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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
THE CHILDREN'S HOSPITAL OF ALABAMA
Employer identification number
63-0307306
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
THE CHILDREN'S HOSPITAL OF ALABAMA
Employer identification number
63-0307306
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
THOMAS N. CARRUTHERS, JR. IS OF COUNSEL IN A FIRM WHICH ACTS AS GENERAL COUNSEL FOR THE HOSPITAL AS WELL AS COUNSEL TO THE OBLIGATED GROUP AND BOND COUNSEL. DERROL DAWKINS, M.D. HAS ADMITTING PRIVILEGES TO THE HOSPITAL. O.B. GRAYSON HALL, JR IS THE CEO OF A BANK THAT PROVIDES THE MAJORITY OF THE BANKING SERVICES TO THE HOSPITAL. RAYMOND J. HARBERT OWNS AN INVESTMENT COMPANY THAT MANAGES A HEDGE FUND IN WHICH THE HOSPITAL HAS INVESTED THROUGH A FUND OF FUNDS. DONALD M. JAMES IS A DIRECTOR OF A BANK WHICH WAS AN UNDERWRITER FOR THE HOSPITAL BONDS. MR. JAMES IS ALSO A DIRECTOR FOR THE PARENT COMPANY OF AN ELECTRIC UTILITY THAT PROVIDES UTILITY SERVICES TO THE HOSPITAL. IN ADDITION, MR. JAMES IS A TRUSTEE FOR UAB HEALTH SYSTEM AND UA HEALTH SERVICES FOUNDATION, BOTH OF WHICH HAVE AN AFFILIATION AGREEMENT TO PROVIDE MEDICAL SERVICES TO THE HOSPITAL. VIRGINA WALKER JONES IS EMPLOYED BY A COMPANY THAT PROVIDES CERTAIN VENDING SERVICES TO THE HOSPITAL. IN ADDITION, MARGARET M. PORTER AND THE SPOUSE OF MS. JONES ARE MEMBERS OF AN ADVISORY BOARD FOR A BANK THAT WAS AN UNDERWRITER AND THAT CURRENTLY PROVIDES THE MAJORITY OF THE BANKING SERVICES TO THE HOSPITAL. MARGARET M. PORTER'S SPOUSE HOLDS A MINORITY OWNERSHIP IN A REAL ESTATE CONSULTING FIRM THAT PROVIDES SERVICES TO THE HOSPITAL. JAMES C. LEE, III IS THE OWNER OF A COMPANY THAT PROVIDES VENDING SERVICES TO THE HOSPITAL. THOMAS H. LOWDER SERVES ON THE BOARD OF TWO ORGANIZATIONS THAT MAKE CONTRIBUTIONS TO THE FOUNDATION. ROBERT S. MCANNALLY IS EMPLOYED BY THE PARENT COMPANY OF A GAS UTILITY THAT PROVIDES UTILITY SERVICES TO THE HOSPITAL. CHARLES D. MCCRARY IS THE CEO OF AN ELECTRIC UTILITY WHICH PROVIDES UTILITY SERVICES TO THE HOSPITAL AS WELL AS SERVES AS A BOARD MEMBER FOR A BANK THAT WAS AN UNDERWRITER AND THAT CURRENTLY PROVIDES THE MAJORITY OF THE BANKING SERVICES TO THE HOSPITAL. HE RESIGNED FROM THE CEO POSITION EFFECTIVE 3/1/2014. HUGH MORGAN IS A DIRECTOR OF A COMPANY FROM WHICH THE HOSPITAL PURCHASED MEDICAL EQUIPMENT DURING 2013. BEN RUSSELL IS THE FOUNDER AND CHAIRMAN OF THE BOARD OF A NON-PROFIT ORGANIZATION THAT LEASES SPACE FROM THE HOSPITAL TO PROVIDE FAMILY SERVICE ACTIVITIES TO PATIENTS AND THEIR FAMILIES. LEE J. STYSLINGER, III SERVES AS A BOARD MEMBER FOR A BANK THAT IS AN UNDERWRITER AND THAT CURRENTLY PROVIDES THE MAJORITY OF THE BANKING SERVICES TO THE HOSPITAL. MARC TYSON IS THE CEO OF A COMPANY, WHICH PROVIDED CONCRETE FOR THE EXPANSION FACILITY. THE HOSPITAL BELIEVES THAT ALL BUSINESS WITH SUCH FIRMS AND BUSINESSES IS CONDUCTED ON TERMS AND CONDITIONS NO LESS FAVORABLE TO THE HOSPITAL THAN THAT WITH UNRELATED THIRD PARTIES.
