Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
AMERICAN ACADEMY OF PEDIATRICS DISTRICT OF COLUMBIA CHAPTER
Employer identification number
52-1457413
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
19,250
25,630
13,909
67,806
65,020
191,615
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
19,250
25,630
13,909
67,806
65,020
191,615
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.
191,615
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
7
Amounts from line 4..
19,250
25,630
13,909
67,806
65,020
191,615
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
191,615
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here........................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
100.000 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
100.000 %
16a
33 1/3% support test—2012.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2011.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
0 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2011.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Part II AS OF JANUARY 13, 2011, THE ORGANIZATION CHANGED ITS ACCOUNTING YEAR-END FROM DECEMBER 31ST TO JUNE 30TH. AS SUCH, TWO RETURNS WERE FILED BY THE ORGANIZATION FOR THE TAX YEAR 2011 1 A RETURN FOR THE SHORT-PERIOD JANUARY 1, 2011 TO JUNE 30, 2011, AND 2 A RETURN FOR THE FULL ACCOUNTING PERIOD JULY 1, 2011 TO JUNE 30, 2012. THE CUMULATIVE GROSS RECEIPTS FROM THE 2011 TAX YEAR ARE COMPRISED AS FOLLOWS JANUARY 1, 2011 TO JUNE 30, 2011 14,022, JULY 1, 2011 TO JUNE 30, 2012 53,784.
Explanation
Part II AS OF JANUARY 13, 2011, THE ORGANIZATION CHANGED ITS ACCOUNTING YEAR-END FROM DECEMBER 31ST TO JUNE 30TH. AS SUCH, TWO RETURNS WERE FILED BY THE ORGANIZATION FOR THE TAX YEAR 2011 1 A RETURN FOR THE SHORT-PERIOD JANUARY 1, 2011 TO JUNE 30, 2011, AND 2 A RETURN FOR THE FULL ACCOUNTING PERIOD JULY 1, 2011 TO JUNE 30, 2012. THE CUMULATIVE GROSS RECEIPTS FROM THE 2011 TAX YEAR ARE COMPRISED AS FOLLOWS JANUARY 1, 2011 TO JUNE 30, 2011 14,022, JULY 1, 2011 TO JUNE 30, 2012 53,784.
Schedule A (Form 990 or 990-EZ) 2012
Additional Data
Software ID:
12000057
Software Version:
12.19.1011.1
-
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
2012
Open to Public Inspection
Name of the organization
AMERICAN ACADEMY OF PEDIATRICS DISTRICT OF COLUMBIA CHAPTER
Employer identification number
52-1457413
Identifier
Return Reference
Explanation
Form 990-EZ, Part I, Line 16, Other Expenses INSURANCE 1,638
Form 990-EZ, Part I, Line 16, Other Expenses WEBSITE NEWSLETTER 982
Form 990-EZ, Part I, Line 16, Other Expenses MEDICAL SUPPLIES FOR CATCH GRANT PROGRAMS 3,312
Form 990-EZ, Part I, Line 16, Other Expenses OFFICE SUPPLIES 854
Form 990-EZ, Part I, Line 16, Other Expenses BANK FEES 12
Form 990-EZ, Part II, Line 24, Other Assets LOAN RECEIVABLE Beginning of year 0, End of year 4,880
Form 990-EZ Part III Mission statement The DC Chapter of AAP is dedicated to promoting the optimal health and development of children and adolescents of Washington, D.C. in partnership with their families and communities, and to support the pediatricians who care for them.
Form 990-EZ Part III Line 30 PROGRAM ACCOMPLISHMENTS CONTINUED 3 CONVENED A CITY-WIDE ADOLESCENT HEALTH WORKING GROUP, FOCUSING ON IMPROVING THE HEALTH OF ADOLESCENTS IN DC. 4 PARTNERED WITH CHILDRENS NATIONAL MEDICAL CENTER, GEORGETOWN UNIVERSITY MEDICAL CENTER, AND LOCAL ADVOCACY GROUPS TO CREATE THE DC CHILDRENS MENTAL HEALTH ACCESS PROJECT 5 PROVIDED EDUCATIONAL TESTIMONY BEFORE LOCAL AND NATIONAL GOVERNMENT OFFICIALS ON ISSUES INCLUDING INCREASING HEALTH EDUCATION GRADUATION REQUIREMENTS IN DC PUBLIC HIGH SCHOOLS AND SECURING CONTINUED FUNDING OF DC LEAD POISONING HEALTHY HOMES PROJECT 6 ENGAGED WITH LOCAL ORGANIZATIONS TO IMPROVE QUALITY OF CARE FOR ASTHMA, ORAL HEALTH, BREASTFEEDING, OBESITY AND SPECIAL NEEDS 7 COLLABORATED WITH LOCAL ORGANIZATIONS IN PARK RX, A PROGRAM DESIGNED TO IMPROVE OUTCOMES IN ASTHMA, OBESITY AND ADHD BY PROMOTING OUTDOOR EXPLORATION AND ACTIVITIES AT OVER 350 DC PARKS 8 LED A COALITION OF DC NONPROFIT AND GOVERNMENTAL ORGANIZATIONS TO INCREASE THE PROPORTION OF CHILDREN WHO ARE READY FOR SCHOOL IN ALL FIVE DOMAINS OF HEALTHY DEVELOPMENT, BY INCREASING DC PEDIATRICIANS KNOWLEDGE OF THE AAP GUIDELINES, RESOURCES IN DC TO ASSIST WITH IMPLEMENTATION, THE REFERRAL PROCESS AND RESOURCES FOR EARLY INTERVENTION AND SPECIAL EDUCATION. TWENTY SEVEN PRACTICES HAVE BEEN TRAINED SO FAR, AND HAVE SEEN INCREASES IN THEIR REFERRALS TO CHILD FIND. 9 HOSTED AN ANNUAL PEDIATRIC CAREER SEMINAR SERIES FOR AREA YOUNG PHYSICIANS, RESIDENTS, MEDICAL STUDENTS AND FELLOWS. 10 CO-SPONSORED AN ADOLESCENT HEALTH SERIES ON TOPICS INCLUDING PRIMARY CARE SCREENING FOR DEPRESSION AND SMOKING CESSATION 11 SPONSORED AN ANNUAL INTERNATIONAL TRAVEL GRANT FOR RESIDENTS
Form 990-EZ Part V Line 34 THE ORGANIZATIONS BYLAWS WERE AMENDED TO UPDATE THE LANGUAGE AND FORMAT OF THE BYLAWS TO MEET NEW LAW REQUIREMENTS AND TO REFLECT THE BOARDS CURRENT POLICIES, PROCEDURES, OFFICER RESPONSIBILITIES AND BOARD COMMITTEES.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012
Additional Data
Software ID:
12000057
Software Version:
12.19.1011.1
-
TIN:
TY 2012 CompensationExplanation
Name:
AMERICAN ACADEMY OF PEDIATRICS DISTRICT OF COLUMBIA CHAPTER