUSTEE, OFFICER OR EMPLOYEE WHO FINDS OR SUSPECTS A VIOLATION OF THIS POLICY MUST IMMEDIATELY REPORT THE CONDUCT TO THE SUPERVISOR OR THE COMPLIANCE OFFICER. ANY EMPLOYEE OR AGENT MAY REPORT CONDUCT THAT MAY BE IN VIOLATION OF THIS POLICY THROUGH THE CENTER'S CONFIDENTIAL REPORTING SYSTEM.
F990_P06_S0B_L15
Form 990, Part VI, Section B, Line 15
EXECUTIVE COMPENSATION INCLUDING SALARY, BONUS AND BENEFITS FOR THE PRESIDENT AND OTHER KEY EMPLOYEES WILL BE REVIEWED AND RECOMMENDED BY A SUB-COMMITTEE OF THE BOARD OF TRUSTEES. NO MEMBER OF THE SUB-COMMITTEE WILL PARTICIPATE IN OR ECONOMICALLY BENEFIT FROM THE PROPOSED COMPENSATION ARRANGEMENT, BE A FAMILY MEMBER OF THE EMPLOYEE OR BE IN AN EMPLOYMENT RELATIONSHIP WITH RESPECT TO THE PARTICULAR EMPLOYEE UNDER WHICH THE MEMBER IS SUBJECT TO DIRECTION OR CONTROL BY THE EMPLOYEE OR HAVE A MATERIAL FINANCIAL INTEREST THAT WILL BE AFFECTED BY THE PROPOSED COMPENSATION PACKAGE OR RECEIVE ECONOMIC BENEFITS THAT ARE SUBJECT TO APPROVAL BY THE EMPLOYEE. RECOMMENDATIONS WILL THEN BE FURNISHED TO THE HUMAN RESOURCES DIRECTOR FOR REVIEW AND PROCESSING. PRIOR TO MAKING ITS DECISION, THE SUB-COMMITTEE WILL OBTAIN RELEVANT INFORMATION SUFFICIENT FOR DETERMINING THAT COMPENSATION ARRANGEMENT IN ITS ENTIRETY IS REASONABLE SUCH AS THE COMPENSATION PACKAGES OF SIMILARLY SITUATED TAX-EXEMPT OR TAXABLE ORGANIZATIONS FOR SIMILAR POSITIONS, THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA, CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS OR ACTUAL WRITTEN OFFERS FROM SIMILAR INSTITUTIONS FOR THE SERVICES OF THE EMPLOYEE. THE SUB-COMMITTEE WILL ACCURATELY RECORD MINUTES AND COMMENT ON THE DETERMINATION OF THE KEY EMPLOYEE COMPENSATION PACKAGE BEFORE THE LATER OF THE NEXT SUB-COMMITTEE MEETING OR 60 DAYS AFTER THE FINAL ACTION IS TAKEN. THE DOCUMENTATION WILL INCLUDE THE TERMS OF THE COMPENSATION PACKAGE AND THE DATE IT WAS APPROVED, THE NAMES OF THE SUB-COMMITTEE MEMBERS WHO WERE PRESENT DURING THE DISCUSSIONS AND THOSE WHO VOTED IN AGREEMENT WITH THE COMPENSATION RATE, THE COMPARABLE DATA OBTAINED AND RELIED UPON BY THE SUB-COMMITTEE AND HOW THE DATA WAS OBTAINED, ANY ACTIONS TAKEN WITH RESPECT TO CONSIDERATION OF THE TRANSACTION BY ANYONE WHO IS A USUAL MEMBER OF THE SUB-COMMITTEE BUT HAD A CONFLICT OF INTEREST AND REMOVED HIMSELF FROM THE ACTIONS OF THE SUB-COMMITTEE, AND IF APPLICABLE, THE REASONS WHY THE SUBCOMMITTEE DETERMINED A REASONABLE COMPENSATION RATE TO BE HIGHER OR LOWER THAN THE COMPENSATION PACKAGES OF COMPARABLE PUBLIC CHARITIES. NO COMPENSATION OF ANY KIND SHALL BE PAID TO THE CENTER'S BOARD OF TRUSTEES.
F990_P06_S0C_L19
Form 990, Part VI, Section C, Line 19
THE CENTER'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 990 AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE AFOREMENTIONED DOCUMENTS MAY BE VIEWED AT THE CENTER OR COPIES OF THE DOCUMENTS WILL BE PROVIDED UPON REQUEST.
F990_P07_S0A_L01a
Form 990, Part VII, Section A, Line 1a
THE FOLLOWING TRUSTEES, OFFICERS, KEY EMPLOYEE, OR HIGHEST COMPENSATED EMPLOYEES AVG WEEKLY HOURS WORKING WITH RELATED ORGANIZATIONS: PATRICIA TURSI 4 HOURS JOHN A. COLEMAN SCHOOL (JAC), 32.5 HOURS ELIZABETH SETON PEDIATRIC CENTER (ESPC); WILIAM VAN LEW 2 HOURS JAC, 31.5 HOURS ESPC; CAROL BARNES 1 HOUR JAC, 1 HOUR ESPC; LUCILLE MANSFIELD 32.75 HOURS JAC, 1 HOUR ESPC.
F990_P10_S00_L15
Form 990, Part X, Line 15
The 329964 represents due from third party payors net of allowance for uncollectible accounts.
F990_P12_S00_L02c
Form 990, Part XII, Line 2c
No changes occurred in either the oversight process or selection process from one year to the next.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.