FORM 990, PART VI, SECTION B, LINE 11
THE COMPLETED FORM 990 IS REVIEWED IN DETAIL BY THE FINANCE AND AUDIT COMMITTEE, AS WELL AS THE BOARD OF TRUSTEES, PRIOR TO FILING THE RETURN.
FORM 990, PART VI, SECTION B, LINE 12C
THE CORPORATE COMPLIANCE OFFICER IS RESPONSIBLE FOR MONITORING COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. ANNUAL DISCLOSURE REQUESTS ARE SENT AND FOLLOWED UP ON TO ENSURE THAT ALL ARE RETURNED. RETURNED CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE CORPORATE COMPLIANCE OFFICER AND COMPLIANCE DEPARTMENT STAFF AS WELL AS OFFICERS OF THE HOSPITAL FOR ACCURACY AND COMPLETENESS. CONFLICT OF INTEREST STATEMENTS ARE MAINTAINED BY THE COMPLIANCE DEPARTMENT. THE COMPLIANCE OFFICER REPORTS ACTIVITY RELATED TO ANY POTENTIAL CONFLICTS OF INTEREST, INCLUDING CHANGES IN PREVIOUSLY REPORTED CONFLICTS TO ADMINISTRATION, THE FINANCE & AUDIT COMMITTEE, AND THE BOARD OF TRUSTEES ON A REGULAR BASIS.
FORM 990, PART VI, SECTION B, LINE 15
THE HOSPITAL MAINTAINS OVERSIGHT CONCERNING ALL EXECUTIVE COMPENSATION ACTION. THIS PROCESS IS LED BY THE HOSPITAL BOARD OF TRUSTEES COMPENSATION COMMITTEE, WHICH IS INVOLVED ANNUALLY, AND THROUGHOUT THE YEAR AS NEEDED, IN PROVIDING OVERSIGHT OF ALL EXECUTIVE COMPENSATION. TOTAL COMPENSATION (I.E. BASE SALARY, INCENTIVE COMPENSATION, AND EXECUTIVE BENEFITS) OF OFFICERS, KEY EMPLOYEES, AND OTHER VICE-PRESIDENTS IS APPROVED BY THE COMPENSATION COMMITTEE PRIOR TO SUCH COMPENSATION BEING PAID. THE TOTAL COMPENSATION THAT IS PRESENTED FOR APPROVAL IS DETERMINED BY EVALUATION OF MARKET DATA COMPARISONS ON EXECUTIVE TOTAL COMPENSATION. THIS INDEPENDENT, OBJECTIVE MARKET DATA IS PROVIDED BY THE HOSPITAL'S INDEPENDENT EXECUTIVE COMPENSATION CONSULTING FIRM, MERCER. ALL COMPENSATION COMMITTEE PROCEEDINGS, DECISIONS, AND ACTIONS ARE DOCUMENTED IN COMMITTEE MINUTES THAT ARE MAINTAINED BY THE HOSPITAL.
FORM 990, PART VI, SECTION C, LINE 19
THE CONFLICT OF INTEREST POLICY IS SUMMARIZED IN THE CORPORATE CODE OF CONDUCT WHICH IS AVAILABLE ON THE HOSPITAL'S WEBSITE. THE GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE NOT GENERALLY AVAILABLE TO THE PUBLIC.
FORM 990, PART IX, LINE 24E
MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 10,630,582. MANAGEMENT AND GENERAL EXPENSES 1,181,176. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,811,758. LAB EXPENSE: PROGRAM SERVICE EXPENSES 10,554,429. MANAGEMENT AND GENERAL EXPENSES 1,172,714. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,727,143. MANAGEMENT CONTRACTS: PROGRAM SERVICE EXPENSES 9,666,591. MANAGEMENT AND GENERAL EXPENSES 1,074,066. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,740,657. EQUIPMENT RENTAL AND MAINTENANCE: PROGRAM SERVICE EXPENSES 7,197,052. MANAGEMENT AND GENERAL EXPENSES 799,672. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,996,724. CONSULTING FEES: PROGRAM SERVICE EXPENSES 5,817,691. MANAGEMENT AND GENERAL EXPENSES 646,410. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,464,101. EQUIPMENT RELATED SUPPLIES: PROGRAM SERVICE EXPENSES 4,578,542. MANAGEMENT AND GENERAL EXPENSES 508,727. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,087,269. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 4,528,348. MANAGEMENT AND GENERAL EXPENSES 503,150. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,031,498. MAINTENANCE: PROGRAM SERVICE EXPENSES 4,476,005. MANAGEMENT AND GENERAL EXPENSES 497,334. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,973,339. MINOR MEDICAL EQUIPMENT: PROGRAM SERVICE EXPENSES 3,503,118. MANAGEMENT AND GENERAL EXPENSES 389,235. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,892,353. TRANSPORTATION: PROGRAM SERVICE EXPENSES 3,021,591. MANAGEMENT AND GENERAL EXPENSES 335,732. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,357,323. SUPPLIES: PROGRAM SERVICE EXPENSES 2,248,485. MANAGEMENT AND GENERAL EXPENSES 249,832. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,498,317. TELEPHONE: PROGRAM SERVICE EXPENSES 1,822,639. MANAGEMENT AND GENERAL EXPENSES 202,515. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,025,154. PROFESSIONAL DUES: PROGRAM SERVICE EXPENSES 1,462,961. MANAGEMENT AND GENERAL EXPENSES 162,551. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,625,512. SUBSCRIPTIONS AND PUBLICATIONS: PROGRAM SERVICE EXPENSES 577,852. MANAGEMENT AND GENERAL EXPENSES 64,206. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 642,058. REGISTRATION FEES: PROGRAM SERVICE EXPENSES 570,868. MANAGEMENT AND GENERAL EXPENSES 63,430. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 634,298. BANKING FEES: PROGRAM SERVICE EXPENSES 545,569. MANAGEMENT AND GENERAL EXPENSES 60,619. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 606,188. PRINTING AND PUBLICATIONS: PROGRAM SERVICE EXPENSES 383,454. MANAGEMENT AND GENERAL EXPENSES 42,606. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 426,060. POSTAGE AND SHIPPING: PROGRAM SERVICE EXPENSES 337,919. MANAGEMENT AND GENERAL EXPENSES 37,547. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 375,466. LODGING: PROGRAM SERVICE EXPENSES 315,345. MANAGEMENT AND GENERAL EXPENSES 35,038. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 350,383. COLLECTION FEES: PROGRAM SERVICE EXPENSES 292,090. MANAGEMENT AND GENERAL EXPENSES 32,454. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 324,544. NOVELTIES: PROGRAM SERVICE EXPENSES 266,974. MANAGEMENT AND GENERAL EXPENSES 29,664. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 296,638. MEALS: PROGRAM SERVICE EXPENSES 236,793. MANAGEMENT AND GENERAL EXPENSES 26,310. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 263,103. SPECIAL FUNCTIONS: PROGRAM SERVICE EXPENSES 119,838. MANAGEMENT AND GENERAL EXPENSES 13,315. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 133,153. RECOGNITIONS: PROGRAM SERVICE EXPENSES 13,577. MANAGEMENT AND GENERAL EXPENSES 1,509. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,086. TELETHON EXPENSE: PROGRAM SERVICE EXPENSES 169. MANAGEMENT AND GENERAL EXPENSES 19. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 188.
FORM 990, PART XI, LINE 9:
TRANSFER TO ALABAMA CHILDREN'S HOSPITAL FOUNDATION -14,493,840.
FORM 990, PART XI, LINE 2C:
THE HOSPITAL MADE NO CHANGES TO ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.